The Alternate Forms Reliability of the Oucher Pain Scale

Judith E. Beyer, RN, PhD; Shawndra B. Turner, MSN, FNP; Leah Jones, MSN, PNP; Laura Young, MSN, PNP; Robin Onikul, DDS; Brenda Bohaty, DDS


Pain Manag Nurs. 2005;6(1):10-17. 

In This Article

History of the Oucher

The Oucher, originally developed by Beyer in 1980, is a color, laminated poster instrument designed for children as young as 3 years of age. Although most of the validity testing has been completed on children as old as 12 years, the Oucher has been used successfully with adolescents as well (Beyer, 2000; Luffy & Grove, 2003). The tool consists of two separate vertical scales: the numeric scale (i.e., 0–100) for older children and the photographic scale for younger children. The photographic scale includes six different pictures of one child, depicting expressions of "no hurt" to "the biggest hurt you can ever have." The photographs were taken during actual pain experiences in the hospital. Children use the Oucher by selecting the photograph or number that most closely represents the level of pain they are experiencing.

Three ethnic versions have been validated: Caucasian (Figure 1), African-American (Figure 2), and Hispanic (Figure 3) (Aradine et al., 1988; Beyer and Aradine, 1986, 1987, 1988; Knott et al., 1994). The first Oucher was very large (i.e., a 14 × 18-inch poster). It was reduced to 6 × 17 inches in the late 1980s. Even with this reduction, the Oucher was awkward to handle, and the large size was seen as a deterrent to its use at the bedside (Keck, Gerkensmeyer, Joyce, & Schade, 1996). In the 1990s, Beyer et al. (1992) further reduced the size of the Oucher to approximately 4 × 11 inches by popular demand to enable clinicians to carry the tool in their pockets, thus strengthening the practicality and accessibility of the tool.

The Caucasian version of the Oucher was developed and copyrighted in 1983 by Judith E. Beyer, PhD, RN (University of Missouri-Kansas City School of Nursing).

The African-American version was developed and copyrighted in 1990 by Mary J. Denyes, PhD, RN (Wayne State University), and Antonia M. Villarruel, PhD, RN (University of Michigan). Cornelia P. Porter, PhD, RN, and Charlotta Marshall, RN, MSN, contributed to the development of this scale.

The Hispanic version of the Oucher was developed and copyrighted in 1990 by Antonia M. Villaruel, PhD, RN (University of Michigan), and Mary J. Denyes, PhD, RN (Wayne State University).


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