Aims and objectives To explore in depth discomfort in intensive care as experienced by patients and attended to by critical care nurses. Background Discomfort in illness is complex and persistent, and its alleviation is a challenge for nurses working in intensive care units (ICU). In previous studies, we showed that ICU patients described little actual pain but suffer from much discomfort. Critical care nurses had a systematic approach to the treatment of pain, but were more haphazard in dealing with other types of discomfort. Design Secondary qualitative analysis of data from two previous exploratory studies. Methods Content analysis was used on existing data from 28 interviews with ICU patients, and 16 field notes and interviews with critical care nurses. Kolcaba's Comfort Theory was applied for further analysis. The COREQ checklist was used. Results Three themes, “Being deprived of a functioning body”, “Being deprived of a functioning mind” and “Being deprived of integrity” characterised the discomfort experienced by ICU patients. The nurses appeared to attend to all areas of discomfort expressed by patients. In need of, and providing acknowledgment and alleviation became a common overarching theme. We identified a comfort gap caused by the discrepancy between the patients’ needs and the nurses’ achievements in fulfilling these needs. Conclusions A gap exists between ICU patients’ comfort needs and nurses’ achievements in fulfilling these, indicating that discomfort currently is an inevitable part of the critical illness trajectory. Increased knowledge about how the brain is affected in ICU patients and more systematic approaches to assessing comfort needs and enhancing comfort may support nurses in fulfilling patient needs and possibly diminish the existing comfort gap. Relevance for clinical practice An increased understanding of the complex experience of discomfort in ICU patients may bring about more systematic approaches to enhance comfort and direct for education and further research.

SUMMARYIntroduction: Research shows that intensive care patients experience pain both at rest and during procedures. Critically ill patients frequently have impaired ability to communicate pain and discomfort, making pain assessment and pain management challenging. Systematic pain assessment with valid tools is essential for good pain management. The Critical-Care Pain Observation Tool (CPOT) is a pain assessment tool with four domains.Objective: To translate The Critical-Care Pain Observation Tool (CPOT) and to examine the tool's validity and reliability.Method: The study has a descriptive quantitative design. The CPOT was first translated into Norwegian using an internationally recommended translation process. Six intensive care nurses were given a one-hour training session in the use of the CPOT, and an instruction video was used to achieve a common understanding of the CPOT scoring system. Independently, two intensive care nurses (in pairs) assessed and scored the patient's pain expression, using the CPOT, before and during a turning procedure. A total of 182 (91 pairwise) CPOT assessments were performed of 18 intensive care patients on mechanical ventilation. The Norwegian version of the CPOT was examined for discriminant validity by comparing the nurses' scores before and during the turning procedure. Research shows that intensive care patients frequently suffer from undertreatment of pain (1)(2)(3)(4)(5). Undertreatment of pain can have serious physical and psychological consequences (6-8). The golden standard for pain assessment is the patient's own description of pain (9, 10). However, the intensive care patient's impaired ability to communicate entails that the patient may experience pain without being able to express it in a way that health care personnel comprehend (4, 7, 11). Patients' inability to self-report pain hinders effective pain management.Systematic pain assessment with valid tools has proven essential to good pain treatment and may be used as a quality indicator of clinical practice (12, 13). There are several tools for assessing pain in adult intensive care patients, but according to international clinical guidelines (14), The Behavior Pain Scale (BPS) (15) and The Critical-Care Pain Observational Tool (CPOT) (16,17) have the highest validity and reliability. Rijkenberg et al. compared the CPOT and the BPS and concluded with a preference for the CPOT, due to better discriminant validity, meaning the tool measures pain better when the intensive care patient is assumed to have pain (19).In the international clinical guidelines, Barr et al. refer to the testing of the two tools' psychometric characteristics (measurement characteristics, user friendliness, the tool's validity and reliability, etc.). The CPOT appeared to be somewhat better, but both the CPOT and the BPS are equally recommended (14). The guidelines recommend that the CPOT and the BPS be translated and validated into more languages (14). The BPS is translated into Norwegian and tested for reliability by Olsen and Rustøen (18). ...

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