Expert clinical reasoning and pain assessment in mechanically ventilated patients: A descriptive study

Gerber, Anne; Thevoz, Anne-Laure; Ramelet, Anne‐Sylvie

doi:10.1016/j.aucc.2014.06.002

Cited by 27 publications

(33 citation statements)

References 43 publications

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“…Although interpretation beyond the tools was needed, there was fair agreement on how to assess and treat pain and that no patient should be in pain. Discomfort, however-although agreed on by the nurses as something that could not be fully eliminated in critically ill patients-seemed ill defined and difficult to distinguish from pain, in line with the findings of Gerber, Thevoz, and Ramelet (2015). The challenge of distinguishing between pain and discomfort in ICU patients also shown in our study complicate nurses' deliberations and enactments.…”

Section: Discussionsupporting

confidence: 78%

“Having the compass–drawing the map”: Exploring nurses’ management of pain and other discomforts during use of analgosedation in intensive care

2018

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Aim To explore the deliberation and enactment processes of nurses in relation to pain and other discomforts in the critically ill patients after the implementation of an analgosedation protocol. Background Nurses in intensive care units (ICU) face great challenges when managing pain and other discomforts and distinguishing between patients’ needs for analgesics and sedatives. An analgosedation protocol favouring pain management, light sedation and early mobilization was implemented in a university hospital ICU in Norway in 2014. Changing sedation paradigms resulting in an increasing number of awake patients during critical illness is expected to affect nursing practice. Design Exploratory, single‐unit study in a mixed adult ICU. Methods Data collection with participant observation and semi‐structured interviews in sixteen clinical situations in 2014 and 2015. Thirteen experienced certified critical care nurses were included. Thematic content analysis was conducted. Results An overall theme “ Having the compass–drawing the map ” emerged from the analysis. The protocol or strategy of analgosedation appeared to provide a direction for treatment and care, although requiring extensive interpretation of needs and individualization of care, often in challenging situations. The overall theme was abstracted from three themes: “Interpreting a complex whole,” “Balancing conflicting goals” and “Experiencing strain from acting across ideals.” Conclusion Nurses seem to attend adequately to patient pain, but the approach to discomforts other than pain appears unsystematic and haphazard. More explicit goals of care and strategies to handle discomfort as distinct from pain are needed. More research is needed to identify effective comfort measures for ICU patients.

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Section: Discussionsupporting

confidence: 78%

“Having the compass–drawing the map”: Exploring nurses’ management of pain and other discomforts during use of analgosedation in intensive care

2018

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“…The development of CCNs' skills in pain assessment has scarcely been studied. Nurses' experience and competence influence their clinical reasoning concerning pain (Gerber et al, 2015), and attaining adequate clinical skills in general is a process that requires experience and education (Lejonqvist et al, 2012). After completing the video education, the CCNs reached an advanced beginner level, still needing support in using the tool.…”

Section: Discussionmentioning

confidence: 99%

Video education for critical care nurses to assess pain with a behavioural pain assessment tool: A descriptive comparative study

Björn

Pudas-Tähkä

Salanterä

et al. 2017

Intensive and Critical Care Nursing

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“…Researchers found a significant percentage of critical care nurses (67%) did not report using pain assessment instruments in patients who were unable to verbalize pain and unaware of professional guidelines for pain management and assessment. Gerber, Thevoz, and Ramelet (2014) Description of pain assessment prior to a procedure was 4%. Themes developed from this study include emergent need to intervene to prevent injury to the patient or staff, nurses unable to discriminate between the need for sedation, analgesia, or anti-psychotic medications, and administrating pain medications for wakefulness.…”

Section: Current Pain Assessment Practice In Critical Carementioning

confidence: 99%

Implementation of the Critical Care Pain Observation Tool

Salvadore¹

2018

Preprint

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In the United States, greater than half of the adult patients who are admitted to critical care experience pain and report poor pain control. Inadequate management of acute pain is associated with negative outcomes, including high blood sugar, insulin resistance, higher infection risk, increased discomfort, decreased satisfaction, and chronic pain. Patients in the intensive care unit (ICU) cannot always express that they are having pain. Recently modified guidelines for the Sustained Use of Sedatives and Analgesics in the Critically Ill Adult recommend a reliable and valid pain assessment instrument for patients who are unable to verbalize pain. For the adult critically ill population, the Critical Care Pain Observation Tool (CPOT) and the Behavioral Pain Scale (BPS) were identified as the most reliable and valid instruments. The purpose of this program development was to provide education for nurses in the Cardiovascular Intensive Care Unit (CVICU) on the CPOT to assist in transitioning to the CPOT as part of the CVICU pain assessment. A pretest-posttest design was utilized to evaluate the nurses’ knowledge of the CPOT. The intervention consisted of a one-hour education session on pain assessment and the CPOT. Thirteen out of a potential twenty-two nurses (n=13, 59%) participated in the educational session with a mean pretest score of 42.3% and a mean posttest score of 93.1%. There was a 50.8% improvement post-intervention total scores. Findings from this quality improvement education intervention suggest that the CVICU nurses’ knowledge increased in both pain assessment and the CPOT following the intervention.

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Expert clinical reasoning and pain assessment in mechanically ventilated patients: A descriptive study

Cited by 27 publications

References 43 publications

“Having the compass–drawing the map”: Exploring nurses’ management of pain and other discomforts during use of analgosedation in intensive care

“Having the compass–drawing the map”: Exploring nurses’ management of pain and other discomforts during use of analgosedation in intensive care

Video education for critical care nurses to assess pain with a behavioural pain assessment tool: A descriptive comparative study

Implementation of the Critical Care Pain Observation Tool

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