Family Perspectives of Traumatically Brain-Injured Patient Pain Behaviors in the Intensive Care Unit

Vanderbyl, Brandy L.; Gélinas, Céline

doi:10.1016/j.pmn.2017.04.005

Cited by 16 publications

(17 citation statements)

References 26 publications

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“…Similar behaviors were identified by family members of nonverbal ICU patients with traumatic brain injury to be relevant for pain assessment in this vulnerable population. 10 Such observations come in support of the current clinical practice recommendations to use behavioral pain scales with critically ill patients who are unable to self-report. 6,21 Family members identified pharmacological analgesia to palliate pain and, interestingly, almost one third of them associated the use of sedation with pain relief because they noticed nurses increasing the infusion of propofol when their loved one appeared to be in pain.…”

Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 54%

“…Questions were directed to family members to explore their unique perception of pain in their nonverbal loved one. The interview guide used open-ended questions 10 10 and aimed to solicit family members’ input regarding the context surrounding the presence of pain (i.e., P rovoking factors) and effective strategies for pain relief in the ICU (i.e., P alliating factors). Moreover, they were asked to describe the behaviors they observed to be related to pain (i.e., Q uality, R egion) including their specificity for pain (i.e., S pecificity) and timing of occurrence (i.e., T iming).…”

Section: Methodsmentioning

confidence: 99%

“…Such findings support the family’s unique contribution in the assessment of pain in the critically ill patient unable to self-report and their potential to assist clinicians in this challenging endeavor. Although the study 10 presents findings regarding family members’ perceptions of pain behaviors in nonverbal ICU patients, previous studies show that patients with traumatic brain injuries express different behaviors than their medical–surgical counterparts. 11 , 12 Given the differences between patient populations, studies are needed to assess family members perceptions of pain behaviors in nonverbal patients admitted to a medical–surgical ICU.…”

Section: Introductionmentioning

confidence: 93%

“…To our knowledge, only one study ( n = 7) examined family members’ perceptions of their nonverbal loved one’s pain behaviors while hospitalized in the ICU after a traumatic brain injury. 10 In this study, family members participated in a semistructured interview to describe their perceptions of their nonverbal loved one’s pain responses and rated the relevance of a list of pain behaviors using a self-administered questionnaire. Family members rated facial expressions (i.e., tearing, brow lowering) and body movements (i.e., attempting to reach or touching pain site, restlessness) as the most relevant behaviors for the detection of pain and described other facial expressions (e.g., lip movements) and reactions (e.g., not moving) related to their intimate knowledge of their loved one.…”

Section: Introductionmentioning

confidence: 99%

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Family members’ perceptions of pain behaviors and pain management of adult patients unable to self-report in the intensive care unit: A qualitative descriptive study

Richard-Lalonde

Boitor

Mohand-Saïd

et al. 2018

Canadian Journal of Pain

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Background: Current guidelines suggest that family members be consulted in the pain assessment process of patients unable to self-report. However, little is known regarding family members' perceptions of their loved one's pain behaviors and pain management. Aims: This qualitative descriptive study aimed to describe family members' perceptions of pain behaviors and pain management in critically ill hospitalized patients admitted to an intensive care unit and unable to self-report. Methods: A qualitative descriptive design was used. This study was conducted in a medicalsurgical intensive care unit in Canada. Family members of nonverbal adult patients participated in a semistructured interview regarding their perceptions of pain behaviors and pain management in the intensive care unit. Results: Ten family members with a nonverbal loved one admitted to the intensive care unit participated. Family members agreed on the presence of pain in the intensive care unit and reported being proactive and applying nonpharmacological interventions to help palliate pain of their loved one. Although family members identified behavioral indicators such as grimace, limb movement, and verbal complaints to assess pain in their loved one, the majority were unsure of their ability to detect pain. Conclusions: Family members have intimate knowledge of their loved one and could be invited to share their perceptions of their loved one's pain when they feel confident to do so. RÉSUMÉ Contexte: Les lignes directrices actuelles suggèrent que les membres de la famille soient consultés lors du processus d'évaluation de la douleur des patients incapables de fournir une auto-évaluation. Toutefois, on sait peu de choses au sujet de perceptions des membres de la famille au sujet des comportements de leur proche relativement à la douleur et à la prise en charge de la douleur. But: Cette étude descriptive qualitative avait pour but de décrire la perception des membres de la famille des comportements relatifs à la douleur et à la prise en charge de la douleur chez des patients en état critique de santé admis dans une unité de soins intensifs et incapables de fournir une auto-évaluation. Méthodes: Un devis descriptif qualitatif a été utilisé. Cette étude a été menée dans une unité de soins intensifs médicale-chirurgicale au Canada. Les membres de la famille de patients adultes non verbaux ont participé à une entrevue semi-structurée concernant leur perception des comportements relatifs à la douleur et à la prise en charge de la douleur à l'unité des soins intensifs. Résultats: Dix membres de famille ayant un proche non verbal admis à l'unité des soins intensifs ont participé. Les membres de famille étaient d'accord pour dire que la douleur était présente dans l'unité des soins intensifs. Ils ont aussi dit être proactifs et appliquer des interventions non pharmacologiques pour aider à soulager la douleur de leur proche. Bien que les membres de la famille ont identifié des indicateurs comportementaux comme une grimace, le mouvement d'un membre ou des plai...

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 54%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

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Family members’ perceptions of pain behaviors and pain management of adult patients unable to self-report in the intensive care unit: A qualitative descriptive study

Richard-Lalonde

Boitor

Mohand-Saïd

et al. 2018

Canadian Journal of Pain

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Development and preclinical testing of the critical care pain observation tool for family caregiver use (CPOT‐Fam)

Shahid

Sept

Longmore

et al. 2022

Health Science Reports

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Background and Aims Pain assessment in noncommunicative intensive care unit (ICU) patients is challenging. For these patients, family caregivers (i.e., family members, friends) may be able to assist in pain assessment by identifying individualistic signs of pain due to their intimate patient knowledge. This study adapted the critical care pain observation tool (CPOT) to facilitate pain assessment in adult ICU patients by family caregivers. Methods This study was conducted through three distinct phases: CPOT adaptation for family caregiver use (to create the CPOT‐Fam): A working group met monthly to adapt the CPOT and develop educational material and sample cases for practice scoring until consensus was reached. CPOT‐Fam preclinical testing: Family caregiver study participants viewed educational materials and scored four randomly selected sample cases using the CPOT‐Fam. Scores were compared to reference scores to assess agreement and identify CPOT‐Fam sections requiring revision. Open‐ended feedback on the CPOT‐Fam was collected. CPOT‐Fam revision: the CPOT‐Fam was revised by the working group considering score agreement and feedback received from study participants. Results Of the n = 30 participants, n = 14 (47.0%) had experience with an ICU patient. Agreement between CPOT‐Fam participant scores and reference scores were highest for the vocalization dimension ( Is the patient making any sounds? ; Intraclass correlation coefficient; ICC = 1.0) and lowest for the body movements dimension ( What are the patient's body movements like? ; ICC = 0.85. Participants indicated they found the CPOT‐Fam to be “informative” and “easy‐to‐use” but “not graphic enough”; participants also indicated that descriptors like “lack of breath” and “struggling to move” are helpful with identifying individualistic behaviors of pain exhibited by their loved ones. Conclusion The CPOT‐Fam shows ease of use and may be of value in involving family caregivers in ICU care. Clinical pilot testing is needed to determine feasibility and acceptability and identify further areas for refinement.

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Content validation of behaviours and autonomic responses for the assessment of pain in critically ill adults with a brain injury

Gélinas

Puntillo

Boitor

et al. 2018

Australian Critical Care

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Family Perspectives of Traumatically Brain-Injured Patient Pain Behaviors in the Intensive Care Unit

Cited by 16 publications

References 26 publications

Family members’ perceptions of pain behaviors and pain management of adult patients unable to self-report in the intensive care unit: A qualitative descriptive study

Family members’ perceptions of pain behaviors and pain management of adult patients unable to self-report in the intensive care unit: A qualitative descriptive study

Development and preclinical testing of the critical care pain observation tool for family caregiver use (CPOT‐Fam)

Content validation of behaviours and autonomic responses for the assessment of pain in critically ill adults with a brain injury

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