Pain Assessment and Management in Critically Ill Intubated Patients: a Retrospective Study

Abstract

• Background Little research has been done on pain assessment in critical care, especially in patients who cannot communicate verbally.• Objectives To describe (1) pain indicators used by nurses and physicians for pain assessment, (2) pain management (pharmacological and nonpharmacological interventions) undertaken by nurses to relieve pain, and (3) pain indicators used for pain reassessment by nurses to verify the effectiveness of pain management in patients who are intubated.• Methods Medical files from 2 specialized healthcare centers in Quebec City, Quebec, were reviewed. A data collection instrument based on Melzack’s theory was developed from existing tools. Pain-related indicators were clustered into nonobservable/subjective (patients’ self-reports of pain) and observable/objective (physiological and behavioral) categories.• Results A total of 183 pain episodes in 52 patients who received mechanical ventilation were analyzed. Observable indicators were recorded 97% of the time. Patients’ self-reports of pain were recorded only 29% of the time, a practice contradictory to recommendations for pain assessment. Pharmacological interventions were used more often (89% of the time) than nonpharmacological interventions (<25%) for managing pain. Almost 40% of the time, pain was not reassessed after an intervention. For reassessments, observable indicators were recorded 66% of the time; patients self-reports were recorded only 8% of the time.• Conclusions Pain documentation in medical files is incomplete or inadequate. The lack of a pain assessment tool may contribute to this situation. Research is still needed in the development of tools to enhance pain assessment in critically ill intubated patients.

Item selection and content validity of the Critical‐Care Pain Observation Tool for non‐verbal adults

“…Both quantitative and qualitative methods were used to collect the data so that triangulation could be done to achieve convergence and to ensure an accurate representation of the indicators for pain assessment in critically ill non-verbal adults (Loiselle et al 2007). More specifically, a four-step process was undertaken: (1) literature review, (2) review of patients' medical files (Gélinas et al 2004), (3) consultation of critical care nurses and physicians (Gélinas et al 2005), and (4) evaluation of content validity with clinicians. To make it easier for readers to grasp the contributions of all the steps in the development of the CPOT, the four steps undertaken (including those which were previously published) are described and linked together in this paper.…”

Care related pain in hospitalized patients: A cross‐sectional study

“…Moreover, surveys of pain among these departments focus on procedures known as potentially painful. Other studies have thoroughly described the pain related to a few specific procedures (Puntillo et al, 2001(Puntillo et al, , 2002Li and Puntillo, 2004;Gelinas et al, 2004). Except in those situations, little scientific information is currently available about painful procedures or about the intensity or frequency of the pain they cause.…”

Development and testing of four instruments to assess prior conditions that influence nurses' adoption of evidence‐based pain management practices

“…When nurses were asked, Manworren and Hayes (2000) reported that 90% over-estimated what percentage of patients exaggerated their amount of pain (correct answer was 0-10%). Some nurses use observable indicators of pain more often than patients' self-reports (Mrozek & Werner 2001, Schaufheutle et al 2001, Gelinas et al 2004. Patient factors including age, lifestyle, ethnicity and gender will often influence a nurse's interpretation of a patient's pain (Celia 2000, McNeill et al 2001, Brockopp et al 2003, Horbury et al 2005.…”

“…The frequency of assessing pain intensity continues to be inadequate and inconsistent (Celia 2000, Dalton et al 2001, Gelinas et al 2004. In a study by Idvall et al (2002), 52% of postoperative patients and 35% of nurses surveyed indicated that they were not asked or did not ask patients to rate their pain intensity at least three times per day.…”

“…By adopting EBPMP, nurses can offer the best available pain relief for patients. However, they do not adequately or consistently use EBPMP , Gelinas et al 2004, Carlson 2006, McDonald et al 2007). Nurses will need to adopt new behaviours and change their practices for knowledge of pain management practices generated by research to be used in clinical practice.…”