Pain Assessment in the Nonverbal Patient: Position Statement with Clinical Practice Recommendations

Pain Assessment and Management in Critically Ill Intubated Patients in Jordan : A Prospective Study

“…This might be explained by the presence of an endotracheal tube in the majority of patients which was found to be a major barrier for adequate assessment and management of pain. (10) However, in the case of those who could communicate their pain such as those undergoing ventilator weaning, no evidence indicated patients' self-reports of pain. This could be explained in several ways: nurses were too busy to document what they were doing to assess and manage pain in those patients, a lack of hospital policies emphasizing the importance of using pain scales, and the absence of well established guidelines concerning pain assessment and management in critically ill patients.…”

“…These guidelines emphasize pain reassessment and its documentation regularly over the time using the methods of the initial pain assessment appropriate for each individual. (10) …”

“…(1) For these reasons, pain management in the ICUs should be a priority and considered as an ethical obligation for all health professionals. (9,10) Appropriate assessment is the first step in managing pain for those who are critically ill. (6,10) Patients' self-reports were found to be the most valid measure of pain for those patients. (11,12) Unfortunately, pain is difficult to be assessed within the ICU environment because patients are often unable to communicate verbally due to many reasons such as the severity of the disease, the presence of an endotracheal tube, and sedating agents.…”

“…(2,13) However, in the absence of a self-reports, objective or observational pain measurements such as physiological and behavioral indicators can be used as alternative approaches to assess pain. (10) For this purpose, many objective pain measurements have been developed to assess pain in nonverbal adult patients in ICUs. These measurements have been categorized as either one dimensional (involving behavioral scales) or multidimensional (objective measures which evaluate two or more pain dimensions including behavioral and physiologic responses).…”

“…(16) Pain assessment and management in these patients need to be a priority with routine monitoring, assessment, reassessment, and clear documentation done to facilitate treatment and communication among healthcare members. (9,10,17) Documenting of patients' pain history, its treatment, and its reassessment actions is needed to improve practice and research. (17) Pain assessment and management documentation in critical care settings has been addressed in many studies.…”