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Fazel SS, Fenton S, Braun N, Forsman-Phillips L, Linn Holness D, Kalia S, Arrandale VH, Tenkate T, Peters CE. Tailored Sun Safety Messages for Outdoor Workers. Saf Health Work 2023; 14:43-49. [PMID: 36941943 PMCID: PMC10024223 DOI: 10.1016/j.shaw.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/25/2022] [Accepted: 01/09/2023] [Indexed: 01/18/2023] Open
Abstract
Background Messaging surrounding skin cancer prevention has previously focused on the general public and emphasized how or when activities should be undertaken to reduce solar ultraviolet radiation (UVR) exposure. Generic messages may not be applicable to all settings, and should be tailored to protect unique and/or highly susceptible subpopulations, such as outdoor workers. The primary objective of this study was to develop a set of tailored, practical, harm-reducing sun safety messages that will better support outdoor workers and their employers in reducing the risk of solar UVR exposure and UVR-related occupational illnesses. Methods We adapted a core set of sun safety messages previously developed for the general population to be more applicable and actionable by outdoor workers and their employers. This study used an integrated knowledge translation approach and a modified Delphi method (which uses a survey-based consensus process) to tailor the established set of sun safety messages for use for outdoor worker populations. Results The tailored messages were created with a consideration for what is feasible for outdoor workers, and provide users with key facts, recommendations, and tips related to preventing skin cancer, eye damage, and heat stress, specifically when working outdoors. Conclusion The resulting tailored messages are a set of evidence-based, expert- approved, and stakeholder-workshopped messages that can be used in a variety of work settings as part of an exposure control plan for employers with outdoor workers.
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Affiliation(s)
- Sajjad S. Fazel
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 4N2, Canada
| | - Shelby Fenton
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 4N2, Canada
- CAREX Canada, School of Population and Public Health, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
| | - Nicole Braun
- Saskatchewan Cancer Agency, Regina, SK, S4W 0G3, Canada
| | - Lindsay Forsman-Phillips
- CAREX Canada, School of Population and Public Health, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
| | - D. Linn Holness
- Occupational Medicine Division, St. Michael's Hospital, Toronto, ON, M5B 1W8, Canada
- Dalla Lana School of Public Health, University of Toronto, ON, M5T 3M7, Canada
- Department of Medicine, University of Toronto, Toronto, ON, M5S 3H2, Canada
| | - Sunil Kalia
- BC Cancer, Vancouver, BC, V5Z 1G1, Canada
- Department of Dermatology and Skin Science, Faculty of Medicine, University of British Columbia, Vancouver, BC, V5Z 4E8, Canada
| | - Victoria H. Arrandale
- Dalla Lana School of Public Health, University of Toronto, ON, M5T 3M7, Canada
- Occupational Cancer Research Centre, Ontario Health, Toronto, ON, M5G 1X3, Canada
| | - Thomas Tenkate
- School of Occupational and Public Health, Toronto Metropolitan University, Toronto, ON, M5B 2K3, Canada
| | - Cheryl E. Peters
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 4N2, Canada
- CAREX Canada, School of Population and Public Health, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
- BC Cancer, Vancouver, BC, V5Z 1G1, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 4Z6, Canada
- British Columbia Centre for Disease Control, Vancouver, BC, V5Z 4R4, Canada
- Corresponding author. Cumming School of Medicine, University of Calgary, CAREX Canada, University of British Columbia, BC Cancer and BC CDC, 655 W 12th Ave, Vancouver, BC, V5Z4R4, Canada.
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Ashkenazy S, Weissman C, DeKeyser Ganz F. Intensive Care Unit Caregivers Perception of Patient Discomfort: A Qualitative Study. Pain Manag Nurs 2022; 23:711-719. [PMID: 36137880 DOI: 10.1016/j.pmn.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 07/20/2022] [Accepted: 08/16/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Being hospitalized in an intensive care unit ICU often involves pain and discomfort. While pain is commonly alleviated with analgesics, discomfort is more difficult to diagnose and treat, thus potentially leading to incorrect analgesic administration. AIM To describe intensive care unit practitioners' perceptions of discomfort in the ICU, and their methods to discern between pain and non-pain discomfort. METHODS Twenty-five intensive care unit practitioners (7 doctors and 18 nurses) were interviewed from medical and general intensive care units at one institution in Jerusalem, Israel. Data collection was performed using semi-structured interviews. Interviews were audio-recorded and transcribed. Transcriptions were coded and categorized by two researchers independently. Content analysis identified common themes. RESULTS Two main discomfort themes were identified: unpleasant physical sensations and unpleasant psychologic feelings, with further subcategories. Physiologic and non-physiologic signs such as facial expression and motor activity helped to diagnose discomfort. Trial and error and cause and effect were used to differentiate pain from other sources of discomfort. CONCLUSIONS Practitioners saw pain as a dominant source of discomfort. Treating overall discomfort should focus on improving the quality of the total intensive care unit experience. Strategies to diagnose non-pain discomfort and pain were similar. Differentiating pain from non-pain discomfort is essential in order to provide appropriate treatment for pain and non-pain-related discomfort.
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Affiliation(s)
- Shelly Ashkenazy
- Hadassah Hebrew University School of Nursing, Hadassah Medical Center, Jerusalem, Israel.
| | - Charles Weissman
- Hadassah-Hebrew University Medical Center, Hebrew University - Hadassah School of Medicine, Jerusalem, Israel
| | - Freda DeKeyser Ganz
- Hadassah Hebrew University School of Nursing, Hadassah Medical Center, Jerusalem, Israel; Hadassah Hebrew University School of Nursing and Jerusalem College of Technology, Jerusalem, Israel
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Kwon JM, Yang SP, Jeong KH. Stereoscopic facial imaging for pain assessment using rotational offset microlens arrays based structured illumination. MICRO AND NANO SYSTEMS LETTERS 2021. [DOI: 10.1186/s40486-021-00139-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
AbstractConventional pain assessment methods such as patients’ self-reporting restrict the possibility of easy pain monitoring while pain serves as an important role in clinical practice. Here we report a pain assessment method via 3D face reading camera assisted by dot pattern illumination. The face reading camera module (FRCM) consists of a stereo camera and a dot projector, which allow the quantitative measurement of facial expression changes without human subjective judgement. The rotational offset microlens arrays (roMLAs) in the dot projector form a uniform dense dot pattern on a human face. The dot projection facilitates evaluating three-dimensional change of facial expression by improving 3D reconstruction results of non-textured facial surfaces. In addition, the FRCM provides consistent pain rating from 3D data, regardless of head movement. This pain assessment method can provide a new guideline for precise, real-time, and continuous pain monitoring.
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Gélinas C, Joffe AM, Szumita PM, Payen JF, Bérubé M, Shahiri T S, Boitor M, Chanques G, Puntillo KA. A Psychometric Analysis Update of Behavioral Pain Assessment Tools for Noncommunicative, Critically Ill Adults. AACN Adv Crit Care 2020; 30:365-387. [PMID: 31951666 DOI: 10.4037/aacnacc2019952] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
This is an updated, comprehensive review of the psychometric properties of behavioral pain assessment tools for use with noncommunicative, critically ill adults. Articles were searched in 5 health databases. A total of 106 articles were analyzed, including 54 recently published papers. Nine behavioral pain assessment tools developed for noncommunicative critically ill adults and 4 tools developed for other non-communicative populations were included. The scale development process, reliability, validity, feasibility, and clinical utility were analyzed using a 0 to 20 scoring system, and quality of evidence was also evaluated. The Behavioral Pain Scale, the Behavioral Pain Scale-Nonintubated, and the Critical-Care Pain Observation Tool remain the tools with the strongest psychometric properties, with validation testing having been conducted in multiple countries and various languages. Other tools may be good alternatives, but additional research on them is necessary.
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Affiliation(s)
- Céline Gélinas
- Céline Gélinas is Associate Professor, Ingram School of Nursing, McGill University, 680 Sherbrooke West, Room 1838, Montréal, Québec, Canada, H3A 2M7; and Researcher, Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital, Montréal, Québec, Canada
| | - Aaron M Joffe
- Aaron M. Joffe is Professor, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Paul M Szumita
- Paul M. Szumita is Clinical Pharmacy Practice Manager and Program Director - PGY2 Critical Care Pharmacy Practice Residency, Department of Pharmacy Services, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jean-Francois Payen
- Jean-Francois Payen is Professor, Department of Anesthesiology and Critical Care, and Researcher, Inserm, U1216, Grenoble Institut Neurosciences, Grenoble Alpes University Hospital, Grenoble, France
| | - Mélanie Bérubé
- Mélanie Bérubé is Assistant Professor, Faculty of Nursing, Université Laval; and Researcher, CHU de Québec, Université Laval Research Center (Hôpital de l'Enfant-Jésus), Québec City, Québec, Canada
| | - Shiva Shahiri T
- Shiva Shahiri T is a PhD Student, Ingram School of Nursing, McGill University
| | - Madalina Boitor
- Madalina Boitor is a Student, Faculty of Dentistry, McGill University
| | - Gerald Chanques
- Gerald Chanques is Professor, Department of Anesthesia & Critical Care Medicine, Montpellier University Hospital Saint Eloi, and PhyMedExp, University of Montpellier, INSERM, CNRS, 34295 Montpellier cedex 5, France
| | - Kathleen A Puntillo
- Kathleen A. Puntillo is Professor of Nursing Emeritus, University of California San Francisco School of Nursing, San Francisco, California
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Intraosseous Administration of Hypertonic Saline in Acute Brain-Injured Patients: A Prospective Case Series and Literature Review. Neurologist 2020; 24:176-179. [PMID: 31688708 DOI: 10.1097/nrl.0000000000000248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Central venous catheters are often used to administer hypertonic saline (HTS) but might be associated with serious complications. Intraosseous (IO) access is an alternative method of medication and fluid delivery which is not associated with life-threatening complications and can be inserted faster than CVCs. METHODS A prospective case series was conducted on critically ill neurological patients that did not have central venous access, and for whom 3% HTS was indicated. Nonverbal indicators of pain were measured using the critical care pain observation tool. The pain score and serum sodium levels were collected at baseline, at 2, 6, 12, 18, and 24 hours after administration of 3% HTS using IO access. The area surrounding the IO insertion site was monitored for needle placement, extravasation, and tissue damage. RESULTS Five patients were enrolled. Three had an IO placed in the proximal humerus and 2 in the proximal tibia. Most patients did not have nonverbal indicators of pain during insertion and initial bolus. Serum sodium levels increased appropriately, as determined by the care providers. There were no cases of device dislodgement, extravasation, infection, soft tissue injury, or other local complications. CONCLUSIONS In this prospective case series, IO administration of 3% HTS was feasible, well-tolerated on the basis of nonverbal indicators of pain in the majority of patients and resulted in an appropriate rise in serum sodium levels. IO fills a niche among vascular access options for HTS, in emergent neurological situations when central venous access is not readily available or peripheral intravenous access is difficult to obtain.
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Fedele S, Strasser S, Roulin MJ. Validation of the Critical Care Pain Observational Tool in Palliative Care. Pain Manag Nurs 2020; 21:360-364. [PMID: 32113802 DOI: 10.1016/j.pmn.2019.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 11/18/2019] [Accepted: 12/31/2019] [Indexed: 01/23/2023]
Abstract
PURPOSE Pain assessment at the end of life remains a problem for patients who are unable to self-report their pain when transitioning across care settings. This study therefore tested the internal consistency and discriminant, concurrent, and convergent validity of the Critical-Care Pain Observational Tool (French version) when used with end-of-life patients in a palliative care setting. DESIGN This was a descriptive correlational study that used a repeated-measures within-subjects prospective design. METHODS The pain of 13 patients was assessed when at rest and during turning. RESULTS The internal consistency reliability coefficient alphas were .64 at rest and .70 during turning. Discriminant validity was shown by a decrease in the total Critical-Care Pain Observation Tool score. Concurrent validity was demonstrated by the association between the patients' self-report of pain and the Critical-Care Pain Observation Tool score at rest (0.65, p < .016) and during turning (0.77, p = .002). Finally, the convergent validity between the Critical-Care Pain Observation Tool score and the Algoplus scale score was demonstrated with a Spearman's correlation coefficient of 0.76 at rest and 0.84 during turning. CONCLUSIONS The results suggest that the Critical-Care Pain Observation Tool can be used with end-of-life patients in French-speaking countries.
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Bunzel AMG, Weber-Hansen N, Schantz Laursen B. To stay in touch - intensive care patients' interactions with nurses during mobilisation. Scand J Caring Sci 2019; 34:948-955. [PMID: 31830323 DOI: 10.1111/scs.12802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 11/13/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Minimal sedation has made it possible to communicate and cooperate with intensive care patients and mobilisation can start earlier during their stay in the intensive care unit. PURPOSE To investigate the intensive care patient's reaction and interaction to mobilisation. METHOD This study used focused ethnography combining observations, interviews and four scores for evaluating awareness, and pain levels were included: Richmond Agitation Sedation Scale Confusion Assessment Method For The Intensive Care Unit, Numeric Rating Scale and Critical Pain Observation Tool. Twelve patients were observed during mobilisation, with subsequent interviews of the involved nurses. FINDINGS Nurses run the risk of overlooking the patient's reactions, such as pain, discomfort or needs during mobilisation. Nurses use several different ways of communicating to create contact with the patients. Patients with an impaired awareness level become more aware during mobilisation. CONCLUSIONS If the nurse's attention is focused on the technical side of caregiving, there is a risk that she might overlook the patient's reactions and needs. If the nurse is aware of the risk of overlooking the patient's reactions, she may plan the mobilisation to ensure that the patient gets the necessary attention and is included in the process. In that way, the patient might avoid unnecessary discomfort and maintain trust and confidence in the nurse.
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Affiliation(s)
| | | | - Birgitte Schantz Laursen
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Herr K, Coyne PJ, Ely E, Gélinas C, Manworren RCB. Pain Assessment in the Patient Unable to Self-Report: Clinical Practice Recommendations in Support of the ASPMN 2019 Position Statement. Pain Manag Nurs 2019; 20:404-417. [PMID: 31610992 DOI: 10.1016/j.pmn.2019.07.005] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/25/2019] [Accepted: 07/21/2019] [Indexed: 11/18/2022]
Abstract
Pain is a subjective experience, unfortunately, some patients cannot provide a self-report of pain verbally, in writing, or by other means. In patients who are unable to self-report pain, other strategies must be used to infer pain and evaluate interventions. In support of the ASPMN position statement "Pain Assessment in the Patient Unable to Self-Report", this paper provides clinical practice recommendations for five populations in which difficulty communicating pain often exists: neonates, toddlers and young children, persons with intellectual disabilities, critically ill/unconscious patients, older adults with advanced dementia, and patients at the end of life. Nurses are integral to ensuring assessment and treatment of these vulnerable populations.
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Affiliation(s)
- Keela Herr
- College of Nursing, University of Iowa, Iowa City, Iowa.
| | - Patrick J Coyne
- Palliative Care Department, Medical University of South Carolina, Charleston, South Carolina
| | - Elizabeth Ely
- Department of Nursing Research, University of Chicago Hospitals, Chicago, Illinois
| | - Céline Gélinas
- Ingram School of Nursing, McGill University, Montréal, Québec, Canada; Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital - CIUSSS, Centre-West-Montréal, Montréal, Québec, Canada
| | - Renee C B Manworren
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Asman O, Slutsker E, Melnikov S. Nurses' perceptions of pain management adequacy in mechanically ventilated patients. J Clin Nurs 2019; 28:2946-2952. [PMID: 31013381 DOI: 10.1111/jocn.14896] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 03/24/2019] [Accepted: 04/14/2019] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To examine how nurses' knowledge of behaviours indicating pain in mechanically ventilated patients and self-perceived collaboration between nurses and physicians affects the adequacy of departmental pain management. BACKGROUND Pain management is a vital factor of medical treatment in a hospital setting. Inadequate pain management requires attention both from a patient-focused perspective and from a departmental one. It would be particularly troubling in the case of inadequate pain management of mechanically ventilated patients. DESIGN The study utilised a cross-sectional design. The instruments developed were validated by a focus group of 25 pain management nurses, who reviewed the questionnaire for face validity, feasibility and comprehensibility, and who did not participate in the study. The questionnaire was revised, readjusted and formulated based on their responses and comments. METHODS A self-administered questionnaire administered in Israel with a convenience sample of 187 registered nurses (RN) from internal medicine and surgical departments and ICUs. Data were collected during February-May 2015. The "STROBE" EQUATOR checklist was used. RESULTS Nurses working in the ICU scored significantly higher on knowledge of behaviours indicating pain in mechanically ventilated patients and on self-perceived collaboration between nurses and physicians. Self-perceived collaboration between physicians and nurses was positively correlated with perceived departmental pain treatment adequacy. Self-perceived collaboration between nurses and physicians, knowledge of behaviours indicating pain in mechanically ventilated patients and seniority (with a borderline significance) explained 27% of the variance of perceived departmental pain management. CONCLUSION Nurses' knowledge of behaviours indicating pain in mechanically ventilated patients, as well as self-perceived collaboration between nurses and physicians, promotes reported adequate pain management. RELEVANCE TO CLINICAL PRACTICE Pain management would benefit from being conducted as a well-performed interprofessional self-perceived collaborative practice. Knowledgeable nurses tend to critically assess the level of departmental pain management.
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Affiliation(s)
- Oren Asman
- Nursing Department, Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Medical Law, Sechenov First Moscow State Medical University, Moskva, Russia
| | - Elena Slutsker
- Nursing Administration, Wolfson Medical Center, Holon, Israel
| | - Semyon Melnikov
- Nursing Department, Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Phillips ML, Kuruvilla V, Bailey M. Implementation of the Critical Care Pain Observation Tool increases the frequency of pain assessment for noncommunicative ICU patients. Aust Crit Care 2018; 32:367-372. [PMID: 30314837 DOI: 10.1016/j.aucc.2018.08.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 08/12/2018] [Accepted: 08/14/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Pain is a common stressor for ICU patients, necessitating routine assessment. For patients who are unable to communicate, self-report tools are unsuitable, and the use of an observational tool is required to assess pain appropriately. The Critical Care Pain Observation Tool (CPOT) is the most reliable tool currently available to assess pain in these patients. We investigated whether the implementation of the CPOT in one Australian ICU could increase frequency of appropriate pain assessments, and if this would affect the administration of analgesia and sedation. METHODS In this before and after study, we first performed a retrospective chart audit on 441 adult ICU patient charts, over 49 days. Data collected included frequency and type of pain assessments, sedation and analgesia administered, communication and CAM-ICU status, and bedside nurse-perceived pain. During the implementation phase, new policy and guideline documents were released, and ICU charts were redesigned to incorporate the CPOT. All nursing staff attended an education session on pain assessment and correct use of the CPOT. The chart audit was repeated, capturing 344 charts over 43 days. RESULTS Mean total assessments in 24 hours increased from 7.2 to 7.9 for communicative, 3.0 to 8.9 for non-communicative, and 5.1 to 9.1 for transitioning patients. For non-communicative patients there was a significant increase in observational assessments including the CPOT (1.7 to 8.3), and a decrease in inappropriate use of self-report tools (1.3 to 0.2). We also observed significant increases in administration of paracetamol, opiates, propofol, patient-controlled analgesia, modified-release opiates, and neuropathic pain agents. CONCLUSIONS Implementation of the CPOT using standardised education and resources led to increased frequency of pain assessment, particularly for non-communicative patients. Appropriate observational assessments were also more frequently used for these patients. Analgesic administration generally increased, as did the use of propofol.
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Affiliation(s)
| | - Vijo Kuruvilla
- Intensive Care Unit, Royal Darwin Hospital, 105 Rocklands Drive, Tiwi NT 0810, Australia.
| | - Michael Bailey
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, Monash University, Level 3, 553 St Kilda Road, Melbourne VIC 3004, Australia.
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Stamp R, Tucker L, Tohid H, Gray R. Reliability and Validity of the Critical-Care Pain Observation Tool: A Rapid Synthesis of Evidence. J Nurs Meas 2018; 26:378-397. [PMID: 30567950 DOI: 10.1891/1061-3749.26.2.378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Staff in a tertiary hospital critical care unit in Doha, Qatar, suggested that the Critical-Care Pain Observation Tool (CPOT) would be a better tool for assessing pain in ventilated and sedated patients than current local practice. We undertook a rapid synthesis of evidence to establish whether current research supports use of CPOT for assessing pain in ventilated and sedated patients in a critical care setting. CPOT has been shown in reviews and more recent primary studies to be reliable and valid for most patients unable to self-report in critical care settings. This finding is supported by several guidelines. Studies also suggest that CPOT is feasible for use in research and clinical practice though training of observers is important. Further research may be warranted to strengthen current evidence, particularly in patients with neurological trauma.
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Affiliation(s)
| | - Lissa Tucker
- Health Services and Population Research Centre, Hamad Medical Corporation, Doha, Qatar
| | - Hiba Tohid
- Clinical Research Coordinator, Weill Cornell Medicine in Qatar, Doha, Qatar
| | - Richard Gray
- School of Nursing and Midwifery, La Trobe University, Northpark Private Hospital, Melbourne, Australia
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Kotfis K, Zegan-Barańska M, Strzelbicka M, Safranow K, Żukowski M, Ely EW. Validation of the Polish version of the Critical Care Pain Observation Tool (CPOT) to assess pain intensity in adult, intubated intensive care unit patients: the POL-CPOT study. Arch Med Sci 2018; 14:880-889. [PMID: 30002708 PMCID: PMC6040120 DOI: 10.5114/aoms.2017.69752] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 08/01/2017] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Pain in the critically ill affects nearly 50% of patients. In patients unable to self-report pain, behavioural scales are used. The aim of this study was to validate the Polish version of the Critical Care Pain Observation Tool (CPOT). MATERIAL AND METHODS The prospective observational cohort study included patients observed during non-nociceptive and nociceptive procedures, at rest, during the intervention, and 15 min after each intervention. Assessments included self-report by patients and CPOT assessment carried out by two blinded observers. RESULTS A total of 71 patients were included in the study (mean age: 66 years), predominantly males (50/71, 70%), mean APACHE II score 26.04 ±10.56. Results showed an excellent inter-rater correlation (ICC) between raters (ICC scores > 0.97). Self-report NRS (numeric rating scale) scores were available from 58/71 patients (82%). Patients' self-reported pain and CPOT showed a very strong correlation (Spearman's R > 0.85, p < 0.0001). The CPOT has high diagnostic value for detection of presence of patients' self-reported pain (ROC AUC = 0.938 for rater A and 0.951 for rater B, p < 0.0001). CPOT score ≥ 2 is an optimal cut-off to detect pain during a nociceptive procedure. A significantly higher mean CPOT score during a nociceptive procedure as compared to a non-nociceptive procedure or at rest was found (p < 0.0001). CONCLUSIONS This study shows that the Polish version of the CPOT can be used to assess pain in critically ill patients with no hypnotic, opioid-based analgo-sedation. Polish CPOT scores correlated well with patients' self-reported presence of pain and showed excellent inter-rater reliability. This makes the Polish version of the CPOT a reliable pain assessment tool.
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Affiliation(s)
- Katarzyna Kotfis
- Department of Anaesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland
| | - Małgorzata Zegan-Barańska
- Department of Anaesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland
| | - Marta Strzelbicka
- Department of Anaesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland
| | - Krzysztof Safranow
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Szczecin, Poland
| | - Maciej Żukowski
- Department of Anaesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland
| | - E. Wesley Ely
- Vanderbilt University School of Medicine, Medicine/Allergy, Pulmonary, and Critical Care, Veterans Affairs Geriatric Research Education Clinical Center (GRECC) for Tennessee Valley, Nashville, Tennessee, USA
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Shan K, Cao W, Yuan Y, Hao JJ, Sun XM, He X, Li GY, Wang YM, Zhou JX. Use of the critical-care pain observation tool and the bispectral index for the detection of pain in brain-injured patients undergoing mechanical ventilation: A STROBE-compliant observational study. Medicine (Baltimore) 2018; 97:e10985. [PMID: 29851854 PMCID: PMC6392730 DOI: 10.1097/md.0000000000010985] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The assessment of pain in patients with brain injury is challenging due to impaired ability to communicate. We aimed to test the reliability and validity of the critical-care pain observation tool (CPOT) and the bispectral index (BIS) for pain detection in critically brain-injured patients.This prospective observational study was conducted in a neurosurgical intensive care unit in a University-Affiliated Hospital. Adult brain-injured patients undergoing mechanical ventilation were enrolled. Nociceptive (endotracheal suctioning) and non-nociceptive (gentle touching) procedures were performed in a random crossover fashion. Before and immediately after the procedure, CPOT was evaluated by 2 residents and 2 chief nurses, and BIS was documented. The ability to self-report pain was also assessed. The inter-observer reliability of CPOT was analyzed. The criterion and discriminant validities of the CPOT and the BIS were tested.During the study, we enrolled 400 brain-injured patients. The ability to self-report pain was maintained in 214 (54%) and 218 (55%) patients during suctioning and gentle touching, respectively. The intraclass correlation coefficients (95% confidence interval) for inter-observer reliability of CPOT ranged from 0.86 (0.83-0.89) to 0.93 (0.91-0.94). Using self-reported pain as the reference, the area under the receiver operating characteristic curve (95% confidence interval) was 0.84 (0.80-0.88) for CPOT and 0.76 (0.72-0.81) for BIS. When the 2 instruments were combined as either CPOT ≥2 or BIS ≥88 after the procedure, the sensitivity and specificity were 0.90 (0.85-0.93) and 0.59 (0.52-0.66), respectively; and when the 2 instruments were combined as both CPOT ≥2 and BIS ≥88, the sensitivity and specificity were 0.62 (0.55-0.68) and 0.89 (0.83-0.93). Both CPOT and BIS increased significantly after suctioning (all P < .001) but remained unchanged after gentle touching (P ranging from .06 to .14).Our criterion and discriminant validity results supported the use of CPOT and BIS to detect pain in critically brain-injured patients. Combining use of CPOT and BIS in different ways might provide comprehensive pain assessment for different purposes.
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Affiliation(s)
| | - Wei Cao
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuan Yuan
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jing-Jing Hao
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiu-Mei Sun
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xuan He
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Gui-Yun Li
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yu-Mei Wang
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jian-Xin Zhou
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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de Goumoens V, Decaillet F, Didier A, Montreuil C, Diserens K, Ramelet AS. [Process for implementing a pain assessment scale for patients with brain injuries: description of a project methodology based on the Integrated Model of Consultation]. Rech Soins Infirm 2018:79-91. [PMID: 28944633 DOI: 10.3917/rsi.128.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Background : in a neurosurgery unit, nurses selected the Critical Pain Observation Tool (CPOT) based on evidence to assess pain in brain-injured patients. However, months after implementation, nursing managers have observed an underutilization.Objectives : support a care team to overcome the pitfalls encountered during the implementation of the CPOT scale for brain-injured patients in neurosurgery unit.Methods : the Lescarbeau, Payette and St-Arnaud's Integrated Model of Consultation was selected. In addition to a scientific literature review, self-administered questionnaire and three interview guides were developed to gather the views of caregivers.Results : the process allowed to identify pitfalls at level of interprofessional collaboration CPOT scale and implementation processes. Improving interprofessional collaboration and adaptation of CPOT scale for brain-injured patients were withholding action priorities.Discussion : a rigorous methodology, the mutual recognition of clinical skills and the development of relationship of trust are prerequisites for the success of clinical innovation.Conclusion : the Integrated Intervention Model is a methodology of choice allowing to take into consideration both evidence and preferences of all actors at every step of the process led to informed choices and priorities setting for a successful implementation.
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Cheng LH, Tsai YF, Wang CH, Tsay PK. Validation of two Chinese-version pain observation tools in conscious and unconscious critically ill patients. Intensive Crit Care Nurs 2018; 44:115-122. [DOI: 10.1016/j.iccn.2017.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 07/19/2017] [Accepted: 08/05/2017] [Indexed: 10/18/2022]
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Content validity testing of the ESAT © : A decision aid tool for performing endotracheal suction in children. Aust Crit Care 2018; 31:23-30. [DOI: 10.1016/j.aucc.2017.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 01/12/2017] [Accepted: 01/23/2017] [Indexed: 11/30/2022] Open
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Content validation of behaviours and autonomic responses for the assessment of pain in critically ill adults with a brain injury. Aust Crit Care 2017; 31:145-151. [PMID: 29146105 DOI: 10.1016/j.aucc.2017.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/12/2017] [Accepted: 10/05/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The evidence shows that brain-injured patients express behaviours that are related to their level of consciousness (LOC), and different from other patients in the intensive care unit (ICU). Therefore, existing behavioural scales should be revised to enhance their content and validity for use in these patients. OBJECTIVES The aim was to evaluate the content relevance of behaviours and autonomic responses for pain assessment of brain-injured ICU patients from the perspective of critical care clinicians. METHODS A total of 77 clinicians from four adult neuroscience ICUs (three from Canada and one from the United States) participated in this descriptive study. A physician/nurse ratio of 21% (13/61) was reached in this quota sample, and three physiotherapists also participated. They completed a content validation questionnaire of 19 items rated on clarity and relevance based on the patient's LOC. Item Content Validity Index (I-CVI), and modified kappa (κ*) were calculated. Values higher than 0.78 and 0.75 respectively were considered excellent. RESULTS Regardless of the patient's LOC, brow lowering, grimacing, and trying to reach the pain site were rated as the most relevant behaviours by clinicians, with excellent values of I-CVI>0.78 and κ*>0.75. Eyes tightly closed, moaning and verbal complaints of pain also obtained excellent values in altered LOC and conscious patients. Eye weeping obtained excellent values only in conscious patients. Other items showed fair (0.40-0.59) to good (0.60-0.74) values, while blinking and coughing showed poor values (<0.40) at various LOC. CONCLUSIONS Facial expressions, movements towards the pain site, and vocalisation of pain were the most relevant pain-related behaviours rated by critical care clinicians. The relevance of some behaviours (e.g., moaning and verbal complaints of pain) varied across LOCs, thereby calling forth adaptations of behavioural pain scales to allow for interpretation in the context of a patient's LOC and ability to express specific behaviours.
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van Diepen S, Katz JN, Albert NM, Henry TD, Jacobs AK, Kapur NK, Kilic A, Menon V, Ohman EM, Sweitzer NK, Thiele H, Washam JB, Cohen MG. Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association. Circulation 2017; 136:e232-e268. [PMID: 28923988 DOI: 10.1161/cir.0000000000000525] [Citation(s) in RCA: 928] [Impact Index Per Article: 132.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cardiogenic shock is a high-acuity, potentially complex, and hemodynamically diverse state of end-organ hypoperfusion that is frequently associated with multisystem organ failure. Despite improving survival in recent years, patient morbidity and mortality remain high, and there are few evidence-based therapeutic interventions known to clearly improve patient outcomes. This scientific statement on cardiogenic shock summarizes the epidemiology, pathophysiology, causes, and outcomes of cardiogenic shock; reviews contemporary best medical, surgical, mechanical circulatory support, and palliative care practices; advocates for the development of regionalized systems of care; and outlines future research priorities.
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Rijkenberg S, Stilma W, Bosman RJ, van der Meer NJ, van der Voort PH. Pain Measurement in Mechanically Ventilated Patients After Cardiac Surgery: Comparison of the Behavioral Pain Scale (BPS) and the Critical-Care Pain Observation Tool (CPOT). J Cardiothorac Vasc Anesth 2017; 31:1227-1234. [DOI: 10.1053/j.jvca.2017.03.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Indexed: 11/11/2022]
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Booker SS, Herr KA. Pain Management for Older African Americans in the Perianesthesia Setting: The "Eight I's". J Perianesth Nurs 2017; 30:181-8. [PMID: 26003763 DOI: 10.1016/j.jopan.2015.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 01/13/2015] [Accepted: 01/18/2015] [Indexed: 10/23/2022]
Abstract
National legislation (Affordable Care Act) emphasizes quality and equitable pain care for all patient populations, but frequently, pain management is not effective and equitable in African American (AA) elders, placing them at higher risk for severe pain and persistent pain. Research shows that AAs are less likely to receive guideline-based pain care. This underscores the need for perianesthesia nurses to be knowledgeable and capable of integrating cultural practices and evidence-based recommendations into their care of older AAs to ensure adequate pain management in this vulnerable population. This article describes differences and disparities in pain management in AA older adults and provides a cultural framework to guide perianesthesia pain management.
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Frandsen JB, O'Reilly Poulsen KS, Laerkner E, Stroem T. Validation of the Danish version of the Critical Care Pain Observation Tool. Acta Anaesthesiol Scand 2016; 60:1314-22. [PMID: 27468726 DOI: 10.1111/aas.12770] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 07/02/2016] [Accepted: 07/05/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Assessing pain in critically ill patients is a challenge even in an intensive care unit (ICU) with a no sedation protocol. The aim of this study was to validate the Danish version of the pain assessment method; Critical Care Pain Observation Tool (CPOT) in an ICU with a no sedation protocol. METHODS Seventy patients were included in this study. The patients were observed during a non-nociceptive procedure (wash of an arm) and a nociceptive procedure (turning). Patients were observed before, during, and 15 min after the two interventions (six assessments). Two observers participated in the data collection and CPOT scores were blinded to each other. Calculations of interrater reliability, criterion validity and discriminant validity were performed to validate the Danish version of CPOT. RESULTS The results indicated a good correlation between the two raters (all scores > 0.9 and P < 0.05). About 48 (68.6%) of the included patients were able to self-report pain. We found a significantly higher mean CPOT score at the nociceptive procedure than at rest or the non-nociceptive procedure (P < 0.05). No correlation was found between CPOT scores and physiological indicators. Patients self-reported pain and CPOT showed a significant correlation (P < 0.05). A CPOT score of ≥ 3 correlated with patients' self-reported pain (ROC AUC 0.83). CONCLUSION The Danish version of CPOT can be used to assess pain in critically ill patients, also when the ICU has a no sedation protocol. CPOT scores showed a good interrater reliability and correlates well with patient's self-reported pain.
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Affiliation(s)
- J. B. Frandsen
- Department of Anaesthesia and Intensive Care Medicine; Odense University Hospital; Odense C Denmark
| | - K. S. O'Reilly Poulsen
- Department of Anaesthesia and Intensive Care Medicine; Odense University Hospital; Odense C Denmark
| | - E. Laerkner
- Department of Anaesthesia and Intensive Care Medicine; Odense University Hospital; Odense C Denmark
| | - T. Stroem
- Department of Anaesthesia and Intensive Care Medicine; Odense University Hospital; Odense C Denmark
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Validation of the Critical-Care Pain Observation Tool and Vital Signs in Relation to the Sensory and Affective Components of Pain During Mediastinal Tube Removal in Postoperative Cardiac Surgery Intensive Care Unit Adults. J Cardiovasc Nurs 2016; 31:425-32. [DOI: 10.1097/jcn.0000000000000250] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Validation of the Critical Care Pain Observation Tool in Critically Ill Patients With Delirium: A Prospective Cohort Study. Crit Care Med 2016; 44:943-7. [PMID: 26783859 DOI: 10.1097/ccm.0000000000001522] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The 2013 clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the ICU suggest that pain be routinely assessed using a validated pain assessment tool. Currently available tools have only been evaluated in nondelirious critically ill patients, yet delirium can affect as many as 80% of ICU patients. The validated pain assessment tool adopted by our institution is the Critical Care Pain Observation Tool, and the objective of this study was to investigate the validity of this tool in patients with evidence of delirium. DESIGN Prospective cohort study. SETTING Two ICUs within a Canadian tertiary healthcare center. PATIENTS Forty consecutive adult patients deemed delirious on the day of enrollment using the Confusion Assessment Method for ICU. MEASUREMENTS AND MAIN RESULTS Serial Critical Care Pain Observation Tool assessments were conducted simultaneously by study personnel and objective nurses at baseline and after nonpainful and painful stimuli. Subjective opinions about pain and objective physical variables (including mean arterial pressure, heart rate, respiratory rate, and oxygen saturation) were collected at the same time points. Discriminant validity was described using paired t tests, whereas internal consistency was described using the Cronbach α statistic. Responsiveness of the Critical Care Pain Observation Tool was measured by effect size, and reliability was described as the agreement between raters. Comparisons between the Critical Care Pain Observation Tool and the subjective assessments and objective measurements were based on positive and negative percent agreement. Critical Care Pain Observation Tool demonstrated excellent discriminant validity as evidenced by a highly statistically and clinically significant change in mean Critical Care Pain Observation Tool scores between baseline and painful procedures (mean difference, 3.13 ± 1.56; p < 0.001; Cohen D, 2.0). Interrater agreement was also excellent (κ > 0.6), and scores between raters were highly correlated (r = 0.957). The Critical Care Pain Observation Tool possessed a high level of internal consistency (overall Cronbach α, 0.778). Percent agreement was found to be greater between the Critical Care Pain Observation Tool and the nurse's subjective opinion of the presence or absence of pain when compared with that between the Critical Care Pain Observation Tool and physiologic variables (80.5% vs 67.5%, respectively). CONCLUSIONS The Critical Care Pain Observation Tool is a valid pain assessment tool in noncomatose, delirious adult ICU patients who are unable to reliably self-report the presence or absence of pain.
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Ortlepp JR, Luethje F, Walz R. [Analgesia in intensive care medicine]. Med Klin Intensivmed Notfmed 2016; 111:6-13. [PMID: 26815840 DOI: 10.1007/s00063-015-0127-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 10/22/2015] [Accepted: 11/02/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND The administration of sedatives and analgesics on the intensive care unit (ICU) is routine daily practice. The correct discrimination between delirium, pain and anxiety or confusion is essential for the strategy and selection of medication. The correct pain therapy and sedation are essential for patient quality of life on the ICU and for the prognosis. OBJECTIVE The aim of this article is to present state of the art recommendations on the classification of pain and pain therapy on the ICU. MATERIAL AND METHODS An online search was carried out in PubMed for publications on the topics of "pain" and "ICU". RESULTS Critical care patients are frequently subjected to many procedures and situations which can cause pain. The perception of pain is, among other things, influenced by the degree of orientation, anxiety and the degree of sedation. The administration of analgesics and non-pharmacological approaches are effective in reducing the stress perceived by patients. DISCUSSION The main aim is improvement in the awareness of nursing and medical personnel for pain inducers and pain perception in ICU patients. The classification of pain must be made objectively. Therapeutic targets must be defined and in addition to the correct selection of pain medication, non-pharmacological approaches must also be consistently implemented.
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Affiliation(s)
- J R Ortlepp
- Klinik für Innere Medizin und Intensivmedizin, Asklepios Kliniken Schildautal, Karl-Herold-Str. 1, 38723, Seesen, Deutschland.
| | - F Luethje
- Internistische Intensivstation, Klinik für Innere Medizin und Intensivmedizin, Asklepios Kliniken Schildautal, Seesen, Deutschland
| | - R Walz
- Klinik für Anästhesiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
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Stilma W, Rijkenberg S, Feijen HM, Maaskant JM, Endeman H. Validation of the Dutch version of the critical-care pain observation tool. Nurs Crit Care 2015; 24:132-140. [PMID: 26689613 DOI: 10.1111/nicc.12225] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 09/24/2015] [Accepted: 09/26/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND Systematic assessment of pain is necessary for adequate treatment of pain. Patient self-reported pain is a superior assessment but is of limited use for intubated patients in the intensive care unit. For these patients, the critical-care pain observation tool (CPOT) has been developed. AIM To perform a validation of the Dutch CPOT. STUDY DESIGN Cross-sectional observational study. METHODS The Dutch translation of the CPOT was used. Clinimetric characteristics were analysed in a cross-sectional design. Internal consistency (Cronbach's alpha) was tested by collecting CPOT scores in patients at rest and during turning. Inter-rater reliability was tested by collecting CPOT scores simultaneously by two different nurses who were blinded to each other's scores. Criterion validity (area under the curve, sensitivity and specificity) of the Dutch CPOT (index test) was analysed using patient self-reported pain (reference test). RESULTS Cronbach's alpha was 0.56. During rest, the inter-rater reliability was 0.38 (95% confidence interval (CI): 0.20-0.53). During turning, the inter-rater reliability was 0.56 (95% CI: 0.42-0.68; area under the curve = 0.65 [95% CI 0.57-0.73]). At a threshold CPOT score of 2, the sensitivity and specificity were 39% and 85%, respectively. CONCLUSION The Dutch CPOT is available for pain assessment in intubated patients unable to self-report. Inter-rater reliability is moderate. At the threshold, a CPOT score of 2, the sensitivity was 39% and the specificity of 85%. RELEVANCE TO CLINICAL PRACTICE The CPOT is easy to use for systematic assessment of pain. Additional information about the threshold is valuable for use in daily practice.
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Affiliation(s)
- Willemke Stilma
- Department of Intensive Care Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Saskia Rijkenberg
- Department of Intensive Care Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Hilde M Feijen
- Department of Intensive Care Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Jolanda M Maaskant
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre and University of Amsterdam, the Netherlands
| | - Henrik Endeman
- Department of Intensive Care Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
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Latorre-Marco I, Solís-Muñoz M, Acevedo-Nuevo M, Hernández-Sánchez ML, López-López C, Sánchez-Sánchez MDM, Wojtysiak-Wojcicka M, De las Pozas-Abril J. Validation of the Behavioural Indicators of Pain Scale ESCID for pain assessment in non-communicative and mechanically ventilated critically ill patients: a research protocol. J Adv Nurs 2015; 72:205-16. [PMID: 26358885 DOI: 10.1111/jan.12808] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2015] [Indexed: 11/29/2022]
Abstract
AIM To investigate the validity and reliability of the Behavioural Indicators of Pain Scale (ESCID) in medically and surgically non-communicative and mechanically ventilated critical patients. BACKGROUND Scales based on behavioural indicators of pain are suggested to measure pain in non-communicative critically ill patients. Scales proposed thus far have a range not comparable to those used with patients who can report their pain. A scale with a 0-10 range and more behavioural indicators is proposed to improve the detection and measurement of pain. DESIGN A multicentre prospective observational design to validate a scale-measuring instrument. METHODS Three hundred non-communicative and mechanically ventilated critical patients from 20 different intensive care units will be observed for 5 minutes before, during and 15 minutes after three procedures: turning, tracheal suctioning and soft friction with gauze on healthy tissue. Two independent observers will assess the pain of subjects with the Behavioural Pain Scale and the ESCID scale simultaneously. Descriptive and inferential statistics will be used. Student's t-test will be used to compare components of the twos scales. Inter-rater and intrarater agreement will be investigated. The reliability scale will be measured using Cronbach's alpha. Approval date for this protocol was January 2012. DISCUSSION A greater number of behavioural indicators in the ESCID scale than in previously validated scales, with a 0-10 score range, can improve the detection and measurement of pain in non-communicative and mechanically ventilated critical patients. Funding granted in 2011 by the Spanish Health Research Fund (PI 11/00766, Health Ministry). TRIAL REGISTRATION Study registered with www.clinicaltrials.gov (NCT01744717).
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Affiliation(s)
- Ignacio Latorre-Marco
- Intensive Care Unit, Puerta de Hierro Majadahonda University Hospital (HUPHM), Madrid, Spain
| | | | | | | | - Candelas López-López
- Emergency and Trauma Intensive Care Unit, 12 de Octubre University Hospital (HU12O), Madrid, Spain
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Liu Y, Li L, Herr K. Evaluation of Two Observational Pain Assessment Tools in Chinese Critically Ill Patients. PAIN MEDICINE 2015; 16:1622-8. [DOI: 10.1111/pme.12742] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Rijkenberg S, Stilma W, Endeman H, Bosman R, Oudemans-van Straaten H. Pain measurement in mechanically ventilated critically ill patients: Behavioral Pain Scale versus Critical-Care Pain Observation Tool. J Crit Care 2015; 30:167-72. [DOI: 10.1016/j.jcrc.2014.09.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 08/06/2014] [Accepted: 09/15/2014] [Indexed: 12/11/2022]
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Echegaray-Benites C, Kapoustina O, Gélinas C. Validation of the use of the Critical-Care Pain Observation Tool (CPOT) with brain surgery patients in the neurosurgical intensive care unit. Intensive Crit Care Nurs 2014; 30:257-65. [DOI: 10.1016/j.iccn.2014.04.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 04/04/2014] [Accepted: 04/05/2014] [Indexed: 11/29/2022]
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Validation and evaluation of two observational pain assessment tools in a trauma and neurosurgical intensive care unit. Pain Res Manag 2014; 18:e107-14. [PMID: 24308026 DOI: 10.1155/2013/263104] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Studies have demonstrated that patients in the intensive care unit experience high levels of pain. While many of these patients are nonverbal at some point during their stay, there are few valid tools available to assess pain in this group. OBJECTIVES To evaluate the validity and clinical utility of two pain assessment tools, the revised Adult Non-Verbal Pain Scale (NVPS-R) and the Critical Care Pain Observation Tool (CPOT), in a trauma and neurosurgical patient population. METHODS Patients were assessed using the NVPS-R and CPOT by trained intensive care unit nurses (n=23) and research assistants before, during and after two procedures: turning of the patient (nociceptive procedure) and noninvasive blood pressure cuff inflation (non-nociceptive procedure). Communicative patients were also asked to report their level of pain during each assessment. RESULTS A total of 66 patients (34 communicative, 32 noncommunicative) were included in the study. CPOT and NVPS-R scores increased significantly when participants were exposed to turning, but not during noninvasive blood pressure measurement (repeated measures ANOVA: CPOT, F=5.81, P=0.019; NVPS-R, F=5.32, P=0.025) supporting discriminant validity. CPOT and NVPS-R scores were significantly higher during the turning procedure for patients who had indicated that they were in pain versus those who were not, indicating criterion validity. Inter-rater reliability was generally higher for the CPOT than NVPS-R. Nurses rated the feasibility of the two tools as comparable but provided higher ratings of acceptability for the CPOT. CONCLUSIONS While the present study supports the use of the CPOT and the NVPS-R with critically ill trauma and neurosurgical patients, further research should explore the role of vital signs in pain.
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Barnett JS, Minnick AF, Norman LD. A description of U.S. post-graduation nurse residency programs. Nurs Outlook 2014; 62:174-184. [DOI: 10.1016/j.outlook.2013.12.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 12/12/2013] [Accepted: 12/27/2013] [Indexed: 11/30/2022]
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32
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Kapoustina O, Echegaray-Benites C, Gélinas C. Fluctuations in vital signs and behavioural responses of brain surgery patients in the Intensive Care Unit: are they valid indicators of pain? J Adv Nurs 2014; 70:2562-76. [PMID: 24750262 DOI: 10.1111/jan.12409] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2014] [Indexed: 01/15/2023]
Abstract
AIM To examine the validity of behaviours and fluctuations in vital signs for pain assessment of postbrain surgery adults in the neurosurgical intensive care unit. BACKGROUND Many patients in an intensive care unit may be unable to self-report their pain. In such cases, the use of observable indicators is recommended. Very little research has explored the validity of the use of behaviours and vital signs for pain assessment of neurocritically ill patients. DESIGN Prospective repeated-measure within-subject observational design. METHODS A total of 43 postbrain surgery patients were video recorded before, during and 15 minutes after a non-nociceptive (non-invasive blood pressure cuff inflation) and a nociceptive (turning) procedures. Their behaviours and vital signs were collected with a pre-tested behavioural checklist and a data collection computer connected to the bedside monitor. The patients' self-report of pain was obtained whenever possible. Data were collected between June-December in 2011. RESULTS A larger number of pain-related behaviours were exhibited by participants during the nociceptive procedure compared with the non-nociceptive procedure supporting discriminant validation. Among vital signs, only respiratory rate differed significantly between the two procedures. Regarding criterion validation, only behaviours were positively correlated with self-reports of pain. CONCLUSION Behaviours were found valid indicators of pain in neurocritically ill patients after elective brain surgery. Fluctuations in vital signs may suggest the presence of pain, but their validity for such use is not supported. They should only be used in combination with other validated pain assessment methods.
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Affiliation(s)
- Oxana Kapoustina
- McGill University, Ingram School of Nursing, Montreal, Quebec, Canada; Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada; McGill University Health Centre (MUHC), Montreal, Quebec, Canada
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Zeleníková R, Žiaková K, Čáp J, Jarošová D. Content Validation of the Nursing Diagnosis Acute Pain in the Czech Republic and Slovakia. Int J Nurs Knowl 2014; 25:139-46. [PMID: 24618248 DOI: 10.1111/2047-3095.12027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Renáta Zeleníková
- Department of Nursing and Midwifery; Faculty of Medicine; University of Ostrava; Ostrava Czech Republic
| | - Katarína Žiaková
- Institute of Nursing; Jessenius Faculty of Medicine in Martin; Comenius University; Bratislava Slovakia
| | - Juraj Čáp
- Institute of Nursing; Jessenius Faculty of Medicine in Martin; Comenius University; Bratislava Slovakia
| | - Darja Jarošová
- Department of Nursing and Midwifery; Faculty of Medicine; University of Ostrava; Ostrava Czech Republic
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Japanese guidelines for the management of Pain, Agitation, and Delirium in intensive care unit (J-PAD). ACTA ACUST UNITED AC 2014. [DOI: 10.3918/jsicm.21.539] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Park JM, Kim JH. Assessment and Treatment of Pain in Adult Intensive Care Unit Patients. Korean J Crit Care Med 2014. [DOI: 10.4266/kjccm.2014.29.3.147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Jun-Mo Park
- Department of Anesthesiology and Pain Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Ji Hyun Kim
- Department of Anesthesiology and Pain Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
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Pudas-Tähkä SM, Axelin A, Aantaa R, Lund V, Salanterä S. Translation and cultural adaptation of an objective pain assessment tool for Finnish ICU patients. Scand J Caring Sci 2013; 28:885-94. [PMID: 24304287 DOI: 10.1111/scs.12103] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 11/06/2013] [Indexed: 01/01/2023]
Affiliation(s)
| | - Anna Axelin
- Department of Nursing Science; University of Turku; Turku Finland
| | - Riku Aantaa
- Department of Anaesthesiology; Intensive Care; Emergency Care and Pain Medicine; Turku University Hospital; Turku Finland
| | - Vesa Lund
- Intensive Care Unit; Satakunta Central Hospital; Pori Finland
| | - Sanna Salanterä
- Department of Nursing Science; University of Turku; Turku Finland
- Hospital District of South-West Finland; Turku Finland
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Flynn Makic MB. Pain management in the nonverbal critically ill patient. J Perianesth Nurs 2013; 28:98-101. [PMID: 23522269 DOI: 10.1016/j.jopan.2013.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 01/24/2013] [Indexed: 11/30/2022]
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López López C, Murillo Pérez MA, Torrente Vela S, Cornejo Bauer C, García Iglesias M, Orejana Martín M, Morales Sánchez C, Cuenca Solanas M, Alted López E. [Pain behaviour indicator scale (ESCID) application in severe non-communicative trauma patients receiving mechanical ventilation]. ENFERMERIA INTENSIVA 2013; 24:137-44. [PMID: 24140448 DOI: 10.1016/j.enfi.2013.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 07/27/2013] [Accepted: 07/29/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess pain in non-communicative patients with severe trauma undergoing mechanical ventilation prior to, during and after tracheal suctioning, mobilization and wound care. MATERIAL AND METHOD A prospective and observational study from October to December 2011 was performed. Study variables were ESCID scale and monitoring of vital signs (blood pressure, heart rate, and respiratory rate). Data were gathering 5 minutes before, during and 15 minutes after the 3 procedures. The nursing evolutive report recorded pain assessment, administration and effectiveness of the analgesia. Descriptive analysis of variables included Student's T test/ANOVA for multivariate analysis with SPSS 17.0. RESULTS A hundred eighty four observations: 46.8% tracheal suctioning, 38.5% mobilization and 14.7% wound care were performed in 29 patients. ESCID score was 0.4±1 before, 3.4±2.7 during and 0.4±1 after for wound care; 0.4±1.1 before, 3.6±2.2 during and 1.1±0.5 for tracheal suctioning; 0.5±1.1 before, 3±2.8 during and 0.2±0.8 after for mobilization. These increased significantly during the performance of the 3 procedures before-during/during-after: P=.000. All the hemodynamic variables were significantly modified during mobilization and tracheal suctioning: before-during/during-after: P=.000, with the exception of the cures that only affected respiratory rate. 27% of the procedures received analgesia: 9% received it before, 15% during and 3.2% after, with more analgesia being required for the wound care (33.3%). The data collected in the nursing report on the evaluation of pain/effectiveness of the analgesia showed 20.66%. CONCLUSION An increase on the ESCID score was observed while performing the procedures.
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Affiliation(s)
- C López López
- UCI de Trauma y Emergencias, Hospital Universitario 12 de Octubre, Madrid, España.
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Changes in the Bispectral Index in Response to Experimental Noxious Stimuli in Adults under General Anesthesia. ISRN PAIN 2013; 2013:583920. [PMID: 27335878 PMCID: PMC4893395 DOI: 10.1155/2013/583920] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 06/25/2013] [Indexed: 11/18/2022]
Abstract
Objective. Pain assessment is a major challenge in nonverbal patients in the intensive care unit (ICU). Recent studies suggest a relationship between the Bispectral Index (BIS) and nociceptive stimuli. This study was designed to examine changes in BIS in response to experimental noxious stimuli. Methods. Thirty participants under general anesthesia were in this quasiexperimental, within subject, pre- and poststudy. In the operating room (OR), BIS was monitored during moderate and severe noxious stimuli, induced by a thermal probe on the participants' forearm, after induction of general anesthesia, prior to surgery. Results. Significant increases in BIS occurred during moderate (increase from 35.00 to 40.00, P = 0.003) and severe noxious stimuli (increase from 37.67 to 40.00, P = 0.007). ROC showed a sensitivity (Se) of 40.0% and a specificity (Sp) of 73.3% at a BIS value > 45, in distinguishing a moderate from a severe noxious stimuli. Conclusion. BIS increased in response to moderate and severe noxious stimuli. The Se and Sp of the BIS did not support the use of the BIS for distinction of different pain intensities in the context of deep sedation in the OR. However, the results justify further studies in more lightly sedated patients such as those in the ICU.
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Abstract
Pain is a common and distressing symptom in critically ill patients. Uncontrolled pain places patients at risk for numerous adverse psychological and physiological consequences, some of which may be life-threatening. A systematic assessment of pain is difficult in intensive care units because of the high percentage of patients who are noncommunicative and unable to self-report pain. Several tools have been developed to identify objective measures of pain, but the best tool has yet to be identified. A comprehensive search on the reliability and validity of observational pain scales indicated that although the Critical-Care Pain Observation Tool was superior to other tools in reliably detecting pain, pain assessment in individuals incapable of spontaneous neuromuscular movements or in patients with concurrent conditions, such as chronic pain or delirium, remains an enigma.
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Affiliation(s)
- Mindy Stites
- Mindy Stites is a critical care clinical nurse specialist at the University of Kansas Hospital, Kansas City, Kansas, and a recent graduate of the University of Missouri, Sinclair School of Nursing, Columbia, Missouri
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Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med 2013; 41:263-306. [PMID: 23269131 DOI: 10.1097/ccm.0b013e3182783b72] [Citation(s) in RCA: 2272] [Impact Index Per Article: 206.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To revise the "Clinical Practice Guidelines for the Sustained Use of Sedatives and Analgesics in the Critically Ill Adult" published in Critical Care Medicine in 2002. METHODS The American College of Critical Care Medicine assembled a 20-person, multidisciplinary, multi-institutional task force with expertise in guideline development, pain, agitation and sedation, delirium management, and associated outcomes in adult critically ill patients. The task force, divided into four subcommittees, collaborated over 6 yr in person, via teleconferences, and via electronic communication. Subcommittees were responsible for developing relevant clinical questions, using the Grading of Recommendations Assessment, Development and Evaluation method (http://www.gradeworkinggroup.org) to review, evaluate, and summarize the literature, and to develop clinical statements (descriptive) and recommendations (actionable). With the help of a professional librarian and Refworks database software, they developed a Web-based electronic database of over 19,000 references extracted from eight clinical search engines, related to pain and analgesia, agitation and sedation, delirium, and related clinical outcomes in adult ICU patients. The group also used psychometric analyses to evaluate and compare pain, agitation/sedation, and delirium assessment tools. All task force members were allowed to review the literature supporting each statement and recommendation and provided feedback to the subcommittees. Group consensus was achieved for all statements and recommendations using the nominal group technique and the modified Delphi method, with anonymous voting by all task force members using E-Survey (http://www.esurvey.com). All voting was completed in December 2010. Relevant studies published after this date and prior to publication of these guidelines were referenced in the text. The quality of evidence for each statement and recommendation was ranked as high (A), moderate (B), or low/very low (C). The strength of recommendations was ranked as strong (1) or weak (2), and either in favor of (+) or against (-) an intervention. A strong recommendation (either for or against) indicated that the intervention's desirable effects either clearly outweighed its undesirable effects (risks, burdens, and costs) or it did not. For all strong recommendations, the phrase "We recommend …" is used throughout. A weak recommendation, either for or against an intervention, indicated that the trade-off between desirable and undesirable effects was less clear. For all weak recommendations, the phrase "We suggest …" is used throughout. In the absence of sufficient evidence, or when group consensus could not be achieved, no recommendation (0) was made. Consensus based on expert opinion was not used as a substitute for a lack of evidence. A consistent method for addressing potential conflict of interest was followed if task force members were coauthors of related research. The development of this guideline was independent of any industry funding. CONCLUSION These guidelines provide a roadmap for developing integrated, evidence-based, and patient-centered protocols for preventing and treating pain, agitation, and delirium in critically ill patients.
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A behaviour-based pain scale for horses with acute colic: scale construction. Vet J 2012; 196:394-401. [PMID: 23141961 DOI: 10.1016/j.tvjl.2012.10.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 09/16/2012] [Accepted: 10/03/2012] [Indexed: 12/26/2022]
Abstract
A validated tool for assessing the severity of acute abdominal pain is needed for the effective management of colic in horses. Two behaviour-based colic pain scales were constructed by combining together mathematical and judgemental approaches. The mathematical approach identified easily-recognised pain behaviours to select as items. The judgemental approach further modified the items and weighted them based on expert-opinion. Thirty equine practitioners assessed the level of pain demonstrated in 23 film clips of clinical cases exhibiting signs of acute abdominal pain prospectively using a 10cm visual analogue scale (VAS). The practitioners also identified behaviours noted in each clip from a checklist of 23 behaviours identified from the literature. Nine behaviours had insignificant bias and moderate-to-excellent inter-observer agreement (multirater kappas: 0.5-0.95). Six experienced veterinarians then completed questionnaires in an iterative Delphi process to independently judge 15 items that best reflected severity of pain out of 42 items generated from the literature. Two behaviours were generated by the process. Subsequently, an advisory panel of three equine practitioners constructed two clinimetric-type scales based on the results of both approaches. The two resulting equine acute abdominal pain scales (EAAPS) included 12 behaviours. One weight was assigned to each behaviour in the EAAPS-1. In the EAAPS-2, gradations of weights were assigned, based on the frequency of the behaviour being demonstrated. The EAAPS scales are the first pain severity scales designed specifically for clinical use in cases of acute colic utilising the clinimetric approach to scale construction. Further studies are underway to validate the scales.
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Bambi S, Solaro M. CPOT: Is there any missing link? Pain Manag Nurs 2012; 13:67; author reply 67. [PMID: 22341142 DOI: 10.1016/j.pmn.2012.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 01/25/2012] [Indexed: 10/28/2022]
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JEITZINER MM, SCHWENDIMANN R, HAMERS JPH, ROHRER O, HANTIKAINEN V, JAKOB SM. Assessment of pain in sedated and mechanically ventilated patients: an observational study. Acta Anaesthesiol Scand 2012; 56:645-54. [PMID: 22404146 DOI: 10.1111/j.1399-6576.2012.02660.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Critically ill patients often undergo unpleasant procedures. We quantified the effects of an unpleasant stimulus on physiological and behavioral parameters and evaluated how they are modified by sedation and analgesia. METHODS A 6-month study in the 30-bed intensive care unit (ICU) of a university hospital examined 21 sedated patients from various diagnostic groups. Hemodynamic and respiratory parameters, pupil size, facial expression, muscle tone, body movement, and the Richmond Agitation-Sedation Scale (RASS) score were measured before and during intratracheal suctioning, first in sedated patients, after sedation was stopped, and after an opioid bolus. RESULTS Before intratracheal suctioning, patients had RASS scores of -1.8 ± 1.2 (mean ± standard deviation; sedation), -0.6 ± 1.7 (sedation stop), and -0.9 ± 1.4 (analgesia) (P = 0.014). Intratracheal suctioning significantly increased RASS during both sedation (to -0.6 ± 1.7) and sedation stop (to 1.0 ± 1.5) (both P < 0.01), but not during analgesia. Systolic blood pressure increased during sedation (by 9 ± 10 mmHg), during sedation stop (by 15 ± 17 mmHg) and during analgesia (by 9 ± 4 mmHg; all P < 0.01), but diastolic pressure only during sedation and sedation stop (both P < 0.01). Facial expression, body movement, and muscle tone changed significantly during the episodes of intratracheal suctioning. Heart rate, tidal volume, and pupil size remained stable under all conditions. CONCLUSIONS Intratracheal suctioning evoked significant changes in some physiological and behavioral parameters. Some physiological changes were suppressed by analgesia, but at our ICU's standard doses, neither analgesia nor sedation attenuated changes in behavioral parameters at the intensity tested.
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Affiliation(s)
- M. -M. JEITZINER
- Department of Intensive Care Medicine; Bern University Hospital (Inselspital) and University of Bern; Bern; Switzerland
| | - R. SCHWENDIMANN
- Institute of Nursing Science; University of Basel; Basel; Switzerland
| | - J. P. H. HAMERS
- Department of Health Care Studies; University of Maastricht; Maastricht; Netherlands
| | - O. ROHRER
- Department of Intensive Care Medicine; Bern University Hospital (Inselspital) and University of Bern; Bern; Switzerland
| | - V. HANTIKAINEN
- Institute of Applied Nursing Science; University of St. Gallen; St. Gallen; Switzerland
| | - S. M. JAKOB
- Department of Intensive Care Medicine; Bern University Hospital (Inselspital) and University of Bern; Bern; Switzerland
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Keane KM. Validity and reliability of the critical care pain observation tool: a replication study. Pain Manag Nurs 2012; 14:e216-e225. [PMID: 24315275 DOI: 10.1016/j.pmn.2012.01.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Revised: 01/12/2012] [Accepted: 01/15/2012] [Indexed: 11/29/2022]
Abstract
Critically ill patients are often not able to self-report the presence of pain. Currently there is no generally accepted assessment tool for this population. The Critical-Care Pain Observation Tool (CPOT) was developed for pain assessment of critically ill patients. The purpose of this study was to replicate the findings of the Gelinas et al. (2006) CPOT reference study and examine the interrater reliability (IRR), discriminant validity (DV), and criterion validity (CV) of the CPOT. This quantitative study used a repeated measures design with a convenience sample of 21 postoperative open heart surgery patients cared for in a tertiary-care teaching hospital. Testing for IRR in this sample showed a range of results resulting in fair to almost perfect IRR; the findings of this study suggest that the instrument's IRR is acceptable but variable. Testing for DV demonstrated a significant difference in mean scores between noxious (painful) and nonnoxious (nonpainful) procedures. Testing for CV showed a weak nonsignificant Spearman correlation of 0.26 (P < .312) between CPOT scores and patient self-report during repositioning after extubation. This replication study adds to four studies that have examined psychometric attributes of the instrument and contributes to the process of translating the use of this instrument to the clinical setting.
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Affiliation(s)
- Kathleen Marie Keane
- Maine Medical Center, Portland, Maine, and Boston College, Chestnut Hill, Massachusetts.
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Abstract
Pain is abundant in the intensive care unit (ICU). Successful analgesia demands a comprehensive appreciation for the etiologies of pain, vigilant clinical assessment, and personalized treatments. For the critically ill, frequent threats to mental and bodily integrity magnify the experience of pain, challenging clinicians to respond swiftly and thoughtfully. Because pain is difficult to predict and physiologic correlates are not specific, self-report remains the gold standard assessment. When communication is limited by intubation or cognitive deficits, behavioral pain scales prove useful. Patient-tailored analgesia aspires to mitigate suffering while optimizing alertness and cognitive capacity. Mindfulness of the neuropsychiatric features of pain helps the ICU clinician to clarify limits of traditional analgesia and identify alternative approaches to care. Armed with empirical data and clinical practice recommendations to better conceptualize, identify, and treat pain and its neuropsychiatric comorbidities, the authors (psychiatric consultants, by trade) reinforce holistic approaches to pain management in the ICU. After all, without attempts to understand and relieve suffering on all fronts, pain will remain undertreated.
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Affiliation(s)
- Pierre N Azzam
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Kwak EM, Oh H. Validation of a Korean Translated Version of the Critical Care Pain Observation Tool (CPOT) for ICU Patients. J Korean Acad Nurs 2012; 42:76-84. [DOI: 10.4040/jkan.2012.42.1.76] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Eun-Mi Kwak
- Nurse, Eulji University Hospital, Deajeon, Korea
| | - Heeyoung Oh
- Professor, College of Nursing, Eulji University, Deajeon, Korea
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Arbour C, Gélinas C. Setting Goals for Pain Management When Using a Behavioral Scale: Example With the Critical-Care Pain Observation Tool. Crit Care Nurse 2011; 31:66-8. [DOI: 10.4037/ccn2011914] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Caroline Arbour
- Caroline Arbour is a PhD nursing candidate at McGill University School of Nursing, Montreal, Quebec, Canada
| | - Céline Gélinas
- Céline Gélinas is an assistant professor at McGill University School of Nursing, a nurse scientist at the Centre for Nursing Research of the Jewish General Hospital and a project director at the Lady Davis Insititute, Montreal, Quebec, Canada
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Herr K, Coyne PJ, McCaffery M, Manworren R, Merkel S. Pain Assessment in the Patient Unable to Self-Report: Position Statement with Clinical Practice Recommendations. Pain Manag Nurs 2011; 12:230-50. [DOI: 10.1016/j.pmn.2011.10.002] [Citation(s) in RCA: 333] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2011] [Accepted: 08/22/2011] [Indexed: 01/16/2023]
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Implementation of the critical-care pain observation tool on pain assessment/management nursing practices in an intensive care unit with nonverbal critically ill adults: a before and after study. Int J Nurs Stud 2011; 48:1495-504. [DOI: 10.1016/j.ijnurstu.2011.03.012] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Revised: 03/17/2011] [Accepted: 03/27/2011] [Indexed: 11/21/2022]
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