scholarly journals Nursing pain assessment in non verbal intensive care patient

2018 ◽  
Vol 4 (4) ◽  
pp. 186
Author(s):  
Anastasia Villioti ◽  
Antonia Kalogianni ◽  
Dimitrios Papageorgiou ◽  
Edison Jahaj
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pain Assessment ◽  
English Language ◽  
Care Patient ◽  
Assessment Tools ◽  
Publication Date ◽  
Nursing Interventions ◽  
The Unconscious ◽  
Experienced Nurses

Introduction:  It has been found out that pain is one of the most important issues that patients have to deal with while they are hospitalized in an intensive care unit (ICU), especially when they are non-communicative. Nurses play the most important role in the pain assessment through the everyday contact with patients and with the use of a variety of pain assessment tools as well.Aim:  The purpose was to determine nurses’ level of knowledge about the use of pain assessment tools (especially pain scales) in the unconscious intensive care patients – To investigate the level of pain assessment tools application in the daily nursing routine by the ICU nurses.Material and Method: A systematic review in the followed database was applied: Pubmed-Medline-Embase. The entry criteria in the review were: a) Publication date: 1990-2017 b) Greek or English language c) the sample of research must necessarily include experienced nurses who work exclusively in an intensive care unit. d) the use of pain assessment tools for non verbal patients should be included in the nursing interventions e) nurses should be responsible for the daily care of non verbal patients f) the results must be concern exclusively non communicative patients.Results: From the research four studies have emerged which met the standards of the review. The common findings among these researches result in the fact that although nurses believe that an effective pain assessment is important to a great extent, very few of them use pain assessment tools according to protocols especially in the unconscious patients.Conclusions:  Nursing pain assessment concerning non verbal patients still remain inadequate and doesn’t seem to be a priority during the daily nursing routine. The promotion of education of nurses concerning pain assessment is required and the use of protocols as well in order to ease the process of a reliable and valid pain assessment.

scholarly journals Using the Model for Improvement to implement the Critical-Care Pain Observation Tool in an adult intensive care unit

2018 ◽  
Vol 7 (4) ◽  
pp. e000304 ◽  
Author(s):  
Mairi Mascarenhas ◽  
Michelle Beattie ◽  
Michelle Roxburgh ◽  
John MacKintosh ◽  
Noreen Clarke ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Pain Assessment ◽  
Best Practice ◽  
Assessment Tool ◽  
Assessment Tools ◽  
Self Report ◽  
Process Measures ◽  
Adult Intensive Care Unit

Managing pain is challenging in the intensive care unit (ICU) as often patients are unable to self-report due to the effects of sedation required for mechanical ventilation. Minimal sedative use and the utilisation of analgesia-first approaches are advocated as best practice to reduce unwanted effects of oversedation and poorly managed pain. Despite evidence-based recommendations, behavioural pain assessment tools are not readily implemented in many critical care units. A local telephone audit conducted in April 2017 found that only 30% of Scottish ICUs are using these validated pain instruments. The intensive care unit (ICU) at Raigmore Hospital, NHS Highland, initiated a quality improvement (QI) project using the Model for Improvement (MFI) to implement an analgesia-first approach utilising a validated and reliable behavioural pain assessment tool, namely the Critical-Care Pain Observation Tool (CPOT). Over a six-month period, the project deployed QI tools and techniques to test and implement the CPOT. The process measures related to (i) the nursing staff’s reliability to assess and document pain scores at least every four hours and (ii) to treat behavioural signs of pain or CPOT scores ≥ 3 with a rescue bolus of opioid analgesia. The findings from this project confirm that the observed trends in both process measures had reduced over time. Four hourly assessments of pain had increased to 89% and the treatment of CPOT scores ≥3 had increased to 100%.

scholarly journals Validation and Evaluation of Two Observational Pain Assessment Tools in a Trauma and Neurosurgical Intensive Care Unit

2013 ◽  
Vol 18 (6) ◽  
pp. e107-e114 ◽  
Author(s):  
Jane Topolovec-Vranic ◽  
Celine Gélinas ◽  
Yangmei Li ◽  
Mary Ann Pollmann-Mudryj ◽  
Jennifer Innis ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Pain Assessment ◽  
Repeated Measures ◽  
Discriminant Validity ◽  
Blood Pressure Measurement ◽  
Assessment Tools ◽  
Noninvasive Blood Pressure ◽  
Neurosurgical Patients

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.

scholarly journals A Systematic Review on Pain Assessment Tools for Intensive Care Unit Patients

2020 ◽  
Vol 13 (1) ◽  
pp. 44-62
Author(s):  
Eun-Jeong Kim ◽  
Jiwon Hong ◽  
Jiyeon Kang ◽  
Na geong Kim ◽  
NaRi Kim ◽  
...  
Keyword(s):  
Systematic Review ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Pain Assessment ◽  
Assessment Tools

scholarly journals Nursing Interventions to Prevent Delirium in Critically Ill Patients in the Intensive Care Unit during the COVID19 Pandemic—Narrative Overview

Healthcare ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 578
Author(s):  
Dorota Ozga ◽  
Sabina Krupa ◽  
Paweł Witt ◽  
Wioletta Mędrzycka-Dąbrowska
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill Patients ◽  
Current Knowledge ◽  
Personalised Medicine ◽  
Nursing Interventions ◽  
Evidence Based ◽  
Current State ◽  
Scientific Disciplines ◽  
Reliable Methods

It has become a standard measure in recent years to utilise evidence-based practice, which is associated with a greater need to implement and use advanced, reliable methods of summarising the achievements of various scientific disciplines, including such highly specialised approaches as personalised medicine. The aim of this paper was to discuss the current state of knowledge related to improvements in “nursing” involving management of delirium in intensive care units during the SARS-CoV-2 pandemic. This narrative review summarises the current knowledge concerning the challenges associated with assessment of delirium in patients with COVID-19 by ICU nurses, and the role and tasks in the personalised approach to patients with COVID-19.

Different assessment tools for intensive care unit delirium: Which score to use?*

2010 ◽  
Vol 38 (2) ◽  
pp. 409-418 ◽  
Author(s):  
Alawi Luetz ◽  
Anja Heymann ◽  
Finn M. Radtke ◽  
Chokri Chenitir ◽  
Ulrike Neuhaus ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Assessment Tools ◽  
Intensive Care Unit Delirium

Reliability of three linguistically and culturally validated pain assessment tools for sedated ICU patients by ICU nurses in Finland

2018 ◽  
Vol 18 (2) ◽  
pp. 165-173 ◽  
Author(s):  
Sanna-Mari Pudas-Tähkä ◽  
Sanna Salanterä
Keyword(s):  
Intensive Care ◽  
Internal Consistency ◽  
Pain Assessment ◽  
Assessment Tools ◽  
Endotracheal Suctioning ◽  
Icu Patients ◽  
Rater Reliability ◽  
Intensive Care Patients ◽  
Video Recordings ◽  
Test Retest Reliability

Abstract Background and aims: Pain assessment in intensive care is challenging, especially when the patients are sedated. Sedated patients who cannot communicate verbally are at risk of suffering from pain that remains unnoticed without careful pain assessment. Some tools have been developed for use with sedated patients. The Behavioral Pain Scale (BPS), the Critical-Care Pain Observation Tool (CPOT) and the Nonverbal Adult Pain Assessment Scale (NVPS) have shown promising psychometric qualities. We translated and culturally adapted these three tools for the Finnish intensive care environment. The objective of this feasibility study was to test the reliability of the three pain assessment tools translated into Finnish for use with sedated intensive care patients. Methods: Six sedated intensive care patients were videorecorded while they underwent two procedures: an endotracheal suctioning was the nociceptive procedure, and the non-nociceptive treatment was creaming of the feet. Eight experts assessed the patients’ pain by observing video recordings. They assessed the pain using four instruments: the BPS, the CPOT and the NVPS, and the Numeric Rating Scale (NRS) served as a control instrument. Each expert assessed the patients’ pain at five measurement points: (1) right before the procedure, (2) during the endotracheal suctioning, (3) during rest (4) during the creaming of the feet, and (5) after 20 min of rest. Internal consistency and inter-rater reliability of the tools were evaluated. After 6 months, the video recordings were evaluated for testing the test-retest reliability. Results: Using the BPS, the CPOT, the NVPS and the NRS, 960 assessments were obtained. Internal consistency with Cronbach’s alpha coefficient varied greatly with all the instruments. The lowest values were seen at those measurement points where the pain scores were 0. The highest scores were achieved after the endotracheal suctioning at rest: for the BPS, the score was 0.86; for the CPOT, 0.96; and for the NVPS, 0.90. The inter-rater reliability using the Shrout-Fleiss intraclass correlation coefficient (ICC) tests showed the best results after the painful procedure and during the creaming. The scores were slightly lower for the BPS compared to the CPOT and the NVPS. The test-retest results using the Bland-Altman plots show that all instruments gave similar results. Conclusions: To our knowledge, this is the first time all three behavioral pain assessment tools have been evaluated in the same study in a language other than English or French. All three tools had good internal consistency, but it was better for the CPOT and the NVPS compared to the BPS. The inter-rater reliability was best for the NVPS. The test-retest reliability was strongest for the CPOT. The three tools proved to be reliable for further testing in clinical use. Implications: There is a need for feasible, valid and reliable pain assessment tools for pain assessment of sedated ICU patients in Finland. This was the first time the psychometric properties of these tools were tested in Finnish use. Based on the results, all three instruments could be tested further in clinical use for sedated ICU patients in Finland.

scholarly journals INVESTIGATING EFFECT OF NURSING INTERVENTIONS, BASED ON WELLS SCORE RESULTS, ON THE INCIDENCE OF DEEP VEIN THROMBOSIS IN PATIENTS ADMITTED TO THE INTENSIVE CARE UNIT

2018 ◽  
Vol 11 (5) ◽  
pp. 377
Author(s):  
Morteza Habibi Moghadam ◽  
Marzieh Asadizaker ◽  
Simin Jahani ◽  
Elham Maraghi ◽  
Hakimeh Saadatifar ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Deep Vein Thrombosis ◽  
Intervention Group ◽  
Control Group ◽  
Nursing Interventions ◽  
Vein Thrombosis ◽  
Wells Score ◽  
Deep Vein ◽  
Pitting Edema

 Objective: Venous thromboembolism, including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common complaint in critically ill patients. Therefore, the present study was conducted to determine the effect of nursing interventions, based on the Wells results, on the incidence of DVT in intensive care unit (ICU) patients.Methods: The present clinical trial was conducted on 72 ICU patients without DVT and PE who met the inclusion criteria according to Wells score in Dr. Ganjavian Hospital, Dezful in 2012. The participants were investigated and randomly divided into intervention (n=36) and control groups (n=36). The intervention group received preventive nursing measures based on the risk level determined by the Wells score, and routine therapeutic interventions were performed for the control group. Then, patients were evaluated using Wells score, D-dimer testing, and Doppler sonography on the 1st, 5th, and 10th days. Data were finally coded and entered into SPSS version 23. Data analysis was performed using Chi-square, Fisher’s exact, and Mann–Whitney U tests.Results: The incidence of DVT in both groups showed that 2 patients of the control group who were identified to be at risk using the Wells score were diagnosed with DVT while none of the patients of the intervention group experienced DVT. The present study showed that 22.2% of the patients of the control group suffered from non-pitting edema, which was significantly different from the intervention group (p=0.005).Conclusion: The results of the present study showed that using the Wells score for early identification of the at-risk patients and nursing interventions based on this score’s results is helpful in the prevention of DVT. Appropriate nursing interventions were also effective in reducing the incidence of non-pitting edema in the lower extremities.

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