ORIGINAL ARTICLEUse of a Behavioural Pain Scale to assess pain in ventilated, unconscious and/or sedated patients
Section snippets
Introduction and background
The ICU is designed to manage the care of patients suffering from a range of complex and life threatening conditions. Critically ill patients undergo many routine procedures and treatments, which are often associated with considerable discomfort and pain (Payen et al., 2001, Stanik-Hutt et al., 2001, Tittle and McMillan, 1994, Kinney et al., 1995, Puntillo, 1990, Turner et al., 1990). In a small study by Puntillo (1990), although seven patients (29%) had no recall of their pain, 71% (n = 17) of
Objectives
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To determine the validity and reliability of the BPS instrument in assessing pain in ICU patients undergoing two routine procedures.
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To determine inter-rater reliability of the BPS instrument with ICU nursing staff.
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To determine factors that may influence BPS scores.
Research design
Using a repeated measures design, patients were assessed twice for pain with eye care and twice for pain with repositioning. Specifically, patients were assessed immediately prior to their routine procedure being conducted and then assessed during the course of the procedure using the BPS tool.
Sample and setting
This study was conducted in an 18 bed medical, surgical, neurological and emergency Intensive Care Unit at a Western Australian adult teaching hospital. Forty-four patients were recruited for this study
Ethics
The Hospital's Human Research Ethics Committee and the Nursing Research Scientific Sub-Committee approved this study. All next of kin were given written information to explain the study prior to signing their consent. All patients were assigned a code number to ensure confidentiality.
Results
Forty-four patients were recruited for this study. A higher proportion of participants were male (59%; n = 26) and the median age was 64 years (range = 16–82 years). The majority (70%; n = 31) were medical patients, with only 13 patients having undergone a surgical procedure. Diagnoses varied greatly from pneumonia and asthma to multi trauma and coronary artery bypass grafting. Intubation via an endotracheal tube was used in the majority of cases (84%; n = 37) with the remainder intubated via a
Discussion
Numerous studies have reported the under-treatment of pain in the critically ill conscious patient (Puntillo et al., 2001, Carroll et al., 1999, Hall-Lord et al., 1998, Puntillo et al., 1997, Tittle and McMillan, 1994, Puntillo, 1990). Yet, very few studies have actually researched how best to assess pain in the unconscious, ventilated ICU patient. Interestingly, a review of the literature found only one study by Payen et al. (2001) which evaluated the use of a pain management tool in this
Acknowledgments
This project was made possible with funding from the SCGH Nursing Research Scholarship. Special thanks to Ms. Rebecca Lee for data collection, the ICU management and team for supporting this study and to Mrs. Janice Low for administrative support.
References (19)
- et al.
Pathophysiology of pain in critically ill patients
Crit Care Nurs Clin N Am
(2001) - et al.
Pain and distress among elderly intensive care unit patients: comparison of patients’ experience and nurses’ assessments
Heart Lung
(1998) - et al.
Evaluation of pain in the critically ill patient
Crit Care Clin
(1999) - et al.
Assessment of pain in the critically ill
Crit Care Nurs Clin N Am
(2001) - et al.
Pain assessment and management in critically ill post operative and trauma patients: a multi-site study
Am J Crit Care
(1999) - et al.
Management of the agitated intensive care patient
Crit Care Med
(2002) - et al.
Pain management in the culture of critical care
Crit Care Nurs Clin N Am
(2001) - et al.
Patterns of prescribing and administering drugs for agitation and pain in patients in a surgical intensive care unit
Crit Care Med
(1994) - et al.
Motor Activity Assessment Scale: a valid and reliable sedation scale for use with mechanically ventilated patients in an adult surgical intensive care unit
Crit Care Med
(1999)
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