Title of Research
SENSITIVITY OF PAIN ASSESSMENT FOR CRITICALLY ILL, NONVERBAL ADULTS
Start Date
17-11-2017 10:00 AM
End Date
17-11-2017 11:30 AM
Abstract
Abstract
Background: Patient’s self-report is a “gold standard” in assessing pain, yet it is not always possible in critically ill, nonverbal adults. In such cases, the use of reliable behavioral pain assessment tools is paramount to patient outcomes. However, the literature presented conflicting information regarding behavioral pain assessment tools and their sensitivity in assessing pain in critically ill, nonverbal adults.
Objective: This integrative research aimed to explore the effectiveness and barriers in the clinical guidelines of the Critical-Care Pain Observation Tool (CPOT) and the Behavioral Pain Scale (BPS) assessment tools for the detection of pain in critically ill, nonverbal adults.
Methods: The framework by Whittemore and Knafl (2005) was utilized throughout the integrative literature review. The databases used in this integrative literature review were accessed through DePaul University’s Richardson Library database. Sources incorporated in this literature review were collected from the following databases: Cumulative Index and Allied Health (CINAHL), PubMed and PsychINFO. The key terms used in the initial search included: “adult,” “critically ill OR critical illness,” “assessment OR evaluation,” “pain,” “sensitivity,” “reliability,” “ventilated OR ventilator,” and “behavioral scale.” The studies were peer-reviewed, full text, and in English. A total of ten studies from 2007-2017 were included in the analysis and met the inclusion and exclusion criteria that focused on pain measurement sensitivity in critically ill, nonverbal patients.
Results: In the case of critically ill, nonverbal adults, current clinical guidelines recommends the use of CPOT and BPS assessment tools as they are shown to be the most valid, reliable, and sensitive. This was evident in the integrated literature review as the majority of studies (90%) found that both, CPOT and BPS, showed fair to good sensitivity. Major themes in regards to barriers for proper pain assessment with behavioral pain assessment tools were: 1) lack of training/experience in using CPOT and BPS assessment tools, 2) pain scale subjectivity, 3) sedation, analgesic, and consciousness effects on CPOT and BPS scores, and 4) confusion with CPOT and BPS scale properties and domains.
Conclusion: This integrative literature review indicated that CPOT and BPS are sensitive and thus valid for use in clinical settings. While this means that we are headed in the right direction in assessing pain in critically ill, nonverbal patients, further research is needed in regards to effects that pharmacotherapeutic agents and consciousness have on CPOT and BPS scores. Studies are needed to determine the most effective way to educate, train and utilize these subjective scales. Lastly, conflicting research on the use of such scales among brain injury patients needs to be reevaluated to support the optimal continuity of care for future critically ill, nonverbal patients.
Included in
SENSITIVITY OF PAIN ASSESSMENT FOR CRITICALLY ILL, NONVERBAL ADULTS
Abstract
Background: Patient’s self-report is a “gold standard” in assessing pain, yet it is not always possible in critically ill, nonverbal adults. In such cases, the use of reliable behavioral pain assessment tools is paramount to patient outcomes. However, the literature presented conflicting information regarding behavioral pain assessment tools and their sensitivity in assessing pain in critically ill, nonverbal adults.
Objective: This integrative research aimed to explore the effectiveness and barriers in the clinical guidelines of the Critical-Care Pain Observation Tool (CPOT) and the Behavioral Pain Scale (BPS) assessment tools for the detection of pain in critically ill, nonverbal adults.
Methods: The framework by Whittemore and Knafl (2005) was utilized throughout the integrative literature review. The databases used in this integrative literature review were accessed through DePaul University’s Richardson Library database. Sources incorporated in this literature review were collected from the following databases: Cumulative Index and Allied Health (CINAHL), PubMed and PsychINFO. The key terms used in the initial search included: “adult,” “critically ill OR critical illness,” “assessment OR evaluation,” “pain,” “sensitivity,” “reliability,” “ventilated OR ventilator,” and “behavioral scale.” The studies were peer-reviewed, full text, and in English. A total of ten studies from 2007-2017 were included in the analysis and met the inclusion and exclusion criteria that focused on pain measurement sensitivity in critically ill, nonverbal patients.
Results: In the case of critically ill, nonverbal adults, current clinical guidelines recommends the use of CPOT and BPS assessment tools as they are shown to be the most valid, reliable, and sensitive. This was evident in the integrated literature review as the majority of studies (90%) found that both, CPOT and BPS, showed fair to good sensitivity. Major themes in regards to barriers for proper pain assessment with behavioral pain assessment tools were: 1) lack of training/experience in using CPOT and BPS assessment tools, 2) pain scale subjectivity, 3) sedation, analgesic, and consciousness effects on CPOT and BPS scores, and 4) confusion with CPOT and BPS scale properties and domains.
Conclusion: This integrative literature review indicated that CPOT and BPS are sensitive and thus valid for use in clinical settings. While this means that we are headed in the right direction in assessing pain in critically ill, nonverbal patients, further research is needed in regards to effects that pharmacotherapeutic agents and consciousness have on CPOT and BPS scores. Studies are needed to determine the most effective way to educate, train and utilize these subjective scales. Lastly, conflicting research on the use of such scales among brain injury patients needs to be reevaluated to support the optimal continuity of care for future critically ill, nonverbal patients.