| Learning Objective #1: Discuss the issues in the measurement of pain in the non-communicative, critically ill, adult patient | |||
| Learning Objective #2: Describe a successful approach to scholarly interdisciplinary practice |
Critically ill patients in pain who cannot self-report is an issue worldwide. What are the behavioral and physiological cues presented by a critically ill non-communicative patient in pain? Can a valid and reliable scale be generated from these cues? Some of our patients have reported that they remember severe pain during the time when they are intubated and unable to self-report their pain. No valid and reliable pain scales for use in critically ill, non-communicative patients were found; yet, a scale is needed by all disciplines in the critical care unit to consistently manage pain in the patient who cannot self-report. An interdisciplinary team was formed to address the issue. MEDLINE and CINAHL were searched for research articles on pain assessment in the non-communicative critically ill adult patient. The research was limited to non-cognitively impaired adults. Each article was reviewed for evidence on cues of non-verbal pain. The team reviewed and systematically critiqued each article for its scientific merit and its feasibility for use, based on the Stetler Model. Information from the articles was synthesized and integrated into tables of behavioral and physiological cues. The research team of experienced intensive care providers identified cues that they use to assess pain in the non-verbal adult. This list of cues was combined with external evidence from the literature. Multiple items were generated within six categories designated as representative of the non-verbal behaviors within the construct of pain. Intensive Care nurses piloted the scale in the immediate postoperative cardiac surgery unit. Behaviors were checked if noted during periods when the nurse perceived the patient was in pain and during re-assessment following medication. Items were weighted and evaluated by non-members of the team considered as experts by their peers. The process of interdisciplinary collaboration, the next steps, and the pilot scale will be presented.
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