Pain assessment and management in critically ill intubated patients: a retrospective study.
BACKGROUND
Little research has been done on pain assessment in critical care, especially in patients who cannot communicate verbally.


OBJECTIVE
To describe (1) pain indicators used by nurses and physicians for pain assessment, (2) pain management (pharmacological and nonpharmacological interventions) undertaken by nurses to relieve pain, and (3) pain indicators used for pain reassessment by nurses to verify the effectiveness of pain management in patients who are intubated.


METHODS
Medical files from 2 specialized healthcare centers in Quebec City, Quebec, were reviewed. A data collection instrument based on Melzack's theory was developed from existing tools. Pain-related indicators were clustered into nonobservable/subjective (patients' self-reports of pain) and observable/objective (physiological and behavioral) categories.


RESULTS
A total of 183 pain episodes in 52 patients who received mechanical ventilation were analyzed. Observable indicators were recorded 97% of the time. Patients' self-reports of pain were recorded only 29% of the time, a practice contradictory to recommendations for pain assessment. Pharmacological interventions were used more often (89% of the time) than nonpharmacological interventions (<25%) for managing pain. Almost 40% of the time, pain was not reassessed after an intervention. For reassessments, observable indicators were recorded 66% of the time; patients self-reports were recorded only 8% of the time.


CONCLUSIONS
Pain documentation in medical files is incomplete or inadequate. The lack of a pain assessment tool may contribute to this situation. Research is still needed in the development of tools to enhance pain assessment in critically ill intubated patients.
Gélinas
Céline
C
Faculty of Nursing, University Laval, Quebec City, Quebec.
Fortier
Martine
M
Viens
Chantal
C
Fillion
Lise
L
Puntillo
Kathleen
K
D000700:Analgesics / Q000627:therapeutic use; D016638:Critical Illness; D003625:Data Collection / Q000295:instrumentation; D004282:Documentation / Q000706:statistics & numerical data; D005149:Facial Expression; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007442:Intubation, Intratracheal; D007697:Kinesics; D008297:Male; D008875:Middle Aged; D009723:Nurse-Patient Relations; D010146:Pain / Q000175:diagnosis*; D059408:Pain Management; D010147:Pain Measurement / Q000379:methods* / Q000451:nursing*; D010817:Physician-Patient Relations; D011792:Quebec; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012650:Self Disclosure
D000700:Analgesics; D006993:Hypnotics and Sedatives