title: Critical care nurses provide their perspectives of patients' symptoms in intensive care units.
abstract: BACKGROUND
  Patients in intensive care units (ICUs) can be adversely affected by distressing symptoms. When critically ill patients are unable to self-report symptoms, ICU nurses become proxy reporters.
  
  
  OBJECTIVE
  The purpose of this prospective, descriptive study was to explore how ICU nurses assess and treat distressing symptoms in critically ill patients at high risk of dying.
  
  
  METHODS
  Twenty-two nurses participated in this single-site, prospective, descriptive study and described their patients' symptoms and how the symptoms were being managed in response to interviews that used open-ended questions. Taped interviews were transcribed verbatim, and themes were identified.
  
  
  RESULTS
  Three major themes were derived from the data: 1) signs of symptoms, (2) treatment of symptoms, and (3) "symptoms" versus "signs." Most nurses did not make distinctions between the assessment of "signs" of disease and the assessment of "symptoms," and consequently, signs and symptoms were frequently inventoried collectively.
  
  
  CONCLUSIONS
  Critically ill patients experience a broad range of symptoms. Continued attempts to validate nonverbal measures of symptoms are warranted because lack of such measures may adversely affect symptom treatment for critically ill patients. Furthermore, heightened awareness and increased education of nurses to differentiate between signs and symptoms lay the foundation for increasing attention on symptoms, improving accuracy of symptom assessment, and guiding appropriate symptom management.
authors.affiliation: University of California San Francisco, Department of Physiological Nursing, San Francisco, California CA 94143-0610, USA.
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Puntillo
authors.forename: Deborah
authors.initials: D
authors.lastname: Smith
authors.forename: Shoshana
authors.initials: S
authors.lastname: Arai
authors.forename: Nancy
authors.initials: N
authors.lastname: Stotts
mesh_terms: D018806:APACHE; D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000401:mortality* / Q000451:nursing*; D016529:Emergency Nursing / Q000592:standards* / Q000639:trends; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D009730:Nursing Assessment; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D017749:Total Quality Management