Completed Research Project
Pain assessment: A prospective investigation into the use of a Behavioural Pain Scale by critical care nurses for patients who are mechanically ventilated, unconscious or sedated in ICU
Investigators: Siffleet J, Young J & Nikoletti
S.
Funding: Nursing Research Scholarship ($5,000).
Abstract: Current empirical evidence supports claims that pain in sedated unconscious Intensive Care Unit patients is under-rated and under-treated. Untreated pain is emotionally distressing and may be a contributing factor to agitation. The aim of this study was to validate the Behavioural Pain Scale (BPS) for the assessment of pain in critically ill unconscious ICU patients by evaluating facial expressions, upper limb movements and compliance with mechanical ventilation. The study was designed so that each of two routine procedures, a painful (repositioning) and non-painful (eye care) procedure was assessed twice with 44 patients. A research nurse recorded BPS scores for the patients before and during each procedure. These were compared to ascertain whether an increase in the score had occurred. Additional variables such as administration of morphine and anaesthetic use were also measured. An average of 73% of the unconscious patients’ BPS scores increased when repositioned as opposed to 14% after eye care. An increase in BPS was observed for a significant percentage of patients (p<0.003), but not for eye care (p>0.3). The odds of an increase in BPS was 29 times higher for turns as opposed to eye care (95% CI (10.2 ; 82.9)), after controlling for administration of morphine, method of ventilation and surgical intervention. The BPS instrument was found to be able to detect changes in pain level as a result of a patient undergoing a painful procedure. Further validation using a variety of procedures and settings is recommended.
