Phenomenon Assignment 2 - Research Paper Example

Phenomenon Assignment: Pain Assessment in Critical Care Nursing Introduction Pain is identified as a primary and critical stressor commonly experienced by patients in critical care. Pain is described as: (1) an unpleasant sensation associated with possible or actual damage to tissue; and (2) a human protective mechanism. Pain sensed by the body may be classified according to the type of pain receptors involved: (1) mechanical, which involves damage caused by cutting or crushing; (2) thermal, caused by response to temperature; and (3) polymodal, which is attributed to all types of stimuli (Elliot, Aitken, & Chaboyer, 2007).

Managing pain presents itself as a very important challenge to the critical care nurse. Statement of the Phenomenon Pain brings much discomfort to critical care patients and its alleviation is a critical element of critical care nursing. It is, therefore, important that pain is managed effectively. Effective pain management starts with pain assessment (Gelinas, Fillion, Puntillo, Viens & Fortier, 2006). Gelinas (2007) maintained that a patient’s self report is the most reliable and valid measure for identifying pain.

Critical care health professionals, however, face the greatest challenge when a patient in the critical care unit is unconscious because of trauma or is unable to talk or move because of the severity of the illness. The phenomenon, therefore, is pain assessment for critically ill patients who are unable to orally communicate, provide a self-report of the pain they are experiencing, or are unable to move and interact with the hospital staff even with just gestures or nods. Pain and Unconsciousness Personally, this author has always wondered if unconscious patients experience physical pain.

This author is torn between Halloran and Pohlman’s (1995, as cited in Gelinas, 2007) assertion that when a patient does not have higher cortical function, there is no perception of pain; and Laurey (2005, as cited in Gelinas, 2007) who argued that “inability to interpret the noxious message as a painful signal does not negate the transmission of pain” (p. 42). As recommended by experts, unconscious patients are to be treated the same way as conscious patients. Hence, it is common practice to assume that unconscious patients feel pain.

Pain Assessment and Management In order to reduce pain, its assessment should be measured through interaction with the patient. Patients usually express and confirm the amount of pain they feel through hand movements, facial expressions, verbal and written confirmation, and self-assessment. For patients with limited capacity for response, nurses need to utilize additional pain indicators such as body movements, vocalizations, facial expressions, and cardiovascular and respiratory signs (Elliot, Aitken, and Chaboyer, 2007).

In a clinical point of view, the goals of pain assessment are to: (1) create a differential diagnosis; (2) predict response to treatment; (3) evaluate the characteristics and impact of pain on the lives of patients; (4) assist in determining disability and limited physical capacity; (5) monitor progress after start of treatment; and (6) evaluate the effectiveness of treatment (Turk and Melzack, 2011). Pain assessment is, therefore, a very significant task for the critical care nurse. A reliable assessment is a requisite towards effective pain management.

Based on readings of scholarly articles pertaining to assessment of critically ill patients who are unconscious or unable to communicate, the Critical Care Pain Observation Tool (CPOT) may be a possible solution to the phenomenon defined in this paper. Three selected journal articles on CPOT were reviewed. The following section summarizes the findings from these readings. Critical Care Pain Observation Tool The Critical Care Pain Observation Tool or CPOT is composed of four components: (1) facial expression; (2) body movements; (3) muscle tension; and (4) compliance with the ventilator for intubated patients or vocalization for extubated patients.

Each component is composed of behaviors measured on a scale of 0 to 2 based on severity. The CPOT was developed based on three pain assessment tools and three descriptive/qualitative studies (Sessler, Grap, and Ramsay, 2008). Since pain assessment involving critical care patients unable to provide a self-report or having cognitive impairment pose a high level of difficulty, the CPOT measures pain based on patient behavior. The study conducted by Vasquez, Pardavila, Lucia, Aguado, Margall & Asiain (2011) on pain assessment in turning procedures confirmed the benefits of using CPOT on critical care patients.

Medical professionals are able to observe patient behavior and the physiological changes enable pain to be objectified. Vasquez, et al. (2011) concluded that CPOT is capable of effective assessment of pain among ICU patients. A comparative study by Gelinas, Tousignant-Laflamme, Tanguay, and Bourgault (2011) on bispectral index, CPOT, and vital signs during rest and painful procedures on critical care patients confirm the advantage of utilizing behavioral indicators on ICU patients. However, in special circumstances such as deep sedation or use of blocking agents, behavioral indicators could be increasingly difficult to observe, and the medical profession would be forced to depend on physiological indicators.

Future Research Direction Based on the information available, the proper and efficient use of CPOT is required, especially for critical care nurses since it provides crucial information fundamental in the provision of pain management. Since critical care covers different age groups, further study on the use of CPOT in neonatal, pediatric and adult ICU settings will offer substantial leverage for the medical and nursing profession in the management of pain. It is, therefore, recommended that a study of the effectiveness of CPOT among neonatal, pediatric and adult settings be carried out to enhance knowledge about the applicability of CPOT for various age groups.

The existing scale for CPOT should also be examined and revised, if necessary for application among neonatal and pediatric critical care patients. References Elliot, D., Aitken, L. & Chaboyer, W. (2007). ACCN’s critical care nursing. New South Wales, AUS : Elsevier. Gelinas, C. (2007). Pain issues in the ICU. In R. Kaplow & S. R. Hardin (Eds.), Critical care nursing: Synergy for optimal outcomes (pp. 41-52). Sudbury, MA: Jones & Bartlett. Gelinas, C., Fillion, L., Puntillo, K. A., Viens, C.

& Fortier, M. (2006). Validation of the critical care pain observation tool. American Journal of Critical Care, 15(4), 420-427. Gelinas, C., Tousignant-Laflamme, Y., Tanguay, A. & Bourgault, P. (2011). Exploring the validity of the bispectral index, the critical-care pain observation tool and vital signs for the detection of pain in sedated and mechanically ventilated critically ill adults: a pilot study. Intensive & Critical Care Nursing, 27(1), 46-52. Sessler, C. N., Grap, M. J. & Ramsay, M. A. E. (2008). Evaluating and monitoring analgesia and sedation in the intensive care unit.

Critical Care, 12(S3), S2. Turk, D.C. & Melzack, R. (2011). Handbook of pain assessment (3rd ed.). New York, NY: Guilford Press.