A Pilot Study on Pain Assessment Using the Japanese Version of the Critical-Care Pain Observation Tool.
Pain Manag Nurs 2021;
22:769-774. [PMID:
33893035 DOI:
10.1016/j.pmn.2021.02.009]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 01/05/2021] [Accepted: 02/08/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND
Critically ill patients experience various types of pain that are difficult to assess because patients cannot communicate verbally due to artificial airways and sustained sedation. The Critical-Care Pain Observation Tool (CPOT) objectively evaluates patients' pain.
AIMS
This study aimed to re-assess the reliability and validity of the Japanese version (CPOT-J) and to reveal limitations of behaviors specific to mechanically ventilated patients.
DESIGN
Secondary analysis of observational pilot study and case report.
PARTICIPANTS
METHODS: We obtained consent preoperatively from 40 cardiovascular surgery patients. CPOT-J scores were evaluated immediately before, immediately after, and 20 minutes after painful stimulation. Inter-rater reliability was determined by the researcher and 18 ICU nurses (minimum one-year ICU experience). Validity was examined by comparing CPOT-J with vital sign values and patients' self-reports of pain. Two cases revealed the tool's characteristics: one score was consistent with patient reports while the other was not.
RESULTS
We evaluated pain in 34 patients (26 men, 8 women; mean age = 66.8 years). Weighted kappa scores ranged from 0.48 to 0.94. The tool only correlated with changes in systolic blood pressure and pulse pressure. Case studies indicated that the tool effectively evaluated mid-sternum-wound pain, but not back pain at rest.
CONCLUSIONS
The CPOT-J can assess pain in mechanically ventilated patients, but being immobile results in a score of 0 for body movement (e.g., being immobile while feeling back pain) and is a limitation of the scoring.
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