两种非语言疼痛评估工具的应用现状分析

目的：通过对两种非语言疼痛评估工具相关研究进行文献分析,为我国非语言疼痛评估工具的选择提供参考。方法运用疼痛评估工具性能评分系统对计算机检索获取的相关文献进行分析。结果共纳入29篇文献,疼痛行为量表( BPS)与重症监护疼痛观察工具( CPOT)平均得分分别为9.20分、9.32分。结论疼痛行为量表( BPS)与重症监护疼痛观察工具( CPOT)逐渐被广泛应用于非语言疼痛患者的疼痛评估,但在不同人群中两者的信效度都存在差异,仍需进一步被验证。     

中文版行为疼痛评估工具的研究进展

介绍了适用于儿童疼痛行为量表(FLACC)、适用于认知障碍病人的晚期老年痴呆疼痛评估量表(PAINAD)和老年痴呆病人疼痛评估量表(Doloplus-2)、成人重症病人行为疼痛量表(BPS)、重症监护疼痛观察工具(CPOT)、非语言成人疼痛评估量表(PAINAD)、非语言疼痛评估工具(NPAT)及修订版非语言疼痛评估工具(NVPS-R)。6个量表均经过汉化及信效度测定,适用于不具备交流能力(包括言语和非言语交流能力)病人的行为疼痛评估,指出量表在使用过程中的注意事项,为医务人员对特殊群体病人开展疼痛评估提供工具应用上的借鉴     

音乐疗法在重症监护病房中的应用研究

目的 观察音乐疗法在重症监护病房的应用效果,提高危重症患者的舒适度.方法 将168例重症患者随机分为观察组84例,对照组84例.观察组采用音乐疗法进行干预,对照组进行常规护理.采用状态焦虑量表进行焦虑状况测定,视觉模拟量表评定疼痛程度,并监测血压、心率变化.结果 观察组与对照组相比较,观察组患者的焦虑程度得到改善（P〈0.05）,疼痛程度明显降低（P〈0.05）,循环系统较稳定,波动小.结论 音乐疗法具有稳定患者血压、心率,缓解焦虑的作用,提高了患者在重症监护病房的舒适度.     

重症监护疼痛观察工具临床应用的SWOT分析

重症监护疼痛观察工具(critical-care pain observation tool,CPOT)是一种以行为变化为评估指标的客观疼痛评估工具,主要用于无法用言语表达疼痛的ICU重症患者的疼痛评估和管理.本文运用SWOT[优势(S)、劣势(W)、机遇(O)、挑战(T)]分析方法,系统分析了CPOT在临床应用的优势...     

中文版晚期老年痴呆症疼痛评估量表在老年精神科护理应用中的信效度研究

目的测试中文版晚期老年痴呆症疼痛评估量表对老年精神障碍患者疼痛评估的信度和效度。方法使用中文版晚期老年痴呆症疼痛评估量表对79例老年精神科住院患者进行疼痛评估,分析该量表的信度和效度。结果中文版晚期老年痴呆症疼痛评估量表的Cronbach’sα系数为0.748,分半信度为0.610,量表得分与语言描述量表、面部表情疼痛量表评分相关性系数为0.366、0.569,因子分析的贡献率是53.11%,显示具有较好的信度和效度。结论晚期老年痴呆症疼痛评估量表能用于评估老年精神障碍患者的疼痛程度。     

重症监护病房患者的睡眠状况及其影响因素分析探讨

目的:探讨分析重症监护病房患者的睡眠状况及其影响因素。方法:选取2018年6月至2019年6月新疆生产建设兵团第十三师红星医院收治的重症监护病患者80例作为研究对象,随机分为观察组和对照组,每组40例。分别采用睡眠状况自评量表(SRSS)以及我院自制的ICU患者睡眠障碍调查量表对我院80例重症监护病房(ICU)患者的睡眠状况以及对其睡眠造成影响的因素进行调查分析。结果:重症监护病房患者的睡眠状况自评量表评分显著高于我院自制的ICU患者睡眠障碍调查量表评分,差异有统计学意义(P 0. 05);医护干扰、噪声、身体不适以及担心自身健康四项因素是造成重症监护病房患者出现睡眠障碍的主要影响因素。结论:改善重症监护病房患者的睡眠质量应从多个方面进行,出去平时应该完成的日常工作外,医护人员应多给予患者关心与关怀,改善重症监护病房的睡眠环境,减少一些不必要的医护干预工作,最大程度上的避免各种影响因素影响致患者睡眠,促使患者早日康复。     

疼痛的评估在冠心病重症监护室中的应用

总结了在冠心病重症监护室中疼痛的评估方法,包括视觉模拟评分法,数字评分法,面部表情疼痛量表,口述疼痛程度分级评分法.认为正确评估疼痛,实施有效的疼痛护理,对患者生理、心理的健康及疾病的转归有着积极作用.     

重症监护谵妄筛查量表在ICU常规监测的效果研究

[目的]探讨重症监护谵妄筛查量表在重症监护室(ICU)常规监测的应用,寻找谵妄低识别的潜在因素,加强薄弱环节的控制,制定谵妄病人的护理流程和措施。[方法]对照组病人遵医嘱行重症监护和治疗;实验组除行重症监护和治疗外,另用重症监护谵妄筛查量表评估病人的意识状态,做到班班评估,班班交接。记录两组病例报告,运用统计学数据分析两组病人谵妄发生率、意外拔管率、脱机困难、住院天数、死亡危险性和医疗费用。[结果]两组病人谵妄发生例数(率)、意外拔管数、死亡数、住院天数、医疗费用、机械通气时间的比较,实验组低于对照组,差异有统计学意义(P0.05)。[结论]通过重症监护谵妄筛查量表在ICU病人中的应用,做到早发现和管理,降低ICU病人的谵妄发生率、节约医疗资源、减少并发症和死亡人数。     

疼痛观察工具应用于ICU非气管插管患者的信效度分析

目的:探讨重症监护病房(ICU)非气管插管患者采用中文版重症监护疼痛观察工具(CPOT)的信效度情况。方法:将CPOT量表进行中文翻译得到中文版CPOT,采用CPOT和疼痛程度数字评估量表(NRS)对2016年10月～2017年10月期间术后入住我院ICU的58例非气管插管患者进行疼痛评估,完成CPOT内部一致性、效标关联效度以及已知族群效度评价。再通过10名ICU护士对另外20例ICU患者进行评估,计算组内相关系数,以完成评定者间信效度的评价。结果:中文版CPOT的Cronbach'sα系数为0. 906。不考虑评定者间相互影响时,中文版CPOT评定者间信度为0. 852,有疼痛时CPOT评定间信度为0. 719,无疼痛时为0. 752。在假定评定者间完全无相互影响时,中文版CPOT评定者间信度为0. 968,有疼痛时CPOT评定者间信度为0. 936,无疼痛时为0. 967。中文版CPOT与NRS评分具有密切关系(r=0. 952),无疼痛和有疼痛刺激时中文版CPOT和NRS评分依然具有相关性(r=0. 751、0. 833)。研究中评价中文版CPOT已知族群效度时,对比无痛刺激测量体温和疼痛刺激翻身时的中文版CPOT各条目评分发现,疼痛刺激翻身时中文版CPOT各项评分均高于无疼痛刺激测量体温时评分(P 0. 05)。结论:中文版CPOT评分对ICU非气管插管患者评价具有良好的信效度,适用于ICU非气管插管患者对疼痛的评估。     

疼痛评估工具在重症监护病房住院患者中的应用与选择

正疼痛是重症监护病房(ICU)危重症患者常见的临床症状~([1])。近年,如何加强对ICU危重症患者的疼痛评估和治疗引起了大量学者的高度关注,并有学者针对ICU危重症患者疼痛评估工具的选择进行了深入研究~([2-3])。本研究复习近年国内外有关疼痛评估工具在ICU危重症患者中的应用现状,现综述如下。1 ICU住院患者疼痛管理的意义疼痛是危重症患者较为显著的临床症状,也是影响其机体代谢应激反应的主要因素~([4])。由于ICU     

A Psychometric Evaluation of Three Pain Rating Scales for People with Moderate to Severe Dementia

Little comparative information exists regarding the reliability and validity of pain rating scales for nurses to assess pain in people with moderate to severe dementia in residential aged care facilities. The objective of this study was to evaluate the relative psychometric merits of the Abbey Pain Scale, the DOLOPLUS-2 Scale, and the Checklist of Nonverbal Pain Indicators Scale, three well-known pain rating scales that have previously been used to assess pain in nonverbal people with dementia. An observational study design was used. Nurses (n = 26) independently rated a cross-section of people with moderate to severe dementia (n = 126) on two occasions. The Abbey Pain Scale and the DOLOPLUS-2 Scale showed good psychometric qualities in terms of reliability and validity, including resistance to the influence of rater characteristics. The Checklist of Nonverbal Pain Indicators Scale also had reasonable results but was not as psychometrically strong as the Abbey Pain Scale and DOLOPLUS-2 Scale. This study has provided comparative evidence for the reliability and validity of three pain rating scales in a single sample. These scales are strong, objective adjuncts in making comprehensive assessments of pain in people who are unable to self-report pain due to moderate to severe dementia, with each having their own strengths and weaknesses. The DOLOPLUS-2 Scale provides more reliable measurement, and the Abbey Pain Scale may be better suited than the other two scales for use by nurse raters who only occasionally use pain rating scales or who have lower level nursing qualifications.     

Clinical tools for the assessment of pain in sedated critically ill adults

Aim: This paper aims to review the evidence regarding pain assessment tools for sedated patients and to establish whether the use of a tool can be recommended in practice. Background: Pain assessment is a challenging area of critical care nursing practice, particularly among sedated patients. Tools to aid in assessing pain among this patient group have been developed and tested recently. Search strategy: In this systematic review five papers that tested pain assessment tools for sedated patients are discussed. These papers were identified via the CINAHL and MEDLINE databases using the search terms: ‘pain assessment’ and ‘sedated’ or ‘unconscious’ or ‘critically ill’ or ‘critical illness’ or ‘critical care’. Conclusions: The Behavioural Pain Scale (BPS) has been tested among the broadest range of patients and was found to be a reliable and valid tool in three studies. Research is needed to further demonstrate the reliability and validity of the Critical‐Care Pain Observation Tool (CPOT), as the paper of Gelinas et al. did not test its internal consistency and domain structure. The CPOT also needs testing among different critical care populations. The design of Odhner et al. study did not allow adequate testing of the Non‐verbal Pain Scale (NVPS). Implications for practice: The implementation of the BPS can be recommended in intensive care units and may improve the management of pain among sedated patients by providing a systematic and consistent approach to pain assessment to guide interventions. The CPOT may also prove useful in assessing pain among sedated patients, but first requires further validation. Also, further research is needed into the effects of pain assessment tools on pain management practices and patient outcomes.     

Item selection and content validity of the Critical-Care Pain Observation Tool for non-verbal adults

Title. Item selection and content validity of the Critical‐Care Pain Observation Tool for non‐verbal adults. Aim. This paper is a report of the item selection process and evaluation of the content validity of the Critical‐Care Pain Observation Tool for non‐verbal critically ill adults. Background. Critically ill patients experience moderate to severe pain in the intensive care unit. While critical care clinicians strive to obtain the patient’s self‐report of pain, many factors compromise the patient’s ability to communicate verbally. Pain assessment methods often need to match the communication capabilities of the patient. In non‐verbal patients, observable behavioural and physiological indicators become important indices for pain assessment. Method. A mixed method study design was used for the development of the Critical‐Care Pain Observation Tool in 2002–2003. More specifically, a four‐step process was undertaken: (1) literature review, (2) review of 52 patients’ medical files, (3) focus groups with 48 critical care nurses, and interviews with 12 physicians, and (4) evaluation of content validity with 17 clinicians using a self‐administered questionnaire. Results. Item selection was derived from different sources of information which were convergent and complementary in their content. An initial version of the Critical‐Care Pain Observation Tool was developed including both behavioural and physiological indicators. Because physiological indicators received more criticism than support, only the four behaviours with content validity indices >0·80 were included in the Critical‐Care Pain Observation Tool: facial expression, body movements, muscle tension and compliance with the ventilator. Conclusion. Item selection and expert opinions are relevant aspects of tool development. While further evaluation is planned, the Critical‐Care Pain Observation Tool appears as a useful instrument to assess pain in critically ill patients.     

Validation of the critical-care pain observation tool in adult patients.

BACKGROUND: Little research has been conducted to validate pain assessment tools in critical care, especially for patients who cannot communicate verbally. OBJECTIVE: To validate the Critical-Care Pain Observation Tool. METHODS: A total of 105 cardiac surgery patients in the intensive care unit, recruited in a cardiology health center in Quebec, Canada, participated in the study. Following surgery, 33 of the 105 were evaluated while unconscious and intubated and 99 while conscious and intubated; all 105 were evaluated after extubation. For each of the 3 testing periods, patients were evaluated by using the Critical-Care Pain Observation Tool at rest, during a nociceptive procedure (positioning), and 20 minutes after the procedure, for a total of 9 assessments. Each patient's self-report of pain was obtained while the patient was conscious and intubated and after extubation. RESULTS: The reliability and validity of the Critical-Care Pain Observation Tool were acceptable. Interrater reliability was supported by moderate to high weighted kappa coefficients. For criterion validity, significant associations were found between the patients' self-reports of pain and the scores on the Critical-Care Pain Observation Tool. Discriminant validity was supported by higher scores during positioning (a nociceptive procedure) versus at rest. CONCLUSIONS: The Critical-Care Pain Observation Tool showed that no matter their level of consciousness, critically ill adult patients react to a noxious stimulus by expressing different behaviors that may be associated with pain. Therefore, the tool could be used to assess the effect of various measures for the management of pain.     

"长海痛尺"在疼痛评估中的应用

目的 探讨“长海痛尺”在临床应用中的可行性和实用性。方法 设计“长海痛尺”并将其应用于临床6个月后，调查评估及患对此量表的评价。结果 疼痛评估对“长海痛尺”的满意度为88．28％，患对“长海痛尺”的满意度为90％。结论 “长海痛尺”设计合理，使用方便，在疼痛评估时能更好地满足医护人员及患的需要。     

Palliative care in the ICU: relief of pain,dyspnea, and thirst—A report from the IPAL-ICU Advisory Board

Purpose

Pain, dyspnea, and thirst are three of the most prevalent, intense, and distressing symptoms of intensive care unit (ICU) patients. In this report, the interdisciplinary Advisory Board of the Improving Palliative Care in the ICU (IPAL-ICU) Project brings together expertise in both critical care and palliative care along with current information to address challenges in assessment and management.

Methods

We conducted a comprehensive review of literature focusing on intensive care and palliative care research related to palliation of pain, dyspnea, and thirst.

Results

Evidence-based methods to assess pain are the enlarged 0–10 Numeric Rating Scale (NRS) for ICU patients able to self-report and the Critical Care Pain Observation Tool or Behavior Pain Scale for patients who cannot report symptoms verbally or non-verbally. The Respiratory Distress Observation Scale is the only known behavioral scale for assessment of dyspnea, and thirst is evaluated by patient self-report using an 0–10 NRS. Opioids remain the mainstay for pain management, and all available intravenous opioids, when titrated to similar pain intensity end points, are equally effective. Dyspnea is treated (with or without invasive or noninvasive mechanical ventilation) by optimizing the underlying etiological condition, patient positioning and, sometimes, supplemental oxygen. Several oral interventions are recommended to alleviate thirst. Systematized improvement efforts addressing symptom management and assessment can be implemented in ICUs.

Conclusions

Relief of symptom distress is a key component of critical care for all ICU patients, regardless of condition or prognosis. Evidence-based approaches for assessment and treatment together with well-designed work systems can help ensure comfort and related favorable outcomes for the critically ill.