It is recommended that patient's self-report of
pain should be obtained as often as possible as the "gold standard." Unfortunately in
critical care, many factors can alter verbal communication with patients, making
pain assessment more difficult. Scientific advances in understanding
pain mechanisms, multidimensional methods of
pain assessment, and
analgesic pharmacology have improved
pain management strategies. However,
pain assessment for nonverbal patients in
critical care continues to present a challenge for clinicians and researchers. The purpose of this study was to compare the
Pain Assessment in Advanced
Dementia (PAINAD) and the
Critical-Care Pain Observation Tool (CPOT) scores for assessment in nonverbal
critical care patients. A descriptive, comparative, prospective design was used in this study. A convenience sample of 100
critical care, nonverbal, adult patients of varying medical diagnoses who required
pain evaluation were assessed with the PAINAD and CPOT scales. Data were collected over a 6-month period in all
critical care areas. Observations of
pain assessments for nonverbal patients who required
pain evaluation were recorded on the PAINAD and the CPOT successively. Internal consistency reliability for the PAINAD was 0.80 and for the CPOT 0.72. Limits of agreement indicated that there was no difference in PAINAD and CPOT scores for assessing
pain in nonverbal patients in
critical care. Further research in the area of
pain assessment for nonverbal patients in
critical care is needed.