Validating a pain assessment tool in heterogeneous ICU patients: Is it possible?

BACKGROUND: Non-communicative adult ICU patients are vulnerable to inadequate pain management with potentially severe consequences. In German-speaking countries, there is limited availability of a validated pain assessment tool for this population. AIM: The aim of this observational study was to test the German version of the Critical-Care Pain Observation Tool (CPOT) in a heterogeneous adult ICU population. METHODS: The CPOT's feasibility for clinical use was evaluated via a questionnaire. For validity and reliability testing, the CPOT was compared with the Behavioural Pain Scale (BPS) and patient's self-report in 60 patients during 480 observations simultaneously performed by two raters. RESULTS: The feasibility evaluation demonstrated high satisfaction with clinical usability (85% of responses 4 or 5 on a 5-point Likert scale). The CPOT revealed excellent criterion validity [agreement between CPOT and BPS 94.0%, correlation of CPOT and BPS sum scores r = 0.91 (P < .05), agreement of CPOT with patient self-report 81.4%], good discriminant validity [mean difference of CPOT scores between at rest and non-painful stimulus 0.33 (P < .029), mean difference of CPOT scores between at rest, and painful stimulus 2.19 (P < .001)], for a CPOT cut-off score of >2 a high sensitivity and specificity (93% and 84%), high positive predictive value (85%), and a high negative predictive value (93%). The CPOT showed acceptable internal consistency (Cronbach's α 0.79) and high inter-rater reliability [90% agreement, no differences in CPOT sum scores in 64.2% of observations, and correlation for CPOT sum scores r = 0.72 (P < .05)]. Self-report obtained in patients with delirium did not correlate with the CPOT rating in 62% of patients. CONCLUSION: This is the first validation study of the CPOT evaluating all of the described validity dimensions, including feasibility, at once. The results are congruent with previous validations of the CPOT with homogeneous samples and show that it is possible to validate a tool with a heterogeneous sample. Further research should be done to improve pain assessment and treatment in ICU patients with delirium. RELEVANCE TO CLINICAL PRACTICE: The German CPOT version can be recommended for ICUs in German-speaking countries.

[Nursing development at the Solothurn hospitals. Towards clinically oriented nursing expertise and practice development]. / Pflegeentwicklung der Solothurner Spitäler. Unterwegs zu klinisch orientierter Pflegeexpertise und Praxisentwicklung.

At the Solothurn Hospitals (soH), 13 academically educated nurses are responsible for the development of nursing care with the goal to improve patient-oriented, effective, appropriate, and economic care. The strategy contains three priorities: a) expert care of single patients in demanding situations, b) sustained application of organisational methods such as primary nursing, nursing process, and skill/grade mix, and c) design and management of practice development projects related to specific patient groups. A first evaluation with qualitative and quantitative methods showed that the exemplary care of single patients by expert nurses was evaluated as positive for the patients as well as for the teams on two wards by nurses who were interviewed. After the introduction of primary nursing, the application rate was 81 to 90 % and the introduction of fall prevention methods in geriatric rehabilitation decreased the fall rate from 8.2 to 5.5 per 1000 patient days. A comparision with the literature shows that the expert nurses of soH perform both, working at the bedside and being responsible for practice development projects, as specialised Advanced Practice Nurses (APNs). APNs at the Solothurn Hospitals work also as generalists when organisational methods need to be consolidated. Their successes depend from their integration into the hierarchy and both, into the nursing as well as into the interprofessional teams. Competencies in Transformational Leadership also are essential at all management levels.

[Needs-oriented education for patients with acute coronary syndrome]. / Individualisierte Schulung und Beratung auf der Intensivpflegestation bei Patienten mit akutem Koronarsyndrom: Ein Pilotprojekt zur Forschungsanwendung.

Information regarding disease and therapy are provided to patients with acute coronary syndrome in the early phase of hospitalisation, often only based on individual preferences of each healthcare professional. Patients' information needs are not systematically assessed and therefore the individual information needs of the patient are unknown. In a pilot project at a cardiology care unit (CCU) of a university hospital, the information needs of acute coronary syndrome patients were systematically assessed with the Cardiac Patient Learning Needs Inventory (CPLNI) and an education and counselling session was provided to the patients. The project was evaluated by investigating patients' assessment of the questionnaire, patients' satisfaction with the education and patients' perceived subjective increase of knowledge. For analysis descriptive statistics and content analysis were used. Five women and five men with acute coronary syndrome participated in the pilot study. The results showed that the patients could indicate their information needs. The interviewed patient's reported an increase in their knowledge about cardiac disease and self management, and a high level of satisfaction with the intervention. Based on these positives results we suggest an early systematic assessment of information needs and an individualised education for patients with acute coronary syndrome in cardiology care units.