The psychometric evaluation of the Italian version of the Surgical Fear Questionnaire in adult patients waiting for major cardiac surgery.

Background and aim: Preoperative surgical fear is an emotional reaction that can be observed in many patients who are waiting to undergo a surgical procedure. The Surgical Fear Questionnaire was originally developed to determine the level of fear in patients who are expected to undergo elective surgery. This study aims to test the validity and reliability of this Italian version in a population of patients waiting for major cardiac surgery. Study design: Methodological research model. Methods: The population of this methodological study included the patients who presented to Lecco Hospital in Italy between January 2022 and October 2023 and were scheduled to undergo valve surgery, aortic surgery or coronary surgery; the sample involved 416 patients who met the inclusion criteria. Results: Results of the analyses showed that the Surgical Fear Questionnaire can be used with two subscales; the "Surgical Fear Questionnaire-S", which shows the fear of the short-term consequences of cardiac-surgery, and the "Surgical Fear Questionnaire-L", which shows the fear of the long-term consequences of cardiac-surgery. The mean score of the patients was 26.32+9.23 on the former, 27.62+11.89 on the latter, and 53.94 +19.16 for the entire questionnaire. The Cronbach's α coefficient was 0.952 for the "Surgical Fear Questionnaire-S", 0.920 for the "Surgical Fear Questionnaire-L", and 0.914 for the entire questionnaire. Conclusion: Based on the validity and reliability tests, we consider the questionnaire adaptable to the Italian reality, specifically to the population waiting for major cardiac surgery.

Impact of COVID-19 on Quality of Life After Hospital Discharge in Patients Treated With Noninvasive Ventilation/Continuous Positive Airway Pressure: An Observational, Prospective Multicenter Study.

BACKGROUND: COVID-19 has caused a worldwide pandemic that has significantly affected people's health and daily lives. Patients hospitalized with COVID-19 have impaired physical and psychological conditions. Despite this, few studies have examined the physical and psychological health of COVID-19 patients after discharge from the hospital. AIMS: To assess the impact of COVID-19 pneumonia on quality of life and residual disability, anxiety, and insomnia at 4 and 8 months after hospital discharge in patients treated with continuous positive airway pressure and noninvasive ventilation. METHODS: This is a prospective, multicenter, longitudinal observational study. The STROBE checklist was observed. We administered the Post-COVID-19 Functional Status scale to identify and objectively quantify the degree of residual disability and the impact on the patient's functional status. Simultaneously, we used the EuroQOL-5D scale to measure the quality of life, the 7-item Generalized Anxiety Disorder Scale to monitor anxiety, and the Insomnia Severity Index to monitor insomnia. RESULTS: The study enrolled 199 patients 4 months after discharge; 145 completed the 8-month follow-up. The quality of life, insomnia, pain, and movement ability seem to worsen over time in our cohort of patients. The quality of life deteriorated significantly between 4 and 8 months after discharge especially in terms of mobility (27.6% of the patients interviewed) and pain (31% of the patients interviewed). There was a significant correlation between COVID-19 symptoms and comorbidities present at admission and inadequate quality-of-life perception. DISCUSSION: The recognition of early signs and symptoms in patients who have already experienced COVID-19 disease is essential for early detection and prevention of chronicity. Health care professionals need to pay more attention to the physical and psychological rehabilitation of COVID-19 patients after hospital discharge. To determine the long-term impacts of COVID-19, a long-term follow-up of COVID-19 patients after discharge is required.

Long-term effects of Coronavirus 2 infection after intensive care: a prospective study.

BACKGROUND: While the multi-organ manifestations of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection are now well-documented, the potential long-term implications of these manifestations remain to be uncovered. The aim of the study was to study the level and predictors of post-traumatic stress, anxiety and depression symptoms, quality of life and functional disability in COVID-19 survivors during the first year post Intensive Care Unit (ICU) discharge. METHODS: A prospective longitudinal study, reported following the STROBE guidance, was conducted in adult patients with SARS-CoV-2 infection admitted to an Italian ICU from March 2020 to March 2021 who were followed until March 2022. RESULTS: A total of 207 patients were included in the study, of which 145 (70.1%) were male. One hundred and six (51.2%) patients between six and 12 months after ICU discharge reported at least one physical or cognitive impairment. The concurrent prevalence of anxiety, depression and PTSD is present in 25/106 patients (23.6% of cases) at six months and increases in 29/106 patients (27.3% of cases) at 12 months. However, the prevalence of anxiety, depression and PTSD was observed in 86 patients (41.5%) at six months and it gets smaller in 78 patients (37.7%) at 12 months (P=0.049). The EqVAS score (58.8 vs. 72.3, P=0.017) and the Barthel Index (61.5 vs. 74.8, P<0.001) increased significantly between six and 12 months after ICU. CONCLUSIONS: Our results show that functional and cognitive recovery improves between six and 12 months after ICU discharge with a high perception of the patients' quality of life. These results will help to inform health system planning and the development of multidisciplinary strategies to reduce chronic health loss among individuals with COVID-19.

Co-infections in critically ill adults with severe acute respiratory syndrome coronavirus 2 infection: an Italian multi-center prospective study.

BACKGROUND: To date, few studies have described Hospital-acquired infections (HAIs) during COVID-19 outbreak. To examine the incidence of HAIs in critically ill adult patients with SARS-CoV-2 infection and to observe risk factors, and the impact on outcome of HAI. METHODS: A prospective multicenter study was conducted that included adult patients with SARS-CoV-2 infection admitted to 18 Italian Intensive Care Units from September 2020 to November 2021. RESULTS: A total of 589 patients were included. A total of 233 patients were diagnosed with at least one HAI (39.6%). The co-infection/co-colonization rate >48 hours after admission was 31.0 per 1000 person-days (95% CI 18.8-34.8). Age, length of ICU stay >7 days, obesity, type 2 diabetes mellitus, cardiovascular disease, inserted central venous catheter, intubation, APACHE II score >25, mechanical ventilation (MV) >48 hours, obesity and inserted urinary catheter are associated outcomes for infection acquisition. The overall mortality rate of patients was found to be significantly higher in patients who had acquired a HAI (RR=4.37; 95% CI 3.30-5.78; P<0.001). CONCLUSIONS: Associated factors for HAI acquisition and mortality in ICU patients were identified and cause for revision of existing infection control policies.

Impact of COVID-19 outbreak on ICU nurses' mental health. An Italian multicenter study. / Impatto dell'epidemia di COVID-19 sulla salute mentale degli infermieri di Terapia Intensiva. Uno studio multicentrico Italiano.

AIM: AIM: The aim of this study was to evaluate variations in ICU nurses ' mental health status over the COVID-19 outbreak by quantifying the extent of symptoms of depression, anxiety and PTSD over time. METHODS: METHODS: This study was an Italian multicenter prospective cohort study assessing caseness of anxiety, depression and PTSD at 6 and 12 months from the beginning of the COVID-19 outbreak in Italy. RESULTS: RESULTS: A total of 359 nurses, 233 (64.9%) were males and 126 (35.1%) were females were enrolled. At 6 months the caseness prevalence for anxiety, depression and PTSD were 31.3%, 32.1% and 18.7% respectively. At 12 months the caseness prevalence for anxiety, depression and PTSD were 34.8%, 36.4% and 24.1 % respectively. No statistically significant increase between 6 and 12 months was recorded for the caseness prevalence anxiety (p= .29) and depression (p= .19). However, an increase for the caseness prevalence PTSD at 12 months was observed (p= .049). The significant risk factors for the 221 patients with at least one disorders were age 31-40 (RR= 1.44, IC= 1.25-1.89; p < .001), female gender (RR= 1.31, IC= 1.02-1.51; p=. 042) and had 0-5 years of professional experience (RR= 1.36, IC= 1.02-1.63; p = .031). CONCLUSION: The results of our study may provide support for the implementation of some interventions for well-being in COVID-19 outbreak condition.

Chronic pain in in survivors of critical illness: prevalence and associated psychological disorders. / Il dolore cronico nei pazienti dimessi dalla Terapia Intensiva: prevalenza e disturbi psicologici associati.

AIM: To investigate the prevalence and characteristics of chronic postICU pain in survivors of critical illness and to examine the association between pain and psychological disorders. METHODS: The study was carried out in an Italian ICU. Six months after ICU discharge, patients were called back for an interview for assessed chronic pain (CP), pain intensity, pain location and interference of pain with activities of daily living. During the interview a battery of psychometric test was administered for evaluate anxiety, depression, insomnia, fatigue and posttraumatic stress disorder (PTSD). RESULTS: A total of 143 patients were interviewed and 34 patients (23.8%) reported pain. Nearly 70.6% of respondents suffering from CP were females (p<.001). The most common sites of pain were the shoulder (16.1%), lower limb (11.9%) and the lumbar spine (11.2%). The largest number of CP patients (n= 14) had pain at 4 or more anatomical regions. The prevalence for chronic pain, anxiety, depression, insomnia, fatigue and PTSD were 23.8%, 9.1%, 13.3%, 4.2%, 5.6% and 2.1% respectively. The multivariable analysis indicated significant associations between chronic pain and anxiety (p= .003), depression (p=.015) and insomnia (p= .027). There was a great use of analgesics and nonsteroidal antiinflammatory drugs (NSAIDs) for the pain treatment in 19 patients (55.9%). DISCUSSION: Cronic pain seems associated with some psychological disorders observed 6 months after an ICU stay. In future, studies that investigate interventions to prevent chronic postICU pain are needed.

[Nosocomial infections during the COVID-19 outbreak. Observational study in an Italian ICU]. / Infezioni nosocomiali durante l'epidemia di COVID-19. Studio osservazionale in una Terapia Intensiva Italiana.

. Nosocomial infections during the COVID-19 outbreak. Observational study in an Italian ICU. INTRODUCTION: Infections are common among ICU patients. AIM: The purpose of this study is to examine the incidence of nosocomial infections among patients admitted to the ICU with SARS-CoV-2 infection. METHODS: A prospective observational study in adults with confirmed SARS-CoV-2 infection requiring intensive care unit (ICU) admission was performed. From May 2020 to October 2021, a total of 109 admitted patients were included. RESULTS: The incidence rate of new infections was 39.4%. The main infections observed were multidrug-resistant germs infections (39.5%), catheter-related blood infections(24.4%), pneumonia (VAP)(18.6%), and urinary tract infections (17.4%). The overall mortality rate was 32.1% (n= 35) and was significantly higher in patients who had a new infection during hospitalization (n= 26/43, 60.4%) than in patients who did not have a new infection (n= 9/66, 13.6%) (RR = 4.43; 95% CI = 2.31-8.52; p <.001). CONCLUSIONS: Our data suggest that secondary infections are associated with a longer duration of mechanical ventilation and hospital stay and may negatively impact patient survival. However, larger studies are needed.

[Burnout-related symptoms among Italian ICU's staff during the COVID-19 emergency. A multicentric survey study]. / Sintomi Burnout-correlati tra il personale sanitario italiano di Terapia Intensiva durante l'emergenza COVID-19. Indagine conoscitiva multicentrica.

AIM: to analyze the prevalence of Burnout defined by the MBI-GS among Italian Intensive Care (ICU) staff during the COVID-19 outbreak. METHOD: a multicentric study was conducted. A sample of 197 ICU health professionals (135 nurses and 62 physicians) participated in the study. Between 25 March and 15 May 2020, the Maslach Burnout Inventory-General Survey (MBI-GS) questionnaire was made available online by using the Google Forms platform in order to detect and measure the severity ofBurnout Syndrome (BOS). RESULTS: BOS-related symptoms (medium or high score) for individual MBI-GS domains have been identified in at least 69% of ICU healthcare professionals. Ninety-eight healthcare professionals (49.7%) had a moderate-high risk of emotional exhaustion, 108 (54.8%) ofdepersonalization, and 102 (51.8%) of reduced professional accomplishment. A high risk of emotional exhaustion, a moderate risk of depersonalization(56.3% vs 32.2%) and a moderate risk for reduced professional accomplishment (60.7% vs 24.2%) were observed among nursing staff. A strong association between increase in age and increase of the Burnout risk in ICU's staff was observed. CONCLUSIONS: the results suggest that ICU staff during the coronavirus pandemic, had high levels of work-related suffering and were at risk of physical and emotional exhaustion. However, further research should be undertaken to establish causal relationships between BOS and personal and environmental risk factors among healthcare professionals in relation to the COVID-19 outbreak.

[The effects of the Critical-Care Pain Observation Tool on pain assessment/management nursing practices in an intensive care unit with brain-injured critically ill patients]. / Gli effetti della scala Critical-Care Pain Observation Tool nella valutazione e gestione del dolore nei pazienti con lesioni cerebrali ricoverati in terapia intensiva.

INTRODUCTION: Accurate pain assessment and management in critically ill patients withcognitive alterations who are unable to communicate constitute a major challenge for themedical and nursing staff of Intensive Care Units (ICUs). This study want assess the impact of Critical Care Pain Observation Tool (CCPOT) scale in ICU practice and evaluate the effects on pain assessment and management in brain-injured critically ill adult patients. METHODS: This before-and-after study was carried out in an Italian ICU, where data were collected before (T0) and after (T1) implementation of the CCPOT in brain-injured critically ill adults. RESULTS: The study population consisted of 81 patients (35 before and 46 after intervention). The use of propofol fell significantly and at the same time the use of morphine increase significantly (morphine: t(80) = 1.51, p =.02) after intervention.Analysis of the data with respect to pain relief and prevention during some nursing care activities revealed a significant increase in the use of fentanyl citrate and paracetamol. Pain management was in line with the protocol, which envisaged administration of pain medications to patients with CCPOT scores less than 3 in 76.8% of cases. CONCLUSION: The present findings strongly support the value of the CCPOT scale in managing ICU patient pain in conjunction with medical and nursing staff training. However, further studies of larger patient samples should be performed.

Prevalence of Post Traumatic Stress Disorder, Anxiety and Depression among COVID-19 survivors 1 year after Intensive Care discharge.

BACKGROUND: Survivors of Intensive Care are known to be at increased risk of developing longer-term psychopathology issues. AIM: The aim of this study was to determine the prevalence of posttraumatic stress disorder, anxiety and depression among COVID-19 survivors 1 year after discharge from an Italian Intensive Care Unit (ICU). METHODS: We conducted a cross-sectional study between April and August 2021 among 86 adults COVID-19 survivors in Lecco (Italy). The PTSD was measured using the PTSD-checklist (PCL), HADS scale was used to measure anxiety and depression. Chi-square test or Fisher exact two-tailed tests were used to test for associations and the multiple logistic regressions model to determine factors that were independently associated with the outcome variables. RESULTS: The mean PTSD, anxiety and depression scores were (38.6 6.3), (5.1 3.8), (6.9 3.7) respectively. Based on cut-off scores, the prevalence of PTSD (PCL ≥ 45), anxiety (HADs score ≥ 8) and depression (HADs score ≥ 8) were (n = 20, 23.2%) (n = 22, 25.6%) and (n = 38, 44.2%) respectively. COVID-19 survivors who experienced a decreased level of exercise post-ICU discharge were more likely to show symptoms of depression (AOR = 2.57; 95%CI: 1.31-6.85, p = 0.027) and anxiety (AOR = 3.19; 95%CI: 1.29-8.32, p = 0.021) compared to those whose exercise remained the same post-ICU discharge. In addition Older COVID survivors were more likely to show symptoms of depression (AOR = 8.2, 95% CI: 1.97-24.45, p = 0.001) and anxiety (AOR = 3.26; 95%CI: 1.12-8.1, p = 0.022) compared to younger ones. CONCLUSIONS: Our findings show that PTSD, anxiety and depression are common among the COVID-19 survivors in Lecco. NURSING IMPLICATIONS: Nurses play a key role in the public health response to such crises, delivering direct patient care and reducing the risk of exposure to the infectious disease.

[The effects of a clinical therapeutic intervention in pain assessment and management in surgical ICU patients: a before-and-after intervention study on pain intensity and use of analgesia]. / Gli effetti di un intervento clinico organizzativo sulla valutazione e gestione del dolore postoperatorio in terapia intensiva: studio before-after sull'intensità di dolore e uso dell'analgesia.

AIMS: the aims of this study were to test the efficacy of a training program in order to reduce pain intensity in surgical ICU patients and improving postoperative pain assessment and management. METHODS: longitudinal, before and after experimental study. A total of 261 patients, 126 in Group A (before intervention) and 135 in Group B (after intervention) were included. Data were collected prospectively before and after a training intervention and the implementation of a pain management protocol. RESULTS: a significant reduction was observed in pain intensity scores collected at 6 hours (p=.016) 12 hours (p -.001) and 48 hours (p=.005) postoperatively. Intense pain was most observed in Group A than Group B (RR=1.98; 95% CI= 1.05-3.71, p=.0302). A significantly smaller proportion of patients treated after intervention received morphine (p=.036) and propofol (p=.045). Although there has been no increase in pain assessments, the interval (hours/minutes) between drugs administrations was reduced (Group A 6.35 +1.19 vs Group B 6.21 +0.5) (p=.006). Mechanical ventilation lasted longer in Group A (3.67 days + 6.6 vs 2.44 days + 4.45) (MD = 1.23; 95% CI= -0.1541- 2.6141) (p=.0415). CONCLUSION: the implementation of the organizational changes on pain prevention in this ICU, using standardized education, led to less pain in surgical ICU patients. However further randomized studies and with larger patient samples are needed.

Long-term consequences in survivors of critical illness. Analysis of incidence and risk factors.

AIM: This study investigates the incidence of long-term consequences in survivors of critical illness 6 months after ICU care. A retrospective analysis of the risk factors was also completed. METHODS: A mixed-method design was used. A qualitative design was used in the questionnaire study (phase 1), and a quantitative design was used for the retrospective study (phase 2). RESULTS: 116 patients were interviewed. Forty-eight patients (41.4%) reported at least one long-term consequence 6 months after ICU discharge. The most frequent consequences were anxiety (n = 33, 28.4%), depression (n = 32, 27.6%) and chronic pain (n = 24, 20.7%). The interview showed the concurrent caseness of PTSD, anxiety and depression in 14 (12.1%) patients. Observed risk factors were age > 60 years (OR = 2.65, IC = 1.23-5.69; p = 0.0119), trauma diagnosis (OR = 5.3, IC = 1.60-17.76; p = 0.0033), length of mechanical ventilation > 7 days (OR = 2.18, IC = 1-4.74; p = 0.0471) length of ICU stay > 10 days (OR = 2.47, IC = 1.16-5.26; p = 0.0185) and clinical conditions at the ICU admission. The quality of life score was lower if the respondent had long-term consequences. DISCUSSION: A high incidence of long-term consequences is found in survivors of critical illness. In future, studies that investigate interventions to prevent these issues after ICU care are need.

[Burnout syndrome among Italian nursing staff during the COVID 19 emergency. Multicentric survey study]. / Sindrome di Burnout tra il personale infermieristico italiano durante l'emergenza COVID 19. Indagine conoscitiva multicentrica.

AIM: To analyze the prevalence of Burnout defined by the MBI-GS among Italian nursing staff during the COVID-19 emergency. INTRODUCTION: The recent health emergency which in the first half of 2020 has seen Italy involved in the management of patients with COVID-19 (COronaVIrus Disease 19), has led to further stress for hospitals both in terms of beds and in terms of workload for healthcare workers. METHOD: A multicenter study was conducted. A convenience sample of 208 nurses participated in the study. Between March 20 and July 20, 2020, the Maslach Burnout Inventory-General Survey (MBI-GS) questionnaire was made available online by using the Google Forms platform in order to detect and measure the severity of Burnout Syndrome (BOS). RESULTS: BOS-related symptoms (medium or high score) for individual MBI-GS domains were identified in at least 68% of nurses. One hundred and sixty-one nurses (77.4%) had a risk of emotional exhaustion, 143 (68.7%) of depersonalization, and 162 (77.9%) of reduced professional accomplishment. High risk was observed among nurses who managed COVID patients at their own operating unit (RR = 1.27, p = 0.016). Severe BOS risk was observed in 146 nurses analyzed (70.2%) with an increased risk among Intensive Care nurses. CONCLUSIONS: Our results suggest that the nurses during the coronavirus pandemic, had high levels of work-related suffering and were at risk of physical and emotional exhaustion. Further research should be undertaken to establish causal relationships between BOS and personal and environmental risk factors among healthcare professionals in relation to the COVID-19.

Prevalence and characteristics of chronic pain in survivors of critical illness and impact on daily life and treatment practices.

AIM: The aim of this study was to evaluate the prevalence and characteristics of Chronic Pain (CP) in survivors of critical illness. The secondary objective was to evaluate the impact of CP on an individual's quality of life and unveiling current pain treatment practices. METHODS: This study was a cross-sectional survey. Twelve months after intensive care discharge, patients were contacted for an interview. Two questionnaires were administered (Brief Pain Inventory and Euroqol 5D instrument) to assess CP and quality of life. Data was obtained between 20 June and 20 December 2019. RESULTS: 118 patients participated in the study. An overall prevalence rate of 26.3% (n= 31) was found for CP in the study population. The highest prevalence of pain was observed in patients with 40-55 years (41.9%) (n= 13). The prevalence rate in males was 26.3%, similar compared to the rate in females (p=.99). The intensity of pain was similar among females (5.6) and males (5.8) (p=.35). Knees (15.3%), legs (12.7%) and minor joints (12.7%) were the most prevalent sites of pain. The perceived quality of life (EQ VAS) was 74.9 (+9.7) in patients without CP and 58.2 (+9.2) in patients with CP. DISCUSSION: CP has significant negative consequences for patients. Thus, we want to emphasize the need to adopt a comprehensive and multidisciplinary approach to improving the patient's condition and circumstances, contemplating both pharmacological treatments and non-pharmacological measures.

Pain prevalence, severity, assessment and management in hospitalized adult patients: a result of a multicenter cross sectional study.

INTRODUCTION: The measurement of pain prevalence among the patients admitted to hospital, estimated that pain remains a common problem for patients. METHODS: This is a multi-center cross sectional study carried out in Italian Hospitals, where data was collected in only one day. All patients aged at least 18 years, hospitalized able or unable to communicate, were eligible to be included in the study. Patients with curarization or quadriplegia (any cause) were excluded. RESULTS: Some hospitals and residential structures took part in our research, 26 centers in total. Pain prevalence has been observed in 268 patients (38%) (95% CI = 34%-41%) (range within wards 31-47%). Women are at higher risk than men (RR = 1.59, 95% CI = 1.29-1.95). Pain prevalence was more observed at 10.9 (+ 1.46) days after surgery. Severe pain has been observed in 148 (21.2%) cases. Pain was managed in 223 (83.2%) cases, and it was predominantly treated with the administration of paracetamol (n = 55; 24.7%) within 30 minutes after having ascertained the presence of pain. CONCLUSIONS: Pain is reported by about 4 out of 10 adults, with a higher prevalence of cases in women, and its appearance does not depend on the care setting. In order to assess the prevalence of pain carefully, an Italian study that involves all regions and a large number of the centers may be necessary.

[Interruptions during nursing handover: observational study in an italian intensive care unit]. / Le interruzioni durante la Consegna Infermieristica: studio osservazionale in una Terapia Intensiva Italiana.

AIM: the purpose of this study is to investigate interruptions as they occur during the nursing handover in an Italian Intensive Care Unit. METHOD: prospective observational study carried out in the Lecco hospital's Department of Anaesthesiology and Critical Care Service (formerly A. Manzoni Hospital) from 15th July 2016 to 30th December 2016. To capture and understand the causes and occurences of interruptions, data were collected through participating observa- tion. RESULTS: the mean handover time was 7.31 (standard deviation [SD] ±3.27) min with a range of 3-25 min. A total of 422 nursing handovers and 352 interruptions were collected with a mean of interruptions for handover of 0.83 (standard deviation [SD] =+0.66). The first author of the interruptions was detected to be the nursing department staff. The interruptions were observed indepentenly of the place of handover. CONCLUSION: Nurses interrupt and allow themselves to be interrupted by collabora- tors, primarily by their nurse collegues and the frequency of interruptions are particu- rarly worrying. After our results, further studies are needed to gather information and data in setting more heterogeneous.

Impact of a Clinical Therapeutic Intervention on Pain Assessment, Management, and Nursing Practices in an Intensive Care Unit: A before-and-after Study.

BACKGROUND: Accurate pain assessment and management constitute a major challenge for medical and nursing staff in intensive care units (ICUs). A distinct recollection of pain is reported by high proportions of ICU patients. PURPOSE: A clinical therapeutic intervention directed at improving pain assessment and management in critically ill patients who are unable to communicate was implemented at an Italian ICU. METHODS: In this before-and-after study, data were collected before (T0) and after (T1) the adoption of a protocol involving pain assessment with an ad hoc behavioral pain scale and the administration of analgesics, rather than sedatives, to patients with intermediate to high pain scores. RESULTS: The main outcome measure was pain recollection a year after discharge; secondary outcome measures were the use and doses of sedatives and analgesics. A significantly (p = .037) smaller proportion of patients treated after protocol adoption recollected feeling severe pain compared with patients treated before the protocol was introduced. This group also received significantly (p < .001) fewer sedatives and significantly (p = .0028) more anti-inflammatory drugs and analgesics on an "as needed" basis. The administration of strong analgesics was similar in the two groups. The intervention was implemented in 70.5% of patients with intermediate to high pain scores. CONCLUSIONS: Appropriately trained ICU nurses have the potential to help adopt pain relief and prevention measures during nursing care and to contribute to the successful management of sedation and analgesia. Further studies of larger patient samples are needed to monitor the stability of results over time and to explore the efficacy of the approach in other populations, such as pediatric and neonatal ICU patients.