Patients and ICU nurses' perspectives of non-pharmacological interventions for pain management.

BACKGROUND: Pain is a major stressor for critically ill patients. To maximize pain relief, non-pharmacological interventions are an interesting avenue to explore. AIMS AND OBJECTIVES: The study aim was to describe the perspectives of patients/family members and nurses about the usefulness, relevance and feasibility of non-pharmacological interventions for pain management in the intensive care unit (ICU). DESIGN: A qualitative descriptive design was used. METHODS: Patients/family members (n = 6) with a previous experience of ICU hospitalization and ICU nurses (n = 32) were recruited. Using a semi-structured discussion guide, participants were asked to share their perspective about non-pharmacological interventions that they found useful, relevant and feasible for pain management in the ICU. Interventions were clustered into five categories: a) cognitive-behavioural, b) physical, c) emotional support, d) helping with activities of daily living and, e) creating a comfortable environment. RESULTS: A total of eight focus groups (FGs) with patients/family members (two FGs) and ICU nurses (six FGs) were conducted. Overall, 33 non-pharmacological interventions were discussed. The top four non-pharmacological interventions found to be useful, relevant and feasible in at least half of the FGs were music therapy and distraction (cognitive-behavioural category), simple massage (physical category) and family presence facilitation (emotional support category). Interestingly, patients/family members and nurses showed different interests towards some interventions. For instance, patients discussed more about active listening/reality orientation, while nurses talked mostly about teaching/positioning. CONCLUSIONS: Four non-pharmacological interventions reached consensus in patients and nurses' FGs to be useful, relevant and feasible for pain management in the ICU. Other interventions seemed to be influenced by personal experience or professional role of the participants. RELEVANCE TO CLINICAL PRACTICE: While more evidence is required to conclude to their effectiveness, ICU nurses can use non-pharmacological interventions complementary to pharmacological treatment of pain as they are low cost and safe.