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Use of a pain assessment and intervention notation (P.A.I.N.) tool in critical care nursing practice: nurses'
Kathleen A Puntillo1, Daphne Stannard, Christine Miaskowski
1Department of Physiological Nursing, University of California, San Francisco, 94143-0610, USA.
Background:
One of the barriers to effective pain management in critical care is the lack of systematic, comprehensive methods for assessing and treating pain. Use of a printed, standardized pain assessment and intervention tool can stimulate critical thinking and provide a framework for organizing pain assessment and management data.
Objectives:
The objectives of this study were to do the following: (1) describe the Pain Assessment and Intervention Notation (P.A.I.N.) tool, (2) detail critical care nurse participants' evaluations of the P.A.I.N. intervention tool when used during care of postoperative patients in pain, and (3) evaluate the tool's usefulness in practice and education.
Methods:
Eleven intensive care unit (n = 7) and postanesthesia care unit (n = 4) nurses completed a questionnaire after they had used the pain tool in their clinical practices with 31 postoperative patients.
Results:
Ten of the 11 nurses who returned an evaluation questionnaire found that the P.A.I.N. tool provided a consistent, systematic method of quantifying their assessment of patient pain and analgesic responsiveness. Five nurse participants believed that the P.A.I.N. tool improved their practice with regard to pain and sedation assessment. Three of the 11 nurses believed that the usefulness of the tool was limited because it was too detailed to be used routinely when caring for critically ill patients. All but 1 of the 11 nurses believed that the tool would have helped them earlier in their practice (ie, when they had less critical care nursing experience).
Conclusions:
The assessment and treatment of pain in critically ill patients are highly complex processes. This study identified many advantages of the use of a standardized, systematic approach to pain assessment and treatment by health professionals.