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Beyond Pain: An Exploratory Secondary Analysis of Psychological and Physical Discomfort Domains in ICU Patients
Sally Halabi Zarka1, Shelly Ashkenazy2, Freda DeKeyser Ganz1
1Hadassah Nursing School, Hadassah Medical Center, Jerusalem, Israel.
Background:
Despite growing recognition that ICU discomfort extends beyond pain, no study has empirically compared the proportion and interrelationships of psychological discomfort, physical discomfort and pain using clinically meaningful thresholds.
Aim:
The aim of this study was to examine the relationships between psychological discomfort, physical discomfort and pain based on patients' recalled discomfort reported within 24 h after ICU discharge.
Study Design:
Patients completed the Inconforts des Patients de REAnimation (IPREA) questionnaire, a general discomfort visual analogue scale (VAS) and a general pain VAS (0-100 mm) anchored by 'no pain' and 'worst imaginable pain' within 24 h after ICU discharge from surgical, medical and cardiac ICUs of a tertiary hospital. A secondary analysis was conducted on the data, and IPREA items were grouped into three domains: psychological discomfort, physical discomfort without pain and pain. Descriptive and inferential statistics examined relationships between the three domains. The proportion of scores at the moderate threshold (40-69/100) and at or above the severe threshold (≥ 70/100) for pain, psychological and physical discomfort was determined.
Results:
Eighty patients participated in the study. Median scores were 21.43 (IQR 8.57-39.64) for psychological discomfort, 28.82 (IQR 11.11-44.33) for physical discomfort without pain and 50.00 (IQR 10.00-70.00) for pain. The proportion of discomfort scores at the moderate threshold (40-69/100) was 21.25%, 27.50% and 32.50% for psychological discomfort, physical discomfort without pain and pain, respectively, at or above the severe threshold (≥ 70/100) in 3.75%, 3.75% and 27.50%, respectively. Psychological discomfort correlated moderately with physical discomfort without pain (rs = 0.65, p < 0.001) and weakly with pain (rs = 0.37, p < 0.001). Friedman's test showed significant overall differences (χ2(2) = 16.84, p < 0.001); after Bonferroni correction, psychological discomfort versus pain remained significant.
Conclusions:
Discomfort in ICU patients extends beyond pain, underscoring the need for multidimensional nursing assessment.
Relevance To Clinical Practice:
Routine multidimensional assessment of discomfort can improve patient-centered ICU care and prevent misinterpretation of non-pain discomfort as pain. These findings reinforce the importance of incorporating psychological and physical discomfort assessments into daily ICU practice.
