PAIN AND DISTRESS AMONG ELDERLY INTENSIVE-CARE UNIT PATIENTS - COMPARISON OF PATIENTS EXPERIENCES AND NURSES ASSESSMENTS

OBJECTIVE: To investigate elderly intensive care unit (ICU) patients' experiences of pain and distress, as well as interventions aimed at re ducing these conditions, and to compare these experiences with the way nurses and assistant nurses, respectively, assess their patients' res ponses related to these issues. DESIGN: Descriptive, correlational, co mparative. SETTING: Two medical-surgical ICUs at county hospitals in t wo medium-sized cities in Sweden. SUBJECTS: Fifty-one elderly patients , 44 nurses, and 37 assistant nurses in two Swedish ICUs. METHODS: Dat a were collected through personal interviews with patients and questio nnaires completed by each nurse and assistant nurse responsible for th e patients. RESULTS: Patients' experiences of pain and distress do not fully agree with nurses' and assistant nurses' assessments; nor is th ere consistency between the views of nurses and those of assistant nur ses. Nurses overestimated patients' breathing and intellectual problem s. Assistant nurses assessed that patients received more assistance to relieve physical pain, physical discomfort, fatigue, and fear than pa tients reported. Compared with nurses' assessments, assistant nurses a lso perceived patients to suffer less from physical discomfort, breath ing problems, and fatigue. CONCLUSIONS: Nurses need more systematic pr ocedures to assess patients' distress and pain experiences. To reduce the discrepancies observed between nurses and assistant nurses, organi zation of care should optimize the possibilities for the caregivers to carry out the desired assessments and interventions with a high degre e of continuity and communication among staff.