RELATIONSHIP BETWEEN BEHAVIORAL AND PHYSIOLOGICAL INDICATORS OF PAIN,CRITICAL CARE PATIENTS SELF-REPORTS OF PAIN, AND OPIOID ADMINISTRATION

Objectives: To examine the accuracy of inferences about critical care patients' pain based on physiological and behavioral indicators and to assess the relationship between registered nurse and patient pain sco res and doses of opioids administered. Design: Descriptive, comparativ e analysis. Setting: Three intensive care units and two postanesthesia care units in two hospitals. Subjects: Fourteen critical care nurses who conducted 114 pain assessments on 31 surgical patients. Interventi ons: Nurses used a pain assessment and intervention notation algorithm that contained lists of behavioral and physiological indicators of pa in to make inferences about a patient's pain intensity. Fourteen regis tered nurses completed up to five pain assessments on each patient ove r a 4-hr period. Following both the physiological and behavioral ratin gs, nurses rated the patients' pain intensity, using a 0 to 10 numeric rating scale, and they asked patients to provide a self-report of pai n intensity, using a similar numeric rating scale. Nurses then adminis tered an intravenous dose of an opioid from a sliding scale prescripti on. Measurements and Main Results: Moderate-to-strong correlations wer e found between the number of behavioral indicators at times 1 through 5 and between the number of physiological indicators and nurses' rati ngs of the patients' pain intensity at times 1 through 4 (p < .05). Al though nurses' pain ratings were consistently lower than patients' pai n ratings across the five time points, these differences were not sign ificant. The amount of opioid analgesic administered by the nurse corr elated more frequently with nurses' pain ratings than with patients' s elf-reports of pain intensity. Conclusions: The use of a detailed, sta ndardized pain assessment and intervention notation algorithm that inc orporates behavioral and physiological indicators-may assist healthcar e professionals in making relatively accurate assessments of a patient 's pain intensity. Further research is needed to determine the specifi c decision-making processes and criteria that healthcare professionals use to choose doses of analgesics to administer to critically ill pat ients.