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1、PainManagementObservationalPainScalesinCriticallyIllAdultsMindyStites,RN,MSN,APRN,ACNS-BC,CCNS,CCRNPainisacommonanddistressingsymptomincriticallyillpatients.Uncontrolledpainplacespatientsatriskfornumerousadversepsychologicalandphysiologicalconsequences,someofwhichmaybelife-threa
2、tening.Asystematicassessmentofpainisdifficultinintensivecareunitsbecauseofthehighpercentageofpatientswhoarenoncommunicativeandunabletoself-reportpain.Severaltoolshavebeendevelopedtoidentifyobjec-tivemeasuresofpain,butthebesttoolhasyettobeidentified.Acomprehensivesearchontherelia
3、bilityandvalidityofobservationalpainscalesindicatedthatalthoughtheCritical-CarePainObservationToolwassupe-riortoothertoolsinreliablydetectingpain,painassessmentinindividualsincapableofspontaneousneuro-muscularmovementsorinpatientswithconcurrentconditions,suchaschronicpainordelir
4、ium,remainsanenigma.(CriticalCareNurse.2013;33[3]:68-79)ainisanimportantproblemintheintensivecareunit(ICU),andinadequatepainassessmentandmanagementhavebeenlinkedtoincreasedmorbidityandmortal-ity.1Thephysiologicalresponsetopainisalmostuniversallyadverse,causingpoten-Ptiallyfatalu
5、nstablehemodynamicstatus,alterationsinimmunesystemfunctioning,hyperglycemia,andincreasedreleaseofcatecholamine,cortisol,andantidiuretichor-mones.2Moreover,uncontrolledpainhasbeenimplicatedinavarietyofpsychosocialeffects,includingdepression,anxiety,delirium,posttraumaticstressdis
6、order,anddisorientation.3DespitetheacknowledgmentthatpainisacommonstressorintheICU,4highratesofuncontrolledpainincriticallyillpatientsremaincommon.5Thissituationcanbeattributed,inpart,tocircumstances,suchasmechanicalventilationorunstablehemodynamicstatus,thatprecludetheassessmen
7、tofpainbyself-report.Despitestrongevidencethatdocumentationofpainassessmentimprovespainmanagementanddecreasespatients’pain,nopainassessmentinstrumenthasbeenuniversallyrecommendedforuseincriticallyillpatientsincapableofself-reporting.6CNEContinuingNursingEducationThisarticlehasbe
8、endesignatedforCNEcredit.Aclosed-book,multiple-
