A SURVEY OF NURSING ASSESSMENTS OF PAIN AND NON-PHARMACOLOGICAL MANAGEMENT METHODS FOR PATIENTS ADMITTED TO INTENSIVE CARE UNITS

I. Piras¹, F. Tiddia², G. Piras³, G. Finco⁴, M. Galletta⁴ | ¹Clinical Trials Sector, General Affairs, "A. Cao" Microcythemia Hospital, ASL Cagliari; ²Department of Emergency, Policlinico “D. Casula” Hospital, AOU Cagliari, Monserrato (Cagliari); ³Sardinia Regional Health Emergency Service, Cagliari; ⁴Department of Medical Sciences and Public Health, University of Cagliari, Monserrato (Cagliari)

INTRODUCTION
Pain assessment and management for patients admitted to intensive care is a complex healthcare issue. The Behavioural Pain Scale (BPS) and the Critical Care Pain Observation Tool (C-CPOT) are recommended by guidelines as suitable tools for adequately assessing pain in such patients. When it comes to pain management, it may be more beneficial to use pharmacological and non-pharmacological methods synergistically. This study aimed to investigate nurses' approach to pain when caring for critically ill patients who require sedation and/or mechanical ventilation, and who are unable to communicate about pain.
METHODS
Between August and October 2022, a questionnaire was administered to 260 nurses working in intensive care units in the Sardinia region. The questionnaire consisted of 32 closed and open-ended questions. It investigated the tools used to measure patients' pain, such as behavioural and quantitative scales, and the care interventions used to manage it. The questionnaire was completed anonymously via an online form. Data analysis was performed using Excel®.
RESULTS
A total of 136 nurses (52.3%) responded to the questionnaire. Of these, 95 were female (69.9%), mainly aged up to 40 years (61.7%), and had worked in intensive care for between two and five years (41.2%). The nurses believed that sedated patients admitted to intensive care experienced pain only sometimes (M = 3.27; 1-5 = Never-Always) and reported that they could recognise patients' pain only sometimes (M = 3.80; 1-5 = Never-Always). Of the nurses, 41.9% (n = 57) stated that they use pain assessment scales during care. However, only 25% of the entire sample (n = 34) reported using the BPS, C-CPOT, or both scales (28 nurses use the BPS, and 11 use the C-CPOT). The remaining 23 nurses only use quantitative scales (VAS - Visual Analogue Scale and NRS - Numerical Rating Scale). Other tools associated with the above include the VRS (Verbal Rating Scale), vital sign monitoring, and observation of behavioural changes. In terms of pain management, 58.8% (n = 80) reported implementing non-pharmacological interventions in addition to those prescribed by a doctor. Physical interventions (n = 51) and creating a comfortable environment (n = 44) were particularly common, as well as providing emotional and cognitive behavioural support. 49.2% of respondents (n = 67) reported experiencing moderate difficulty in managing the pain of their patients (M = 5.6 on a scale of 1-10). Furthermore, they are dissatisfied with the pain assessment and management methods used in their workplace (M = 2.8; 1-5 = Not at all - Very much). They have also proposed some possible strategies for improvement.
CONCLUSIONS
The results show that the use of behavioural scales to assess pain is still limited and that non-pharmacological pain management could be implemented in the context studied. Nurses report that they need to use non-pharmacological techniques and appropriate pain assessment scales more, but would also like to participate in specific training courses and introduce an operational protocol on pain management.