Critically ill patients in intensiv

Critically ill patients in intensive care units (ICUs) may experience moderate to severe pain due to surgery, trauma, invasive procedures, therapeutic devices, and certain nursing interventions. Of these nursing interventions, endotracheal suctioning, blood sample collection, drain removal procedures, and turning or repositioning have been previously identified to be major sources of pain.

Studies have shown that ICU nurses rate pain intensity at consistently lower levels than patients do and have concluded that this is likely to cause inadequate pain relief. In addition, pain is often underestimated during critical periods, because the priority in critically ill patients is resuscitation and pain assessments are incomplete and difficult.

Much pain research in brain injury patients has focused on the rehabilitation or management of chronic pain, because the physical and psychosocial sequelae of chronic pain include depression, anxiety, decreased socialization, sleep disturbance, and job loss, which all affect overall health outcome. On the other hand, acute pain in brain injury patients during critical periods has received little research attention.

Unrelieved acute pain can initiate stress responses that alter neuroendocrine secretions, which causes oxygen consumption to increase, prolonged catabolism, hyperglycemia with insulin resistance, immune function alterations, blood pressure changes, heart rate increases, arrhythmia, sodium retention, and urine volume reductions, which in turn, exert a negative effect on recovery. Therefore, ICU nurses need to be aware of the importance of precise pain assessment and appropriate management.

Although pain is usually assessed with the use of self-reports, critically ill patients, particularly patients with a brain injury, are often unable to provide a selfreport on the presence and intensity of pain, because of a reduced level of consciousness, tracheal intubation, or the administrations of sedatives, paralyzing agents, or muscle relaxants. Herr et al. (2006) advocated that all patients have the right to have pain assessed and treated immediately, and therefore special considerations are necessary for patients who cannot communicate their pain. Furthermore, even though self-reporting is the most reliable way of assessing pain, other valid and reliable measures are clearly required to assess pain in nonverbal patients.

A number of studies have shown that behavioral assessments provide a relatively valid and reliable means of assessing pain in nonverbal patients, and concurrently various behavioral pain assessment tools have been developed, e.g., the Behavioral Pain Rating Scale, the Behavioral Pain Scale, the Pain Behavior Assessment Tool, the Critical Care Pain Observation Tool (CPOT), the Pain Assessment and Intervention Notation Algorithm, the Pain Algorithm, and the Nonverbal Pain Scale. The majority of these tools include facial expression, body movement, muscle tension, and ventilator compliance as behavioral pain indicators.

The CPOT was originally developed based on the findings of a literature review and reviews of the medical records of cardiopulmonary and neurosurgery patients and of physicians’ and nurses’ notes. This tool evaluates four behavioral domains: facial expression, body movement, muscle tension, and ventilator compliance/ vocalization. Li, Puntillo, and Miaskowski (2008) provided good evidence for face, constructive, and criterion validity and the interrelater reliability of this scale in nonverbal adult patients, including brain injury patients. Therefore, CPOT appears to be suitable for use in brain-injured nonverbal patients.

The present study was conducted to assess the patterns and clinical correlates (brain injury severity, brain surgery, and particular nursing procedures, such as endotracheal suctioning) of acute pain in brain injury patients during the critical period with the use of the CPOT. The specific aims were: 1) to assess the intensities and temporal patterns of acute pain in brain injury patients during the critical period; 2) to compare pain according to injury severity and whether the patients underwent brain surgery or not; and 3) to compare pain before and after endotracheal suctioning, a major nursing activity in brain injury patients in ICUs.

Hasil (Bahasa Indonesia) 1:

Pasien sakit kritis di unit perawatan intensif (ICU) mungkin mengalami sedang untuk sakit parah karena pembedahan, trauma, prosedur invasif, terapi perangkat dan intervensi Keperawatan tertentu. Ini intervensi keperawatan, Suction Massif, pengambilan sampel darah, tiriskan penghapusan prosedur, dan mengubah atau reposisi telah sebelumnya diidentifikasi untuk menjadi sumber utama dari rasa sakit.Penelitian telah menunjukkan bahwa perawat ICU tingkat intensitas nyeri pada tingkat yang secara konsisten lebih rendah daripada pasien dan telah menyimpulkan bahwa hal ini mungkin menyebabkan nyeri yang tidak memadai. Selain itu, rasa sakit sering diremehkan selama masa-masa kritis, karena prioritas pada pasien sakit kritis resusitasi dan sakit penilaian tidak lengkap dan sulit.Banyak penelitian nyeri pada pasien trauma otak telah difokuskan pada pengelolaan sakit kronis, atau rehabilitasi karena gejala sisa fisik dan psikososial sakit kronis termasuk depresi, kecemasan, penurunan sosialisasi, gangguan tidur, dan kehilangan pekerjaan, yang semua mempengaruhi keseluruhan hasil kesehatan. Di sisi lain, akut rasa sakit di otak pasien trauma selama masa-masa kritis telah menerima sedikit perhatian penelitian. Nyeri akut sakitnya dapat memulai respons stres yang mengubah sekresi neuroendokrin, yang menyebabkan konsumsi oksigen peningkatan katabolisme berkepanjangan, hiperglikemia dengan resistensi insulin, perubahan fungsi kekebalan tubuh, perubahan tekanan darah, denyut jantung meningkat, aritmia, retensi natrium, dan pengurangan volume urin, yang pada gilirannya, mengerahkan efek negatif pada pemulihan. Oleh karena itu, perawat ICU perlu menyadari pentingnya rasa sakit tepat penilaian dan manajemen yang sesuai.Meskipun sakit biasanya dinilai dengan menggunakan diri laporan, pasien sakit kritis, khususnya pasien dengan cedera otak, sering tidak dapat menyediakan selfreport tentang kehadiran dan intensitas rasa sakit, karena penurunan tingkat kesadaran, trakea intubasi atau administrasi obat penenang, melumpuhkan agen, atau relaksan otot. Herr et al. (2006) menganjurkan bahwa semua pasien memiliki hak untuk memiliki sakit dinilai dan ditangani segera, dan oleh karena itu pertimbangan khusus diperlukan untuk pasien yang tidak dapat berkomunikasi rasa sakit mereka. Selanjutnya, bahkan meskipun diri pelaporan adalah cara yang paling dapat diandalkan untuk menilai rasa sakit, lain berlaku dan langkah-langkah yang dapat diandalkan jelas diperlukan untuk menilai rasa sakit di nonverbal pasien.A number of studies have shown that behavioral assessments provide a relatively valid and reliable means of assessing pain in nonverbal patients, and concurrently various behavioral pain assessment tools have been developed, e.g., the Behavioral Pain Rating Scale, the Behavioral Pain Scale, the Pain Behavior Assessment Tool, the Critical Care Pain Observation Tool (CPOT), the Pain Assessment and Intervention Notation Algorithm, the Pain Algorithm, and the Nonverbal Pain Scale. The majority of these tools include facial expression, body movement, muscle tension, and ventilator compliance as behavioral pain indicators.The CPOT was originally developed based on the findings of a literature review and reviews of the medical records of cardiopulmonary and neurosurgery patients and of physicians’ and nurses’ notes. This tool evaluates four behavioral domains: facial expression, body movement, muscle tension, and ventilator compliance/ vocalization. Li, Puntillo, and Miaskowski (2008) provided good evidence for face, constructive, and criterion validity and the interrelater reliability of this scale in nonverbal adult patients, including brain injury patients. Therefore, CPOT appears to be suitable for use in brain-injured nonverbal patients.Penelitian ini dilakukan untuk menilai pola dan berkorelasi klinis (tingkat keparahan cedera otak, operasi otak, dan prosedur perawatan khusus, seperti Massif suction) akut nyeri pada pasien trauma otak selama periode kritis dengan menggunakan CPOT. Tujuan spesifik: 1) untuk menilai intensitas dan temporal pola akut nyeri pada pasien trauma otak selama periode kritis; 2) untuk membandingkan rasa sakit menurut keparahan cedera dan apakah pasien menjalani operasi otak atau tidak; dan 3) untuk membandingkan rasa sakit sebelum dan sesudah Massif suction, aktivitas utama perawatan pasien cedera otak di ICU.