Assessment of procedural pain in intensive care patients using two different pain evaluation scales

In the Intensive Care Unit (ICU), the nursing interventions aimed at ensuring and maintaining the well-being of patients may include invasive and/or non-invasive procedures that can potentially cause pain. Although the standard measure of pain is the patient's own statement, ICU patients who lack verbal communication skills cannot express the pain they experience. The inability to communicate does not eliminate the patient's pain and often leads to neglect of the pain they endure. ICU nurses play a crucial role in addressing this problem by evaluating effective behavioral pain scales. This study aimed to evaluate the procedural pain levels of mechanically ventilated adult patients hospitalized in the Cardiovascular Surgery Intensive Care Unit at Gaziantep City Hospital, using physiological parameters and two different pain assessment scales. This descriptive-observational study was conducted between February 2024 and May 2024 and involved a total of 54 ICU patients undergoing 5 nursing interventions. The study utilized a Volunteer Information Consent (consent) form, Patient Socio-demographic Characteristics and Descriptive Information Form, Patient Follow-up Form, Behavioral Pain Scale, and Intensive Care Pain Observation Scale. Research data were analyzed using the SPSS 22.0 program. The normality distribution of continuous variables was assessed using the Kolmogorov-Smirnov test, and non-parametric tests were used. The differences between the measurements taken 1 minute before, during, and 20 minutes after the nursing intervention were analyzed using Friedman and Cochran's Q tests. The average age of the 54 patients participating in the study was 57,98 ±10,52, with 68,5% being male, 72,2% married, and 40,7% having completed primary education. The average length of stay in the ICU was 2,83±2,70 days, and the Glasgow Coma Scale score was 9,78±1,60. In the subcutaneous drug administration, no significant difference was found in heart rate, oxygen saturation, pupil dilation, sweating, nausea-vomiting, skin pallor, and redness (p>0,05), while an increase was observed in systolic-diastolic blood pressure and respiratory rate (p=0,010; p=0,024; p=0,048, respectively). A significant difference was detected in all vital and physiological findings (heart rate, systolic-diastolic blood pressure, respiratory rate, oxygen saturation, pupil dilation, sweating, nausea-vomiting, skin pallor, and redness) during the aspiration procedure (p<0,001). Significant differences were also found in heart rate, systolic-diastolic blood pressure, respiratory rate, oxygen saturation, pupil dilation, sweating, skin pallor, and redness during the surgical dressing change, sponge bath, and active-passive exercise procedures (p<0,001). The pain score averages of the Behavioral Pain Scale and Intensive Care Pain Observation Scale showed similar changes in measurements taken before, during, and after subcutaneous drug administration, aspiration, surgical dressing change, sponge bath, and active-passive exercise applications (p<0,001). In both scales, the average pain score was lowest during subcutaneous drug administration and highest during the aspiration procedure. In conclusion, it can be said that these two scales can provide similar results in evaluating and managing procedural pain in patients with inadequate verbal communication skills due to respiratory tract intubation.