Original Article
Nurses’ Evaluations of the Feasibility and the Clinical Utility of the Critical-Care Pain Observation Tool

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Abstract

Feasibility and clinical utility are essential characteristics to consider when it comes to developing or selecting a pain assessment tool to implement into practice. However, these characteristics have not been widely studied with available pain assessment tools in critically ill adults. The objective of this study was to describe nurses’ evaluations of the feasibility and clinical utility of the Critical-Care Pain Observation Tool (CPOT) in assessing pain in critically ill ventilated adults. A descriptive design was used. Of the 51 nurses who used the CPOT with the enrolled patients (n = 55), 33 returned their completed evaluation form. Overall, the feasibility and clinical utility of the CPOT were positively evaluated by the nurse participants. More than 90% of them supported that the directives about the use of the CPOT were clear and that it was simple to understand and easy to complete. Regarding its clinical utility, a little more than 70% of the nurses mentioned that the CPOT was helpful for nursing practice and recommended its use routinely. They acknowledged that the CPOT provided them with a common language and a standardized way to assess patients’ pain. Half of the nurse participants supported that the CPOT had influenced their practice. On the other hand, six nurses mentioned that they were already sensitive to nonverbal cues of pain before the introduction of the CPOT. In conclusion, the CPOT is a valid behavioral pain scale, which has been suggested by experts in recent critical reviews. So far, the CPOT is being used for research purposes and has been implemented into clinical practice of various health care centers of North America.

Section snippets

Background

A consensus has not yet been reached regarding the definitions of feasibility and clinical utility; as such, these concepts are sometimes used interchangeably (Stevens & Gibbins, 2002). Generally, feasibility refers to the ease with which the clinicians can apply the tool in the clinical setting (e.g., the tool is simple to understand, easy to complete, and quick to use) whereas clinical utility refers to the ability to use the results of the tool in a useful or informative way within

Aim

The purpose of this study was to describe nurses’ evaluations of the feasibility and clinical utility of the Critical-Care Pain Observation Tool in assessing pain in critically ill ventilated adults.

Design and Sample

A descriptive design was chosen for this study. It was conducted in the ICU of a university health care center in the Montreal area (Québec, Canada). Patients (n = 55) cared for by the nurse participants during the time of the study were ≥18 years, had a diagnosis of trauma, medical reason (e.g., pulmonary or cardiac problem, hemorrhage, sepsis), or had undergone abdominal or thoracic surgery and were mechanically ventilated. Thirty of them were able to self-report their pain, and the other 25

Nurse Participants

Sociodemographic information of nurse participants is described in Table 1. The ICU nurses were aged 24-53 years, with a mean age of 39 years. Most of them were full-time staff nurses and had either a college diploma or a bachelor's degree in nursing. Years of experience in the ICU varied from 6 months to 28 years, with an average of 9 years. Two-thirds of them acknowledged that they had received education in pain in the past at school (college, university), at a conference, or at the hospital.

CPOT Feasibility and Clinical Utility

Discussion

The feasibility and clinical utility of the CPOT were examined for the first time in the present study. A high proportion of the nurse participants found the CPOT to be easy to use and relevant for clinical practice. Only 15% of the nurses (5 out of 33) criticized the CPOT as long or complex to use, compared with 36% of the nurses (4 out of 11) who used the PAIN tool (Puntillo et al., 2002) and 25% of those (7 out of 28) who used the BPS (Payen et al., 2001). The CPOT includes only four

Conclusions

So far, the CPOT has demonstrated acceptable results of reliability and validity in both conscious and unconscious ICU adults. Its feasibility and clinical utility have also been positively evaluated by ICU nurses who used it for the purpose of research. The use of a valid behavioral pain scale is recommended in clinical guidelines for pain assessment in nonverbal patients (Herr et al., 2006), and the CPOT is suggested by many experts in critical reviews (Li et al., 2008; Sessler et al., 2008).

Acknowledgement

The author thanks Lindsay Hammond, master's degree student in nursing at McGill University, for her work in updating the literature review.

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    Supported by a Research Development Grant from the Jewish General Hospital Foundation.

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