Kennesaw State University DigitalCommons@Kennesaw State University MSN in Leadership in Nursing Final Projects Wellstar School of Nursing Fall 10-31-2017 Comparison of the Behavioral Pain Scale and the Critical-Care Pain Observation Tool in Assessing Pain in Ventilated Critical Care Patients John Weldon [email protected]Follow this and additional works at: hp://digitalcommons.kennesaw.edu/nursmast_etd Part of the Critical Care Nursing Commons is esis is brought to you for free and open access by the Wellstar School of Nursing at DigitalCommons@Kennesaw State University. It has been accepted for inclusion in MSN in Leadership in Nursing Final Projects by an authorized administrator of DigitalCommons@Kennesaw State University. For more information, please contact [email protected]. Recommended Citation Weldon, John, "Comparison of the Behavioral Pain Scale and the Critical-Care Pain Observation Tool in Assessing Pain in Ventilated Critical Care Patients" (2017). MSN in Leadership in Nursing Final Projects. 4. hp://digitalcommons.kennesaw.edu/nursmast_etd/4
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Kennesaw State UniversityDigitalCommons@Kennesaw State University
MSN in Leadership in Nursing Final Projects Wellstar School of Nursing
Fall 10-31-2017
Comparison of the Behavioral Pain Scale and theCritical-Care Pain Observation Tool in AssessingPain in Ventilated Critical Care PatientsJohn [email protected]
Follow this and additional works at: http://digitalcommons.kennesaw.edu/nursmast_etd
Part of the Critical Care Nursing Commons
This Thesis is brought to you for free and open access by the Wellstar School of Nursing at DigitalCommons@Kennesaw State University. It has beenaccepted for inclusion in MSN in Leadership in Nursing Final Projects by an authorized administrator of DigitalCommons@Kennesaw StateUniversity. For more information, please contact [email protected].
Recommended CitationWeldon, John, "Comparison of the Behavioral Pain Scale and the Critical-Care Pain Observation Tool in Assessing Pain in VentilatedCritical Care Patients" (2017). MSN in Leadership in Nursing Final Projects. 4.http://digitalcommons.kennesaw.edu/nursmast_etd/4
there was not a statistically significant difference between nurses' perceptions of satisfaction
with the use of the Behavioral Pain Scale (M = 2.8571, SD =69007) compared to the Critical-
Care Pain Observation Tool (M = 3.7143, SD = .48795), t(7) = 3.286,p = .017. Results, along
with questions included in each category are listed in Table 3.
Table 3
Nurse Participants ' Responses to the BPS/CPOT Questionnaires about the Feasibility, Clinical Relevance and Satisfaction with the BPS/CPOT use in the ICU (n=7)
Characteristics no CPOT M SD M SD
Feasibility Score 3.3214 .57217 3.7143 .46611
1) Is the BPS/CPOT quick to use?
2) Were the directives about the use of the
BPS/CPOT clear?
3) Is the BPS/CPOT simple to understand?
4) Is the BPS/CPOT easy to complete?
Clinical Relevance Score
1) Is the BPS/CPOT helpful for nursing practice?
2) Has the BPS/CPOT influenced your practice in
assessing the patient's pain?
3) Has the BPS/CPOT allowed you to adequately
evaluate pain in patients who are unable to
communicate?
2.9592 .59313 3.6939 .39922
COMPARISON OF THE BPS AND CPOT 35
4) Has the BPS/CPOT allowed you to improve
your practice in terms of pain management?
5) Has the BPS/CPOT helped you communicate
effectively the results of the pain assessment to
other members of the team:
Nurses
Doctors and residents
Other members of the team
(physiotherapists, occupational therapists)
2.8571 .69007 3.7143 .48795 Satisfaction Score
1) How satisfied are you with the use of the BPS/CPOT Tool in ICU?
COMPARISON OF THE BPS AND CPOT 36
Chapter 5: Discussion
This chapter will focus on an interpretation of data, limitations of the study, and
implications of the findings for future research.
Interpretation of Data for Research Question 1
The first research question addressed the relationships between the Behavioral Pain Scale
(BPS) and the Critical-Care Pain Observation Tool (CPOT) in assessing pain in ventilated
critical care patients. Eighty-five total assessments were conducted and the BPS and CPOT were
both measured when patients were at rest, following a normal noninvasive blood pressure check,
and after turning. BPS mean scores ranged from 3.600 at rest, to 3.906 with a noninvasive blood
pressure check, to 6.377 following turning, and CPOT mean scores ranged from 0.894 at rest, to
1.212 following a noninvasive blood pressure check, to 4.012 following turning. Only a slight
increase in mean scores was found between assessments conducted at rest and following a
noninvasive blood pressure check. This was an expected finding, given that noninvasive blood
pressure checks are classified as a non-painful procedure according to Payen et al. (2001).
However, a greater increase was found between resting and turning, which supports the findings
of Rijkenberg et al. (2015), whom found BPS and CPOT scores of studied patients increased by
two points from rest when conducting a painful procedure. An increase in mean pain scores
totals between rest and turning suggest that the tools do detect and reflect the presence of pain, as
also concluded by Rijkenberg et al. (2015).
Statistically significant relationships were also found between the BPS and CPOT scores
at rest r(85) =0.821, p=.Ol , after taking a noninvasive blood pressure r(85) =r0.815, p.Ol, and
after turning r(85) =0.906, p=.Ol, indicating that total scores on both assessment tools are
sensitive and similar in the way they reflect pain. Sensitivity and correlational scores between the
COMPARISON OF THE BPS AND CPOT 37
two tools represent an expected finding concurrent with research conducted by Liu et al. (2015),
Payen et al. (2001), and Gélinas, Fillion, Puntillo, Viens and Fortier (2006). These correlations
also indicate that both the BPS and CPOT are similar in their ability to reflect pain consistently
which also supports the findings of Chanques et al. (2014).
Interpretation of Data for Research Question 2
The second research question addressed the difference in nurses' evaluation of the
feasibility, clinical relevance, and satisfaction with the use of the Behavioral Pain Scale (BPS)
compared to the Critical-Care Pain Observation Tool (CPOT). Seven nurses evaluated the scales,
and their evaluations showed that the overall mean values between the BPS and CPOT did not
show a significant statistical difference between the two scales in their feasibility, clinical
relevance, or satisfaction. Though the difference was not statistically significant, mean scores
were determined to be slightly higher for the CPOT in feasibility, clinical relevance, and
satisfaction when compared to the mean evaluation scores of the BPS. These results do seem to
slightly reflect the findings of Rijkenberg et al. (2015) which found that the CPOT was generally
found to be more useful than the BPS in assessing pain.
The study also supported the decoding nature of the BPS and CPOT as described by The
Social Communication Model of Pain (Hadjistavropoulos et al., 2011). The mean scores of
nurses' evaluations on the BPS (M= 2.9592) and CPOT (M= 3.6939) in regards to clinical
relevance does reflect that the scales did have an impact on increasing the likelihood that pain
was decoded or detected by the nurses or care providers. The mean clinical relevance scores
reflect that the two tools did moderately influence the nurses' practice of assessing pain and
communicating it with the healthcare team. These results support findings from Dehghani et al.
(2014) and Gélinas et al. (2014), which found that the BPS and CPOT were feasible and relevant
COMPARISON OF THE BPS AND CPOT 38
in nurses' daily practice. Overall, these findings concerning the decoding nature of the two
scales, as well as nurses' evaluations of the scales support the argument of Georgiou et al.
(2015), which recommends that pain assessment tools like the BPS and CPOT be used in every
day nursing practice to assist nurses in accurately assessing pain in all patients.
Limitations of the Study
The study had a few limitations. One limitation of the study involved use of the
behavioral pain scales in patients with actual or near brain death scenarios. In these scenarios,
pain measurements provided minimal scores and could serve as a means of potentially skewing
data results. However, in efforts to protect the privacy of patients, no identifiable information or
diagnosis information was collected, making it impossible to distinguish the amount of
significantly brain injured patients included in the study. Another limitation of this study
included the varied assessment skills and subjective nature of the nurses performing the
assessment. Though all nurses attended the same training class and were supervised completing
an assessment, the subjective nature of assessment cannot be eliminated. Generalizability was
also limited by use of a single midsized community hospital in the southeastern US, and a
relatively small convenience sample of critical care nurses within this individual facility.
Implications
This study supports the utility of observational pain scales, such as the BPS and CPOT, to
evaluate pain in mechanically ventilated critically ill patients. Pudas-Tähkä et al. (2009) found
that further research was a necessity before one of these observational pain scales could be
considered a "gold standard" for pain assessment in the mechanically ventilated critically ill
patient. This study serves as further research to establish the gold standard for pain assessment so
pain in the critically ill mechanically ventilated patient can be more appropriately managed.
COMPARISON OF THE BPS AND CPOT 39
Further comparative studies, such as this one, that evaluates the effectiveness and clinicians'
evaluations of observational pain scales are paramount to promote their usage and acceptance in
the medical profession.
Conclusion
Effective pain assessment is paramount in critically ill patients. Critically ill patients are
much more vulnerable to the side effects of untreated pain, and ineffective assessment of pain is
associated with negative patient outcomes (Gélinas, 2016). Self-reporting pain remains the gold
standard for pain measurement, and should be obtained whenever possible. This study has shown
that observational pain scales, such as the Behavioral Pain Scale (BPS) and Critical Care Pain
Observation tool (CPOT) are effective in measuring pain in the ventilated nonverbal patient.
Though more comparative research is needed to establish a gold standard for observational pain
scales, the comparative nature of this study can serve as a framework to reproduce and repeat
going forward with hope of establishing a critical care nationally accepted observational pain
scale.
COMPARISON OF THE BPS AND CPOT 40
References
Arbour, C., Gélinas, C., & Michaud, C. (2011). Impact of the implementation of the critical-care
pain observation tool (CPOT) on pain management and clinical outcomes in
mechanically ventilated trauma intensive care unit patients: A pilot study. Journal of
I am seeking nurses in critical care units to participate in this research study. The purpose of the study is to:
1. Examine the relationship between the Behavioral Pain Scale (BPS) and the Critical-Care Pain Observation Tool (CPOT) in assessing ventilated critical care patients.
2. Examine the difference in nurses' evaluation of the feasibility, clinical relevance, and satisfaction with the use of the Behavioral Pain Scale compared to the Critical-Care Pain Observation Tool?
Procedures: If you decide to participate, you will need to attend a mandatory training seminar in which you will be taught how to assess pain using both the CPOT and BPS. Following your collection of data, you will be asked to complete an evaluation of both tools which consists of 10 questions each and a demographic questionnaire which consists of 6 questions. The CPOT and BPS evaluation tool will ask questions concerning the feasibility, clinical relevance, and satisfaction of the two tools. The demographic survey will be attached to each evaluation questionnaire and filled out after participation in the study. The demographic questionnaire will assess the variables of sex, race, age, highest college degree that was achieved, national certification and years of nursing experience. Your completion of the training course and the questionnaires denotes your consent to participate.
Risks: There are no physical risks in participating in the study outside of typical exposure risks that come with any nursing care. You may experience the urge to discuss results or feel uneasy after completing some of the questions on the questionnaires due to reflecting on the outcomes of some of the evaluated patients.
Benefits: There may be no direct benefit to you for participating in this study. However, it is possible that through participating in this study that a new behavioral pain scale can be adopted for ventilated patients that would better benefit patient care in the future.
Incentives: The researcher will provide a drawing for a $25 Walmart gift card. Upon receipt of your completed packet a raffle ticket will be provided in which you can drop in a designated bin. The drawing will be completed after all data has been collected and the drawn ticket holder will win the prize.
COMPARISON OF THE BPS AND CPOT 46
Confidentiality: No personal identifying information will be collected or reported in the results of the study. The results will be presented in a group format without identifying information. Demographic questionnaires are only obtained to promote the generalizability of the study. You maintain all of your rights during the study.
Voluntary Participation/Withdrawal: Participation in this study is strictly voluntary. Participants have the right to drop out or to stop participating at any point in the study without any repercussions. You also have the right to refuse to answer any question on the provided questionnaires.
Data Security: Participant confidentiality will be assured through restriction of data access and no use of identifying information. Only the student nurse researcher, school faculty, and statistician will have access to the data. Data will be entered electronically and stored on a secured drive. All data will be kept secured, locked, and destroyed after the research study is completed.
Contact Person: If you have any questions or concerns about this study, you may contact the investigator: Tyler Weldon RN BSN @ [email protected]
Institutional Review Board: Research at Kennesaw State University involving human participants is conducted under the oversight of the Institutional Review Board. You may contact the Institutional Review Board with any questions or concerns regarding the protection of your rights. The address is as follows: Institutional Review Board, Kennesaw State University, 1000 Chastain Road, Kennesaw, GA, 30144, (678) 797-2268,
COMPARISON OF THE BPS AND CPOT 47
Appendix B
Nurse Recruitment Flier
COMPARISON OF THE BPS AND CPOT 48
PME401=cao,NY111111110~~We)mll!I!1!1
SICU NURSING PARTICIPANTS NEEDED
I am conducting a research study to evaluate behavioral pain scales in mechanically ventilated
patients and need your help in obtaining data.
A brief mandatory training class will be conducted to educate and to complete competency.
Classes will be conducted at your convenience. All participants may enter into a drawing to win
a
$25 Walmart gift card.
Your participation would be greatly appreciated. Please
Directions: Assess your patient using the Behavioral Pain Scale. Patients should be assessed at rest, following a normal blood pressure check, and immediately after turning. Data can be collected up to 3 times per shift. Record the scores in the appropriate boxes. Allow at least five minutes between each measurement. Remember, this tool is to be used for the research study only, and should NOT be used to guide treatment.
Date: Facial Upper Compliance Total
Time: Expression Limbs with Ventilator Score At Rest
Following B/P Check
Immediately After Turning
Date: Facial Upper Compliance Total Time: Expression Limbs with Ventilator Score
At Rest
Following B/P Check
Immediately After Turning
Date: Facial Upper Compliance Total Time: Expression Limbs with Ventilator Score
Compliance Tolerating movement with Coughing but tolerating 2 mnechamaictml ventilation for the most of time ventilation Fighting ventilator 3
Unable to control ventilation 4
BPS score latlees from 3 (no pain) to 12 (maximtutm pain)
COMPARISON OF THE BPS AND CPOT 51
Appendix D
Behavioral Pain Scale Consent
COMPARISON OF THE BPS AND CPOT 52
From: John Weldon <[email protected].> Dale: Wed, Aug 24, 2016 at 3:27 PN1 To: jfpayen@ ujf-grenoble. fr
Dear Dr. Payen,
I am a graduate student at Kennesaw State University in the United States. I read your article titled, "Assessing pain in critically ill sedated patients by using a behavioral pain scale." I am asking for permission to use the tool in my thesis research study. If you approve, could you send me a copy of the tool?
Thank you for your time and consideration with this request.
Sincerely, Tyler Weldon
From: Jean-Francois Payen <zJean-Fmucois.Payen@ujf- grenoble. fr> Date: Wed, Aug 24, 2016 at 3:30 PM
To: John Weldon <jweldon8@ students. kennesaw.edu>
Of course you can use the BPS. Attached is the requested item. JF Payen Pr JeanFrancois PAYEN Pole Anesthésie-Réanimation CHU Grenoble CS 10217 F-38043 Grenoble Cedex 9 Tel 04 76 76 92 88 ou 04 76 76 72 53 Fax : 04 76 76 51 83
COMPARISON OF THE BPS AND CPOT 53
Appendix E
Critical Care Pain Observation Tool
COMPARISON OF THE BPS AND CPOT 54
Critical Care Pain Observation Tool Data Collection Sheet
Directions: Assess your patient using the critical care pain observation tool. Patients should be assessed at rest, following a normal blood pressure check, and immediately after turning. Data can be collected up to 3 times per shift. Record the scores in the appropriate boxes. Allow at least five minutes between each measurement. Remember, this tool is to be used for the research study only, and should NOT be used to guide treatment.
Date: Facial Body Muscle Compliance Total
Time: Expression Movements Tension with Ventilator Score
At Rest
Following B/P Check
Immediately After Turning
Date: Facial Body Muscle Compliance Total
Time: Expression Movements Tension with Ventilator Score
At Rest
Following B/P Check
Immediately After Turning
Date: Facial Body Muscle Compliance Total
Time: Expression Movements Tension with Ventilator Score
Feasibility, Clinical Relevance and Satisfaction Evaluation of Pain Scales Behavioral Pain Scale Tool
Please circle the number that best represents your opinion about the Behavioral Pain Scale Tool.
Not at A Little
Sufficien Very All
2 tly
(1) _______
(3)
1. Is the Behavioral Pain Scale Tool quick 2 3 4 to use?
2. Were the directives about the use of the 2 3 4 Behavioral Pain Scale Tool clear?
3. Is the Behavioral Pain Scale Tool 1 2 3 4 simple to understand?
4. Is the Behavioral Pain Scale Tool easy 1 2 3 4 to complete?
5. Is the Behavioral Pain Scale Tool 2 3 4 helpful for nursing practice?
6. Has the Behavioral Pain Scale Tool influenced your practice in assessing the 1 2 3 4 patient's pain?
7. Has the Behavioral Pain Scale Tool allowed you to adequately evaluate pain in 1 2 3 4 patients who are unable to communicate?
8. Has the Behavioral Pain Scale Tool demonstrated potential to improve your 1 2 3 4 practice in terms of pain management?
9. Has the Behavioral Pain Scale Tool helped you communicate effectively the results of the pain assessment to other members of the team:
Nurses 1 2 3 4
1 2 3 4 Doctors/Residents
Other members of the team (physiotherapists, occupational 1 2 3 4 therapists)
10. How satisfied are you with the use of 2 3 4 the Behavioral Pain Scale Tool in ICU?
COMPARISON OF THE BPS AND CPOT
Feasibility, Clinical Relevance and Satisfaction Evaluation of Pain Scales Critical Care Pain Observation Tool
Please circle the number that best represents your opinion about the Critical Care Pain Observation Tool.
Not at A Little Sufficien Very
All 2
tly (1)
______ (3)
1. Is the Critical Care Pain Observation 1 2 3 4 Tool quick to use?
2. Were the directives about the use of the 2 3 4 Critical Care Pain Observation Tool clear?
3. Is the Critical Care Pain Observation 1 2 3 4 Tool simple to understand?
4. Is the Critical Care Pain Observation 1 2 3 4 Tool easy to complete?
5. Is the Critical Care Pain Observation 1 2 3 4 Tool helpful for nursing practice?
6. Has the Critical Care Pain Observation Tool influenced your practice in assessing 1 2 3 4 the patient's pain?
7. Has the Critical Care Pain Observation Tool allowed you to adequately evaluate 2 3 4 pain in patients who are unable to communicate?
8. Has the Critical Care Pain Observation Tool demonstrated potential to improve 1 2 3 4 your practice in terms of pain management?
9. Has the Critical Care Pain Observation Tool helped you communicate effectively the results of the pain assessment to other members of the team:
Nurses 1 2 3 4
1 2 3 4 Doctors/Residents
Other members of the team (physiotherapists, occupational 1 2 3 4 therapists)
10. How satisfied are you with the use of the Critical Care Pain Observation Tool in 1 2 3 4
ICU?
COMPARISON OF THE BPS AND CPOT 61
Appendix H
Nurses' Evaluations of the BPS and CPOT Consent
COMPARISON OF THE BPS AND CPOT 62
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Appendix I
Demographic Survey
COMPARISON OF THE BPS AND CPOT
Demographic Survey
Directions,: Please place a check mark [LIfl in the appropriate box or fill in the blank.
1. What is your gender? Male LI Female
2. What is your age?
3. What is your race/ethnicity?
LI White/Caucasian LI Black/African American LI Hispanic/Latino
LI Native American LI Asian or Pacific Islander LI Arabic
Other (specify):
4. What is your highest college degree achieved?
LI Diploma LI Associate's LI Bachelor's LI Master's LI Doctorate's
5. How many years have you been working as a registered nurse?
6. Are you nationally certified? LI No LI Yes, if so in what area is your certification?
COMPARISON OF THE BPS AND CPOT
Appendix J:
Hamilton Medical Center 1kB approval
COMPARISON OF THE BPS AND CPOT 70
Hamilton Nr.AfJF Medical Center
May 3, 2017
Tyler Weldon Principal Investigator-Kennesaw State University
Comparison of the Behavioral Pain Scale and the Critical-Care Pain Observation Tool in
Assessing Pain in Ventilated Critical Care Patients
Dear Mr. Weldon:
This letter is to inform you that the Hamilton Medical Center IRB has reviewed and approved
the study entitled, "Comparison of the Behavioral Pain Scale and the Critical-Care Pain
Observation Tool in Assessing Pain in Ventilated Critical Care Patients", beginning June 2017.
The Hamilton IRB reviewed as well as approved use of the informed consent submitted as
written. However if further modifications are made to the informed consent, it will be the
responsibility of the P1 to inform the local IRB.
Please share your results with us once the study Is complete. An annual update and review are
Study 17-561: Comparison of the Behavioral Pain Scale (BPS) and the Critical-Care Pain Observation Tool (CPOT) in Assessing Pain in Ventilated Critical Care Patients
From [email protected] Fri, May 12, 2017 02:55 PM Subject :Study 17-561: Comparison of the
Behavioral Pain Scale (BPS) and the Critical-Care Pain Observation Tool (CPOT) in Assessing Pain in Ventilated Critical Care Patients
RE: Your application dated 5/8/2017, Study #17-561: Comparison of the Behavioral Pain Scale (BPS) and the Critical-Care Pain Observation Tool (CPOT) in Assessing Pain in Ventilated Critical Care Patients
Dear Mr. Weldon:
Your application for the new study listed above has been administratively reviewed. This study qualifies as exempt from continuing review under DHHS (OHRP) Title 45 CFR Part 46.101(b)(2) - educational tests, surveys, interviews, public observations. The consent procedures described in your application are in effect. You are free to conduct your study.
NOTE: All surveys, recruitment flyers/emails, and consent forms must include the IRB study number noted above, prominently displayed on the first page of all materials.
Please note that all proposed revisions to an exempt study require IRB review prior to implementation to ensure that the study continues to fall within an exempte d category of research. A copy of revised documents with a description of planned changes should be submitted to [email protected] for review and approval by the IRB.
Thank you for keeping the board informed of your activities. Contact the IRB at [email protected] or at (470) 578-2268 if you have any questions or require further information.
Sincerely,
Christine Ziegler, Ph.D. KSU Institutional Review Board Chair and Director