Assessment of Acute Pain Using Physiologic Variables in Non-communicative Patients: Nurses' Perspectives (S748)

Abstract

•Provide a synopsis of selected literature of physiologic variables (i.e., diaphoresis, blood pressure, heart rate, and respiratory rate) as they relate to the assessment of acute pain in adult patients who cannot self-report.•Discuss acute care nurses' use of specific physiologic variables (i.e., diaphoresis, blood pressure, heart rate, and respiratory rate) to assess pain in patients unable to self-report, including their perceptions of what constitutes significant changes indicative of acute pain. Physiologic variables (PV) believed to indicate acute pain include diaphoresis and changes in blood pressure (BP), heart rate (HR), and respirations. Nurses report using PV to help determine if patients who cannot self-report are experiencing pain, but literature is lacking. To explore how nurses use PV and PV changes to assess pain in patients unable to self-report. Two focus groups were conducted with 13 nurses at an academic medical center to elicit their experiences and opinions using PV and changes in PV to assess acute pain in patients who can't self-report. Open-ended questions and systematic probes were used until saturation was reached. Data were organized and synthesized using content analysis. When nurses noted PV changes, they said they explore and rule out other causes before attributing them to pain. They reported that changes in respiratory rate, pattern, and depth are the first and most easily observed pain-related PV. Changes in systolic BP were more relevant than changes in diastolic BP and HR changes may also be relevant. Diaphoresis was considered a late sign of uncontrolled pain. Behavioral indicators of acute pain in non-communicative patients were deemed more important than physiologic indicators. Nurses recommended using PV to help assess acute pain and pain relief. PV may add important information to the assessment of acute pain in non-communicative patients and may be useful for evaluating pain and pain relief. Although PV changes can be explained by other factors, their complimentary role to behavioral indicators needs systematic exploration.