Exploring how nurses assess, monitor and manage acute pain for adult critically ill patients in the emergency department: protocol for a mixed methods study

Wayne Varndell,Margaret Fry,Doug Elliott

doi:10.1186/s13049-017-0421-x

Abstract

BackgroundMany critically ill patients experience moderate to severe acute pain that is frequently undetected and/or undertreated. Acute pain in this patient cohort not only derives from their injury and/or illness, but also as a consequence of delivering care whilst stabilising the patient. Emergency nurses are increasingly responsible for the safety and wellbeing of critically ill patients, which includes assessing, monitoring and managing acute pain. How emergency nurses manage acute pain in critically ill adult patients is unknown. The objective of this study is to explore how emergency nurses manage acute pain in critically ill patients in the Emergency Department.MethodsIn this paper, we provide a detailed description of the methods and protocol for a multiphase sequential mixed methods study, exploring how emergency nurses assess, monitor and manage acute pain in critically ill adult patients. The objective, method, data collection and analysis of each phase are explained. Justification of each method and data integration is described.DiscussionSynthesis of findings will generate a comprehensive picture of how emergency nurses’ perceive and manage acute pain in critically ill adult patients. The results of this study will form a knowledge base to expand theory and inform research and practice.

Highlights

Many critically ill patients experience moderate to severe acute pain that is frequently undetected and/or undertreated
In Australia, the number of critically ill patients managed in the emergency department (ED) is increasing [1]
Between 2011 and 2016, the number of critically ill patients presenting to the ED increased by nearly 60% [2,3,4], with over a third of patients (39%) needing intubation and mechanical ventilation [5]

Summary

Introduction

Many critically ill patients experience moderate to severe acute pain that is frequently undetected and/or undertreated. The most reliable and valid indicator of pain is the patient’s self-report, yet for critically ill patients, communication of pain intensity is problematic; for those with altered levels of consciousness, endotracheal intubation, requiring sedation, analgesia and potentially paralysing agents [14]. These factors place the critically ill patient at greater risk of inadequate pain detection, assessment and inappropriate management [15]. In the absence of a patient’s ability to self-report pain, clinicians usually rely on observable pain indicators such as facial grimacing, crying and compliance with mechanical ventilation. These observations form the basis for identification and evaluation of a patient’s pain intensity [16]

Objectives

Findings

Discussion

Conclusion