Pain Intensity among Patients with Disturbed Consciousness on Mechanical Ventilator: Tool Development and Validation

Background: In the intensive care unit environment (ICU), patients are subjected to several procedures that can be painful, and not always healthcare professionals are alert to pain in these patients especially those with disturbed conscious levels. Ineffective assessment of pain is associated with negative patient outcomes that can include: an increased need for mechanical ventilation, increased length of hospitalization and increased mortality. Aim: The study aimed to develop and validate the pain intensity scale for patients with disturbed consciousness on a mechanical ventilator. Design: A methodological research design. Methods: This study was conducted in surgical Intensive care Units at Ain Shams University Hospital. Research Design: A methodological research design was used for the development of pain scale. Sample:  The study included 25 experts from critical care medicine and nursing to validate the scale and (300) patients in the general surgical and neurosurgery intensive care unit ICU.  Tools: 1) The patient assessment record was used to assess the demographic data, medical data, and Glasgow Coma scale. 2) The Critical Care Pain Observation Tool. 3) The Mechanically Ventilated Disturbed Consciousness Pain Assessment scale was used as a developed tool to assess pain intensity. 4) Face and Content Validation Opinionnaire. Results: The results show a similarity in pain assessment between the developed tool (mechanically ventilated disturbed consciousness pain assessment scale) and the standard tool (critical care pain observational tool) with a strong positive correlation between them. Conclusion: The developed scale is valid and reliable in measuring the pain intensity for patients with disturbed consciousness on mechanical ventilator. Recommendations: Replication of the current study on non-surgical patients is recommended to achieve generalization of the results, moreover, on sedated and analgesic patients.