Vanderbyl Brandy L, Gélinas Céline
Jewish General Hospital, Montréal, Québec, Canada.
Jewish General Hospital, Montréal, Québec, Canada; Ingram School of Nursing, McGill University, Montréal, Québec, Canada.
Pain Manag Nurs. 2017 Aug;18(4):202-213. doi: 10.1016/j.pmn.2017.04.005. Epub 2017 Jun 7.
Behavioral scales allow for the pain assessment of vulnerable critically ill patients who are unable to self-report. However, validity of the use of such scales is limited in traumatic brain injury patients with an altered level of consciousness as a result of the different way that these patients express pain. Family participation is considered as an important component of pain assessment for those unable to self-report, but research in this area is minimal so far. This study aimed to describe what behaviors family caregivers deemed relevant to pain for patients with a traumatic brain injury with an altered level of consciousness in the intensive care unit. Using a mixed-method descriptive design, semistructured interviews were conducted and behaviors' relevance was quantitatively rated by seven family caregivers of nonverbal patients with traumatic brain injury in the intensive care unit of a tertiary trauma center in Montreal, Canada. Family caregivers were able to provide rich descriptions of a number of behaviors they observed in their loved ones that were perceived to be relevant indicators of pain, such as muscle tension and key facial expressions and body movements. Several factors influenced how behaviors were interpreted by family, including personal medical beliefs and intimate knowledge of the patient's history. The pain behaviors determined by family caregivers can be useful in the pain assessment process of traumatic brain injury patients with an altered level of consciousness. Their input could also be helpful in further development of pain assessment tools.
行为量表可用于对无法自我报告的脆弱重症患者进行疼痛评估。然而，由于这些患者表达疼痛的方式不同，此类量表在意识水平改变的创伤性脑损伤患者中的有效性有限。对于那些无法自我报告的患者，家庭参与被视为疼痛评估的一个重要组成部分，但迄今为止该领域的研究很少。本研究旨在描述家庭照顾者认为哪些行为与加拿大蒙特利尔一家三级创伤中心重症监护病房中意识水平改变的创伤性脑损伤患者的疼痛相关。采用混合方法描述性设计，进行了半结构化访谈，并由加拿大蒙特利尔一家三级创伤中心重症监护病房中7名非语言创伤性脑损伤患者的家庭照顾者对行为的相关性进行了定量评分。家庭照顾者能够详细描述他们在亲人身上观察到的一些行为，这些行为被认为是疼痛的相关指标，如肌肉紧张、关键的面部表情和身体动作。几个因素影响了家庭对行为的解读，包括个人医疗观念和对患者病史的深入了解。家庭照顾者确定的疼痛行为在意识水平改变的创伤性脑损伤患者的疼痛评估过程中可能有用。他们的意见也可能有助于疼痛评估工具的进一步开发。
