Pain and distress among elderly intensive care unit patients: comparison of patients' experiences and nurses' assessments.

OBJECTIVE

To investigate elderly intensive care unit (ICU) patients' experiences of pain and distress, as well as interventions aimed at reducing these conditions, and to compare these experiences with the way nurses and assistant nurses, respectively, assess their patients' responses related to these issues.

DESIGN

Descriptive, correlational, comparative.

SETTING

Two medical-surgical ICUs at county hospitals in two medium-sized cities in Sweden.

SUBJECTS

Fifty-one elderly patients, 44 nurses, and 37 assistant nurses in two Swedish ICUs.

METHODS

Data were collected through personal interviews with patients and questionnaires completed by each nurse and assistant nurse responsible for the patients.

RESULTS

Patients' experiences of pain and distress do not fully agree with nurses' and assistant nurses' assessments; nor is there consistency between the views of nurses and those of assistant nurses. Nurses overestimated patients' breathing and intellectual problems. Assistant nurses assessed that patients received more assistance to relieve physical pain, physical discomfort, fatigue, and fear than patients reported. Compared with nurses' assessments, assistant nurses also perceived patients to suffer less from physical discomfort, breathing problems, and fatigue.

CONCLUSIONS

Nurses need more systematic procedures to assess patients' distress and pain experiences. To reduce the discrepancies observed between nurses and assistant nurses, organization of care should optimize the possibilities for the caregivers to carry out the desired assessments and interventions with a high degree of continuity and communication among staff.