Background Pain assessment in critically ill patients who are intubated, sedated, and unable to verbalize their needs remains a challenge. No universally accepted pain assessment tool is used in all intensive care units. Objectives To examine concurrent validation of scores on the Critical-Care Pain Observation Tool for a painful and a nonpainful procedure and to examine interrater reliability of the scores between 2 nurse raters. Methods A prospective, repeated-measures within-subject design was used. A convenience sample of 35 patients was recruited to achieve enrollment of 30 patients during a 5-month period. Observational data were collected on patients intubated after cardiac surgery during routine turning and during dressing changes for central catheters. Results Raters' mean scores did not increase significantly during dressing changes (increase, +0.25; 95% CI, -0.07 to 0.57; P = .12) but did increase significantly during turning (increase, +3.04; 95% CI 2.11-3.98; P < .001). The degree to which mean scores increased was significantly greater during turning than during dressing changes (increase, +2.80; 95% CI, 1.84-3.75; P < .001). The Fleiss-Cohen weighted κ for the interrater reliability of the ratings of research nurses was 0.87 (95% CI, 0.79-0.94). Conclusion The results support previous research investigations on validity and reliability of the Critical-Care Pain Observation Tool for evaluating pain in intubated, critically ill adults.

Cancer affects more than 1 million people each year. Of all of the symptoms related to cancer, the most frequently experienced is fatigue. Cancer-related fatigue (CRF) is an extreme tiredness that contributes to morbidity and mortality due to resulting inactivity.Extreme inactivity related to CRF may cause severe complications affecting multiple body systems. The Oncology Nursing Society (ONS) recommends exercise as the only evidence-based intervention shown to be significant for CRF. The purpose of this project was to provide a nurse-driven, exercise-based intervention to combat severe CRF. The site was an oncology out-patient clinic of a 247 bed Magnet hospital in Providence, RI; no specific intervention for oncology patients with fatigue levels >4/10 was in place. A program development project was developed that included creating a brochure for patients targeted at CRF, revising clinic treatment sheets for easy intervention documentation, and educating the nurses by means of in-services regarding the project.