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.
<p>Evidenced-based practice (EBP) as defined by the Institute of Medicine(IOM) is the integration of "best research with clinical expertise and patient values for optimum care"(IOM, 2003, p.45-46). Evidence-based practice (EBP) is considered a standard for safe and quality care (Carlson & Plonczynski, 2008). Healthcare leaders recognize EBP as an integral part of achieving quality outcomes and attaining high reliability. The Institute of Medicine (IOM) has established a goal that 90% of healthcare decisions in the United States be evidenced based by the year 2020 (IOM, 2009). Despite the fact that EBP has been promoted for many years, inconsistencies in implementation and adoption have been noted. Barriers to the implementation of EBP need to be understood. Assessing organizational culture has been identified as a necessary first step in to overcoming common barriers (Carlson & Plonczynski, 2008; Frasure, 2008). The purpose of this study was to assess the practice, attitudes and knowledge of EBP in registered nurses using the Evidence-Based Practice Questionnaire (EBPQ). The study used a descriptive design with convenience sampling. All staff registered nurses (RNs), Clinical Managers (CMs) and Assistant Clinical Managers (ACMs) on inpatient units within a large medical center in the Northeast were invited to participate in this survey. Study results are similar to those found in literature previously cited: a positive attitude towards EBP with a lower perception of knowledge or practice (Melnyk et al., 2004) and belief that more knowledge is needed (Alspach, 2006; Melnyk et al., 2004; Melnyk, Fineout-Overholt, Gallagher-Ford, & Kaplan, 2012). This assessment indicates a degree of environmental readiness and provides relative estimation of educational needs.</p>
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