The American Association of Critical Care Nurses awards the Pioneering Spirit Award to medical professionals who have “significant contributions that influence acute and critical care nursing. Successful applicants exemplify a pioneering spirit, influencing the direction of acute and critical care nursing. The recipient addresses or resolves a significant issue facing acute and critical care nursing on a regional or national scale.”
One of the 2019 award winners is Celine Gelinas, PhD, RN in recognition of “her work developing the Critical-Care Pain Observation Tool (CPOT), one of the most valid and reliable behavioral pain scales for assessing pain in critically ill adult patients unable to communicate pain.” She is an associate professor at Ingram School of Nursing, McGill University, and a researcher at the Centre for Nursing Research and the Lady Davis Institute of the Jewish General Hospital in Montréal, Québec, Canada
She was interviewed recently by Mary Watts, BSN, RN, allnurses.com Content and Community Director at NTI 2019 in Orlando, Florida. Vital signs alone can not be used to assess pain in a patient that can’t communicate. Dr. Gelinas commented that as a critical nurse there was no consistent assessment for pain prior to 2000. She was frustrated with her inability to gauge her patient's pain and relay that to the physician in a meaningful and consistent manner. She wanted to develop a tool that could be used by any nurse to adequately and successfully assess their patients’ pain and relay this to the physician in order to obtain pain relief. “We had no evidenced based tool and we had discussions about this need. This is what motivated me to do something about it and even change practice.” Mary also asked about the subjective nature of the tool and Dr. Gelinas stated, “It’s not clear-cut. We try as much as we can to make the parts of the tool to be as subjective as possible but of course, there will always be a difference in perception of the individual observer.”
Dr. Gelinas commented that there are several components of this assessment including grimace or facial expression which can consist of “brow lowering, eyes clenching, and cheek contractions.” There is also “muscle tension which the nurse can assess when turning the patient. We also have another item selection which we choose based on a patient’s compliance. If they are on a ventilator; are they fighting it, or trying to over breathe.” Body movements is a fourth part of the CPOT tool. Patients are scored on four components of the assessment and it is expected that the score will decrease after successful pain reduction intervention. Dr. Gelinas added that it's very important to have a tool that all nurses can utilize and that provides consistent clinical information for the physician to determine comprehensive pain management. The CPOT tool can be used for pain reassessment as well with the goal to reduce the CPOT score by at least 2 points.
This tool was originally developed in French and then translated into English. Currently, it has been utilized around the world and translated into at least 15 languages. The original CPOT has been revised to include hearing loss in the assessment and they have added additional assessments for patients with brain injuries who are deeply sedated. This new version for use with brain injuries is referred to as CPOT-Neuro.
Here is the entire NTI interview with Dr. Gelinas:
Education on the use of this tool is easily accomplished by watching a free 15-minute video training video which was funded and developed by Kaiser Permanente Northern California Research.