Pain assessment in the intensive care unit: development and psychometric testing of the nonverbal pain assessment tool.

BACKGROUND: Few standardized tools measure pain in nonverbal patients in the intensive care unit (ICU). Evidence exists that patient behaviors provide important information about pain in those unable to report their pain. OBJECTIVE: The Nonverbal Pain Assessment Tool (NPAT), a behavioral pain assessment tool, was developed for the nonverbal adult patient in the ICU. Content and criterion validity and internal and interrater reliability were evaluated. METHODS: The validity of NPAT was assessed against the patients' self-reports of pain. Interrater reliability was tested by 5 teams of 2 nurses assessing pain in nonverbal adult patients in 4 different ICUs. RESULTS: The tool underwent 2 revisions and involved 270 patients. During the final evaluation, strong internal reliability (chronbach's α, .82; 95% confidence interval), moderately strong interrater reliability (concordance coefficient, .72; 95% confidence interval; and weighted κ statistic, .35), and moderately strong validity (concordance coefficient, .66; 95% confidence interval) were achieved. CONCLUSION: The NPAT was found to possess moderately strong validity and strong internal and interrater reliability. It is easy to use, and provides a standard approach to assessing pain in the nonverbal adult patient.

The other nursing shortage: a regional collaboration to address the shortage of nursing faculty.

A regional collaborative of one major hospital system and nine schools of nursing has addressed the critical shortage of nursing faculty in Northeast Ohio. This model of institutional collaboration is preparing expert nurse clinicians from the hospital nursing staff to assume clinical faculty roles in regional schools of nursing while maintaining their primary role as clinical staff. The model included the development of a recruitment campaign, a uniform application process, an online database, faculty orientation programs, and continuing faculty development opportunities. Currently, more than 240 clinical nursing staff have applied for the program. Two faculty orientation sessions were attended by more than 100 prospective faculty. Additionally, the first continuing faculty development workshop was attended by more than 170 current and prospective nursing faculty. Now in its third year of implementation, the project is expanding its scope to include a broader base of regional partners and to address the issue of sustainability.

Use of an automated learning management system to validate nursing competencies.

Maintaining nurse competencies in a dynamic environment is not an easy task and requires the use of resources already strained. An online learning management system was created, and 24 annual competencies were redesigned for online validation. As a result of this initiative, competencies have been standardized across many disciplines and are completed in a more timely manner, nurses and managers are more satisfied with this method of annual assessments, and cost savings have been realized.

Leadership and nurse retention: the pivotal role of nurse managers.

As the link between executives and bedside nurses, nurse managers assume roles that bridge both organizational and professional goals. Nurse retention is one of the many responsibilities that characterize the nurse manager's work. To better understand the pivotal role of nurse managers, the authors describe the views of 32 nurse managers regarding their roles and the characteristics they need to promote retention.