Newswise — A newly released practice alert from the American Association of Critical-Care Nurses (AACN) aims to standardize how nurses evaluate patients for pain, especially when patients are unable to speak.

The AACN Practice Alert “Assessing Pain in Critically Ill Adults” summarizes expected nursing practice related to pain assessment, including evidence-based recommendations and supporting documentation.

Many critically ill patients experience significant pain but are often unable to describe how they feel, due to their condition, sedation or mechanical ventilation.

“The gold standard is for patients to tell nurses directly about any pain, but many critically ill patients are unable to do that,” said Linda Bell, MSN, RN, AACN clinical practice specialist. “If patients are unable to self-report, validated pain assessment tools should be used as standard practice.”

Pain assessment should be performed regularly and consistently, including a baseline evaluation at the beginning of shifts, evaluations during activities or procedures known to be painful and before and after administration of analgesics.

If possible, nurses should assess pain jointly during patient handoffs to ensure consistency with the tools. When assessed individually, the results should be included in patient handoff discussions and shift reports. 

Among the tools mentioned in the practice alert are the Behavioral Pain Scale in intubated (BPS) and nonintubated (BPS-NI) patients and the Critical-Care Pain Observation Tool (CPOT). Also, the Behavior Pain Assessment Tool is a newly developed scale that holds promise for its ability to discriminate between painful procedures and rest and to correlate positively with the patient’s self-reports of pain.

According to the practice alert, vital signs should never be used as the sole indicator of pain. Instead, they should be considered cues to begin further pain assessment.

Someone who knows the patient well can assist nurses in identifying less obvious changes in behavior that may indicate the presence of pain. These proxy reports should be combined with other evidence, including direct observation and the presence of known or potentially painful conditions.

The alert is the most recent addition to the growing library of clinical resources from AACN with the latest evidence-based resources and research. Each AACN Practice Alert outlines the scope of the problem, summarizes the expected nursing practice and provides supporting evidence and research. AACN Practice Alerts are available to download at no cost on the AACN website,, after you sign in.

Supported by authoritative evidence, each AACN Practice Alert seeks to ensure excellence in practice along with promotion of safe and humane work environments. Topics address both nursing and interprofessional activities of importance for patients and families in acute and critical care environments. Some alerts include additional resources for staff education and performance-improvement activities.

Previously released alerts address verification of feeding-tube placement, pulmonary artery pressure monitoring, family presence during CPR and invasive procedures, and prevention of aspiration.


About the American Association of Critical-Care Nurses: Founded in 1969 and based in Aliso Viejo, California, the American Association of Critical-Care Nurses (AACN) is the largest specialty nursing organization in the world. AACN represents the interests of more than half a million acute and critical care nurses and includes more than 200 chapters in the United States. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution.

American Association of Critical-Care Nurses, 101 Columbia, Aliso Viejo, CA 92656-4109;




Journal Link: AACN Practice Alert