Original Article| Volume 11, ISSUE 2, P115-125, June 2010

Nurses’ Evaluations of the Feasibility and the Clinical Utility of the Critical-Care Pain Observation Tool

  • Céline Gélinas
    Address correspondence to Céline Gélinas, RN, PhD, Assistant Professor, School of Nursing, McGill University, 3506, University Street, Wilson Hall, Room 420, Montreal, Quebec, H3A 2A7 Canada.
    School of Nursing, McGill University, Montréal, Québec, Canada and the Centre for Nursing Research, Jewish General Hospital
    Search for articles by this author
Published:September 22, 2009DOI:


      Feasibility and clinical utility are essential characteristics to consider when it comes to developing or selecting a pain assessment tool to implement into practice. However, these characteristics have not been widely studied with available pain assessment tools in critically ill adults. The objective of this study was to describe nurses’ evaluations of the feasibility and clinical utility of the Critical-Care Pain Observation Tool (CPOT) in assessing pain in critically ill ventilated adults. A descriptive design was used. Of the 51 nurses who used the CPOT with the enrolled patients (n = 55), 33 returned their completed evaluation form. Overall, the feasibility and clinical utility of the CPOT were positively evaluated by the nurse participants. More than 90% of them supported that the directives about the use of the CPOT were clear and that it was simple to understand and easy to complete. Regarding its clinical utility, a little more than 70% of the nurses mentioned that the CPOT was helpful for nursing practice and recommended its use routinely. They acknowledged that the CPOT provided them with a common language and a standardized way to assess patients’ pain. Half of the nurse participants supported that the CPOT had influenced their practice. On the other hand, six nurses mentioned that they were already sensitive to nonverbal cues of pain before the introduction of the CPOT. In conclusion, the CPOT is a valid behavioral pain scale, which has been suggested by experts in recent critical reviews. So far, the CPOT is being used for research purposes and has been implemented into clinical practice of various health care centers of North America.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Pain Management Nursing
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Aissaoui Y.
        • Zeggwagh A.A.
        • Zekraoui A.
        • Abidi K.
        • Abouqal R.
        Validation of a behavioral pain scale in critically ill, sedated, and mechanically ventilated patients.
        Anesthesia & Analgesia. 2005; 101: 1470-1476
        • Bjoro K.
        • Herr K.
        Assessment of pain in the nonverbal or cognitively impaired older adult.
        Clinics in Geriatric Medicine. 2008; 24: 237-262
        • Chanques G.
        • Jaber S.
        • Barbotte E.
        • Violet S.
        • Sebbane M.
        • Perrigault P.F.
        • Mann C.
        • Lefraut J.Y.
        • Eledjam J.J.
        Impact of systematic evaluation of pain and agitation in an intensive care unit.
        Critical Care Medicine. 2006; 34: 1691-1699
        • Duhn L.J.
        • Medves J.M.
        A systematic integrative review of infant pain assessment tools.
        Advances in Neonatal Care. 2004; 4: 126-140
      1. Gélinas, C., & Arbour, C. (in press). Behavioral and physiologic indicators during a nociceptive procedure in conscious and unconscious mechanically ventilated adults: Similar or different? Journal of Critical Care. December 2009.

        • Gélinas C.
        • Fillion L.
        • Puntillo K.A.
        Item selection and content validity of the Critical-Care Pain Observation Tool: An instrument to assess pain in critically ill nonverbal adults.
        Journal of Advanced Nursing. 2009; 65: 203-216
        • Gélinas C.
        • Fillion L.
        • Puntillo K.
        • Viens C.
        • Fortier M.
        Validation of a Critical-Care Pain Observation Tool in adult patients.
        American Journal of Critical Care. 2006; 15: 420-427
        • Gélinas C.
        • Fortier M.
        • Viens C.
        • Fillion L.
        • Puntillo K.
        Pain assessment and management in critically ill intubated patients: A retrospective study.
        American Journal of Critical Care. 2004; 13: 126
        • Gélinas C.
        • Harel F.
        • Fillion L.
        • Puntillo K.A.
        • Johnston C.
        Sensitivity and specificity of the Critical-Care Pain Observation Tool for the detection of pain in intubated adults after cardiac surgery.
        Journal of Pain & Symptom Management. 2009; 37: 58-67
        • Gélinas C.
        • Johnston C.
        Pain assessment in the critically ill ventilated adult: Validation of the Critical-Care Pain Observation Tool and physiological indicators.
        The Clinical Journal of Pain. 2007; 23: 497-505
        • Gélinas C.
        • Viens C.
        • Fortier M.
        • Fillion L.
        Les indicateurs de la douleur en soins critiques.
        Perspective Infirmière. 2005; 2 ([Pain indicators in critical care]): 12-22
        • Herr K.
        • Coyne P.J.
        • Key T.
        • Manworren R.
        • Mccaffery M.
        • Merkel S.
        • Pelosi-Kelly J.
        • Wild L.
        • et al.
        Pain Assessment in the Nonverbal Patient: Position statement with clinical practice recommendations.
        Pain Management Nursing. 2006; 7: 44-52
        • International Association for the Study of Pain (IASP)
        Pain terms: A list with definitions and notes on usage recommended by the IASP Subcommittee on Taxonomy.
        Pain. 1979; 6: 249-252
        • Jacobi J.
        • Fraser G.L.
        • Coursin D.B.
        • Riker R.R.
        • Fontaine D.
        • Wittbrodt E.T.
        • Chalfin D.B.
        • Masica M.F.
        • Bjerke H.S.
        • Coplin W.M.
        • Crippen D.W.
        • Fuchs B.D.
        • Kelleher R.M.
        • Marik P.E.
        • Nasraway S.A.
        • Murray M.J.
        • Peruzzi W.T.
        • Lumb P.D.
        • Task Force of the American College of Critical Care Medicine (ACCM) of the Society of Critical Care Medicine (SCCM)
        • American Society of Health-System Pharmacists (ASHP)
        • American College of Chest Physicians
        Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult.
        Critical Care Medicine. 2002; 30: 119-141
        • Kwekkeboom K.
        • Herr K.
        Assessment of pain in the critically ill.
        Critical Care Nursing Clinics of North America. 2001; 13: 181-194
        • Li D.
        • Puntillo K.
        • Miaskowski C.
        A review of objective pain measures for use with critical care adult patients unable to self-report.
        The Journal of Pain. 2008; 9: 2-10
        • Mateo O.M.
        • Krenzischek D.A.
        A pilot study to assess the relationship between behavioral manifestations and self-report of pain in postanesthesia care unit patients.
        Journal of Post Anesthesia Nursing. 1992; 7: 15-21
        • Payen J.F.
        • Bru O.
        • Bosson J.L.
        • Lagrasta A.
        • Novel E.
        • Deschaux I.
        • Lavagne P.
        • Jacquot C.
        Assessing pain in critically ill sedated patients by using a behavioral pain scale.
        Critical Care Medicine. 2001; 29: 2258-2263
        • Puntillo K.A.
        • Miaskowski C.
        • Kehrle K.
        • Stannard D.
        • Gleeson S.
        • Nye P.
        Relationship between behavioral and physiological indicators of pain, critical care patients’ self-reports of pain, and opioid administration.
        Critical Care Medicine. 1997; 25: 1159-1166
        • Puntillo K.
        • Stannard D.
        • Miaskowski C.
        • Kehrle K.
        • Gleeson S.
        Use of a Pain Assessment and Intervention Notation (PAIN) tool in critical care nursing practice: Nurses’ evaluations.
        Heart & Lung. 2002; 31: 303-314
        • Rotondi A.J.
        • Chelluri L.
        • Sirio C.
        • Mendelsohn A.
        • Schulz R.
        • Belle S.
        • Im K.
        • Donahoe M.
        • Pinsky M.R.
        Patients’ recollections of stressful experiences while receiving prolonged mechanical ventilation in an intensive care unit.
        Critical Care Medicine. 2002; 30: 746-752
      2. Sessler, C.N., Grap, M.J., & Ramsay, M.A.E., (2008). Evaluating and monitoring analgesia and sedation in the intensive care unit. Critical Care, 12. Available at:

        • Shannon K.
        • Bucknall T.
        Pain assessment in critical care: What have we learnt from research.
        Intensive and Critical Care Nursing. 2003; 19: 154-162
        • Stevens B.
        • Gibbins S.
        Clinical utility and clinical significance in the assessment and management of pain in vulnerable infants.
        Clinics in Perinatology. 2002; 29: 459-468
        • Voight L.
        • Paice J.A.
        A standardized pain flow sheet: Impact on patient-reported pain experience after cardiovascular surgery.
        American Journal of Critical Care. 1995; 4: 308-313
        • Young J.
        • Siffleet J.
        • Nikoletti S.
        • Shaw T.
        Use of a Behavioral Pain Scale to assess pain in ventilated, unconscious and/or sedated patients.
        Intensive and Critical Care Nursing. 2006; 22: 32-39