Document Type
DNP Project
Department
School of Nursing
Date of Degree
Spring 2026
Degree
Doctor of Nursing Practice (DNP)
Primary Advisor
Richard Ricciardi, PhD, CRNP, FAANP, FAAN, FRCSI
Keywords
Intensive Care Unit; Non-Communicative Patients; Critical Care Pain Observation Tool; Quality Improvement
Abstract
Background
Approximately half of intensive care unit (ICU) patients experience moderate-to-severe pain during admission, yet pain assessment in non-communicative patients remains inconsistent. Evidence-based behavioral tools such as the Critical Care Pain Observation Tool (CPOT) have been recommended to improve detection and management of pain in this population.
Aims/Objectives
This quality improvement (QI) project aimed to implement the Critical Care Pain Observation Tool (CPOT) among registered nurses in a 29-bed medical ICU and evaluate its impact on nurse knowledge, acceptability, and documentation of pain assessments.
Methods
A pre–post quality improvement design was used. A convenience sample of registered nurses in a 29-bed medical ICU participated. The intervention consisted of a CPOT education bundle that included staff training and implementation of CPOT documentation within an electronic submission tool. Outcomes were measured using the modified Knowledge and Attitudes Survey Regarding Pain (mKASRP), the modified Acceptability and Feasibility Tool (mAFT), and CPOT documentation frequency. Descriptive statistics and independent t-tests were used to evaluate changes in knowledge scores.
Results
Seventy-three nurses completed the pre-test and 23 completed the post-test. Mean mKASRP scores improved from 73.40 (SD 7.03) to 82.00 (SD 13.22), representing an 11.7% increase and a statistically significant difference (p < .05). During the two-month implementation period, 226 CPOT assessments were documented (3.37 assessments per day). Additionally, 65.9% of participants reported readiness to integrate CPOT into their workflow.
Conclusion
Implementation of a CPOT education bundle improved nurses’ knowledge of pain assessment and demonstrated feasibility of integrating CPOT documentation into routine ICU workflow. These findings support broader adoption of standardized behavioral pain assessment tools to improve pain recognition and management among non-communicative critically ill patients.
Copyright Notice
©2026 Tyler J. Wiorek. All rights reserved.
Recommended Citation
Wiorek, T. J. (2026). Improving Pain Assessments in the Medical ICU. , (). Retrieved from https://hsrc.himmelfarb.gwu.edu/son_dnp/204
Open Access
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