Nociception Coma Scale-Revised: Nurses' Experience in Clinical Practice

Ingrid Poulsen; Maria Balle; Kirsten Lavi Givard

doi:10.1016/j.pmn.2019.02.003

Nociception Coma Scale-Revised: Nurses' Experience in Clinical Practice

Pain Manag Nurs. 2019 Dec;20(6):592-598. doi: 10.1016/j.pmn.2019.02.003. Epub 2019 May 15.

Authors

Ingrid Poulsen¹, Maria Balle², Kirsten Lavi Givard³

Affiliations

¹ RUBRIC (Research Unit on Brain Injury Rehabilitation Copenhagen), Department of Neurorehabilitation, Traumatic Brain Injury, Copenhagen University Hospital, Rigshospitalet, Hvidovre, Denmark; Section of Nursing Science, Health, Aarhus University, Aarhus C, Denmark. Electronic address: Ingrid.poulsen@regionh.dk.
² Department of Neurology, Copenhagen University Hospital, Herlev, Denmark.
³ RUBRIC (Research Unit on Brain Injury Rehabilitation Copenhagen), Department of Neurorehabilitation, Traumatic Brain Injury, Copenhagen University Hospital, Rigshospitalet, Hvidovre, Denmark.

PMID: 31103500
DOI: 10.1016/j.pmn.2019.02.003

Abstract

Background: The Nociception Coma Scale-Revised (NCS-R) is a rating scale developed and validated for measurement of nociception and pain among patients with brain injuries in unresponsive wakefulness syndrome or minimally conscious state. However, little is known about its use in daily clinical practice.

Aims: The aim of this study was to explore clinical experience with the NCS-R by means of focus group interviews with nurses and nurse assistants in a subacute rehabilitation ward for patients with severe brain injuries.

Design: Qualitative focus group interview study.

Settings: Department for highly specialized neurorehabilitation for patients with severe brain injuries.

Participants/subjects: Nurses and nurse assistants.

Methods: In total, 12 experienced registered nurses and nurse assistants participated in two recorded focus group interviews. The participants were selected from the subacute neurorehabilitation ward on the following criteria: Employed at the ward for at least 11 months and being introduced to and having experience with using the NCS-R in own patients for a minimum period of 6 months. An inductive qualitative analysis was conducted by reading the interview text through several times, and meaning units were defined first separately and later jointly between the authors. Then meaning units were coded and categorized into subthemes and themes.

Results: We found three themes, general relevance of the NCS-R, NCS-R versus level of consciousness, and overall assessment of pain in patients with disorders of consciousness, with a total of eight subthemes.

Conclusions: The content and subscales of the NCS-R are relevant for pain assessment in patients with severe brain injury in subacute rehabilitation. However, with the present cutoff value at 4 points, challenges are associated with using NCS-R, especially in patients with unresponsive wakefulness syndrome because they are at risk of not being assessed with respect to pain.

MeSH terms

Adult
Coma / classification*
Female
Focus Groups / methods
Humans
Nurses / psychology*
Nurses / statistics & numerical data
Pain Measurement / methods
Pain Measurement / standards*
Pain Measurement / statistics & numerical data
Qualitative Research