Development of Pain Assessment Instrument in Critical Care Nursing Based on Kolcaba’s Comfort Theory: A Systematic Review
Keywords:
CPOT, critical care nursing, instrument development, kolcaba comfort theory, pain assessmentAbstract
Pain is a common and complex problem among critically ill patients in the Intensive Care Unit (ICU), particularly those unable to communicate due to sedation, impaired consciousness, or mechanical ventilation. Several pain assessment instruments, including the Critical-Care Pain Observation Tool (CPOT) and the Behavioral Pain Scale (BPS), have been developed; however, they primarily assess behavioral and physiological indicators and do not comprehensively reflect patients' pain experiences from a holistic nursing perspective. This systematic review aimed to synthesize current evidence on pain assessment instruments for critically ill patients and identify research gaps supporting the development of a Kolcaba's Comfort Theory-based instrument. This systematic review followed the PRISMA 2020 guidelines. Literature searches were conducted in ProQuest, EBSCOhost, Sage Journals, and PubMed for studies published between 2019 and 2025. A total of 4,150 records were identified from four databases. After screening and eligibility assessment based on the PICOS criteria, 10 studies were ultimately included and analyzed using thematic synthesis. The included studies demonstrated that CPOT is a valid, reliable, and sensitive instrument for assessing pain in non-communicative critically ill patients. However, existing instruments primarily assess physical and behavioral responses and do not incorporate psychospiritual, sociocultural, or environmental dimensions.
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Copyright (c) 2026 Kiki Ayu Kusuma, Esty Yunitasari, Rifky Octavia Pradipta, Daniel Nong Danche
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