الفهرس 
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Abstract
Summary
Introduction:
Pain determination in a patient who cannot communicate depends on objective and subjective measurements. This two-pronged approach should be tailored to the individual patient, clinical picture, and healthcare setting. On other hand, nursing clinical judgment and behavioral observation comprise the second branch of determination and may inspire a more accurate assessment of the pain levels of a patient with disturbed conscious (Abd-El Sayed, 2019).
The successful assessment of pain is possible through one reliable and authentic assessment method, which needs exact measurement of pain for directing the treatment team toward decision-making for the determination of the type and accurate dosage of the medication. Although accurate assessment of pain has been emphasized, its execution isn’t as possible as the evaluation of other vital signs because pain may be a subjective and mental experience, and there are no objective instruments to measure it, particularly in the non-communicating patient or patient with disturbed conscious, which increase the complexity of pain assessment (Rafiei et al., 2016).
Adequate pain assessment in disturbed conscious patients on mechanical ventilator requires reliable instruments that help in its detection and measurement of pain intensity. Recent international guidelines recommend the utilization of scales based on behavioral markers of pain for patients who are unable of self-report, their motor function may be absent or disturbed, and behaviors are observable (Latorre-Marco et al., 2016).
The diagnosis of pain in patients with disturbed consciousness may be a major challenge within the intensive care unit. Nurses are the cornerstone in this evaluation, as ICU nurses are attending for 24 hrs, observing meticulously, recording the onset, intensity, duration, radiation, pain medication response, utilizing numerous choices for pain relief, and following it up (Rijkenberg et al., 2016).
Aim of the study:
The present study was conducted to fulfill the following aim:
Develop and validate the pain intensity for patients with disturbed consciousness on a mechanical ventilator through:
• Developing a scale to measure pain intensity for patients with disturbed consciousness on the mechanical ventilator.
• Testing the validity and reliability of the developed scale.
Research Hypothesis
The current study hypothesized that:
• The developed scale will be valid in measuring the pain intensity for patients with disturbed consciousness on mechanical ventilator.
• The developed scale will be reliable in testing the pain intensity for patients with disturbed consciousness on mechanical ventilator.
Research design:
A methodological research design was used for the development of the study tool.
Methodology:
Setting:
This study was conducted at surgical Intensive Care, neurosurgery and emergency neurosurgery ICU Unit at El Demerdash Hospital.
Subject:
A purposive sample of (300) patients for scale validation as a rule of thumb according to (Clark& Watson, 1995), and a panel of experts, they were (25) experts from critical care medicine and nursing to validate the scale.
Tools of data collection:
The data were collected through using the following tools:
Tool I - Patient assessment record: it was written in English language and filled by the researcher based on the patient’s health record after a review of relevant recent related literature. It includes (demographic data, medical data, and the Glasgow coma scale).
II- Critical Care Pain Observation Tool: This tool is adapted from Gelinas, (2016). It was a valid tool used to assess the level of patient’s comfort, and pain among critically ill mechanically ventilated patients. It was the gold standard tool in this study.
III- The mechanically Ventilated Disturbed Consciousness Pain Assessment scale (MV-DCPAS): was developed by the researcher and used to measure pain intensity among mechanically ventilated disturbed consciousness patients.
VI- Pain assessment record:
It was developed by the researcher to record the patient response to pain 1 minute before, during, and after 10 minutes after procedures for turning, wound dressing and blood pressure procedures.
V- Face and Content Validation Opinionnaire
It consisted of the preliminary self-assessment opinionnaire developed by the researchers. The jury members were asked for their agreement/disagreement with each item regarding face, content validity, and their comments.
Results:
The present study revealed that:
The results show excellent face, content and criterion validity, high reliability with the internal consistency of >0.9(Cronbach’s alpha), and a good to excellent interrater reliability with a weighted Cohen’s kappa minimum of 0.780 to maximum 0.819, higher sensitivity than specificity with AUC= >0.8, with significantly less than 0.01** in all procedure regarding to the developed pain intensity scale.
Conclusion
The developed scale shows excellent face and content validity, high reliability (internal consistency and equivalence), high sensitivity, and specificity for detecting pain in patients with disturbed consciousness on mechanical ventilation.
Recommendations:
• Further studies are recommended to assess pain intensity of mechanically ventilated patient.
• Replication of the current study on large sample and different hospitals settings to be able to generalize the results.
• Developing a simplified and comprehensive booklet including guidelines about how to use and implement the behavioral pain scale and critical care pain observational tool in intensive care units.