الفهرس 
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Abstract
Pain is a frequent event in Intensive Care Unit (ICU) patients, with an incidence of up to 50% in medical as well as surgical patients. Pain is associated with an acute stress response including changes in neurovegetative system activity, neuroendocrine secretion and psychological distress often manifested as agitation. Improved pain management is associated with better patient outcomes in the ICU (Chanques, et al., 2014).
Critically ill patients frequently experience both procedural pain and pain at rest. Chest tube removal, tracheal suctioning, wound care, turning and arterial line insertion have been shown to be the most painful procedures. Untreated acute pain in adult ICU patients can lead to short- and long-term physiological and psychological complications such as postoperative myocardial infarction, insufficient sleep and posttraumatic stress disorder (Rijkenberg, Peter & Voort, 2016).
Practice guidelines recommend an individualized and goal directed pain management. This includes a systematic assessment of pain with a validated pain scale appropriate to the patient’s level of consciousness. (Baron & Binder,2015)
Aim of the study:
The present study was conducted to fulfill the following aim:
Assess pain intensity for mechanically ventilated patient through:
1. Applying Critical care Pain Observational Tool for mechanically ventilated patient
2. Applying Behavioral Pain Scale for mechanically ventilated patient
3. Compare between critical care pain observational tool and behavioral pain scale
Research Questions:
Which pain assessment scale is more effective in assessing pain for mechanically ventilated patient?
Research design:
A Comparative, Descriptive study will be utilized to conduct this study.
Methodology:
Setting:
This study was conducted at surgical Intensive Care Unit at El Demerdash Hospital.
Subject:
A purposive sample of 80 patients from three critical care units: general surgical ICU which consist of fifty beds, neurosurgery which consist of 6 beds and emergency neurosurgery ICU which consist of ten beds.
Tools of data collection:
The data were collected through using the following tools:
Tool I - Patient assessment record: it was developed by the researcher based on review of relevant recent related literatures
The patient assessment record includes four parts: demographic characteristics, biomedical data, physiological parameters and Glasco coma scale.
II- Critical Care Pain Observation Tool: To assess pain in mechanically ventilated patient
III- Behavioral pain scale: To assess pain in mechanically ventilated patient.
Results:
The present study revealed that:
(62.5%) of them were males with mean age and SD of 54±12.30 years old. 68.8% had mechanical ventilation for the first time While 73.8% of them were on SIMV mode.
Regarding internal consistency the critical care observational tool were more than the behavioral pain scale.
Regarding inter rater reliability the critical care observational tool was (0.904).While the behavioral pain scale was (0.851).
Regarding the inter rater reliability the critical care observational tool was (0.632), while the behavioral pain scale was (0.515).
A significant positive correlation of pain score during procedure and 10 minutes after using both scales at r.0.387 and 0.248.
Conclusion
The study revealed that, the Critical pain observation tool is more accurate than Behavioral pain scale due to: Inter consistency ”Cronbach alpha”, Inter-rater reliability ”ICCs” and test-retest reliability ”correlation coefficient” at critical pain observation higher than observational pain scale.
Recommendations:
• Further studies are recommended to assess pain intensity of mechanically ventilated patient.
• 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.
• Replication of the current study on large sample and different hospitals settings to be able to generalize the results.