Date of Completion

Fall 10-31-2017

Project Type


Degree Name

Master of Science in Nursing - Nursing Administration and Health Policy



Committee Chair/First Advisor

Richard Sowell

Committee Member

Nancy Ballard


Purpose: The study aimed to compare the Behavioral Pain Scale (BPS) and the Critical Care Pain Observation Tool (CPOT) in their effectiveness to identify the presence of pain in nonverbal mechanically ventilated critically ill patients. Nurses’ evaluation with the feasibility, clinical relevance, and satisfaction of the tools were also gathered and compared.

Design: This study followed a non-experimental, correlational, comparative design.

Methods: Nurses were recruited from the surgical intensive care unit in a midsized community hospital in the Southeastern United States. After training, nurse participants obtained pain assessments on ventilated critically ill patients at rest, following a normal blood pressure measurement, and following endotracheal suctioning. Pain assessments were gathered and recorded using the Critical Care Pain Observation tool and the Behavioral Pain Scale. The researcher aimed to obtain 84 total assessments. Following collection of the pain assessments, nurses were provided evaluation tools with the two scales along with a demographic questionnaire.

Data Analysis: IBM SPSS 24.0 software was utilized to compute and report statistical data following data collection. Descriptive statistics such as frequencies, percentages, means, and standard deviations were utilized to describe demographic variables and scores for the CPOT, BPS, and the nurses’ evaluation tool. Correlational statistics such as Pearson’s r analyzed the relationships between the CPOT and the BPS scores. Paired t tests examined the differences in nurses’ evaluation between the CPOT and BPS.

Results: Internal consistency reliability was assessed for the questionnaires assessing the Behavioral Pain Scale (BPS) for feasibility, clinical relevance, and satisfaction and for the questionnaires assessing the Critical Care Pain Observation Tool (CPOT) ) for feasibility, clinical relevance, and satisfaction by calculating Cronbach’s alpha reliability coefficients.The results of these Cronbach’s alpha reliability coefficients indicate that the two questionnaires demonstrate high levels of internal consistency reliability. Statistically significant relationships were also found between the BPS and CPOT scores at rest r(85) =0.821, p=.01 , after taking a noninvasive blood pressure r(85) =0.815, p=.01, and after turning r(85) =0.906, p=.01. BPS and CPOT scores had positive high correlations at each level of pain assessment. The correlation strengthened following turning indicating that both pain assessment tools do tend to increase and reflect sensitivity. Overall, 85 total pain assessments were collected by seven nurses, including the primary investigator. There was not a statistically significant difference between nurses’ perceptions of the feasibility, clinical relevance, or satisfaction with the two tools.

Discussion: The findings show that observational pain scales, such as the Behavioral Pain Scale (BPS) and Critical Care Pain Observation tool (CPOT) are effective in measuring pain in the ventilated nonverbal patient. The correlation strength indicates that both pain assessment tools do tend to reflect sensitivity to pain. Though the difference was not statistically significant, mean scores were determined to be slightly higher for the CPOT in feasibility, clinical relevance, and satisfaction when compared to the mean evaluation scores of the BPS. The study also supported the decoding nature of the BPS and CPOT as described by The Social Communication Model of Pain. More comparative research is needed to establish a gold standard for observational pain scales, however, the comparative nature of this study can serve as a framework to reproduce and for research going forward.