Pain management interventions of the non-communicating patient in intensive care: What works for whom and why? A rapid realist review

Abstract

Aim: The utility and uptake of pain management interventions across intensive care settings is inconsistent. A rapid realist review was conducted to synthesise the evidence for the purpose of theory building and refinement.

Design: A five-step iterative process was employed to develop project scope/ research questions, collate evidence, appraise literature, synthesise evidence and interpret information from data sources.

Methods: Realist synthesis method was employed to systematically review literature for developing a programme theory.

Data sources: Initial searches were undertaken in three electronic databases: MEDLINE, CINHAL and OVID. The review was supplemented with key articles from bibliographic search of identified articles. The first 200 hits from Google Scholar were screened.

Results: Three action-oriented themes emerged as integral to successful implementation of pain management interventions. These included health facility actions, unit/team leader actions and individual nurses' actions.

Conclusion: Pain assessment interventions are influenced by a constellation of factors which trigger mechanisms yielding effective implementation outcomes.

Implications: The results have implications on policy makers, health organisations, nursing teams and nurses concerned with optimising the successful implementation of pain management interventions.

Impact: The review enabled formation of a programme theory concerned with explaining how to effectively implement pain management interventions in intensive care.

Reporting method: This review was informed by RAMESES publication standards for realist synthesis.

Public contribution: No patient or public contribution. The study protocol was registered in Open Science Framework. 10.17605/OSF.IO/J7AEZ.

Keywords: implementation; intensive care; interventions; pain; protocols.