Fernandez, RitinGuilhermino, MichelleAlotni, Majid Ali Saleh2025-02-022024Australian Critical Care0000https://hdl.handle.net/20.500.14154/74793Thesis by publications included 4 publication. First the thesis sttarted with an integrative review to explore hte barriers to nurs-led pain management in Adult ICU, and these barriers was mapped to beahvioural framework (COM-B model) to assign each barriers to best behaviour category and then find the best solution. the COM-b model suggested using implementation stduy to implement new pain scale called CPOT. the method for this implementation was chosen the stepped wedge design. after the implementaition study a feasibility study was conducted to survey nurses participated in this study to measure thier readiness to implement. also psychometric analysis used for this as well.Thesis Abstract The prevalence of pain among patients in the intensive care unit (ICU) resulting from invasive procedures and medical interventions remains high. This issue is particularly complex for ICU patients unable to self-report their pain, leading to undetected and untreated pain and affecting quality of life. The specific aims were to: 1. Identify the barriers to nurse-led pain management in adult ICUs through an integrative review. 2. Implement the Critical Care Pain Observation Tool (CPOT) in Saudi Arabia to improve pain assessment in patients unable to self-report pain, with the goal of improving nurse practice and patient outcomes. 3. Develop and investigate the psychometric properties of an instrument designed to measure nurses’ readiness for implementing the CPOT, in ICUs in Saudi Arabia. Method An integrative review was conducted to identify the barriers to nurse-led pain management. Which were mapped to the COM-B model. This model suggested specific strategies to address the barriers. A stepped-wedge trial was conducted to assess the effect of the implementation of the CPOT on pain assessment. Finally, nurses’ readiness to implement was tested using the cross-sectional method with validity and psychometric analysis. Results The integrative review revealed several barriers to nurse-led pain management and informed the intervention. The intervention resulted in a significant increase in the number of pain assessments (Rate Ratio: 1.77, 95% confidence interval [CI]:1.45, 2.16, p < 0.001) and re-assessment (Rate Ratio: 13.99, 95% CI: 8.14, 24.02, p < 0.001) between the intervention and control groups. There was no significant effect on patient outcomes. The content validity of the mAFt. resulted in two factors: acceptability (10 items) and feasibility (five items). Conclusion Identifying barriers to nurse-led pain management in the ICU is crucial. Selecting the most effective interventions is essential to achieving optimal outcomes for both nurses and patients.182enPainPain assessmentPain managementStepped- wedgeNursingThesis