Data in brief 25 (2019) 103997

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Data Article

Nurses’ evaluation of critical care pain

observation tool (CPOT) implementation for
mechanically ventilated intensive care patients
Hadi Maatouk a, Ahmad Al Tassi b, Mirna A. Fawaz b, *,
Mohammad S. Itani b
a
Emergency Department, American University of Beirut Medical Center, Beirut, Lebanon
b
Beirut Arab University, Faculty of Health Sciences, Beirut, Lebanon

a r t i c l e i n f o a b s t r a c t

Article history: Despite the fact that self-report of pain is considered the most
Received 23 November 2018 consistent indicator of its presence, pain assessment for the criti-
Received in revised form 1 May 2019 cally ill mechanically ventilated patients is quite challenging, as
Accepted 9 May 2019
the altered level of consciousness, sedation and the presence of life
Available online 14 June 2019
support devices commonly affect the self-report mechanism.
However, in Lebanon, nearly no research articles or local profes-
Keywords:
sional organizations have raised this topic. Therefore, addressing
Pain
CPOT and introducing the “Critical Care Pain Observation Tool” (CPOT) is
Intensive care patients of great importance and would help the healthcare providers
especially “Critical Care Nurses” (CCN) in identifying and managing
the patient’s hidden pain Curry Narayan, 2010. The data followed a
non-experimental post-test only design to gather data from a
sample of 30 critical care registered nurses where well-established
psychometric instruments were used in primary data collection
method, which is Critical Care Pain Observation Tool and the
Feasibility and clinical utility CPOT Questionnaire. The data in this
article provides demographic data about critical care nurses and
their evaluation of the Critical Care Pain Observation Tool (CPOT)
implementation for mechanically ventilated intensive care pa-
tients. The analyzed data is provided in the tables included in this
article.
© 2019 The Author(s). Published by Elsevier Inc. This is an open
access article under the CC BY license ([Link]
org/licenses/by/4.0/).

* Corresponding author.
E-mail address: [Link]@[Link] (M.A. Fawaz).

[Link]
2352-3409/© 2019 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license (http://
[Link]/licenses/by/4.0/).
2 H. Maatouk et al. / Data in brief 25 (2019) 103997

Specifications table

Subject area Critical Care Nursing

More specific subject area Pain Management
Type of data Tables
How data was acquired Quantitative Questionnaires
Data format Analyzed
Experimental factors - Sample consisted of 30 critical care nurses.
- Educational sessions were given to the participating nurses about the
importance of pain assessment for mechanically ventilated patients, in which
CPOT was introduced as the sole tool for pain assessment for these patients to
be used by the staff, and they were fully instructed about how to use it.
- Nurses started to use the CPOT for routine pain assessment as per hospital
pain policy. In addition to that, nurses were instructed to get CPOT scores
during 2 procedures that were proved painful by many researchers, which are
suctioning and positioning at the beginning and at the end of the procedure.
Experimental features The researchers measured the nurses' evaluation of the CPOT after a month of
starting its implementation by using the CPOT Evaluation Questionnaire.
Data source location Lebanon
Data accessibility Data is available within this article
Related research article Gelinas, C., Arbour, C., Michaud, C., Vaillant, F., & Desjardins, S. (2011).
Implementation of the critical-care pain observation tool on pain assessment/
management nursing practices in an intensive care unit with nonverbal
critically ill adults: a before and after study. International journal of nursing
studies, 48(12), 1495e1504.

Value of the data

 The data provided in this paper may be used to increase awareness about this overlooked topic.
 The data shows the Critical Care Pain Observation Tool (CPOT) is an efficient instrument to detect nonverbalized pain
among mechanically ventilated patients.
 Further studies on CPOT would be essential to examine its effectiveness in various other hospitals and areas to generalize
its adoption in practice.
 Our data are concurrent with previous research studies, thus making it of interest to other researchers.

1. Data

Table 1 represents the demographic characteristics of critical care nurses who participated, while
Table 2 shows the pain assessment profile of the nurses where it depicts that most critical care nurses
do not asses pain on regular basis. Shockingly, none of the participants (n ¼ 30) had heard about the
presence of CPOT, yet 90.0%(n ¼ 27) of the nurses had received general education regarding pain
assessment and management. In addition to that, data showed that 66.7% (n ¼ 20) rely on vital signs for
pain detection. In order to assess the inter-reliability of the CCNs we first conducted the weighted
kappa analysis and the intra-class correlation coefficient studies for a confidence interval of 95%. Kappa
values range from 1 to þ1. The higher the value of kappa, the stronger the agreement. Intra-class
correlation values ranges from 0 to 1, in which the higher value closer to 1 yields the most perfect
correlation and reliability of values among raters. Table 3 shows the weighted kappa analysis during
position assessment. The degree to which two raters or observers, operating independently, assign the
same ratings or values for an attribute being measured or observed. Three raters assessed the patients:
R1, R2, and R3 (super-user). The weighted kappa score for the total CPOT score at the beginning of the
positioning procedure ranged between 0.417 and 0.468 thus expressing moderate agreement score
among the three different rater, having the greatest agreement between the R2 and the super-user
(k ¼ 0.468) and the weakest agreement between R1 and the super-user (k ¼ 0.417). On the other
hand, at the end of the procedure, the weighted kappa score for the total CPOT score ranged between
0.475 and 0.628 indicating also a moderate agreement between raters, in which the modest agreement
was between R1 and the super-user (k ¼ 0.628) and the weakest agreement was between R2 and the
super user (k ¼ 0.475). In addition, Table 4 shows the data of the second assessment that was done for
 H. Maatouk et al. / Data in brief 25 (2019) 103997 3

Table 1
Demographic characteristics of the participants (N ¼ 30).

Variables Frequency Percentage (%)

Age
Less than 25 11 36.7
26e30 12 40.0
31e35 5 16.7
More than 35 2 6.7
Gender
Male 15 50.0
Female 15 50.0
Educational level
Bachelor degree 26 86.7
Master’s degree 4 13.3
Years of experience in critical care unit
Less than 1 year 5 16.7
2e5 years 9 30.0
More than 5 and less than 10 years 12 40.0
More than 10 years 4 13.3

Table 2
Pain assessment awareness among the sample (N ¼ 30).

Criteria Frequency Percentage (%)

Assess pain regularly

Yes 0 0
No 30 100
Used CPOT before
Yes 0 0
No 30 100.0
Received education regarding pain assessment and management
Yes 27 90.0
No 3 10.0
Best way to tell whether your patient in pain
Vital signs 20 66.7
Behavior 9 30.0
Ventilator compliance 1 3.3

Table 3
Inter rater reliability for the overall CPOT score at the beginning and at the end of positioning procedure (N ¼ 150,
CI ¼ 95%, p < 0.0001).

Weighted Kappa

Observation At beginning At the end

R1 & R2 0.439 (Moderate) 0.485 (Moderate)

R1 & Super-user 0.417 (Moderate) 0.628 (Substantial)
R2 & Super-user 0.468 (Moderate) 0.475 (Moderate)

Table 4
Inter rater reliability for the overall CPOT score at the beginning and at the end of suctioning (N ¼ 150, CI ¼ 95%,
p < 0.0001).

Weighted Kappa

Observation At beginning At the end

R1 & R2 0.463 (Moderate) 0.477 (Moderate)

R1 & Super-user 0.582 (Moderate) 0.467 (Moderate)
R2 & Super-user 0.663 (Substantial) 1.687 (Substantial)
4 H. Maatouk et al. / Data in brief 25 (2019) 103997

the suctioning procedure with 150 observations. In addition, the data for the assessment of patient at
the beginning of positioning procedure showed an excellent reliability with an average intra-class
coefficient (ICC)of 0.945 with a 95% confidence interval from 0.912 to 0.967 (F (49,98) ¼ 18.213,
p < 0.0001) (Refer to Table 5). While at the end of the positioning procedure, the agreement of the CPOT
total score was analyzed in which the average measure ICC was 0.767 showing an excellent reliability
with a 95% confidence interval from 0.627 to 0.860 (F (49,98) ¼ 4.289, p < 0.0001) (Refer to Table 6).
Moreover, the data for the assessment of patient at the beginning of suctioning showed excellent
reliability with an average measure of ICC was 0.964 with a 95% confidence interval from 0.942 to 0.978
(F (49,98) ¼ 27.649, p < 0.0001) (Refer to Table 7). On the other hand, at the end of the suctioning the

Table 5
Intra-class correlation coefficient table with 95% confidence interval with p < 0.0001 for the total CPOT score at the beginning of
positioning.

Intra-class Correlation Coefficient

Intra-class Correlationb 95% Confidence Interval F Test with True Value 0

Lower Bound Upper Bound Value df1 df2 Sig

Single Measures .852a .776 .907 18.213 49 98 .000

Average Measures .945c .912 .967 18.213 49 98 .000

Two-way mixed effects model where people effects are random and measures effects are fixed.
a
The estimator is the same, whether the interaction effect is present or not.
b
Type C intra-class correlation coefficients using a consistency definition. The between-measure variance is excluded from
the denominator variance.
c
This estimate is computed assuming the interaction effect is absent because it is not estimable otherwise.

Table 6
Intra-class correlation coefficient table with 95% confidence interval with p < 0.001 for the total CPOT score at the end of
positioning.

Intra-class Correlation Coefficient

Intra-class Correlationb 95% Confidence Interval F Test with True Value 0

Lower Bound Upper Bound Value df1 df2 Sig

Single Measures .523a .359 .672 4.289 49 98 .000

Average Measures .767c .627 .860 4.289 49 98 .000

Two-way mixed effects model where people effects are random and measures effects are fixed.
a
The estimator is the same, whether the interaction effect is present or not.
b
Type C intra-class correlation coefficients using a consistency definition. The between-measure variance is excluded from
the denominator variance.
c
This estimate is computed assuming the interaction effect is absent because it is not estimable otherwise.

Table 7
Intra-class correlation coefficient table with 95% confidence interval with p < 0.001 for the total CPOT score at the beginning of
suctioning.

Intra-class Correlation Coefficient

Intra-class Correlationb 95% Confidence Interval F Test with True Value 0

Lower Bound Upper Bound Value df1 df2 Sig

a
Single Measures .899 .844 .938 27.649 49 98 .000
Average Measures .964c .942 .978 27.649 49 98 .000

Two-way mixed effects model where people effects are random and measures effects are fixed.
a
The estimator is the same, whether the interaction effect is present or not.
b
Type C intra-class correlation coefficients using a consistency definition. The between-measure variance is excluded from
the denominator variance.
c
This estimate is computed assuming the interaction effect is absent, because it is not estimable otherwise.
 H. Maatouk et al. / Data in brief 25 (2019) 103997 5

agreement of the CPOT total score was analyzed with an average measure of ICC of 0.882 showing also
excellent reliability among the raters with a 95% confidence interval from 0.811 to 0.929 (F
(49,98) ¼ 8.475, p < 0.0001) (Refer to Table 8). Finally, Table 10 shows the Critical Care Nurses’ eval-
uation after they were asked to provided their feedback after the implementation of CPOT using the
“CPOT Participant Evaluation Form” (see Table 9).

Table 8
Intra-class correlation coefficient table with 95% confidence interval with p < 0.001 for the total CPOT score at the end of
suctioning.

Intra-class Correlation Coefficient

Intra-class Correlationb 95% Confidence Interval F Test with True Value 0

Lower Bound Upper Bound Value df1 df2 Sig

Single Measures .714a .589 .814 8.475 49 98 .000

Average Measures .882c .811 .929 8.475 49 98 .000

Two-way mixed effects model where people effects are random and measures effects are fixed.
a
The estimator is the same, whether the interaction effect is present or not.
b
Type C intra-class correlation coefficients using a consistency definition. The between-measure variance is excluded from
the denominator variance.
c
This estimate is computed assuming the interaction effect is absent, because it is not estimable otherwise.

Table 9
Data of the questionnaire about the feasibility and clinical utility of the critical-care pain observation tool (n ¼ 30).

Question Not at all A Little Uncertain Sufficiently Very

(1) (2) (3) (4) (5)

Was the length of time sufficient to train 0 0 0 56.7% (n ¼ 17) 43.3% (n ¼ 13)
to use the CPOT accurately?
Were the directives about the 0 0 6.7% (n ¼ 2) 33.3% (n ¼ 10) 60% (n ¼ 18)
use of the CPOT clear?
Is the CPOT quick to use? 0 3.3% (n ¼ 1) 0 33.3% (n ¼ 10) 63.3% (n ¼ 19)
Is the CPOT simple to understand? 6.7% (n ¼ 2) 0 0 23.3% (n ¼ 7) 70% (n ¼ 21)
Is the CPOT easy to complete? 0 16.7% (n ¼ 5) 0 0 83.3% (n ¼ 25)
Would you recommend using 0 0 6.7% (n ¼ 2) 26.7% (n ¼ 8) 66.7% (n ¼ 20)
the CPOT routinely?
Is the CPOT helpful for nursing practice? 3.3% (n ¼ 1) 0 6.7% (n ¼ 2) 36.7% (n ¼ 11) 53.3% (n ¼ 16)
Has the CPOT positively influenced your 0 6.7% (n ¼ 2) 0 30% (n ¼ 9) 63.3% (n ¼ 19)
practice in assessing the patient’s pain?

Table 10
Results of the questionnaire about the feasibility and clinical utility of the critical-care pain observation tool (n ¼ 30).

Question Not at all A Little Uncertain Sufficiently Very

(1) (2) (3) (4) (5)

Was the length of time sufficient to 0 0 0 56.7% (n ¼ 17) 43.3% (n ¼ 13)

train to use the CPOT accurately?
Were the directives about the 0 0 6.7% (n ¼ 2) 33.3% (n ¼ 10) 60% (n ¼ 18)
use of the CPOT clear?
Is the CPOT quick to use? 0 3.3% (n ¼ 1) 0 33.3% (n ¼ 10) 63.3% (n ¼ 19)
Is the CPOT simple to understand? 6.7% (n ¼ 2) 0 0 23.3% (n ¼ 7) 70% (n ¼ 21)
Is the CPOT easy to complete? 0 16.7% (n ¼ 5) 0 0 83.3% (n ¼ 25)
Would you recommend 0 0 6.7% (n ¼ 2) 26.7% (n ¼ 8) 66.7% (n ¼ 20)
using the CPOT routinely?
Is the CPOT helpful for nursing practice? 3.3% (n ¼ 1) 0 6.7% (n ¼ 2) 36.7% (n ¼ 11) 53.3% (n ¼ 16)
Has the CPOT positively influenced 0 6.7% (n ¼ 2) 0 30% (n ¼ 9) 63.3% (n ¼ 19)
your practice in assessing the patient’s pain?
6 H. Maatouk et al. / Data in brief 25 (2019) 103997

2. Experimental design, materials, and methods

2.1. Design

A Quasi-experimental Design was implemented to answer the following research questions (1)“Is
the CPOT an efficient tool to be used by critical care nurses in assessing pain of mechanically ventilated
patients?” and (2) What are the Critical Care Nurses’ views towards the introduction and imple-
mentation of CPOT?“.

2.2. Sample and settings

The subjects were critical care registered nurse working in adult critical care unit caring for adult
mechanically ventilated patients. A sample of 30 critical care nurses that fit the inclusion criteria were
recruited. Critical care nurses who failed the CPOT training module and part-time adult critical care
nurses were not included. The data collection extended over 4 phases from August 21, 2017 till October
14, 2017.

2.3. Questionnaires

Well-established psychometric instruments were used in primary data collection method, which
is Critical Care Pain Observation Tool and the Feasibility and clinical utility CPOT Questionnaire. The
critical-care pain observation tool “CPOT” is based on four domains: Patient’s facial expressions,
Body movements, Compliance with a ventilator (or voice use for non-intubated patients), Muscle
tension. The CPOT was chosen as it is a valid, reliable and clinically feasible tool adding up to Barr
et al. (2013) and other researchers recommendation for the usage of this tool, besides the top
management choice of this tool [1-3]. The CPOT was developed for assessing pain in critically ill
adult patients unable to self-report pain. The CPOT is to be used when a patient is at rest to obtain a
baseline value, during painful procedures, and before and after administering analgesics to assess
the effectiveness of treatment [4]. In addition, CPOT includes four behavioral pain pointers: facial
expression, body movements, compliance with ventilator and muscle tension. Each indicator is
notched on a scale from 0 to 2, with the total score of 8 [5]. Feasibility and clinical utility are
considered when it comes to studying the effect of implementing and launching a new practice.
Feasibility is referred as the tool is simple to understand, easy to complete, and quick to use,
whereas clinical utility is the ability to use the data of the tool in a useful or informative way within
the clinical setting [6]. The evaluation form consists of eight closed-ended questions on a Likert scale
response from 1 to 4 developed by conclusiveness made by the research team of [6,7]. It includes
questions for its ease of use, clear directions, helpful for nursing practice, help with pain assessment,
adequate pain evaluation, and satisfaction with the tool. In addition, it includes a part in which nurse
will be asked for any suggestions for improvement or modifications to the actual tool to adapt it to
the local setting.

2.4. Statistical analysis

To address the objectives, data was collected for the purpose of evaluating the tool implementation.
Statistical Package for the Social Sciences (SPSS) version 24 was used to examine and understand the
distribution of data [8]. Data were expressed as percentages for discrete variables. Weighted kappa
analysis was used to measure the inter-rater agreement among CCNs and Intra-class correlation
analysis was also employed to assess the correlation between these raters. Kappa values range from 1
to þ1, the higher the value of kappa, the stronger the agreement. In addition, a descriptive analysis for
the Likert-type scale was used to perceive the nurse's response after using the CPOT.
 H. Maatouk et al. / Data in brief 25 (2019) 103997 7

Acknowledgments

The authors are thankful to the Faculty of Health Sciences of Beirut Arab University and the nurses
that have participated in the data collection as well as to anyone who contributed to its
accomplishment.

Conflict of interest

The authors declare that they have no known competing financial interests or personal relation-
ships that could have appeared to influence the work reported in this paper.

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