Majid Akhond - MSc Student in Critical Care Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
Razieh Froutan - Assistant Professor, Dept. of Medical Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.
Javad Malekzadeh - Instructor of Nursing, Department of Medical Emergency, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
Seyed Reza Mazlom - Instructor, Dept. of Medical Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran; Member of Evidence Based Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

Background: Neglecting the pain assessment in intensive care unit (ICU) patients with decreased level of consciousness (LOC) can lead to inappropriate pain management. Implementation of a pain management protocol may contribute to avoiding such negligence. Aim: This study aimed to determine the effect of using a pain monitoring protocol on the pain intensity of ICU patients with decreased LOC. Method: This clinical trial was conducted on 60 nurses and 120 patients in the surgical ICUs of Imam Reza and Ghaem hospitals, Mashhad, Iran, 2016. The nurses in the intervention group were trained about pain management protocol in three 20-minute sessions (each session for 10 nurses). Before and after two weeks of training, the patients pain intensity was monitored using the Nonverbal Pain Scale (NVPS) for three months during the resting-state, suctioning, and dressing change. The patients in the control group received routine nursery care. Data analysis was performed using independent and paired t-tests in the SPSS software version 22. Results: The nurses in the intervention and control groups had a mean age of 38.1±6.4 and 41.2±7.1 years, respectively. The results of independent t-test demonstrated no difference between overall pain intensity (P=0.08), pain intensity during resting-state (P=0.11), suctioning (P=0.23), and dressing change (P=0.06) scores among two groups before the intervention, however after the intervention, there was a significant reduction in the intervention group in comparison to the control group in all mentioned aspects (P<0.001) Implications for Practice: It was found that a satisfactory prediction of pain intensity during resting-state and painful procedures is obtained by using a pain management protocol, which enables the nurses to address the underlying causes of the pain and provide the necessary cares. 

Decreased consciousness, ICU, pain intensity, Pain management