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

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. 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. Realist synthesis method was employed to systematically review literature for developing a programme theory. 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. 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. Pain assessment interventions are influenced by a constellation of factors which trigger mechanisms yielding effective implementation outcomes. The results have implications on policy makers, health organisations, nursing teams and nurses concerned with optimising the successful implementation of pain management interventions. The review enabled formation of a programme theory concerned with explaining how to effectively implement pain management interventions in intensive care. This review was informed by RAMESES publication standards for realist synthesis. No patient or public contribution. The study protocol was registered in Open Science Framework. 10.17605/OSF.IO/J7AEZ.