• Kathleen A Puntillo, Deborah Smith, Shoshana Arai, and Nancy Stotts.
• University of California San Francisco, Department of Physiological Nursing, San Francisco, California CA 94143-0610, USA.
• Heart Lung. 2008 Nov 1; 37 (6): 466-75.

BackgroundPatients in intensive care units (ICUs) can be adversely affected by distressing symptoms. When critically ill patients are unable to self-report symptoms, ICU nurses become proxy reporters.ObjectiveThe purpose of this prospective, descriptive study was to explore how ICU nurses assess and treat distressing symptoms in critically ill patients at high risk of dying.MethodsTwenty-two nurses participated in this single-site, prospective, descriptive study and described their patients' symptoms and how the symptoms were being managed in response to interviews that used open-ended questions. Taped interviews were transcribed verbatim, and themes were identified.ResultsThree major themes were derived from the data: 1) signs of symptoms, (2) treatment of symptoms, and (3) "symptoms" versus "signs." Most nurses did not make distinctions between the assessment of "signs" of disease and the assessment of "symptoms," and consequently, signs and symptoms were frequently inventoried collectively.ConclusionCritically ill patients experience a broad range of symptoms. Continued attempts to validate nonverbal measures of symptoms are warranted because lack of such measures may adversely affect symptom treatment for critically ill patients. Furthermore, heightened awareness and increased education of nurses to differentiate between signs and symptoms lay the foundation for increasing attention on symptoms, improving accuracy of symptom assessment, and guiding appropriate symptom management.

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