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Unlabelled: Many critically ill patients are unable to self-report their pain. In such situations, the use of valid behavioral pain scales is recommended., Objective: To validate the use of the Critical-Care Pain Observation Tool (CPOT) with brain surgery adults in the neurosurgical intensive care unit., Design: Repeated-measure within subject prospective design., Settings: Forty-three elective brain surgery patients of a Canadian university hospital participated., Method: Participants were video recorded and scored with the CPOT before, during and after a non-nociceptive (non-invasive blood pressure using cuff inflation) and a nociceptive (turning) procedure for a total of six assessments. Self-reports of pain were also obtained., Results: Discriminant validation was supported with higher mean CPOT scores during the nociceptive procedure compared with the non-nociceptive one. More participants reported higher pain intensity during turning compared with cuff inflation. Criterion validation was supported with a moderate positive correlation between self-reports of pain intensity and CPOT scores during turning. Interrater and intrarater reliability of CPOT scores through the viewing of participants' videos by two trained raters was supported with high Intraclass Correlation Coefficients., Conclusion: The CPOT appears to be valid for the detection of pain in elective brain surgery patients in the neurosurgical intensive care unit., (Copyright © 2014. Published by Elsevier Ltd.)

Intensive care units are arguably one of the most costly resources a hospital has to maintain in terms of nursing staff, skills and technology. Given that the Government's agenda on quality remains one of obtaining cost-effective healthcare, it is imperative that nursing managers consider the implications of the new policy shift for how they currently provide services. The purpose in this paper is to compare the different staffing levels adopted by managers in generalized and neurosurgical intensive care in an acute hospital trust. The dilemmas facing managers making staffing decisions without any definitive guidelines for resourcing these specialized units are examined.