Pain Assessment in Non-Communicative Critically Ill Adult Patients: The Contribution of the CPOT to Specialized Nursing Practice

Pain assessment in non-communicative critically ill adult patients is a clinical challenge that requires approaches adapted to their ability to communicate. This scoping review aimed to map the scientific evidence on the use of the Critical-Care Pain Observation Tool (CPOT) for pain assessment in this population in intensive care units and to identify its potential contributions to specialized nursing practice. The review followed the Joanna Briggs Institute methodology and was reported according to PRISMA-ScR. Eligibility was defined using the Population–Concept–Context framework, and data were charted and synthesized narratively. Of 330 records identified, 9 studies were included, conducted in different intensive care settings. CPOT implementation increased the frequency of pain assessment and, in one study, reassessment, and promoted its integration into clinical protocols. The instrument showed acceptable validity and variable inter-rater reliability, including in its European Portuguese version. CPOT scores were associated with disease severity and sedation level, with reduced behavioral expression of pain under deeper sedation. The mapped evidence indicates that the CPOT strengthens systematic pain assessment and supports individualized pain management, contributing to evidence-based specialized nursing practice.