Nurses’ perceived feasibility and the clinical utility of the Nociception Level (NOL™) Index for pain assessment in critically ill adults

Introduction: The Nociception Level (NOL™) Index monitors nociception and related pain using multiple physiologic parameters through a non-invasive finger probe and is currently undergoing validation for pain assessment in the Intensive Care Unit (ICU). This study aimed to describe its feasibility and clinical utility from nurses’ perspectives, which is crucial for its potential adoption in clinical practice. Methods: This descriptive study involved ICU nurses who received a brief training (5-minute video and handout) as part of the validation process of the NOL Index in a medical-surgical ICU. Trained nurses who used the NOL Index at the ICU bedside completed a self-administered questionnaire on its feasibility and clinical utility on a 4-point scale. Scores of 3 and 4 supported its feasibility and clinical utility. Results: Of the 21 trained nurses, nine (43%) used the NOL on enrolled patients, but eight (38%) completed the questionnaire. Their average age was 34 years, and 63% were female. Feasibility indicators were endorsed by 95% of nurses supporting the NOL’s easy application, installation, and calibration, with clear usage instructions. Training strategies (i.e., video and handout) were rated positively with scores ≥ 3/4 by 95% of nurses. Nurses recommended adding more hands-on practice for the bedside use of the NOL. Clinical utility indicators were endorsed by 87.5 % of nurses suggesting it should remain an assistive, not a diagnostic tool. Indeed, several factors including patient’s hemodynamic instability and movements limit the NOL Index’s use in the ICU. Conclusion: Nurses perceived the NOL Index as a potential alter- native measure for pain assessment in mechanically ventilated and sedated ICU patients unable to self-report.