Skip to main content
NCBI home page
Wiley Open Access Collection logoLink to Wiley Open Access Collection
. 2024 Aug 11;34(3):795–804. doi: 10.1111/jocn.17385

Construction of an assessment scale for thirst severity in critically ill patients and its reliability and validity

Chunli Liao 1, Qiongyao Guan 1, Xiangping Ma 1,✉, Xueting He 1, Yan Su 1, Dandan Fan 1, Jing Liu 2, jinyu Ye 2, Xifeng He 2, Pengyu Cui 1,✉
PMCID: PMC11808416  PMID: 39128973

Abstract

Objective

Developing a severity assessment scale for critically ill patients' thirst and conducting reliability and validity tests, aiming to provide healthcare professionals with a scientific and objective tool for assessing the level of thirst.

Methods

Based on literature review and qualitative interviews, a pool of items was generated, and a preliminary scale was formed through two rounds of Delphi expert consultation. Convenience sampling was employed to select 178 ICU patients in a top‐three hospital from May 2023 to October 2023 as the study subjects to examine the reliability and validity of the severity assessment scale for critically ill patients' thirst.

Results

The developed severity assessment scale for critically ill patients' thirst consists of 8 evaluation items and 26 evaluation indicators. The agreement coefficients for two rounds of expert consultation were 100% and 92.6% for the positive coefficient, and the authority coefficients were .900 and .906. Kendall's concordance coefficients were .101 and .120 (all p < .001). The overall Cronbach's α coefficient for the scale was .827. The inter‐rater reliability coefficient was .910. The Item‐Content Validity Index (I‐CVI) ranged from .800 to 1.000, and the Scale‐Content Validity Index/Average (S‐CVI/Ave) was .950.

Conclusion

The critically ill patients' thirst assessment scale is reliable and valid and can be widely used in clinical practice.

Patient or Public Contribution

The AiMi Academic Services (www.aimieditor.com) for English language editing and review services.

Implications for Clinical practice

The scale developed in this study is a simple and ICU‐specific scale that can be used to assess the severity of thirst in critically ill patients. As such, the severity of thirst in critically ill patients can be evaluated quickly so that targeted interventions can be implemented according to the patient's specific disease and treatment conditions. Therefore, patient comfort can be improved, and thirst‐related health problems can be prevented.

Keywords: assessment, critically ill patients, develop, nursing, reliability, scale, thirst, validity

What does this paper contribute to the wider global community?

  • Now, The lack of thirst assessment tools for critically ill patients at home and abroad, this study developed a thirst assessment tool suitable for critically ill patients, to provide a scientific and reliable assessment tool for the management and intervention of thirst in critically ill patients.

  • It is beneficial for medical staff to correctly identify the thirst disturbance and symptoms of critically ill patients, enabling them to implement appropriate interventions and strategies to alleviate thirst in critically ill patients.

1. INTRODUCTION

Water is a basic human need, thirst is a subjective sensation that makes one desire to drink water (Waldréus et al., 2013). Additionally, it is a protective mechanism for the body to regulate body fluid balance and maintain homeostasis in the internal environment (McKinley et al., 2004). Greenleaf, (1992) defined thirst as the desire to drink water caused by the lack of sufficient water due to physiological or behavioural factors, and this was mainly divided into hypertonic thirst and hypovolemic thirst. Critically ill patients commonly experience symptoms of thirst due to illness, treatment, medication, and the environment (Negro et al., 2022; Rose et al., 2014; Wu et al., 2022). Research has shown (Baumstarck et al., 2019; Puntillo et al., 2010, 2014) that thirst is one of the most intense and distressing symptoms experienced by critically ill patients. The suffering caused by a thirst for these patients can even exceed that of pain and anxiety. Furthermore, many critically ill patients retain painful memories of discomfort, such as thirst, experienced during their time in the ICU, even after they have been discharged (Wang et al., 2015).

However, due to cognitive impairments, endotracheal intubation, and communication difficulties, most critically ill patients cannot report their thirst. In addition, clinical medical staff have insufficient awareness of the thirst of critically ill patients and are not readily aware of their demands (Li et al., 2022). As a result, the symptoms of thirst in these patients often are not promptly alleviated (Zhang, Jiang, et al., 2022). Additionally, persistent and severe thirst can lead critically ill patients to experience a strong sense of helplessness and despair, increasing the risk of delirium (Lin, Li, & Luo, 2023; Sato et al., 2019) and triggering nursing safety incidents. It also places patients in a heightened state of stress, further increasing their oxygen consumption and metabolic burden, delaying their recovery, and ultimately contributing to an increased mortality rate (Han et al., 2021; Schittek et al., 2021).

ICU patients commonly experience a sense of thirst that significantly affects their quality of life (Kjeldsen et al., 2018). Thus, healthcare professionals must recognize and address this issue appropriately, as it requires widespread attention. Accurate nursing assessment serves as the first step in improving the quality of care (Zhao et al., 2019). Currently, various countries use the Thirst Distress Scale (TDS) (Diao et al., 2019; Zhang et al., 2019), the Visual Analog Scale (VAS) (Tu et al., 2020), and Numeric Rating Scale (NRS) (Kong, 2022) to measure thirst in patients with heart failure and maintenance haemodialysis. Additionally, the Postoperative Thirst Distress Scale (PTDS) measures thirst in perioperative patients (Huang et al., 2022; Zhang, Gu, et al., 2022). However, assessing thirst in critically ill patients is still in its early stages, primarily utilizing the NRS (Doi et al., 2021; Zhang & You, 2021) and the VAS (Can et al., 2023; Sato et al., 2023). However, the above scales are subjective assessment tools that require patients ‘self‐assessment and self‐report. Moreover, they have high requirements for patients’ consciousness state and cognitive function, which may limit their applicability in assessing thirst in critically ill patients (Zhao et al., 2019).

In view of the lack of thirst assessment tools for critically ill patients at home and abroad, this study aims to develop a thirst assessment tool suitable for critically ill patients and evaluate its reliability and validity in critically ill patients, The goal is to provide a scientific and reliable assessment tool for the management and intervention of thirst in critically ill patients. Moreover, it is beneficial for medical staff to correctly identify the thirst disturbance and symptoms of critically ill patients, enabling them to implement appropriate interventions and strategies to alleviate thirst in critically ill patients. Doing so is expected to reduce complications caused by thirst, ensure patient safety, and improve the overall quality of life for critically ill patients.

2. METHODS

2.1. Establishing a research team on the subject

To carry out this research, a research team was established, taking into account the actual staffing situation and the willingness of personnel within the department. The research team comprised 10 members, including one doctoral student, five master's students, and four undergraduate students. The professional titles within the research team were three senior associate titles, six intermediate titles, and one junior title. Among them was one nurse manager who served as the team leader and was responsible for overseeing the project's direction and ensuring the research's quality management. Additionally, there was one head of the nursing research department responsible for coordinating the study's progress and assessing the completion status at different stages of the study. The remaining team members were responsible for the following primary tasks: (1) Conducting literature reviews from domestic and international sources, conducting qualitative interviews, they determined the item pool and prepared an expert inquiry questionnaire. (2) Identified expert consultants and established communication with them. (3) Collected questionnaires, organized and analysed the opinions and rating results obtained from the expert consultations. Developed the final assessment scale for thirst in critically ill patients.

2.2. Constructing the item pool for the assessment scale of thirst severity in critically ill patients

Using search terms such as ‘ICU/intensive care unit/critical care/critically ill patients’ AND ‘thirsty/thirst/xerostomia/dry mouth/feeling thirsty’ AND ‘Assessment/evaluation/prediction/scale,’ the research team conducted literature searches in the following databases: CNKI, Wanfang Medical Online, VIP Chinese Journal Database, CBM, PubMed, Medline, Web of Science, Embase, CINAHL. The search covered the period from January 1900 to January 2023. Additionally, the research team reviewed and analysed the retrieved literature and summarized the findings. Five assessment items were extracted (lip moisture/dryness, oral mucosa, tongue surface, saliva volume, sputum viscosity). A semi‐structured, in‐depth interview was conducted with five doctors and 10 nurses from the Intensive Care Medicine Department of the Affiliated Hospital of Medical University. The sample inclusion criteria were as follows: ① Having at least 5 years of working experience in critical care. ② Possessing a valid medical practitioner licence or nursing licence. ③ Capable of actively participating in and completing the interview smoothly. ④ Those who are well‐informed about the research and have provided their consent to participate. Exclusion criteria were as follows: Individuals engaged in further education or professional development. A preliminary interview guide was developed based on the literature review and in alignment with the research objectives. Subsequently, two medical specialists and three nursing specialists in critical care (all holding senior professional titles) were invited to discuss the comprehensiveness and rationality of the interview guide. We carefully listened to the expert opinions and made records. The formal interview outline was revised according to the expert opinions: ① Do you think the critically ill patients will feel thirsty? ② What medical and nursing problems do you think are caused by thirst in critically ill patients? ③ What signs and movements do you recognize from the patient's thirst? ④ What are your assessments of thirst in critically ill patients? Please talk about the specific evaluation process. ⑤ Do you have advice for constructing a thirst assessment scale for critically ill patients? The interviews were conducted in a quiet, undisturbed location for 20–30 min. Two researchers conducted the interviews. After each interview, the researchers promptly transcribed the collected data into written form. They then summarized, coded, and extracted key themes from the interviews. The themes of extraction are dry lips, dry tongue, dry mouth, sticky saliva, sticky sputum, bad breath, oliguria, patient suction action, fingers to lips, lips, chewing hose, and knock bedrails. Based on literature results and qualitative interviews, the research team formulated the evaluation framework of critically ill patients with seven assessment items (lip moisture, oral mucosa moisture, tongue and tongue coating, saliva volume, sputum viscosity, dry mouth accompanying symptoms, patient behavioural signs) and 22 evaluation indicators.

2.3. Delphi method was used to construct a rating scale for assessing the degree of thirst in critically ill patients

2.3.1. Developing an expert inquiry questionnaire

The research team referred to the literature (Doi et al., 2021; Pan et al., 2019; Wen et al., 2015; Zhang, Jiang, et al., 2022) and combined the results of qualitative interviews with clinical practice. They also conducted group discussions to construct the Delphi expert inquiry questionnaire, consisting of an introductory letter to the experts, the questionnaire itself, and an expert information survey form. Moreover, an introductory letter to experts briefly introduced the purpose and significance of the study, the requirements for completing the questionnaire, the time frame for return, and the contact information of the person in charge of the consulting experts. Regarding the consultation form for indicators of thirst severity assessment scale in critically ill patients, the experts were asked to use the LIKERT 5‐point scale to score the ‘importance’ of the primary items and the ‘reasonableness’ of the secondary items in which the higher the score, the higher the degree of ‘importance and reasonableness.’ Additionally, they were to set up supplementary, modification, and deletion columns for the experts to fill in when needed. The expert information survey form included the name, age, gender, education, professional title, position, field of expertise, year of experience, judgement basis and familiarity with each item.

2.3.2. Selection of experts for correspondence

Based on the research needs of the project and following the principles of expert selection (Dai et al., 2024), the following selection criteria have been established: (1) Having more than 10 years of work experience in the field of critical care. (2) Holding a senior or higher professional title. (3) Holding a bachelor's degree or higher. (4) A high level of field knowledge before this survey.

2.3.3. Expert letter

Before the inquiry, we contacted the experts who met the selection criteria, introduced the purpose and significance of this research to the experts, and obtained their consent. After obtaining the consent, distribute the questionnaire via email, WeChat, or face‐to‐face and request the experts to complete and return the questionnaire within 2 weeks. The research consisted of two rounds of expert inquiries. After each round, the research team members summarized, organized, and analysed the experts' opinions. After a collective discussion in the team meeting, modifications, deletions, or additions were made to the various indicators. We then deleted or modified entries with mean <4.0 and coefficient of variation >.2. We added items that two or more experts suggested. After completing the second round of expert inquiries, the ‘Assessment Form for the Severity of Thirst in Critically Ill Patients’ was created.

2.4. Reliability and validity testing

2.4.1. Study subjects

The convenience sampling method was used to select patients admitted to the Intensive Care Unit of Affiliated Hospital of Medical University from May 2023 to October 2023 as the study subjects. Inclusion criteria were: ① Patients with cognitive dysfunction, endotracheal intubation, and communication difficulties are unable to report thirst independently; ② age ≥18 years; ③ patients or their family members willing to participate in this study and sign the written informed consent. Exclusion criteria were: The patient is under rescue. This study has been approved by the Ethics Committee of our hospital with the approval number KYLX2023‐095.

2.4.2. Survey tools

① The formal survey version of the ‘Assessment Form for the Severity of Thirst in Critically Ill Patients.’ This survey included bed number, name, gender, age, hospitalization number, diagnosis, evaluation date, responsible person, and thirst assessment form for critically ill patients.

2.4.3. Survey methods

Prior to the start of the survey, the head nurse conducted offline training for the nurses. The training included the current status of thirst in critically ill patients, the harm caused by thirst to critically ill patients, the purpose and significance of thirst assessment in critically ill patients, the usage guidelines for the ‘Assessment Form for the Severity of Thirst in Critically Ill Patients,’ intervention measures for thirst in critically ill patients. The training was conducted in a PowerPoint presentation format, followed by practical exercises. Following training, nurses were assessed on their operational skills, and all nurses were required to pass the assessment before conducting this study. Nurses evaluated each item of thirst evaluation, including the moisture/dryness of the patients' lips, condition of the oral mucosa, tongue texture and coating, viscosity of sputum, salivation quantity and viscosity, accompanying symptoms of dry mouth, and behavioural signs of patients. Based on the evaluation, nurses completed the formal survey version of the ‘Assessment Form for the Severity of Thirst in Critically Ill Patients.’ The assessment was conducted every 4 h.

2.5. Statistical methods

The data was entered and cross‐verified by two individuals. Statistical analysis of the data was conducted using SPSS 26.0 software. Frequency and composition ratios were used for categorical data. The questionnaire response rate represented the positive coefficient of experts. The authority coefficient (Cr) will be used to indicate the level of expertise, calculated as Cr = (judgement basis (Ca) + familiarity level (Cs)) /2. The mean and coefficient of variation represented the concentration of expert opinions. The degree of agreement among expert opinions was represented by Kendall's coefficient of concordance (Kendall W). The item discrimination uses critical ratio analysis to compare, the difference between two extreme groups (the first 27% of the total score is the high group, and the last 27% is the low group), using an independent sample t‐test. If p > .05 or the critical ratio <3.00, the item discrimination is poor and should be considered for deletion. Reliability testing was evaluated using Cronbach's α coefficient and inter‐rater reliability. Validity testing will be evaluated using content validity.

3. RESULTS

3.1. Basic information of experts

This study's final selected expert panel consisted of 27 experts, including the Dean of the School of Nursing, the Director of the Nursing Department, the Department head, the head nurse, and clinical frontline doctors and nurses. The experts had an average age of 42.52 ± 5.28 years and an average work experience of 18.30 ± 5.94 years. Please refer to Table 1 for more detailed information.

TABLE 1.

Basic information table for correspondence experts (n = 27).

Items Number of people (n) Composition ratio (%)
Age (years)
30~ 8 29.63
40~ 16 59.26
≥50 year 3 11.11
Gender
Male 7 25.93
Female 20 74.07
Professional work experience (in years)
10 ~ 19 years 12 44.44
20 ~ 29 10 37.04
≥30 years 5 18.52
Professional field
Clinical medicine 7 25.92
Clinical care 11 40.74
Care management 5 18.52
Nursing education 2 7.41
Nursing research 2 7.41
Education
Undergraduate 9 33.33
Master's degree 13 48.15
Doctoral students 5 18.52
Title
Intermediate 11 40.74
Associate senior 12 44.44
Senior 4 14.82
Position
Clinical frontline doctors and nurses 12 44.44
Head nurse 6 22.22
Department Head 2 7.41
Director of the Nursing Department 5 18.52
Vice President of hospital 2 7.41
Open in a new tab

3.2. Positive coefficient of experts

In this study's first and second rounds, 27 questionnaires were sent to experts. In the first round, 27 questionnaires were collected, while in the second round, 25 questionnaires were collected. The response rates for the questionnaires were 100% and 92.6%, respectively. After the first round of inquiries, 18 experts provided 27 suggestions for modifications and supplements. After the second round of inquiries, two experts provided three suggestions for modifications and supplements.

3.3. Expert authority coefficient

In this study, The familiarity coefficients (Cs) for the two rounds of inquiries were .867 and .876, while the judgement coefficients (Ca) were .930 and .936. Therefore, the authority coefficients were calculated as .900 and .906.

3.4. Concentration and coordination level of expert opinions

The concentration of expert opinions was expressed using the mean of essential indicators and the coefficient of variation. In this study, the mean importance scores for the two rounds of inquiries ranged from 4.30 to 4.93 and 4.32 to 4.92, while the coefficient of variation ranged from .05 to .19 and .04 to .18. Kendall's W coefficient represents the coordination of expert opinions. In this study, Kendall's W coefficients for the two rounds of expert inquiries were .101 (χ 2 = 83.516) and .120 (χ 2 = 77.451), with both p < .001.

3.5. Modification status of the items

In the first round of expert consultation, the experts pointed out that: ① The evaluation methods of sputum viscosity in patients with tracheal intubation and non‐tracheal intubation patients were inconsistent; the non‐tracheal intubation patients were judged by whether they could cough up sputum by themselves. In contrast, tracheal intubation patients could not cough up sputum by themselves, and endotracheal aspiration was required; whether the sputum in the suction tube was easily flushed by water should be used as the criterion for judgement. ② It is only necessary to evaluate the saliva volume and viscosity of patients with tracheal intubation. Since the swallowing function of non‐intubated patients is normal, there is likely no saliva accumulation in the mouth. Thus, it is not necessary to evaluate the saliva volume and viscosity. Patients with tracheal intubation will also accumulate a large amount of saliva in the mouth due to catheter irritation and swallowing dysfunction. ③ In addition to dry mouth, lip peeling, phlegm sticky, dry skin, skin turgor, sunken eye socket, hoarse voice, and difficulty swallowing are also external manifestations of thirst. When patients have these symptoms, indicating insufficient water intake or dry mouth, patients will also experience thirst. In addition, it is necessary to consider the balance of the patient's intake, outflow, and various abnormalities in urine volume. Following intensive discussion, the research team decided to distinguish sputum viscosity between tracheal intubated and non‐intubated patients for evaluation and not to evaluate saliva volume and viscosity in non‐intubated patients. Likewise, they supplemented, modified, and improved the evaluation indicators put forward by experts. After the end of the first round of consultation, one evaluation item and four evaluation indicators were added, and the expression of 22 evaluation indicators was modified and improved. After the end of the second round of expert consultation, the contents of the items were not modified, the expert opinions were reached, and the expert consultation was ended.

3.6. Form a thirst assessment scale for critically ill patients

The thirst assessment scale of critically ill patients formed after two rounds of expert letter inquiry contains eight assessment items and 26 assessment indicators, as shown in Table 2. According to the index description, ‘0,1,2 and 3’ points were assigned from ‘no thirst, mild thirst, moderate thirst, and severe thirst,’ respectively. The total score was the sum of the scores for each item. The higher the score, the more severe the patient's thirst was.

TABLE 2.

Assessment scale for thirst severity in critically ill patients.

Scores 0 1 2 3 Score
Items
Degree of lip moisture/dryness Smooth and moist Mild peeling Dry and cracked Cracking and bleeding
Oral mucosal condition Moist and smooth oral mucosa, pink in colour Intact oral mucosa, slightly dry Dry and rough oral mucosa with or without congestion and redness Very dry oral mucosa with or without ulcers, inflammation, and bleeding
Tongue texture and coating Pale red tongue with a thin white coating Red tongue with a light yellow coating Deep red tongue with thick and dry yellow coating Deep purple tongue with cracks, grey‐black and dry coating
No intubation Sputum viscosity Clear or white foamy sputum, easily expectorated White or yellow‐white sticky sputum requires effort to expectorate Significantly thick and sticky sputum, yellow and concentrated, difficult to expectorate Extremely sticky sputum that cannot be expectorated voluntarily, with sputum crust adhering to the oral cavity
Tracheal intubation Sputum viscosity No sputum retention on the inner wall of the suction catheter A small amount of sputum is retained in the suction catheter, easily flushed with water A large amount of sputum is retained in the suction catheter, not easily flushed with water Suction catheter with sputum crust adhesion or blockage, leading to collapse due to excessive negative pressure
Saliva volume and viscosity Normal saliva secretion, abundant and frothy or watery Decreased saliva secretion, slightly viscous with stringy consistency Reduced saliva production, viscous consistency resembling jelly No saliva pooling at the base of the mouth
Accompanying symptoms of dry mouth – – – Dry skin, poor skin elasticity, sunken eye sockets, oral odour, abnormal urine volume (anuria, oliguria, polyuria, etc.), negative balance in and out volume, non‐pathological hoarseness, or difficulty swallowing
Patient behavioural signs – – – Awake patients may moisten their lips with their fingers, patients with impaired consciousness may exhibit sucking motions, licking lips, etc.
Total Score
Open in a new tab

Note: Classification of thirst severity: ① 0 points, not thirsty; ② 1–3 points, mild thirst; ③ 4–6 points, moderate thirst; ④ ≥7 points, severe thirst.

3.7. Scale reliability and validity test

3.7.1. General information of the surveyed subjects

A total of 178 ICU patients were included in this study. Among them were 95 males (53.4%) and 83 females (46.63%). The age ranged from 18 to 91 years (mean age: 60.9±7.3). The main diagnoses included 67 cases of respiratory system diseases, 50 cases of digestive system diseases, 26 cases of urinary system diseases, 15 cases of gynaecological diseases, and 20 cases of other diseases. Furthermore, there were 77 mechanically ventilated patients, including 55 patients with tracheal intubation, 10 with tracheostomy, and 12 receiving non‐invasive ventilation.

3.7.2. Results of the critical ratio analysis

Twenty‐seven patients with ≥9 scores were classified as the high group, and 26 patients with ≤1 score were classified as low. Comparing the two groups, the critical ratio (Cr) of the eight thirst assessment items was 5.774–10.684, with significance levels <.001. Notably, all assessment items were >3.00 and p < .01, and there were no items needing to be deleted.

3.7.3. Reliability test results

The half‐fold coefficient of all possible items in the scale was averaged, namely Cronbach's α coefficient. In this study, Cronbach's α coefficient of the total scale was .827, indicating that the scale has good reliability. Two nurses were selected to evaluate the same patients. A total of 30 patients were assessed after the study; the correlation coefficient of the two nurses was calculated as the inter‐rater reliability, and the inter‐rater reliability of this scale was .910.

3.7.4. Content validity test results

Five experts in the field of critical illness (Associate professor and above) were invited to assess the content validity of the Thirst Assessment Form for Critical Patients. The Likert 4‐level scoring method was also used to evaluate the correlation of each item with the scale (including the empirical correlation and the measured structural concept correlation): (1) is ‘very irrelevant/incomprehensible/incomplete’; (2) is ‘irrelevant/incomprehensible/incomplete’; (3) are tolerableness; (4) are very relevant/easy to understand/comprehensive. Importantly, the results of this study showed that the I‐CVI was .800 ~ 1.000, and the S‐CVI/Ave was .950, indicating that the content validity is good.

4. DISCUSSION

4.1. The assessment scale for thirst severity in critically ill patients has good reliability and validity

This study developed the scale through Delphi expert consultation. The selection of experts during the Delphi consultation was a critical step (Liao et al., 2021). In this study, experts covered many areas, including critical care medicine, critical care nursing, nursing management, nursing education, and nursing research. 66.7% had Master's or Doctoral degrees with 59.3% having associate senior or senior titles, indicating good representativeness of the experts. Reliability refers to the stability, consistency, and reliability of the measurement results of a scale. In this study, Cronbach's α coefficient of the scale and the inter‐rater reliability were .827 and .910, respectively, indicating good reliability of the scale and reliable assessment results. Validity refers to whether the research tool truly measures the intended content and whether the scale items reflect the degree of the intended content being measured. When the Item‐Content Validity Index (I‐CVI) is ≥.78, and the Scale‐Content Validity Index/Average (S‐CVI/Ave) is ≥.90, the scale is considered to have high content validity (Gao & Guo, 2021). In this study, the I‐CVI of the developed Thirst Severity Assessment Scale ranged from .80 to 1.00, and the S‐CVI/Ave was .950, indicating a high content validity of the scale.

4.2. The assessment scale for thirst severity in critically ill patients has good practicality

Assessing thirst in critically ill patients is challenging in critical care nursing (Li & Mi, 2022), especially in patients with cognitive impairment and communication difficulties. The International Classification for Nursing Practice (ICNP) defines thirst as a perception of dryness in the mouth and throat and a desire for water (Alves Do Nascimento et al., 2021), Dry mouth is due to various factors caused by insufficient drinking water, or consumption and loss of a large amount of water that cannot be replenished in time, or the body water is reduced, so that the oral mucosa is not fully moisturized (Pierotti et al., 2018), Thus, thirst and dehydration in critically ill patients are highly related. In this study, based on a comprehensive understanding of the definition of thirst and related concepts and drawing on previous studies (Alves Do Nascimento et al., 2021; Doi et al., 2021; Landström et al., 2009), the research team developed an assessment scale for thirst severity in critically ill patients suitable for healthcare professionals. Importantly, this scale applies to all critically ill patients, including mechanically ventilated patients and non‐mechanically ventilated patients. These assessment items are comprehensive and easily recognizable indicators in daily work. Furthermore, the item descriptions are concise and easy to understand, and the assessment takes approximately 2±1.5 min, making it highly practical for clinical use.

4.3. Importance of using scale assessment in healthcare

Risk management is an important part of nursing management, including quantifying risk, identifying risk, dealing with risk. Notably, quantifying risk is the first step and the most important part of risk management. Thus, using the scale for comprehensive nursing assessment of critical patients can help medical staff understand the patient's needs and formulate personalized nursing measures to ensure the most suitable treatment and care for the patient (Lin, Li, Chen, & He, 2023). Through a comprehensive assessment of patients, potential complications or other health problems can be identified early, the effectiveness of treatment can be monitored, and treatment plans can be adjusted promptly based on the evaluation results. Moreover, the comprehensive assessment of critically ill patients requires the participation of different medical professionals. As such, this multidisciplinary cooperation can provide more comprehensive and integrated care, ensure that patients receive comprehensive physical, psychological, and social support, and improve patient and family satisfaction (Xiaoyu et al., 2021). The scale evaluation method is simple, low‐cost, and fast. It is also an effective and practical nursing risk assessment tool for caregivers to screen a large number of patients (Wang et al., 2014). Unfortunately, thirst is common in ICU patients and seriously affects their quality of life, leading to nursing adverse events that require medical personnel to pay attention to and give active management and intervention. Therefore, accurate nursing assessment is the first step in thirst management (Li & Mi, 2022).

4.4. The significance of constructing the assessment scale for thirst severity in critically ill patients

Critically ill patients generally experience thirst that cannot be relieved. A dry mouth leads to an imbalance of oral flora, which increases the chance of oral mucosal ulcer and infection. Moreover, the discomfort of thirst can easily lead to agitation and sleep disorders, greatly increase the risk of delirium, and easily induce nursing safety incidents. Worse still, continuous thirst puts patients in a state of intense stress, delaying and hindering the recovery of patients, increasing the mortality rate, and reducing the quality of life of patients after discharge.

However, there is currently a lack of assessment scales specifically designed to measure the severity of thirst in critically ill patients (Han et al., 2021). Constructing an assessment scale for thirst severity in critically ill patients is essential. First, it helps healthcare professionals deepen their understanding of patients' thirst. Second, it can help medical staff make accurate, comprehensive, and objective judgements of thirst in critically ill patients, allowing for interventions to be implemented based on the patient's specific diseases and treatment conditions. This can also help reduce patient discomfort and the occurrence of adverse events caused by thirst in critically ill patients, ensuring patient safety and improving both their survival rates and the quality of their care (Waldréus et al., 2018).

4.5. Study limitations and prospects

It should be noted that using the Delphi expert consultation method in this study introduces a certain degree of subjectivity, and there may be potential biases in the research results (He et al., 2021). In addition, all participants, including the consulting experts, are from China. Due to regional bias and cognitive influence, expert representation may be insufficient. In the future, more objective methods, such as multi‐attribute decision‐making, can be used to construct the thirst assessment scale. This study did not conduct further research on the clinical application effect of the scale. Although the mechanism of thirst occurrence has been clearly defined, thirst, like pain, is a subjective experience and feeling with significant individual differences. Likewise, these experiences can be influenced by factors such as health‐disease process, emotion, and environment. It is also a multi‐factor symptom (Stevenson et al., 2015), which is difficult to evaluate and manage. Thus, further research is needed to investigate the clinical application of the scale. Future multicentre studies with larger sample sizes are recommended to validate the clinical applicability of the assessment scale.

5. CONCLUSION

Through literature review, qualitative interview, and two rounds of Delphi expert correspondence, this study constructed the thirst degree assessment scale for critically ill patients and tested the reliability and validity of the scale. The rigorous development process ensured the scale's reliability, scientificity, clinical practicability, and good reliability and validity. Notably, ICU medical staff can use this scale to assess the degree of thirst in critically ill patients. As such, this not only helps to deepen the medical staff's understanding of thirst and improve the current situation of clinically neglected thirst in critically ill patients but also helps medical staff to accurately identify the thirst symptoms of critically ill patients and give timely intervention in future work. Thus, we aim to reduce the pain and adverse consequences caused by thirst and improve the quality of care for critically ill patients.

AUTHOR CONTRIBUTIONS

Chunli Liao: The conception and design of the study, drafting the article, revising it critically for important intellectual content. Pengyu Cui: The conception and design of the study, project administration, final approval of the version to be submitted. Qiongyao Guan: Funding acquisition, final approval of the version to be submitted. Xiangping Ma: Acquisition of data, revising it critically for important intellectual content. Xueting He: Analysis and interpretation of data. Yan Su: Acquisition of data. Dandan Fan: acquisition of data. Jing Liu: Final approval of the version to be submitted. jinyu Ye: The conception and design of the study. Xifeng He: The conception and design of the study.

FUNDING INFORMATION

This work was supported by The Science Research Fund Project of Yunnan Provincial Department of Education, China (2022 J0155).

CONFLICT OF INTEREST STATEMENT

None.

ETHICS STATEMENT

The hospital's ethics committee has approved this study (KYLX2023‐095).

ACKNOWLEDGEMENTS

The authors thank AiMi Academic Services (www.aimieditor.com) for English language editing and review services.

Liao, C. , Guan, Q. , Ma, X. , He, X. , Su, Y. , Fan, D. , Liu, J. , Ye, j. , He, X. , & Cui, P. (2025). Construction of an assessment scale for thirst severity in critically ill patients and its reliability and validity. Journal of Clinical Nursing, 34, 795–804. 10.1111/jocn.17385

Chunli Liao, Qiongyao Guan and Jing Liu are co‐first authors.

Contributor Information

Xiangping Ma, Email: 1152410799@qq.com.

Pengyu Cui, Email: 116142025@qq.com.

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

REFERENCES

  1. Alves do Nascimento, L. , de Oliveira Lopes, M. V. , & Fahl Fonseca, L. (2021). Development and validation of a new nursing diagnosis: Perioperative thirst. International Journal of Nursing Knowledge, 32(4), 253–261. 10.1111/2047-3095.12319 [DOI] [PubMed] [Google Scholar]
  2. Baumstarck, K. , Boucekine, M. , Estagnasie, P. , Geantot, M. , Berric, A. , Simon, G. , Floccard, B. , Signouret, T. , Fromentin, M. , Nyunga, M. , Sossou, A. , Venot, M. , Robert, R. , Follin, A. , Audibert, J. , Renault, A. , Garrouste‐Orgeas, M. , Collange, O. , Levrat, Q. , … IPREA Study group . (2019). Assessment of patients' self‐perceived intensive care unit discomforts: Validation of the 18‐item version of the IPREA. Health and Quality of Life Outcomes, 17(1), 29. 10.1186/s12955-019-1101-5 [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Can, S. , Gezginci, E. , & Yapici, N. (2023). Effect of menthol lozenges after extubation on thirst, nausea, physiological parameters, and comfort in cardiovascular surgery patients: a randomized controlled trial. Intensive & Critical Care Nursing, 76, 103415. 10.1016/j.iccn.2023.103415 [DOI] [PubMed] [Google Scholar]
  4. Dai, Q. , Liu, X. , Xu, X. , Fu, Y. , She, Z. , Huang, Y. , Xia, Y. , Chen, Y. , Cheng, A. S. K. , & Feuerstein, M. (2024). Development of a supportive care framework for breast cancer survivor's unmet needs: A Modified Delphi study. Journal of Clinical Nursing, 33(4), 1376–1386. 10.1111/jocn.16963 [DOI] [PubMed] [Google Scholar]
  5. Diao, Q. , Chen, Y. , Jiang, Q. , Yan, Y. , & Hu, Q. (2019). Evaluation for the application of thirst pain scale in maintenance hemodialysis patients. Journal of Nurses Training, 34(13), 1179–1183. 10.16821/j.cnki.hsjx.2019.13.007 [DOI] [Google Scholar]
  6. Doi, S. , Nakanishi, N. , Kawahara, Y. , & Nakayama, S. (2021). Impact of oral care on thirst perception and dry mouth assessments in intensive care patients: an observational study. Intensive & Critical Care Nursing, 66, 103073. 10.1016/j.iccn.2021.103073 [DOI] [PubMed] [Google Scholar]
  7. Gao, X. , & Guo, L. (2021). Development and reliability and validity test of the risk factor assessment scale for intraoperative acquired pressure injury. Chinese Journal of Nursing, 56(4), 556–560. 10.3761/j.issn.0254-1769.2021.04.013 [DOI] [Google Scholar]
  8. Greenleaf, J. E. (1992). Problem: Thirst, drinking behavior, and involuntary dehydration. Medicine and Science in Sports and Exercise, 24(6), 645–656. [PubMed] [Google Scholar]
  9. Han, Z. , He, Y. , Lu, Z. , Shi, Y. , Jin, J. , & Wang, X. (2021). Research progress on nursing care of thirst in critically ill patients. Chinese Journal of Nursing, 56(5), 782–785. [Google Scholar]
  10. He, F. , Guo, X. , Wang, Q. , Zhang, J. , & Jiao, H. (2021). Based on the Delphi method, the primary prevention self‐care checklist for people with high incidence of female pelvic floor dysfunction was constructed. Chinese Nursing Research, 35(21), 3906–3909. [DOI] [Google Scholar]
  11. Huang, C. , Lin, R. , Chen, L. , Chen, X. , Chen, M. , & Li, H. (2022). Chinese version and reliability and validity test of the perioperative thirst discomfort scale. Chinese Journal of Nursing, 57(7), 892–896. 10.3761/j.issn.0254-1769.2022.07.020 [DOI] [Google Scholar]
  12. Kjeldsen, C. L. , Hansen, M. S. , Jensen, K. , Holm, A. , Haahr, A. , & Dreyer, P. (2018). Patients' experience of thirst while being conscious and mechanically ventilated in the intensive care unit. Nursing in Critical Care, 23(2), 75–81. 10.1111/nicc.12277 [DOI] [PubMed] [Google Scholar]
  13. Kong, C. (2022). Construction of a Perioperative Thirst Management Program for Cardiac Surgery Patients. Shandong University. 10.27272/d.cnki.gshdu.2022.003692 [DOI] [Google Scholar]
  14. Landström, M. , Rehn, I. , & Frisman, G. H. (2009). Perceptions of registered and enrolled nurses on thirst in mechanically ventilated adult patients in intensive care units–A Phenomenographic study. Intensive & Critical Care Nursing, 25(3), 133–139. 10.1016/j.iccn.2009.03.001 [DOI] [PubMed] [Google Scholar]
  15. Li, S. , & Mi, J. (2022). ICU nurses' nursing dilemma of thirst in critically ill patients: A Qualitative study. China Nursing Management, 22(9), 1397–1400. [Google Scholar]
  16. Li, S. , Mi, J. , & Tang, Y. (2022). A qualitative study of nurses' perception on patients' thirst in intensive care units. Intensive & Critical Care Nursing, 69, 103184. 10.1016/j.iccn.2021.103184 [DOI] [PubMed] [Google Scholar]
  17. Liao, C. , Wang, J. , Cui, P. , Ma, X. , & Li, W. (2021). Construction of physical restraint assessment scale for ICU patients in cancer hospitals by Delphi method. Journal of Kunming Medical University, 42(3), 170–175. [Google Scholar]
  18. Lin, J. , Li, Q. , & Luo, Q. (2023). Risk factors for delirium in ICU non‐invasive mechanical ventilation patients. Jilin Medical Journal, 44(1), 228–231. 10.3969/j.issn.1004-0412.2023.01.073 [DOI] [Google Scholar]
  19. Lin, R. , Li, H. , Chen, L. , & He, J. (2023). Prevalence of and risk factors for thirst in the intensive care unit: An Observational study. Journal of Clinical Nursing, 32(3–4), 465–476. 10.1111/jocn.16257 [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. McKinley, M. J. , Cairns, M. J. , Denton, D. A. , Egan, G. , Mathai, M. L. , Uschakov, A. , Wade, J. D. , Weisinger, R. S. , & Oldfield, B. J. (2004). Physiological and pathophysiological influences on thirst. Physiology & Behavior, 81(5), 795–803. 10.1016/j.physbeh.2004.04.055 [DOI] [PubMed] [Google Scholar]
  21. Negro, A. , Villa, G. , Greco, M. , Ciriolo, E. , Luraschi, E. L. , Scaramuzzi, J. , Manara, D. F. , & Zangrillo, A. (2022). Thirst in patients admitted to intensive care units: An Observational study. Irish Journal of Medical Science, 191(5), 2283–2289. 10.1007/s11845-021-02817-7 [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Pan, L. , Yan, S. , Li, Y. , & Sun, L. (2019). Research on comprehensive oral care intervention with modified beck oral assessment scale in ICU patients receiving mechanical ventilation via endotracheal intubation. Journal of Nursing Administration, 19(12), 906–910. 10.3969/j.issn.1671-315x.2019.12.016 [DOI] [Google Scholar]
  23. Pierotti, I. , Fracarolli, I. F. L. , Fonseca, L. F. , & Aroni, P. (2018). Evaluation of the intensity and discomfort of perioperative thirst. Escola Anna Nery Revista de Enfermagem, 22, 3. 10.1590/2177-9465-ean-2017-0375 [DOI] [Google Scholar]
  24. Puntillo, K. , Nelson, J. E. , Weissman, D. , Curtis, R. , Weiss, S. , Frontera, J. , Gabriel, M. , Hays, R. , Lustbader, D. , Mosenthal, A. , Mulkerin, C. , Ray, D. , Bassett, R. , Boss, R. , Brasel, K. , & Campbell, M. (2014). Palliative care in the icu: Relief of pain, dyspnea, and thirst—A report from the ipal‐icu advisory board. Intensive Care Medicine, 40(2), 235–248. 10.1007/s00134-013-3153-z [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Puntillo, K. A. , Arai, S. , Cohen, N. H. , Gropper, M. A. , Neuhaus, J. , Paul, S. M. , & Miaskowski, C. (2010). Symptoms experienced by intensive care unit patients at high risk of dying. Critical Care Medicine, 38(11), 2155–2160. 10.1097/CCM.0b013e3181f267ee [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Rose, L. , Nonoyama, M. , Rezaie, S. , & Fraser, I. (2014). Psychological wellbeing, health related quality of life and memories of intensive care and a specialised weaning centre reported by survivors of prolonged mechanical ventilation. Intensive & Critical Care Nursing, 30, 145–151. 10.1016/j.iccn.2013.11.002 [DOI] [PubMed] [Google Scholar]
  27. Sato, K. , Okajima, M. , & Taniguchi, T. (2019). Association of persistent intense thirst with delirium among critically ill patients: A cross‐sectional study. Journal of Pain and Symptom Management, 57(6), 1114–1120. 10.1016/j.jpainsymman.2019.02.022 [DOI] [PubMed] [Google Scholar]
  28. Sato, K. , Tsuda, C. , Odawara, S. , Kushida, A. , & Taniguchi, T. (2023). Effect of high‐flow nasal cannula therapy on thirst sensation and dry mouth after extubation: A single‐centre prospective cohort study. Intensive & Critical Care Nursing, 74, 103339. 10.1016/j.iccn.2022.103339 [DOI] [PubMed] [Google Scholar]
  29. Schittek, G. A. , Simonis, H. , & Bornemann‐Cimenti, H. (2021). Pain, nausea, vomiting, thirst, cold, … the challenge of well‐being in post‐operative patients. Intensive & Critical Care Nursing, 66, 103090. 10.1016/j.iccn.2021.103090 [DOI] [PubMed] [Google Scholar]
  30. Stevenson, R. J. , Mahmut, M. , & Rooney, K. (2015). Individual differences in the interoceptive states of hunger, fullness and thirst. Appetite, 95, 44–57. 10.1016/j.appet.2015.06.008 [DOI] [PubMed] [Google Scholar]
  31. Tu, W. , Yin, Z. , Ye, D. , & Cao, Y. (2020). Management of thirst during postoperative tracheal intubation in patients with acute type a aortic coarctation. Journal of Nurses Training, 35(9), 824–827. 10.16821/j.cnki.hsjx.2020.09.013 [DOI] [Google Scholar]
  32. Waldréus, N. , Hahn, R. G. , & Jaarsma, T. (2013). Thirst in heart failure: A systematic literature review. European Journal of Heart Failure, 15(2), 141–149. 10.1093/eurjhf/hfs174 [DOI] [PubMed] [Google Scholar]
  33. Waldréus, N. , Jaarsma, T. , van der Wal, M. H. , & Kato, N. P. (2018). Development and psychometric evaluation of the Thirst Distress Scale for patients with heart failure. European Journal of Cardiovascular Nursing, 17(3), 226–234. 10.1177/1474515117728624 [DOI] [PubMed] [Google Scholar]
  34. Wang, J. , Lin, Y. , Zeng, K. , Yang, Y. , Hu, X. , Zhao, R. , & Li, Z. (2014). Development and validation of a nutritional and nursing risk assessment method for diabetic patients. Experimental and Therapeutic Medicine, 7(5), 1323–1326. 10.3892/etm.2014.1575 [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Wang, Y. , Li, H. , Zou, H. , & Li, Y. (2015). Analysis of complaints from patients during mechanical ventilation after cardiac surgery: A retrospective study. Journal of Cardiothoracic and Vascular Anesthesia, 29(4), 990–994. 10.1053/j.jvca.2015.01.036 [DOI] [PubMed] [Google Scholar]
  36. Wen, M. , Zhao, M. , & Zeng, T. (2015). Oral care assessment scale for orally intubated critically ill patients: Making and testing of reliability and validity. Journal of Nursing Science, 30(11), 5–8. 10.3870/hlxzz.2015.11.005 [DOI] [Google Scholar]
  37. Wu, C. , Luo, Q. , Fu, B. , Zhang, X. , Fu, X. , & Chen, F. (2022). Investigation and analysis of influence factors of thirst in ICU patients with oral tracheal intubation and ventilator assisted ventilation. Chinese Journal of Respiratory and Critical Care Medicine, 21(5), 316–321. [Google Scholar]
  38. Xiaoyu, L. , Jinxue, L. , Fengqiong, J. , Yan, Z. , & Qiaohua, Y. (2021). Development and application of nursing risk management evaluation system. Studies in Health Technology and Informatics, 284, 414–420. 10.3233/SHTI210761 [DOI] [PubMed] [Google Scholar]
  39. Zhang, Q. , & You, W. (2021). The effect of non‐pharmacological local intervention on relieving thirst intensity of surgical intensive care unit patients. FUDAN University Journal of Medical Sciences, 48(1), 66–70. 10.3969/j.issn.1672-8467.2021.01.010 [DOI] [Google Scholar]
  40. Zhang, R. , Jiang, H. , Zhang, J. , Quan, Y. , & Tian, L. (2022). Chinese version and reliability and validity test of the perioperative thirst discomfort scale. Chinese Nursing Research, 36(19), 3439–3444. 10.12102/j.issn.1009-6493.2022.19.010 [DOI] [Google Scholar]
  41. Zhang, W. , Gu, Q. , Gu, Y. , Zhao, Y. , & Zhu, L. (2022). Symptom management to alleviate thirst and dry mouth in critically ill patients: A randomised controlled trial. Australian Critical Care, 35(2), 123–129. 10.1016/j.aucc.2021.04.002 [DOI] [PubMed] [Google Scholar]
  42. Zhang, W. , Hao, Y. , & Tian, T. (2019). The reliability and validity of the Chinese version of thirst distress scale with heart failure. Chinese Journal of Nursing, 54(6), 957–960. 10.3761/j.issn.0254-1769.2019.06.032 [DOI] [Google Scholar]
  43. Zhao, F. , Wu, L. , Peng M., & Guan, H. (2019). Research progress on the nursing evaluation of patients' thirst. China Nursing Management, 19(10), 1590–1593. [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Articles from Journal of Clinical Nursing are provided here courtesy of Wiley

RESOURCES