<![CDATA[Background: Patients with decreased levels of consciousness may have difficulty communicating pain verbally. In such circumstances, observational assessment can help nurses document behavioral responses that may be associated with pain; however, the findings must still be interpreted in conjunction with the patient’s clinical condition. Objective: To describe the application of the Critical-Care Pain Observation Tool (CPOT) in three adult patients with decreased levels of consciousness in the Emergency Department (ED) of RSUD dr. Kanujoso Djatiwibowo, Balikpapan. Methods: This descriptive case series included three adult patients diagnosed with non-hemorrhagic stroke, head injury, and diabetic ketoacidosis. The cases were documented between August 10 and 14, 2026. Each patient underwent one CPOT assessment, and the findings were presented descriptively according to the four CPOT domains and the total score. Results: The patient with stroke and a Glasgow Coma Scale (GCS) score of 7 had a CPOT score of 6, comprising facial expression 2, body movement 2, muscle tension 1, and vocalization 1. The patient with head injury and a GCS score of 7 also had a score of 6, with the same domain scores. The intubated patient with diabetic ketoacidosis who was receiving mechanical ventilation scored 0 across all four observed domains. These scores describe the behaviors observed at the time of assessment. Conclusion: CPOT can provide a structured approach to documenting behavioral responses in patients with decreased levels of consciousness who cannot adequately self-report pain. A score of 0 indicates that no behavioral indicators of pain were observed during the assessment and does not establish the complete absence of pain. This case series did not evaluate the effectiveness or diagnostic accuracy of CPOT.]]>
