Nursing Staff, Patient, and Environmental Factors Associated with Accurate Pain Assessment

Shugarman, Lisa R.; Goebel, Joy R.; Lanto, Andy; Asch, Steven M.; Sherbourne, Cathy D.; Lee, Martin L.; Rubenstein, Lisa V.; Wen, Li; Meredith, Lisa; Lorenz, Karl A.

doi:10.1016/j.jpainsymman.2010.02.024

« Previous Next »Journal of Pain and Symptom Management
Volume 40, Issue 5 , Pages 723-733, November 2010

Nursing Staff, Patient, and Environmental Factors Associated with Accurate Pain Assessment

Lisa R. Shugarman, PhD
- RAND Corporation, Santa Monica, California, USA
Joy R. Goebel, RN, PhD
- Department of Nursing, California State University School of Nursing, Long Beach, California, USA
Andy Lanto, MS
- Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, California, USA
Steven M. Asch, MD, MPH
- RAND Corporation, Santa Monica, California, USA
- Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Geffen School of Medicine at UCLA, Los Angeles, California, USA
Cathy D. Sherbourne, PhD
- RAND Corporation, Santa Monica, California, USA
Martin L. Lee, PhD, MS
- Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, California, USA
Lisa V. Rubenstein, MD, MSPH
- RAND Corporation, Santa Monica, California, USA
- Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Geffen School of Medicine at UCLA, Los Angeles, California, USA
Li Wen, MD
- Veterans Administration Long Beach Healthcare System, Long Beach, California, USA
Lisa Meredith, PhD
- RAND Corporation, Santa Monica, California, USA
Karl A. Lorenz, MD, MSHS
- RAND Corporation, Santa Monica, California, USA
- Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Address correspondence to: Karl A. Lorenz, MD, MSHS, Veterans Administration of Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard, Code 111-G, Los Angeles, CA 90073, USA.

Accepted 11 February 2010. published online 09 August 2010.

Abstract

Context

Although pain ranks highly among reasons for seeking care, routine pain assessment is often inaccurate.

Objectives

This study evaluated factors associated with nurses (e.g., registered) and other nursing support staff (e.g., licensed vocational nurses and health technicians) discordance with patients in estimates of pain in a health system where routine pain screening using a 0–10 numeric rating scale (NRS) is mandated.

Methods

This was a cross-sectional, visit-based, cohort study that included surveys of clinic outpatients (n=465) and nursing staff (n=94) who screened for pain as part of routine vital sign measurement during intake. These data were supplemented by chart review. We compared patient pain levels documented by the nursing staff (N-NRS) with those reported by the patient during the study survey (S-NRS).

Results

Pain underestimation (N-NRS<S-NRS) occurred in 25% and overestimation (N-NRS>S-NRS) in 7% of the cases. Nursing staff used informal pain-screening techniques that did not follow established NRS protocols in half of the encounters. Pain underestimation was positively associated with more years of nursing staff work experience and patient anxiety or post-traumatic stress disorder and negatively associated with better patient-reported health status. Pain overestimation was positively associated with nursing staff’s use of the full NRS protocol and with a distracting environment in which patient vitals were taken.