The Pain Care Quality Study: One Hospital's Experience

Purpose:
The purpose of this project was to assess adult medical surgical patients' perception about the quality of pain management using a reliable and valid instrument.

Background/Significance:
Pain is a common occurrence for hospitalized patients that is frequently a challenge to effectively manage. Failure to achieve a balance between comfort and optimal functional independence negatively impacts clinical outcomes and quality of life. Nurses play a critical role in promoting quality pain management by assisting patients in establishing a realistic comfort goal, administering analgesics and adjunctive measures as needed, evaluating effects, and advocating for the patient.

Methods:
This tertiary care facility, in a multi-center study, used a pre-test/post-test design to survey patients' report of pain quality indicators on one day, 8 months apart, using structured interview. All eligible patients on 5 units were invited to participate. Pre-test (G1) findings were reported back to units 3 months after data collection to direct strategies (pain brochure in admit kit, comfort goal discussion) to improve pain quality indicators. Post-testing (G2) occurred 8 months after G1. Data were analyzed using descriptive statistics for demographics and survey items; bivariate correlations tested for inter-item associations between groups; t-test and X2 to detect group differences.

Results:
Data from 121 patients were included in analyses. The mean age was 50.29 years (SD=16.70), 67 (55%) females. No differences (t=.52, p>.05) in age or gender (X2=3.55, p>.05) between G1 (n=47) and G2 (n=74) groups. No differences between groups for mean 24 hour pain scores (G1 M=6.20, SD=2.26; G2 M=7.29, SD=11.14, t=.81, p>.05) or % time pain was severe (G1 M=70.47, SD=25.72; G2 M=67.23, SD=30.03, t=.60, p>.05). Spearman's rho detected significant associations (p<.01) in both groups for nurses' belief of pain and 4 items: patient included in decisions (G1 r=.42, G2 r=.40), know med ordered (G1 r=.42, G2 r=.36), told med side effects (G1 r=.45, G2 r=.32), and med worked (G1 r=.65, G2 r=.38).

Conclusions and Implications for Practice:
Findings support the need to improve pain quality. Nurses' belief of pain may drive quality indicators. The 4 months between strategy implementation and G2 measures limits conclusions about strategy-related outcomes. Longitudinal followup and monitoring unit-based strategy compliance is warranted.