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

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

Published in: Journal of Pain and Symptom Management, v. 40, no. 5, Nov. 2010, p. 723-733

Posted on 2010

by Lisa R. Shugarman, Joy R. Goebel, Andrew B. Lanto, Steven M. Asch, Cathy D. Sherbourne, Martin L. Lee, Lisa V. Rubenstein, Li Wen, Lisa S. Meredith, Karl Lorenz

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-NRSS-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 posttraumatic 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. CONCLUSION: Despite a long-standing mandate, pain-screening implementation falls short, and informal screening is common.

This report is part of the RAND external publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

RAND is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.