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Pain care quality and RN staffing characteristics among United States adult medical, surgical units

      Previous research has shown that over 50% of adult medical-surgical patients were in pain during the past 24 hours. Nurses are the front-line caregivers in pain management yet there is not a national consensus measure of nurse-sensitive pain quality indicators. Hospitals participating in the National Database of Nursing Quality Indicators (NDNQI), a national nursing database, were recruited to participate in this research study. Pain care quality indicators were assessed in 326 U.S hospitals in 1611 nursing units; including 468 adult medical, surgical and medical-surgical combined units. Patients (n=3, 631 ) rated their average pain intensity on 0-10 scale and responded to six questions on how well their nurse managed their pain. Data were aggregated to the unit level and combined with data on nursing skill mix, RN education and national RN specialty certification. Hospital characteristics of staffed bed size, teaching status and ANCC Magnet designation were used as controls. Using hierarchical mixed modeling, the association between patient’s rate of pain and staffing, nurse specialty certification, pain care quality and hospital demographic variables were examined. The mean unit level of patient’s pain was 6.09 (SD =1.30). Significant associations were found with RN hours per patient day (B=-0.203, p=<.001), having pain medication available when needed (B=-0.009, p=.01) and nurse suggesting non-pharmacological pain management approaches (B=0.008, p=.002). Overall, the model had a moderate fit (R2=0.45). Pain management is a multi-faceted activity. The analysis demonstrates a relationship between patients’ rating of pain and RN staffing levels, as well as nursing care. More research is needed to investigate deeper relationships and continued exploration of pain care quality amongst hospitalized patients.