The pain care quality study: one hospital's experience

Pain is frequently a challenge to manage in hospitalized patients. 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. The purpose of this study was to assess patients’ perception about the quality of pain management. 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. Eligible patients on 5 units participated. Pre-test (G1) findings reported back to units 3 months later directed strategies (admission pain brochure, comfort goal discussion) to improve pain quality indicators. Post-testing (G2) occurred 8 months after G1. Data from 121 patients were analyzed. 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 group differences 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 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). Findings support nurses’ belief of pain may drive quality indicators. The 4 months between strategy implementation and G2 measures limits conclusions. Longitudinal follow-up and monitoring unit-based strategy compliance is warranted. This initiative was part of the Pain Quality Study and supported by the Robert Wood Johnson Foundation.