Experts call for greater pain assessment in hospitals as 65 percent of patients report problems

Nearly two-thirds of the hospital in-patients who took part in a survey had experienced pain in the last 24 hours and 42% of those rated their pain as more than seven out of ten, where ten was the worst pain imaginable, according to the March issue of the Journal of Clinical Nursing.

Although eight out of ten patients had been asked about their pain levels by staff, less than half of those had been asked to rate their pain on a simple numeric scale.

Researchers from Uppsala University, Sweden, studied 759 patients aged from six weeks to 95, with parents completing the surveys for the younger children. The average age of the patients was 59 and 52% were female. Just over two-thirds (68%) of the 1,112 patients in the hospital on the day of the survey were able or willing to take part.

"Pain is a natural part of many medical conditions, but it can have a negative affect on quality of life, how successful treatment is and the patient's prognosis" says lead author Dr Barbro Wadensten, associate professor in the Department of Public Health and Caring Sciences at the University.

"Managing a patient's pain is very important and our survey sought to quantify how common pain was, how it was being managed by hospital staff and whether patients were satisfied with the opportunities they were offered to get involved in their own pain management."

Key findings of the study included:

• 65% of patients had experienced pain in the last 24 hours, ranging from 52% to 82% in the seven hospital departments included. Pain levels were highest in Diagnostic, Anaesthesia and Technology (82%), the Surgery Division (76%) and Women's Health and Paediatrics (73%).

• 81% rated their pain as three out of ten or more on a simple numeric scale, where zero was no pain at all and ten was the worst pain imaginable.

• 42% rated their pain as seven out of ten or more. Patients from the Surgery Department were most likely to report pain as exceeding seven at the time of the survey and in the preceding 24 hours.

• 82% had been asked about their pain levels by staff, but less than 39% had been asked to rate their pain using a numeric scale. Patients in the Surgery Division were much more likely to be asked to rate their pain using a scale (62%) than in any other department, where the levels ranged from 9% to 44%.

• 30% of patients were completely satisfied with their involvement in their pain management, but 12% were not at all satisfied. Satisfaction rates were highest in the Surgery Division and lowest in the Psychiatry Division.

"Our survey showed that too many patients are still suffering from pain and our findings echo the results of pain prevalence studies from other countries" concludes Dr Wadensten. "We also found that the simple Numeric Rating Scale is not being used as often as it should be".

"It is important that healthcare professionals work together on wards to improve pain management, especially on wards where pain levels may not be so obvious.

"Using a pain assessment tool such as the Numeric Rating Scale helps patients to express their pain, makes them feel involved in their care and improves communication between patients and healthcare staff."

Why is pain still not being assessed adequately? Results of a pain prevalence study in a university hospital in Sweden. Wadensten et al. Journal of Clinical Nursing. 20, pp624-634. (March 2011). DOI: 10.1111/j.1365-2702.2010.03482.x

The Journal of Clinical Nursing (JCN) is an international, peer reviewed, scientific journal that seeks to promote the development and exchange of knowledge that is directly relevant to all spheres of nursing and midwifery practice. The primary aim is to promote a high standard of clinically related scholarship which supports the practice and discipline of nursing. JCN publishes high quality papers on issues related to clinical nursing, regardless of where care is provided. This includes - but is not limited to - ambulatory care, community care, family care, home, hospital, practice, primary and secondary, and public health. http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-2702

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