A pain monitoring program for nurses: Effects on communication, assessment and documentation of patients' pain

Nurses need to be informed about the patient's pain to be able to take appropriate measures to alleviate pain. However; communication, assessment, and documentation of pain by nurses is often a problem for hospitalized patients. In this study we aimed to overcome the main barriers by developing implementing and evaluating a Pain Monitoring Program (PMP)for nurses. The PIMP consists of two components: educating nurses about pain, pain assessment and pain management; and implementing daily pain assessment by means of a numeric rating scale. We describe the effects of the PIMP on communication about pain between nurses and patients and between physicians and patients, agreement between patients' pain in tensity and nurses estimations of patients' pain intensity, and documentation about pain in the nursing records. Factors that might influence communication, assessment, and documentation are also discussed. The effects of the PIMP were measured in a quasi-experimental design with a nonequivalent control group. In total, 703 patients participated: 358 patients in the control group and 345 in the intervention group. Results of the control group showed that communication about pain between nurses and patients, agreement between patients' and nurses pain ratings, and documentation about pain in nursing records, remain inadequate. Patients' pain intensify and age were related to communication, assessment, and documentation. Communication and documentation is better in patients with moderate to severe pain than in patients with mild pain, and assessment is better in patients with mild pain. Older patients communicate less with nurses and physicians about pain, and nurses document less about pain in nursing records for older patients compared with younger patients. The PMP proved to be effective in improving nurses' assessment of patients' pain and documentation about pain in nursing records. Patients' pain intensity and care setting were related to the efficacy of the PMP Communication about pain between patients and nurses, and between patients and physicians did not improve as a result of the PIMP Based on this study it can be concluded that in using a simple method such as the numeric rating scale, together with an education program, attention is focused in a systematic way on patients' pain complaints and creates a common language between patients and nurses. Because the PMP proved effective in a heterogenous population in multiple care settings, it is recommended to implement the PNP in nursing-practice, J Pain Symptom Manage 2000;20:424-439. (C) U.S. Cancer Pain Relief Committee, 2000.