Accuracy of emergency nurses in assessment of patients' pain

Kathleen Puntillo, Martha Neighbor, Nel O'Neil, Ramona Nixon
Pain Management Nursing: Official Journal of the American Society of Pain Management Nurses 2003, 4 (4): 171-5
Pain is a common complaint in Emergency Departments. Inpatient studies have shown discrepancies between patients' and nurses' pain assessments. The accuracy of emergency nurse assessments of their patients' pain has not been well investigated. Using a 0 to 10 numeric rating scale (NRS), researchers asked patients to rate their pain intensity in triage. Separately, the triage nurse was asked to rate the patient's pain. This process was repeated with the same patients but different nurses after patients were taken back to a clinical area within the Emergency Department. At triage, patients' average pain intensity score was 7.5 +/- 2.2. The triage nurses' ratings were significantly lower at 5.1 +/- 2.4 (p <.001). In the clinical area, patients' scores were also significantly higher than nurses' at 7.7 +/- 2.2 and 4.2 +/- 2.3, respectively (p <.001). Differences between nurses' and patients' pain intensity scores depended on the patient's chief complaint. Considerable underestimation of patient's pain occurred in both triage and in the clinical area. Underestimation of patient's pain can have negative effects if appropriate treatment is withheld. Minimizing patient-nurse discrepancies in pain intensity ratings through careful evaluations and acceptance of the patient's self report of pain are important first steps in improving pain management in the Emergency Department.

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