Accuracy of Emergency Nurses in Assessment of Patients' Pain???

  1. Accuracy of Emergency Nurses in Assessment of Patients' Pain

    Posted 12/18/2003


    Kathleen Puntillo, RN, DNSc; Martha Neighbor, MD; Nel O'Neil, RN, MS; Ramona Nixon, RN, MS


    Abstract and Introduction

    Abstract

    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.

    http://www.medscape.com/viewarticle/465817
    •  
  2. 10 Comments

  3. by   teeituptom
    Lets have some fun here

    who invented the zero to ten painscale

    who invented the Face pain scale

    who invented the pedi pain scale

    I would bet that whoever invented these scales doesnt work with patients

    and how do educate the engineer from EDS that a response of 25.639 on the zero to ten scale does not compute

    to me life is simple

    1. if you have a kidney stone you hurt like hell

    2. for the women if your in active labor it hurts like hell

    3 if you have severe urinary retention it hurts like hell

    4. if you have a nasty burn it hurts like hell

    5 bottom line anything you have hurts like hell untill you treat it, and thats our job.

    see life is simple why complicate it

    you treat the pain till they say its better, see life is simple.

    all this pain scale charting gives me a major P I T A
  4. by   wwwilly3
    A good indicator of severity of pain in patients seeking treatment in the ED is blood pressure. Not the top number but the lower number. It is my experience that if it isnt over 90 the pain is usually not severe.
  5. by   augigi
    Quote from wwwilly3
    A good indicator of severity of pain in patients seeking treatment in the ED is blood pressure. Not the top number but the lower number. It is my experience that if it isnt over 90 the pain is usually not severe.
    Do you have any research on the relationship of diastolic blood pressure to pain rating?
  6. by   canoehead
    Perhapsthe nurses scored the pain lower because their idea of excruciating pain is much greater than the average person. They see people in painful situations every day. It would make sense that a 10/10 for a teenager would not be considered the worst pain possible for an ER nurse.

    Just as a patient saying "I can't breathe" may not mean literally unable to breathe...and they are not being deceitful. The nurse may rate the level of SOB much lower because they have a greater range of experience.

    In both situations the treatment needs to be geared towards the actual distress level, not perceived distress level. For example, you would not intubate someone who was pink, RR 22, but wheezy. Likewise you would not pull out the Fentanyl for every 10/10 pain as rated by the patient.
  7. by   augigi
    I have to disagree there. Pain is subjective, shortness of breath and airways decompensation is not.
  8. by   Patient
    I have to disagree on using bp as an indicator of pain. My bp is naturally low - most days 90/60. When I'm in pain, it runs around 130/85. So you're going to tell me I'm not experiencing "real" pain? Gimme a break!

    Also consider patients who regularly follow a physical exercise routine. We all know weightlifting and cardio exercise can really lower bp, and it STAYS low even with a high level of pain.
  9. by   MSADN
    People who have chronic pain conditions do not have an elevation in BP. The body adjusts to the level of pain after a time.
  10. by   BSNtobe2009
    Quote from Patient
    I have to disagree on using bp as an indicator of pain. My bp is naturally low - most days 90/60. When I'm in pain, it runs around 130/85. So you're going to tell me I'm not experiencing "real" pain? Gimme a break!

    Also consider patients who regularly follow a physical exercise routine. We all know weightlifting and cardio exercise can really lower bp, and it STAYS low even with a high level of pain.
    I totally agree. My blood pressure stays at a "good low" and always has.

    I have went a few times in my life into the ER in excrutiating levels of pain to where I was sitting in the ER...and I probably looked more like a psych patient...from my migraines....I would be sitting there in tears, rocking back and forth, I would actually bite on the fleshy part of the base of my thumb...ANYTHING to for a second...get rid of the soon-to-explode-pressure feeling in my head. All of this coupled with blurred vision and speech, and I've been sitting in a fetal position in the rock-hard-ER chairs.

    My longest stint? I sat like that for 4 1/2 hours one time....and when I finally went back to see a doctor, I was out of there in 5 minutes.

    Things like that really upset me, because I feel the wait was unncessary.

    Once I gave up my turn for a little 5 year old girl who had cut her foot so bad she was bleeding all over the ER waiting room floor.
  11. by   vamedic4
    Quote from MSADN
    People who have chronic pain conditions do not have an elevation in BP. The body adjusts to the level of pain after a time.
    This is not totally correct. Many patients with chronic conditions absolutely have blood pressure changes, it is an indication that what they're doing at home is not working. It is a stress mediated response with chronic pain patients.

    Yes, they have meds they take at home, and other modalities to deal with pain. However, when these methods are exhausted to no avail, they become frustrated, depressed, scared..all of these lead to an increase in blood pressure. It's not uncommon for a chronic pain patient (including those on C II meds) to have markedly increased blood pressures.

    Have a good day.
    vamedic4
  12. by   MSADN
    And the word missing in my original post is "always," as in "do not always have a BP increase." You are quite correct in your correction. I misposted.

close