Patient and nurse assessment of quality of care in postoperative pain management.

OBJECTIVE

To describe and compare patient and nurse assessments of the quality of care in postoperative pain management, to investigate differences between subgroups of patients, and to compare patient assessments in different departments.

DESIGN

Patient and nurse questionnaires.

SETTING

Five surgical wards in general surgery, orthopaedics, and gynaecology in a central county hospital in Sweden.

SAMPLE

Two hundred and nine inpatients and 64 registered nurses. The response rates were 96% for the patients and 99% for the nurses; there were 196 paired patient-nurse assessments.

METHOD

The Strategic and Clinical Quality Indicators in Postoperative Pain Management patient questionnaire was used which comprises 14 items in four subscales (communication, action, trust, and environment). The items were scored on a 5 point scale with higher values indicating a higher quality of care. Five complementary questions on levels of pain intensity and overall satisfaction with pain relief were scored on an 11 point scale. Twelve of the 14 items in the patient questionnaire and two of the complementary questions were adjusted for use in the nurse questionnaire.

RESULTS

The patients' mean (SD) score on the total scale (scale range 14-70) was 58.6 (8.9) and the nurses' mean (SD) score (scale range 12-60) was 48.1 (6.2). The percentage of patients who scored 1 or 2 for an individual item (disagreement) ranged from 0.5% to 52.0%, while for nurses the percentage ranged from 0.0% to 34.8%. Forty two patients (24%) reported more pain than they expected; these patients assessed the quality of care lower. There were differences between patient and nurse assessments concerning the environment subscale, the question on overall satisfaction, and patients' experience of worst possible pain intensity.

CONCLUSION

The results provided valuable baseline data and identified important areas for quality improvement in postoperative pain management.