Patients' versus nurses' assessments of pain and sedation after cesarean section.

OBJECTIVE

To compare nurses' and patients' assessments of pain and sedation in patients receiving epidural or intravenous patient-controlled analgesia (PCA) after cesarean section.

DESIGN

Prospective, randomized study.

SETTING

The perinatal unit and labor and delivery unit in a 1,036-bed university hospital in the mid-Atlantic region.

PARTICIPANTS

Twenty-six patients receiving epidural PCA or intravenous PCA. Nurses participating in the study were assigned as caregivers to the 26 patients.

MAIN OUTCOME MEASURES

Pain and sedation were assessed using 10-cm visual analogue scales completed by both the patient and the patient's nurse twice daily on the day of surgery and on the 1st and 2nd postoperative days.

RESULTS

No significant correlation was found between the nurses' and patients' pain or sedation scores. Chi-square analysis showed that the nurse was as likely to underestimate as to overestimate the patient's pain score. The nurse underestimated the patient's sedation score 85% of the time.

CONCLUSIONS

The results suggest that nurses' and patients' assessments of pain and sedation differ. The routine use of a standardized self-assessment tool, such as the visual analogue scale, is recommended to ensure that analgesic treatment is based on the subjective nature of the patient's pain experience rather than the nurse's judgment.