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Congruence between nurses' and patients' assessment of postoperative pain: a literature review

27 February 2020
20 min read
Volume 29 · Issue 4

Abstract

Postoperative pain remains poorly managed for many patients. Effective pain management begins with accurate pain assessment, with patient self-reporting considered the most accurate measure of pain. This literature review aimed to identify how congruent nurses' assessments of pain were with patients' self-reporting. A search identified six observational studies and one quasi-experimental study that met the inclusion criteria. The findings from these studies were summarised under two themes: nurses' underestimation of patients' pain and nurses' knowledge and understanding of pain assessment. Some nurses' pain management knowledge was deemed inadequate, with evidence of negative attitudes towards managing pain in certain groups of patients. Educational interventions have so far had limited impact on correcting the ethical and professional problem of inadequate pain relief in many patients postoperatively. Randomised controlled trials are required to identify effective education interventions that can contribute to ending this avoidable suffering.

Despite efforts to improve the management of patients' pain postoperatively with the introduction of guidelines (Wu and Raja, 2011) and the branding of pain as the ‘fifth vital sign’ to raise awareness of the importance of assessment (Campbell, 1996; Morone and Weiner, 2013), many patients continue to suffer high levels of postoperative pain (Rockett et al, 2013; Scher et al, 2018). One reason suggested for this is that postoperative pain is complex, involving both inflammation and nerve injury, which requires a complex person-centred management strategy rather than the administration of analgesia alone (Pogatzki-Zahn et al, 2017). Although most people experience pain after surgery, less than half report adequate pain relief (Institute of Medicine (IOM), 2011). Poorly managed postoperative pain is a global issue (Wu and Raja, 2011). For most patients who report inadequate postoperative pain relief their pain is rated at moderate or higher intensity (IOM, 2011). Prevalence rates of such inadequate pain relief vary by country, from 18% in Norway (Johansen et al, 2012) to as high as 62% reported in South Africa (Murray and Retief, 2016). At discharge, the prevalence rates of severe postoperative pain have been estimated to be in the range of 5-10% (Italy) (Sansone et al, 2015) and 12% (USA) (Buvanendran et al, 2015). In the study by Buvanendran et al (2015), 13% of patients reported severe pain 2 weeks postoperatively. The situation is not that different in the UK, where the prevalence of postoperative pain has been estimated at around 64% (Rockett et al, 2015).

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