The Status and Challenges of Pain Assessment in Hospitalized Patients: A Cross-Sectional Study.

Abstract

Background: Accurate pain assessment still faces many challenges, which impact the effectiveness of analgesic interventions. Understanding the current status of pain assessment implementation and its inhibiting and facilitating factors might help facilitate accurate pain assessment.

Purpose: To investigate the nurses' current pain assessment practices for hospitalized patients and analyze the factors that facilitate or inhibit the standardization of pain assessment implementation.

Design: This study is a cross-sectional survey that includes a questionnaire survey and an on-site observation. The questionnaire survey was conducted in 78 public hospitals in 18 districts or counties of Sichuan Province, China, with 1,050 clinical registered nurses surveyed. The on-site observation was conducted in a university-affiliated tertiary hospital, separate from the public hospitals.

Method: In the questionnaire survey, a structured self-administered "Pain Nursing Practice Questionnaire" was used to assess nurses' pain practice behaviors in four aspects: pain assessment, recording, intervention, and education. Additionally, in third-party on-site observations, observers evaluated nurses' pain assessment practices in clinical settings.

Results: Results for the questionnaire survey showed that pain assessments were most frequently conducted once per day (53.4%), primarily triggered by patient reports of pain (93.0%) and following pain management interventions (93.0%). The Numerical Rating Scale was the most commonly used tool for patients who could report pain (86.7%), while the Checklist of Nonverbal Pain Indicators was most used for nonverbal patients (63.2%). Factors affecting accurate pain assessment included poor compliance with protocols (79.71%) and insufficient knowledge of pain assessment (65.43%). The average assessment time reported by nurses for speaking patients was 198 seconds. However, the average time nurses took to assess the pain of speaking patients was 98 seconds in on-site observations. The on-site observations showed an average assessment time of 124.9 seconds upon patient admission and 77.3 seconds for patients during hospitalization, with the difference being statistically significant (t = 2.123, p = .038). Additionally, 10.2% of nurses did not inquire about specific pain complaints, and 18.4% did not use pain assessment tools.

Conclusions: The study reveals significant discrepancies in pain assessment practices among nurses. In the process of pain assessment practice, the assessment time is shorter, and the process is less standardized compared to self-reported results. The factors impeding standardized pain assessment included nurses' insufficient knowledge and poor protocol adherence. Therefore, enhanced training, more explicit guidelines, and robust institutional support are needed to standardize pain assessments and improve patient outcomes.