pain management

Patient-related barriers to pain management
Of all patients, 40.7% expressed experiencing difficulties with the
assessment of pain intensity. Nurses indicated that 12.6% of the
patients experienced difficulties with reporting their pain intensity.
Reluctance to report pain was reported by 37.9% of patients compared with the nurses indicating this issue in 10.5% of patients.
Some patients reported being reluctant to take pain medication
out of fear of an addiction (37.0%) or side effects (47.0%). Nurses
indicated that 5.3% and 7.7% of patients were reluctant to take pain
medication out of fear of an addiction and side effects respectively.
Almost half of the patients expressed being reluctant to take opioids
(51.0%) compared with the nurses indicating this reluctance in
16.6% of patients (Table 3).
3.5 | Agreement in pain intensity
The following results are based on the 176 dyads of assessments
included in pain intensity analysis.
The difference between the patients’ (Mdn 2.0) and nurses’ (Mdn
2.0) pain intensity assessments was not significant at group level
(z = .26; p = .79). At individual level, a moderate agreement in the
assessment of pain intensity was found between patients and nurses
(ICC = .43) (Table 2).
Across the four levels of pain, a slight agreement in pain intensity was found between patients and nurses. Higher agreement was
found for patients with mild pain (ICC = .19) and for patients with
severe pain (ICC = .15) compared with patients with no pain
(ICC = .00) and patients with moderate pain (ICC = .08) (Table 2).
The subgroup analysis (Table 2) based on type of ward showed a
higher level of agreement for patients hospitalized in an internal
medicine (ICC = .40) and a surgical ward (ICC = .46) compared with
patients hospitalized in a geriatric ward (ICC = .26).
The subgroup analysis based on the assessment method used by
nurses to assess pain intensity revealed a higher level of agreement
for those nurses using a validated scale (e.g. VAS) to assess pain
intensity in patients (ICC = .44) compared with nurses using their
expertise to assess the pain (ICC = .36) or nurses who did not assess
the pain (ICC = .41).
The subgroup analysis based on patients’ age showed a higher
level of agreement for patients younger than 65 years (ICC = .53)
compared with patients aged 65 years and older (ICC = .29). The
subgroup analysis based on patients’ gender showed a higher level
of agreement for male patients (ICC = .45) compared with female
patients (ICC = .40).
Nurses underestimated pain intensity for 13.7% of the patients
and overestimated pain intensity for 14.3% of the patients. The multiple logistic regressions (Table 4) showed a significant association
between pain intensity reported by patients and the under-, overand adequate estimation of pain by nurses. The odds to adequately
estimate pain by nurses decreased with 24.0% when the pain intensity in patients increased (OR = .76; 95% CI .67–.86). The odds to
overestimate pain by nurse