Comparisons between patients' and nurses' assessment of pain and medication efficacy in severe burn injuries.
In order to provide burn patients with adequate pain relief, the nurses must be able to accurately evaluate the patients' pain levels and to assess whether sufficient analgesia is achieved or not. The present study examined this issue by comparing the pain ratings in 42 patients hospitalized for burn injuries and 42 nurses. The patient and the attending nurse were asked to rate, independently of each other, the intensity of the pain felt by the patient during a therapeutic procedure and at rest. When analgesic medication was given prior to the procedure, both the patients and the nurses were asked to estimate the degree of pain relief. All ratings were obtained using visual analogue and verbal scales. The results revealed significant but small correlations between the nurses' and patients' ratings. Frequently, the nurses underestimated or overestimated the patients' pain. Discrepancies were also observed in the evaluation of pain medication efficacy, the nurses showing a tendency to overestimate the degree of pain relief. The accuracy of the nurses' perception did not vary as a function of the patients' age, socioeconomic status or burn severity. However, the number of years of experience in burn-nursing had a significant influence on the nurses' estimation of the patients' pain during therapeutic procedures. Theoretical and clinical implications of these results are discussed with a particular emphasis on the need to implement systematic procedures to assess pain and success of analgesia. Additional recommendations to optimize pain management in burn patients are also made.
Choinière
Manon
M
Burn Centre, Hôtel-Dieu of Montreal, 3840 Saint-Urbain, Montreal, Que. H2W 1T8 Canada Dept. of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal, Que. H3A 1B1 Canada Burn and Isolation Unit, Montreal General Hospital, 1650 Cedar Avenue, Montreal, Que. H3G 1A4 Canada.
Melzack
Ronald
R
Girard
Normand
N
Rondeau
Johanne
J
Paquin
Marie-Josée
MJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D002056:Burns / Q000150:complications / Q000451:nursing / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009726:Nurses / Q000523:psychology*; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D010147:Pain Measurement