title: Nursing staff, patient, and environmental factors associated with accurate pain assessment.
abstract: BACKGROUND
  Although pain ranks highly among reasons for seeking care, routine pain assessment is often inaccurate.
  
  
  OBJECTIVE
  This study evaluated factors associated with nurses (e.g., registered) and other nursing support staff (e.g., licensed vocational nurses and health technicians) discordance with patients in estimates of pain in a health system where routine pain screening using a 0-10 numeric rating scale (NRS) is mandated.
  
  
  METHODS
  This was a cross-sectional, visit-based, cohort study that included surveys of clinic outpatients (n=465) and nursing staff (n=94) who screened for pain as part of routine vital sign measurement during intake. These data were supplemented by chart review. We compared patient pain levels documented by the nursing staff (N-NRS) with those reported by the patient during the study survey (S-NRS).
  
  
  RESULTS
  Pain underestimation (N-NRS<S-NRS) occurred in 25% and overestimation (N-NRS>S-NRS) in 7% of the cases. Nursing staff used informal pain-screening techniques that did not follow established NRS protocols in half of the encounters. Pain underestimation was positively associated with more years of nursing staff work experience and patient anxiety or post-traumatic stress disorder and negatively associated with better patient-reported health status. Pain overestimation was positively associated with nursing staff's use of the full NRS protocol and with a distracting environment in which patient vitals were taken.
  
  
  CONCLUSIONS
  Despite a long-standing mandate, pain-screening implementation falls short, and informal screening is common.
authors.affiliation: RAND Corporation, Santa Monica, California, USA.
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Shugarman
authors.forename: Joy R
authors.initials: JR
authors.lastname: Goebel
authors.forename: Andy
authors.initials: A
authors.lastname: Lanto
authors.forename: Steven M
authors.initials: SM
authors.lastname: Asch
authors.forename: Cathy D
authors.initials: CD
authors.lastname: Sherbourne
authors.forename: Martin L
authors.initials: ML
authors.lastname: Lee
authors.forename: Lisa V
authors.initials: LV
authors.lastname: Rubenstein
authors.forename: Li
authors.initials: L
authors.lastname: Wen
authors.forename: Lisa
authors.initials: L
authors.lastname: Meredith
authors.forename: Karl A
authors.initials: KA
authors.lastname: Lorenz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009740:Nursing Staff; D010045:Outpatients; D010146:Pain / Q000175:diagnosis*; D010147:Pain Measurement / Q000379:methods* / Q000451:nursing*; D014728:Veterans