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Qual Saf Health Care 2002;11:327-334 doi:10.1136/qhc.11.4.327

Patient and nurse assessment of quality of care in postoperative pain management

  1. E Idvall1,
  2. E Hamrin3,
  3. B Sjöström4,
  4. M Unosson2
  1. 1Researcher, Department of Medicine and Care, Division of Nursing Sciences, Faculty of Health Sciences, Linköping University, Linköping, and Västervik Hospital, Västervik, Sweden
  2. 2Senior Lecturer, Department of Medicine and Care, Division of Nursing Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden
  3. 3Professor Emeritus, Department of Medicine and Care, Clinical Pharmacology, Faculty of Health Sciences, Linköping University, Linköping, Sweden
  4. 4Senior Lecturer, Department of Health Care Pedagogics, Göteborg University and Department of Health Sciences, University of Skövde, Skövde, Sweden
  1. Correspondence to:
 Dr E Idvall, Department of Medicine and Care, Division of Nursing Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden;
 evaid{at}ltkalmar.se

    Abstract

    Objective: To describe and compare patient and nurse assessments of the quality of care in postoperative pain management, to investigate differences between subgroups of patients, and to compare patient assessments in different departments.

    Design: Patient and nurse questionnaires.

    Setting: Five surgical wards in general surgery, orthopaedics, and gynaecology in a central county hospital in Sweden.

    Sample: Two hundred and nine inpatients and 64 registered nurses. The response rates were 96% for the patients and 99% for the nurses; there were 196 paired patient-nurse assessments.

    Method: The Strategic and Clinical Quality Indicators in Postoperative Pain Management patient questionnaire was used which comprises14 items in four subscales (communication, action, trust, and environment). The items were scored on a 5 point scale with higher values indicating a higher quality of care. Five complementary questions on levels of pain intensity and overall satisfaction with pain relief were scored on an 11 point scale. Twelve of the 14 items in the patient questionnaire and two of the complementary questions were adjusted for use in the nurse questionnaire.

    Results: The patients’ mean (SD) score on the total scale (scale range 14–70) was 58.6 (8.9) and the nurses’ mean (SD) score (scale range 12–60) was 48.1 (6.2). The percentage of patients who scored 1 or 2 for an individual item (disagreement) ranged from 0.5% to 52.0%, while for nurses the percentage ranged from 0.0% to 34.8%. Forty two patients (24%) reported more pain than they expected; these patients assessed the quality of care lower. There were differences between patient and nurse assessments concerning the environment subscale, the question on overall satisfaction, and patients’ experience of worst possible pain intensity.

    Conclusion: The results provided valuable baseline data and identified important areas for quality improvement in postoperative pain management.

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