Beyond the Pain Scale

Provider Communication and Staffing Predictive of Patients' Satisfaction With Pain Control

Judith Shindul-Rothschild, PhD, MSN, RN; Jane Flanagan, PhD, RN, ANP-BC; Kelly D. Stamp, PhD, ANP-C, RN, FAHA; Catherine Y. Read, PhD, RN

Disclosures

Pain Manag Nurs. 2017;18(6):401-409. 

In This Article

Results

Analysis of variance was used to examine the relationship between hospital staff FTE HPPD and patients' perception of pain control. The likelihood ratio test from the analysis of variance (α = .05) was used to examine pain control by low (≤4%), average (5%-11%), and high (≥12%) percent of patients reporting their pain was "never" or "sometimes" controlled by hospital staffing levels. Categories for the factor pain control were determined by adding or subtracting the standard deviation of pain control (SD ± 3.567) from the median sum of 8%. Figure 1 illustrates that higher nursing staff FTE HPPD (F = 5.348, p = .005) and higher registered nurse FTE PPS (F = 3.131, p =.045) were significantly associated with lowering percentages of patients who reported their pain was "never" or "sometimes" controlled.

Figure 1.

Pain "never" or "sometimes" controlled with hospital staffing; N = 512. Data for pain "never" or "sometimes" controlled from CMS HCAHPS, 2011–2012; data for full-time equivalent hours per patient day from AHA, 2011.

Figure 2 illustrates that higher hospitalist FTE HPPD significantly lowered the percentage of patients reporting their pain was "never" or "sometimes" controlled (F = 3.408, p = .035). Conversely, higher resident/intern FTE HPPD significantly increased the percentage of patients reporting their pain was not well controlled (F = 4.679, p = .010), whereas physician (M.D.) FTE HPPD had no effect on patients' perception of pain control (F = .296, p = .744). Figure 1, Figure 2 illustrate that an increase of 2.61 hours per day for nursing staff, 1.7 hours per day for registered nurses, and approximately 30 minutes per day for a hospitalist decreased the percentage of patients reporting poor pain control by more than half. Conversely, an increase of 63 minutes per day for a resident/intern had the opposite effect, doubling the percentage of patients reporting poor pain control.

Figure 2.

Pain "never" or "sometimes" controlled with physician staffing; n = 512 medical doctors and residents/interns, n = 262 hospitalists. Data for pain "never" or "sometimes" controlled from CMS HCAHPS, 2011–2012; and data for full-time equivalent hours per patient day from AHA, 2011.

Covariates significantly positively or negatively correlated with patients' perception of pain control, as well as factors known to be associated with pain management measured in HCAHPS, were included in the stepwise linear regression analysis. Table 1 describes the pairwise correlations of 20 covariates examined for significant association or scientific relevance with the dependent variable. All covariates were initially placed in the linear regression model and then eliminated by stepwise modeling if they remained associated at p = .05 and were removed at p = .10. This was determined by stepwise procedures and likelihood ratio tests.

Table 2 shows the six factors that significantly explained 79% of the variance patients' self-report that their pain was "never" or "sometimes" controlled. The percentage of patients self-reporting their pain was "never" or "sometimes" controlled increased by .277 SD for each increase of 1 standard deviation in the percentage of patients self-reporting they "never" or "seldom" received help when they wanted, by .234 SD when patients self-reported nurses "never" or "seldom" communicated well to the patient, by .090 SD when patients reported staff "never" or "sometimes" explained medicines before giving them, and by .776 SD in teaching hospitals. Conversely, the percentage of patients self-reporting their pain was "never" or "seldom" controlled decreased by .076 for each standard deviation increase in nursing staff FTE HPPD and by .768 in nonprofit hospitals.

In clinical terms, approximately 50% of the variance in each percentage increase in patients self-reporting their pain was "never" or "seldom" controlled was explained by patients reporting they "never" or "seldom" received help as soon as they wanted; approximately 25% when patients reported nurses "never" or "sometimes" communicated well to them; and approximately 15% when staff "never" or "seldom" explained medications. Hospital characteristics including Medicare case mix, Medicaid days to adjusted patient days, city/county hospitals, for-profit hospitals, total adult intensive care unit beds to total facility beds staffed, and hospital region did not explain the variation in patients' perception of pain control. Registered nurse, licensed practical nurse, nursing assistant, physician (M.D.), resident/intern, and hospitalist FTE HPPD did not independently contribute to the explained variation in patients' perception of pain control in the linear regression analysis.

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