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.

Conclusions

This study sought to explore how hospital characteristics, staffing, and nursing care factors in California, Massachusetts, and New York hospitals were associated with patient satisfaction with pain control in the Hospital Consumer Assessment of Health Care Providers Systems (HCAHPS) survey. Our findings indicate that patients who are more satisfied with pain management report higher satisfaction with nurse responsiveness to care, nurse communication, and medication education. Higher numbers of nursing staff and hospitalists as well as nonprofit hospitals were associated with higher satisfaction with pain control, whereas teaching hospitals and a higher number of residents and interns were associated with poor pain control.

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Acknowledgments
Matt Gregas, Ph.D., Research Services at Boston College provided statistical consultation. Dana Cassidy and Amy Lu, research fellows at Boston College, assisted with data entry. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Abstract and Introduction
Patient Satisfaction with Pain Control in Hcahps
Methods
Results
Discussion
Conclusions
References

Table 1. Correlations with Percentage of Patients' Self-Reporting Their Pain Was "Never" or "Sometimes" Controlled ^a (One-Tailed) (N = 255)
Model Factors Included in Stepwise Linear Regression	Coefficient	P
Patients "never" or "sometimes" received help as soon as they wanted^a	.841	<.001
Nurses "never" or "sometimes" communicated well with patient^a	.809	<.001
Staff "never" or "sometimes" explained medicines before giving them^a	.660	<.001
Medicaid days/adjusted patient days^b	.553	<.001
Nonprofit hospitals (0 = no, 1 = yes)^b	−.345	<.001
City/county hospitals (0 = no, 1 = yes)^b	.325	<.001
Teaching hospitals (0 = no, 1 = yes)^b	.299	<.001
Nursing assistant FTE HPPD^b	−.291	<.001
New York (0 = Massachusetts and California, 1 = New York)^b	.251	<.001
Hospitalist FTE HPPD^b	−.190	.001
Licensed practical nurse FTE HPPD^b	.178	.002
Massachusetts (0 = California and New York, 1 = Massachusetts)^b	−.174	.003
Residents/interns FTE HPPD^b	.172	.003
Nursing staff FTE HPPD^b	−.164	.004
Registered nurse FTE HPPD^b	−.132	.016
California (0 = Massachusetts and New York, 1 = California)^b	−.123	.025
Total ICU/CCU beds/total facility beds staffed^b	−.116	.032
For-profit hospitals (0 = no, 1 = yes)^b	.101	.055
Medicare case mix, 2011	−.053	.200
Medical doctor FTE HPPD^b	.015	.406

FTE = full-time equivalent; HPPD = hours per patient day; ICU = intensive care unit; CCU = critical care unit; LPN = licensed practical nurse; NA = nursing assistant.
Total Nursing Staff FTE HPPD = RN FTE HPPD + LPN FTE HPPD + NA FTE HPPD.

Table 2. Stepwise Linear Regression of Patients' Self-Report of Pain "Never" or "Sometimes" Well Controlled (%) With Predictors
Predictors	Unstandardized Coefficients		Standardized Coefficients	t	95% CI		p
Predictors	B	SE(B)	(β)	t	Lower	Upper	p
Patients "never" or "sometimes" received help as soon as they wanted (%)	.277	.028	.499	9.933	.222	.332	<.001
Nurses "never" or "sometimes" communicated well to patient (%)	.234	.053	.237	4.409	.129	.338	<.001
Teaching hospital	.776	.210	.113	3.691	.362	10.191	<.001
Staff "never" or "sometimes" explained medicines before giving them (%)	.090	.025	.146	3.645	.042	.139	<.001
Nursing staff FTE HPPD	−.076	.022	−.104	−3.507	−.119	−.033	.001
Nonprofit hospitals	−.768	.230	−.107	−3.340	−1.221	−.315	.001

CI = confidence interval; SE = standard error; FTE = full-time equivalent; HPPD = hours per patient day.
Stepwise: R ² = .795; adjusted R ² = .790; standard error of estimate = 1.319; SS = 2,106.196; p < .001, N = 254.

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