Congruency of Nurse–Patient Pain Scoring in the Emergency Department: A Cross-Sectional Observational Study

Abstract

Aim: To examine the congruency between patient self-reporting and nurse assessment of pain in the emergency department (ED) through the use of the numerical rating scale (NRS) and visual analogue scale (VAS). Materials & methods: Patient self-reporting of pain and nurse assessments were concurrently conducted using the NRS and VAS. Results & conclusion: Self-reported pain assessment was collected from 200 ED patients in parallel with their corresponding nurse-reported pain scores, conducted by 67 ED nurses. Although nurse–patient pain scoring was associated with a high congruency using both NRS and VAS (88.2 and 91.5%, respectively), nurses still underestimated patients’ pain intensity using both tools (t = 2.37 and 2.60; p = 0.007 and 0.010 and CI: 0.17–1.1 and 0.06–0.46, respectively). Some nurse–patient characteristics showed relationships with a discrepancy in pain scoring.

Plain language summary

This study was conducted to answer the following question: to what extent do emergency department nurses match their pain assessment with their patients pain assessment? The study used two common pain assessment tools: numerical rating scale (pain scored from 1 to 10) and visual analogue scale (pain scored using five facial expressions). The results indicated that nurses slightly underestimated patients’ pain but not to a great extent. Differences between nurse and patient pain assessments were the lowest when using visual analogue scale, meaning that this method of pain assessment facilitates greater matching between nurse and patient assessments. It was noted that patients who frequently visit the emergency department had greater matching between their pain assessment and their nurse’s assessment.

Keywords::

• assessment
• emergency department
• nurse
• pain
• patient

Acknowledgments

The authors are indebted to all nurses and patients who participated in the study. The study would not be possible without the generous amenities offered by the hospitals involved in the study represented by their ED staff and administration.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they have obtained appropriate institutional review board approval or have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations. In addition, for investigations involving human subjects, informed consent has been obtained from the participants involved.