Beyond the Pain Scale: Provider Communication and Staffing Predictive of Patients' Satisfaction with Pain Control

This paper examined hospital characteristics, staffing, and nursing care factors associated with patient perception of poor pain control by conducting a secondary analysis of the Hospital Consumer Assessment of Health Care Providers Systems (HCAHPS) survey in California, Massachusetts, and New York hospitals. Analysis of variance was used to analyze the relationship between nurse, hospitalist, physician, and resident staffing and patients' perception of pain control. Twenty-one factors correlated with patients' reports of pain control were included in the stepwise linear regression analysis. Patients' perception of pain control significantly improved with higher numbers of registered nurses (p = .045), nursing staff (p = .005), and hospitalists (p = .035) and worsened with higher numbers of residents or interns (p = .010). Six predictors explained 79% of the variance in patients' self-reports of pain control. Four factors increased the likelihood that patients reported their pain was poorly controlled: (1) patients did not receive help as soon as they wanted (p < .001), (2) poor nurse communication (p < .001), (3) poor medication education (p < .001), and (4) teaching hospitals (p < .001). Two factors decreased the likelihood that patients reported their pain was poorly controlled: (1) higher numbers of nursing staff (p = .001) and (2) nonprofit hospitals (p = .001). Nurse staffing and nurse-patient communication are highly predictive of patients' perception of pain management. In teaching hospitals, with rotating intern/resident assignments, patients reported less satisfaction with pain management. This study provides new evidence for the importance of continuity of care in controlling the pain of hospitalized patients.