The nature of informal pain questioning by nurses--a barrier to post-operative pain management?

Objective: The aim of this study was to explore the nature of nurses' informal pain-related questioning.

Methods: Non-participant observations were performed on one vascular and one urology surgery ward, involving 26 nurses in 402 patient contacts on eight days (total observation time: 39 hours). A questionnaire survey of 180 (of 335 = 53.7% response rate) nurses working on the same two types of surgery wards in 14 UK hospitals was also undertaken. Instruments (observation sheet & questionnaire) were based on initial qualitative work and developed alongside each other to enable complementation of data.

Results: Both methods identified routine drug administration rounds as the predominant time for informal pain questioning. Observed nurses asked about one third of patients at those times. The majority of pain questions were closed, and interactions were generally brief and task-orientated, often involving one question.

Conclusion: This study has shown the need for a more systematic way to assess patients' pain in routine practice. Suggestions are made about how pain questioning could be improved even if it continues to take place during drug rounds. These may provide a good opportunity for efficient pain questioning within a work environment acknowledging pressures of time and workload. Furthermore, within the current climate of increased multidisciplinary collaboration, the relevance of this study to medicines management and pharmacy are discussed.