The Pain Experience of Inpatients in a Teaching Hospital
This descriptive, cross-sectional study was conducted in a 530-bed tertiary care teaching hospital in Western Canada on a single day. Study participants in this convenience sample included patients admitted to 12 units representing three clinical programs: (1) Cardiac Sciences (cardiac surgery and cardiology); (2) Medicine (rehabilitation/geriatrics, family, and internal medicine); and (3) Surgery (general surgery, gynecology, otolaryngology, plastics, urology, and vascular). The inclusion criteria were hospital admission greater than 24 hours; age 18 years or older; fully conscious with no cognitive impairment; able to read, write, and converse in English; and medically stable. The study received approval from the institutional research review committee and a university-affiliated research ethics board.
Data were collected using the Short Form–Brief Pain Inventory (SF-BPI) survey (Cleeland, 2009). The SF-BPI consists of four pain severity items and seven items related to pain interference with daily activities rated on scales of 0 to 10. The survey instrument includes a question about the degree of pain relief and what pain treatments or medications have been received. The reliability of this tool has been established with reported Cronbach's alpha coefficients of 0.77 to 0.91 and it has been psychometrically validated in multiple languages (University of Texas MD Anderson Cancer Center, 2012).
Demographic and additional data were collected from participants to obtain a more comprehensive understanding of the study population and to explore the relationships between these variables and the pain experience. Some of the variables collected were gender, age, length of stay, surgical intervention, pain duration, involvement in pain treatment decision making, and helpfulness of hospital staff with pain management.
The surveys were distributed and administered by 24 study volunteers recruited from Volunteer Services and the Nursing Practice Council. Study volunteers were paired and assigned specific clinical areas, purposefully different from the clinical area where the Nursing Practice Council member held a current working position. The study volunteers were briefed on the recruitment and survey administration processes, including the infection prevention and control precautions to be followed.
Upon entering the clinical areas, study volunteers received a list of eligible patients from the charge nurses. Using a script to ensure consistency in information, volunteers provided eligible patients with a letter of additional study information and invited them to participate. Their consent was implied by their completion of the survey. The survey was self-administered by a small number of participants, although most requested assistance and an interview approach was used. Anecdotally, it was reported that it took approximately 10 minutes for the survey to be completed. A maximum 4-hour period was provided for data collection, which included distribution, administration, and return of completed surveys.
Analysis was performed using the SPSS Statistical Software Version 14 (SPSS Inc., Chicago, IL). Frequencies were examined for normal distribution. Continuous variables were summarized using means and standard deviations (SDs) and categorical measures were described using frequencies and percentages. Differences between categorical variables were examined using the Chi-square test (X). The nature of the relationship among variables of age, length of stay, involvement in deciding pain treatment, and length of time with pain on mean pain intensity and interference scores was measured using Pearson's product moment correlations. To detect differences in mean SF-BPI scores between two and three groups, two-tailed Student t-test and analysis of variance were used, respectively. Statistical significance was preset at the p ≤ .05 level.
Methods
Study Design and Sample
This descriptive, cross-sectional study was conducted in a 530-bed tertiary care teaching hospital in Western Canada on a single day. Study participants in this convenience sample included patients admitted to 12 units representing three clinical programs: (1) Cardiac Sciences (cardiac surgery and cardiology); (2) Medicine (rehabilitation/geriatrics, family, and internal medicine); and (3) Surgery (general surgery, gynecology, otolaryngology, plastics, urology, and vascular). The inclusion criteria were hospital admission greater than 24 hours; age 18 years or older; fully conscious with no cognitive impairment; able to read, write, and converse in English; and medically stable. The study received approval from the institutional research review committee and a university-affiliated research ethics board.
Study Instrument and Data Collection
Data were collected using the Short Form–Brief Pain Inventory (SF-BPI) survey (Cleeland, 2009). The SF-BPI consists of four pain severity items and seven items related to pain interference with daily activities rated on scales of 0 to 10. The survey instrument includes a question about the degree of pain relief and what pain treatments or medications have been received. The reliability of this tool has been established with reported Cronbach's alpha coefficients of 0.77 to 0.91 and it has been psychometrically validated in multiple languages (University of Texas MD Anderson Cancer Center, 2012).
Demographic and additional data were collected from participants to obtain a more comprehensive understanding of the study population and to explore the relationships between these variables and the pain experience. Some of the variables collected were gender, age, length of stay, surgical intervention, pain duration, involvement in pain treatment decision making, and helpfulness of hospital staff with pain management.
The surveys were distributed and administered by 24 study volunteers recruited from Volunteer Services and the Nursing Practice Council. Study volunteers were paired and assigned specific clinical areas, purposefully different from the clinical area where the Nursing Practice Council member held a current working position. The study volunteers were briefed on the recruitment and survey administration processes, including the infection prevention and control precautions to be followed.
Upon entering the clinical areas, study volunteers received a list of eligible patients from the charge nurses. Using a script to ensure consistency in information, volunteers provided eligible patients with a letter of additional study information and invited them to participate. Their consent was implied by their completion of the survey. The survey was self-administered by a small number of participants, although most requested assistance and an interview approach was used. Anecdotally, it was reported that it took approximately 10 minutes for the survey to be completed. A maximum 4-hour period was provided for data collection, which included distribution, administration, and return of completed surveys.
Statistical Analysis
Analysis was performed using the SPSS Statistical Software Version 14 (SPSS Inc., Chicago, IL). Frequencies were examined for normal distribution. Continuous variables were summarized using means and standard deviations (SDs) and categorical measures were described using frequencies and percentages. Differences between categorical variables were examined using the Chi-square test (X). The nature of the relationship among variables of age, length of stay, involvement in deciding pain treatment, and length of time with pain on mean pain intensity and interference scores was measured using Pearson's product moment correlations. To detect differences in mean SF-BPI scores between two and three groups, two-tailed Student t-test and analysis of variance were used, respectively. Statistical significance was preset at the p ≤ .05 level.