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Patient and nurse assessment of quality of care in postoperative pain management
Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medicine and Health Sciences, Clinical Pharmacology . Linköping University, Faculty of Health Sciences.
Department of Health Care Pedagogics, Göteborg University and Department of Health Sciences, University of Skövde, Skövde, Sweden .
Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
2002 (English)In: Quality & Safety in Health Care, ISSN 1475-3898, Vol. 11, no 4, 327-334 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To describe and compare patient and nurse assessments of the quality of care in postoperative pain management, to investigate differences between subgroups of patients, and to compare patient assessments in different departments.

Design: Patient and nurse questionnaires.

Setting: Five surgical wards in general surgery, orthopaedics, and gynaecology in a central county hospital in Sweden.

Sample: Two hundred and nine inpatients and 64 registered nurses. The response rates were 96% for the patients and 99% for the nurses; there were 196 paired patient-nurse assessments.

Method: The Strategic and Clinical Quality Indicators in Postoperative Pain Management patient questionnaire was used which comprises14 items in four subscales (communication, action, trust, and environment). The items were scored on a 5 point scale with higher values indicating a higher quality of care. Five complementary questions on levels of pain intensity and overall satisfaction with pain relief were scored on an 11 point scale. Twelve of the 14 items in the patient questionnaire and two of the complementary questions were adjusted for use in the nurse questionnaire.

Results: The patients’ mean (SD) score on the total scale (scale range 14–70) was 58.6 (8.9) and the nurses’ mean (SD) score (scale range 12–60) was 48.1 (6.2). The percentage of patients who scored 1 or 2 for an individual item (disagreement) ranged from 0.5% to 52.0%, while for nurses the percentage ranged from 0.0% to 34.8%. Forty two patients (24%) reported more pain than they expected; these patients assessed the quality of care lower. There were differences between patient and nurse assessments concerning the environment subscale, the question on overall satisfaction, and patients’ experience of worst possible pain intensity.

Conclusion: The results provided valuable baseline data and identified important areas for quality improvement in postoperative pain management.

Place, publisher, year, edition, pages
2002. Vol. 11, no 4, 327-334 p.
Keyword [en]
postoperative pain, quality improvement, patient assessment, nurse assessment
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-13617OAI: oai:DiVA.org:liu-13617DiVA: diva2:21061
Available from: 2001-05-29 Created: 2001-05-29 Last updated: 2009-05-19
In thesis
1. Development of Strategic and Clinical Quality: Indicators in Postoperative Pain Management
Open this publication in new window or tab >>Development of Strategic and Clinical Quality: Indicators in Postoperative Pain Management
2001 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this thesis was to identify important aspects of surgical nursing care, designing strategic and clinical quality indicators in postoperative pain management, investigate content validity, develop and evaluate psychometric properties of an instrument to measure the indicators, test the applicability of the instrument and investigate patient and nurse assessment.

To identify the important aspects of nursing care which might impact on quality of care in surgical wards, it was conducted 4 focus group interviews with clinical nurses (n=20). A tentative model with 15 categories in 2 dimensions, elements of performance and prerequisites, emerged from the data analysis. The categories were, e.g. detecting and acting on signs and symptoms, informing and educating, promoting relationships, responsibility and attitudes. The model was used as a foundation for developing indicators in postoperative pain management, one in each category, each supported by a literature review. To assess the content validity of the indicators, a questionnaire was compiled and sent to registered nurses with a special interest in pain (n=210) and to a random sample of clinical nurses working in surgical wards (n=321). The groups assessed the indicators as essential for achieving high quality, realistic to carry out and possible for nurses to influence management. The first group validated 14 of the 15 indicators and the second group validated 12 as “major” factors in terms of being essential to achieve high quality of care. The remaining factors were classified as “supportive”. No indicator was discarded.

To measure the indicators, an instrument was developed and psychometric properties were evaluated. The indicators were converted to statements suitable for a patient questionnaire and were scored on a 5-point scale with higher values indicating higher quality of care. Patients (n=198) answered the questionnaire on their second postoperative day. The inter-item and item-total correlation coefficients were in a satisfactory range, and Cronbach’s coefficient alpha (0.84) supported internal consistency reliability. Four sub-scales, entitled communication, action, trust and environment emerged from the factor analysis with a total variance of 61.4%. The total scale correlated (rs=0.53) with the single item pain-relief-satisfaction question. The patients who reported more pain than expected scored lower on the total scale and the patients who received epidural analgesia reported higher scores on the total scale. A nurse questionnaire, similar to the patient questionnaire, was compiled. The responsible nurse at the time (n=63) answered 196 questionnaires paired with the individual patient. The new instrument appeared to be useful in identifying important areas for improvement both from the patients’ and nurses’ perspectives, based on the number of disagreements (1 and 2). Differences were found among departments. The patients’ assessments on the environment sub-scale and the overall satisfaction question were higher than the nurses’ assessments. The findings suggest initial support for the instrument as a means to measure the quality of nursing care in postoperative pain management. Key words: quality indicators; health care, pain; postoperative, focus groups, psychometrics, questionnaires, nursing care.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2001. 67 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 671
Keyword
quality indicators; health care, pain; postoperative, focus
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-5158 (URN)91-7219-966-0 (ISBN)
Public defence
2001-05-11, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 09:00 (English)
Opponent
Supervisors
Note
On the day of the public defence of the doctoral thesis the status of the articles III was: Accepted; article IV and V was: Accepted for publishing.Available from: 2001-05-29 Created: 2001-05-29 Last updated: 2012-01-24Bibliographically approved

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Idvall, EwaHamrin, ElisabethUnosson, Mitra

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