Good patients cope with their pain: postoperative analgesia and nurses' perceptions of their patients' pain

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Abstract
Patients routinely receive less analgesia postoperatively than they need. Previous attempts to understand this have examined the nurses' attitudes to analgesia and their ability to assess accurately the intensity of their patients' pain. The present study examined three hypotheses derived from an alternative view that undermedication results from patients failing to disclose their difficulty in coping with pain because this would lead to disapproval by nurses: (i) that analgesic intake is related, not to pain intensity but to patients' feelings of being unable to cope with pain and to nurses' assessment of their inability to cope; (ii) that nurses specifically underestimate patients' ability to cope with their pain; and (iii) that poor coping with pain is seen by nurses as indicative of a 'bad' patient. Pain ratings were completed by 56 patients undergoing minor abdominal surgery; nurses completed similar scales to show their perception of patients' pain, as well as a specially devised scale which measured how negatively or positively they felt about their patients. Nurses were sensitive to the intensity of their patients' pain, but underestimated how well patients felt they coped with pain and how much they wanted analgesia. Patients who experienced the worst pain, or whom the nurses perceived as coping least well with their pain, were evaluated by the nurses as unpopular and demanding.