Comparing nurses' and patients' pain evaluations: a study of hospitalized patients in Kuwait

All eligible patients hospitalized on the general medical, surgical and pediatric wards of a district hospital in Kuwait during the first 2 weeks of April 1990 (N = 199) were interviewed about their pain and the medical care provided. Patients rated their current pain using a 0-10 visual analogue scale (VAS) on which 0 was labelled 'no pain' and 10 'unbearable pain', and also the least and worst levels of pain which they had experienced during the previous 24 hr. Pediatric patients rated their mood at these times using a cartoon faces scale ([1]: McGrath P.A., DeVeber L. L. and Hearn M. T. Advances in Pain Research and Therapy, pp. 387-393. Raven Press, New York, 1985). Patients were asked to describe the most painful procedure which they had experienced whilst hospitalized, to detail their reactions to any uncontrolled pain, and recount the outcome of any requests made for additional analgesics. Whichever nurse on duty had had prime responsibility for caring for the patient was asked to furnish comparable VAS ratings of the patient's pain, and to categorize the patient as providing an accurate picture of, exaggerating, or understating his/her pain. Overall, nurses returned significantly lower pain estimates than their patients. Pediatric patients and patients described by their nurses as 'understating their pain', however, were exceptions. The vast majority of patients approved of the medical care provided and the pain management, and considered that nurses are well able to judge patients' pain and are concerned about what pain patients experience. And yet the VAS reports from patients indicated that uncontrolled pain was common. Also, when specifically questioned, a substantial proportion of patients stated that pain had had a negative impact on their mood and activity. Various explanations for these findings are discussed, and their implications for effective pain management. Some of the special problems facing nurses in Kuwait are considered.