Pain management documentation: The effects of the perception of the practice environment and clinical expertise
Pain is known to be pervasive, severe, and under treated in hospital settings (Abbott et al., 1992; Carroll et al., 1999; Whelan, Jin, & Meltzer, 2004). Since pain management is both an organizational and individual process, the purpose of this study was to examine the contribution of individual nurses' perceptions of their practice environments and their clinical expertise to their pain management documentation in the surgical population. A convenience sample of 85 nurses from two teaching hospitals in the Boston area volunteered to participate in the study. The nurses completed the Practice Environment Scale of the Revised Nursing Work Index (Lake, 2002a) and the Staff Registered Nurse Survey (Lake, 2002b) to measure the independent variables. A new instrument developed by the investigator, the Pain Management Documentation Rating Scale, based on experts' ratings of nurses' charted activities, was used to rate pain management documentation. Data were analyzed first descriptively, then using multiple regression. Results showed that the perception of the practice environment did not contribute to pain management documentation whereas clinical expertise explained 4.4% of the variance. Clinical expertise and pain management documentation were inversely related. Study methods, nurse sample demographics and the overall state of pain management documentation impacted the results. Implications for nursing administration and staff educators are that consistent implementation of guidelines on which experts agree are necessary for improvement in pain management documentation.