• Patient self-reported pain;
  • Pain evaluation congruence;
  • Pain over-estimation;
  • Pain under-estimation;
  • Inpatients;
  • Nurse;
  • Situational moderators


Objective: To enhance the awareness that biased pain estimation may undermine its treatment, we sought to determine the congruence categories (CCs) between inpatient self-reported pain (PSRP) and nurse pain-evaluation (NEP) and to look for associations between CCs and inpatient and situational moderators.

Design: A point cross-sectional survey.

Subjects: The inpatient population [(n=869), ≥6years old and hospitalised for at least 24h] and n=115 nurses of the University of Bologna's teaching hospital, Italy.

Measures: Using numerical rating scale, inpatients self-reported their pain while nurses indirectly rated these patients’ pain using information acquired during their professional activity prior to the study and by reviewing patients’ medical charts.

Outcome measures: Congruence moderator data were: gender, age, marital status, clinical area and length of hospital stay. The study was set to assess: PSRP–NEP mean of absolute difference (MAD), agreement and correlation; and to analyse the CCs dependence upon the PSRP and the congruence moderator variables.

Results: PSRP–NEP agreement and correlation were mild and moderate, respectively, while their MAD=2.0 (95% CI 1.8–2.2). Congruence was found in 50% of the cases. Under-estimation (21%) was directly proportional to the PSRP severity, while congruence and over-estimation (29%) were inversely proportional to it. The ‘PSRP effect’ on the CCs detected was further modulated by the moderators studied.

Conclusions: PSRP–NEP congruence was limited while CCs were associated with PSRP, inpatient and situational moderators. Further prospective studies are needed to verify generalization and whether the studied moderators operate through patient stereotyping mechanisms. Awareness of the influence of such mechanisms on pain evaluation may ameliorate pain assessment.