Pain assessment by patients and nurses in the early phase of acute myocardial infarction

Authors

  • E. Bondestam RN,

    Corresponding author
    1. Department of Medicine 1, Sahlgren's Hospital, Department of Medicine, Ostra Hospital, Göteborg and College of Nursing, Medical Center, University of Nebraska, Nebraska, USA
      E. Bondestam, Ward 38, Department of Medicine 1, Sahlgren's Hospital, 413 45 GoUteborg, Sweden.
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  • K. Hovgren RN,

    1. Department of Medicine 1, Sahlgren's Hospital, Department of Medicine, Ostra Hospital, Göteborg and College of Nursing, Medical Center, University of Nebraska, Nebraska, USA
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  • F. Gaston Johansson RN,

    1. Department of Medicine 1, Sahlgren's Hospital, Department of Medicine, Ostra Hospital, Göteborg and College of Nursing, Medical Center, University of Nebraska, Nebraska, USA
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  • S. Jern MD,

    1. Department of Medicine 1, Sahlgren's Hospital, Department of Medicine, Ostra Hospital, Göteborg and College of Nursing, Medical Center, University of Nebraska, Nebraska, USA
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  • J. Herlitz MD,

    1. Department of Medicine 1, Sahlgren's Hospital, Department of Medicine, Ostra Hospital, Göteborg and College of Nursing, Medical Center, University of Nebraska, Nebraska, USA
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  • S. Holmberg MD

    1. Department of Medicine 1, Sahlgren's Hospital, Department of Medicine, Ostra Hospital, Göteborg and College of Nursing, Medical Center, University of Nebraska, Nebraska, USA
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E. Bondestam, Ward 38, Department of Medicine 1, Sahlgren's Hospital, 413 45 GoUteborg, Sweden.

Abstract

In 47 patients admitted to the coronary care unit (CCU) at Sahlgren's Hospital in Göteborg, Sweden, due to acute myocardial infarction (MI) the intensity of pain independently assessed by the patient and by the nurse on duty was evaluated during the first 24 hours in CCU. Pain was assessed according to a modified numerical rating scale graded from 0-10, where 0 meant no pain and 10 meant the most severe pain. A positive correlation between the patients’ and nurses’ assessments was found (r = 0-76; P < 0-001). However, the nurses under-estimated the patients’ pain in 23% of the situations and over-estimated it in 20%. Over-estimation was particularly found when heart rate and blood pressure increased. Many patients scoring their pain to fairly high degrees were not given pain-relieving treatment. Treatment with morphine did not cause substantial pain relief in a substantial number of patients. A significantly positive correlation was found between the patients’ and nurses’ assessments of pain, although underestimation as well as over-estimation occurred. A few patients with severe pain were not treated and when treatment was given it was often ineffective.

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