Nursing Students' Assessment Ratings and Treatment Choices For Patients Experiencing Pain in a Case Vignette: Implications for Nursing Education

Patients’ pain has not been adequately controlled due to inaccurate assessments, inadequate treatments, and inconsistent nursing care. The purpose of this study was to examine nursing students’ assessment ratings and treatment choices for patients experiencing pain in a case vignette. Data collected from junior nursing students (prior to formal classroom instruction) compared to senior nursing students (one year after initial instruction) provided implications for nursing education, as well as conclusions about the understanding of pain assessment among student participants. The sample consisted of 270 junior and senior nursing students from two schools of nursing in East Tennessee, representing 95 percent of the identified population. The methodology included a descriptive design with a survey approach, utilizing a patient behavior case vignette and a demographic questionnaire for data collection. McCaffery and Ferrell, pain management experts, designed the case vignette instrument.

A majority of the students participating in the study rated the pain correctly for both patients in the case vignette; however 17.78 percent fewer students correctly rated pain for the patient who displayed atypical behavioral manifestations, such as smiling, laughing, and joking with a visitor. A majority of the students, at both program levels (junior/senior), rated the patients’ pain correctly; however, senior students at both schools of nursing were more prepared than junior students to assess, rate, and document pain in the case vignettes. Ratings of pain intensity were also disaggregated for nine subcategories of the entire respondent group.

There was not a strong connection between choosing the correct pain intensity rating and choosing the recommended dosage of analgesic. The principle of accepting, respecting, and documenting the patient’s self-report of pain was only one of the various rationales provided by students in this sample for correctly rating pain intensity.

Nursing faculty’s efforts to dispel myths and encourage adequate pain control through the curriculum have been only partially effective. The results of this study, as well as reports from other studies identified in the literature, suggest that education fosters some increase in knowledge, which leads to improved decision-making about pain management. However, it appears that current educational interventions are not sufficient.