Pain Assessment in the Acute Care Setting

Pain assessment and management are dominant issues in the healthcare setting confounded by the opioid epidemic. As healthcare improves based on the best evidence available, it is clear that pain assessment viewed in a holistic manner is a key approach moving forward. The use of the Clinically Aligned Pain Assessment© (CAPA©) takes into consideration the multi-dimensional aspects of pain. The purpose of this evidence-based practice project is to evaluate the effect of an alternative pain assessment, CAPA©, on patient satisfaction with nurse communication and pain management, and it’s influence on nursing self-efficacy. Nurses in an adult medical-surgical acute care unit were provided education and coaching on using CAPA© instead of a traditional numeric rating scale. Adherence to CAPA© performance was measured during the project period. Comparison of patient satisfaction prior to and after the implementation of CAPA© did not reveal a consistent improvement in results. Nursing self-efficacy demonstrated no statistically significant improvement overall. However, data from this evidence-based practice project demonstrated a statistically significant increase in self-efficacy scores for nurses with longevity on the unit. Adherence data collected during the implementation of CAPA© showed higher than expected rates of adherence when compared to similar practice changes. The CAPA© instrument implementation did not result in overall improvements in patient satisfaction and nursing self-efficacy. These findings suggest there is more work to be done when it comes to improving pain assessment, and that CAPA© may not be the ideal instrument to move pain assessment practice forward in all practice settings and with all clinician experience levels.