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Measuring the Quality of Care Related to Pain Management: A Multiple-Method Approach to Instrument Development

Larsen Beck, Susan; Towsley, Gail L.; Berry, Patricia H.; Brant, Jeannine M.; Lavoie Smith, Ellen M.

doi: 10.1097/NNR.0b013e3181d1a732

Background: Research to document the effects of nursing on patient outcomes such as pain has been limited by the inability to measure the quality of nursing care effectively.

Objective: The purpose of this study was to establish content validity and to evaluate patient understanding of Pain Care Quality (PainCQ) survey items using cognitive interviewing.

Method: In the development phase, 101 items representing four constructs were generated from the transcriptions of 33 qualitative interviews conducted with cancer patients in pain. In the judgment phase, items were reviewed systematically by two panels of pain experts. In the final phase, cognitive interviews were conducted with hospitalized cancer patients reporting pain.

Results: Content validity was established if eight of nine (p < .05) experts agreed the item was relevant or very relevant. On the basis of the expert panel review, items were deleted, reworded, and added, and 73 items remained. These items were evaluated by cognitive interviews with 39 hospitalized patients with multiple types of cancer in three states. The mean age was 58.87 years, and 60.5% were women. Most were non-Hispanic White (94.7%), and education varied. On a 0 to 10 scale, worst pain during the past shift averaged 5.24 (SD = 2.43). Participant responses to the PainCQ survey items were summarized for each item using a matrix tool and evaluated in team meetings. Through an iterative process, items were revised and reduced to produce the PainCQ survey (v3) with 44 items.

Discussion: Through this deliberative and iterative process, an instrument was produced that will contribute to the measurement of the quality of nursing and interdisciplinary care related to pain management. The items retained in the PainCQ were understood and judged by hospitalized patients with pain easily. Further psychometric testing of the PainCQ is indicated.

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Susan Larsen Beck, PhD, APRN, FAAN AOCN, is Professor and Robert S. and Beth M. Carter Endowed Chair in Nursing; Gail L. Towsley, PhD, is Assistant Professor; and Patricia H. Berry, PhD, APRN, FAAN, is Associate Professor, College of Nursing, University of Utah, Salt Lake City.

Jeannine M. Brant, PhD, APRN, AOCN, is Clinical Nurse Specialist and Nurse Scientist, Billings Clinic, Montana.

Ellen M. Lavoie Smith, PhD, APRN-BC, AOCN, is Assistant Professor, School of Nursing, University of Michigan, Ann Arbor.

Editor's Note Additional information provided by the authors expanding this article is on the editor's Web site at

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Accepted for publication September 21, 2009.

This study was funded by an Interdisciplinary Nursing Quality Research Initiative grant from the Robert Wood Johnson Foundation. The expertise of Carol Estwing Ferrans, PhD, RN, FAAN, Professor and Associate Dean for Research, University of Illinois at Chicago, College of Nursing, is acknowledged gratefully. The authors also thank the patients in pain who agreed to share their perspectives and experiences.

Corresponding author: Susan Larsen Beck, PhD, APRN, FAAN AOCN, College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT 84112-5880 (e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.