- Patient-nurse postoperative pain discordance is interpretive, shaped by trust, family dynamics, multilingual communication, workload and hierarchy, not just numeric scores.
- Nurses use clinical judgement beyond pain scores to decide whether to administer, delay, question or escalate analgesia, balancing relief with opioid harm avoidance.
- Strengthen postoperative management via support for nurses' judgement, cross-cultural communication, structured team decision making and opioid stewardship responsive to assessment uncertainty.
Pain Manag Nurs. 2026 Sep 18:S1524-9042(26)00275-4. doi: 10.1016/j.pmn.2026.08.014. Online ahead of print.
ABSTRACT
PURPOSE: To explore how surgical-ward nurses experience and interpret patient-nurse discordance in postoperative pain assessment and how this discordance shapes pain management and opioid stewardship in practice.
DESIGN: Qualitative study using Interpretive Description.
METHODS: Nineteen registered nurses providing direct postoperative care in adult surgical wards were purposively recruited from two hospitals in southern Saudi Arabia to maximize variation across sites, experience, roles, and specialties. Individual semi-structured interviews were audio-recorded, transcribed verbatim, and analyzed concurrently using Interpretive Description.
RESULTS: Four interpretive themes were identified: Reading pain beyond the number; negotiating credibility in a relational and cultural space; practicing caution under the shadow of opioids; and carrying discordance within organizational constraints. Discordance was described not as a simple mismatch between pain scores and clinical observation, but as an interpretive challenge shaped by trust, family dynamics, multilingual communication, workload, and hierarchical decision-making. Participants described it as influencing whether analgesia was administered, delayed, questioned, or escalated, and intensifying the tension between relieving suffering and avoiding opioid-related harm.
CONCLUSIONS: Patient-nurse discordance in postoperative pain assessment is a clinically consequential phenomenon that extends beyond numeric pain scoring and was described as shaping analgesic decision-making and opioid stewardship in surgical wards. Nurses navigate this discordance through interpretive, relational, and organizational work not fully captured by standard pain assessment tools alone.
CLINICAL IMPLICATIONS: Postoperative pain management may be strengthened by approaches that support nurses’ clinical judgement, communication across linguistic and cultural differences, structured team-based decision-making, and opioid stewardship practices responsive to uncertainty in pain assessment.
PMID:42760244 | DOI:10.1016/j.pmn.2026.08.014
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