Evidence indicates that higher levels of pain and depression are linked to poor satisfaction with care in ambulatory settings.

Patient satisfaction with care is strongly tied to their experiences with pain during hospitalization. Hospitals stand to lose reputation as well as profit if pain is poorly managed. 7 Nurses, as part of the collaborative team responsible for managing pain during hospitalization, also may be liable for legal action. Having standards of care in place increases the risk of legal action against clinicians and institutions for poor pain management, 6 and there are instances of law suits filed for poor pain management by physicians. Current standards for pain management, such as the national standards outlined by the Joint Commission (formerly known as the Joint Commission on Accreditation of Healthcare Organizations, JCAHO), 5 require that pain is promptly addressed and managed. Poorly managing pain may put clinicians at risk for legal action. (For more detail, go to the section, вЂњHarmful Effects of Unrelieved Pain,вЂќ below.) Patients who have experienced inadequate pain management may be reluctant to seek medical care for other health problems. The inability to escape from pain may create a sense of helplessness and even hopelessness, which may predispose the patient to a more chronic depression. Common psychological responses to pain include anxiety and depression. Postsurgical complications related to inadequate pain management negatively affect the patientвЂ™s welfare and the hospital performance because of extended lengths of stay and readmissions, both of which increase the cost of care.Д¬ontinuous, unrelieved pain also affects the psychological state of the patient and family members. Of particular importance to nursing care, unrelieved pain reduces patient mobility, resulting in complications such as deep vein thrombosis, pulmonary embolus, and pneumonia. Sympathetic activation can have negative effects on the cardiovascular, gastrointestinal, and renal systems, predisposing patients to adverse events such as cardiac ischemia and ileus.

Continuous, unrelieved pain activates the pituitary-adrenal axis, which can suppress the immune system and result in postsurgical infection and poor wound healing. Inadequately managed pain can lead to adverse physical and psychological patient outcomes for individual patients and their families.

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