Nursing Sensitive Quality Indicators Sample Paper


Nursing Sensitive Quality Indicators (NSQI) describe the key values and elements used to measure the impact and the contribution of nurses on patients’ health outcomes. Today, patient satisfaction is a critical factor in assessing patient outcomes. The American Nurses Association has identified about ten critical NSQIs that are used in acute care settings. The quality indicator that I have chosen to discuss is patient satisfaction with pain management.

Patient Satisfaction with Pain Management.

One of the most critical issues for patients is managing pain. Consequently, pain management has become an essential measurement tool for patient satisfaction. Being a subjective issue, healthcare facilities are judged by how satisfied patients are in terms of pain management. In acute settings, healthcare facilities employ numerous ways of managing pain such as using opioids. The use of opioids in chronic pain management, according to Miclette et al., (2018), elicits mixed reactions among those who support its use and those who oppose it.

He same applies to other drugs and substances used in pain management, such as medicinal marijuana. One of the most advanced theories that have been used to explain as well as provide an effective framework for pain management is the Brain Theory of Social Attachment, BOTSA. This theory provides that managing physical and emotional pain can be achieved by managing social connections, and subjective experiences of patients within the healthcare setting.

For instance, the dilemma that exists for patients who use marijuana medicinally is that in as much as half of the States in America have legalized the use of marijuana medicinally even with the doctor’s approval, the United States Code section 844 expressly outlines that possession of a controlled substance of any amount is a crime (Dougherty et al, 2013, P. 207). Therefore, in as much as State Laws permit the use of marijuana for medicinal purposes, it is still possible for one to get prosecuted criminally under Federal laws.

The Federal Government, through its many Federal agencies particularly the Drug enforcement Administration DEA, has made their intentions clear to stop the distribution of medical marijuana through strict enforcement of Federal drug laws. The DEA argues that there is no binding consensus in medicine that marijuana really helps patients. In 1970, the Congress enacted laws prohibiting the use of marijuana based on this argument that the drug has no proven medical effect or value.

According to Inagaki (2018), BOTSA theory holds that strong social connections or attachments can lead to reduced pain in patients. This means that patients or people under opioid treatment are encouraged to always be in the presence of friends or loved ones rather than live in separation (Scarborough & Smith, 2018). Staying in isolation increases the urge in patients to use more opioids as a way of responding to social stressors. Thus, Brain Theory of Social Attachment asserts that social connection is related to wellbeing.

The Brain Theory of Social Attachment provides a clear framework for the treatment of opioid addiction. In this case, the issue of stopping opioid addiction is dependent on the allegiances or strong bonds formed by addicts (Inagaki, 2017, p. 4). However, this process would require an effective grieving and or mourning process such as losing a loved one. The social connection process is considered therapeutic and can help in the healing process among opioid addicts. However, this theory works on the assumption that for every addict, there will be a sufficient grieving process that may never occur (p. 149). On the other hand, even without the grieving process, the strong connections and bonds formed by addicts and their loved ones may be sufficient to control their opioid intake.

Importance of Pain Management in Patient satisfaction

Nurses must have an ethical responsibility for pain management to reduce patient suffering. If not managed well, pain adversely affects patients psychologically and physically. Based on this analogy, nurses must bear the responsibility of helping patients to find relief from their pain. Apart from physical pain, other adverse effects of pain in patients include depression and anxiety. Poor pain management by nurses have numerous adverse effects for both patients and healthcare facilities, hence the need for pragmatic interventions.

Poor pain management may put nurses/physicians at the risk of legal suits. The joint Commission on Accreditation of Healthcare Organizations (JCAHO) clearly stipulates that pain in patients must be managed and addressed promptly. Poor pain management may make patients to perceive it as neglect (Bonnie et al., 2019). The fact that there are set standards for pain management make hospitals more vulnerable to lawsuits from patients. It is the responsibility of healthcare facilities to have in place effective mechanisms for pain management.

Poor pain management may result in poor reputation for hospitals. Patient satisfaction is directly tied to their experiences with pain. Higher levels of pain is often associated with poor patient satisfaction. When a healthcare facility fails to effectively manage pain in patients, the facility quickly loses reputation as many patients begin to avoid it (Wood, Simel, & Klimas, 2019). The reputation of a hospital is based on the experiences of patients during their stay. Proper pain management boosts customer satisfaction which also directly affects profits and reputation.

Cheatle (2015), after a critical assessment of pain management, asserts the need to maintain the rights of patients receiving pain management by the use of relevant mechanisms (P.6). Cheatle further asserts that patients with acute pain should not be denied access to opioids based on the fears about risks of addiction. According to Cheatle, administering opioids to patients should be accompanied by therapeutic management to help reduce addiction to opioids. The shortcoming with Cheatle’s assertion is that he advocates for the continued use of opioids while completely ignoring the issue of dependency, neither does he provide a way out for a safe and effective alternative.

According to Bolliger and Stevens (2019), there is a need to recognize that dependency on opioids is a serious health hazard that practitioners ought not to ignore. Citing a study by WHO on efforts to reduce opioid addiction, Bolliger and Stevens assert that the more a person is on opioids, the higher the chances of becoming dependent on the drug, a factor that should not be taken for granted if the millions of Americans currently addicted to the drug is anything to go by.


Pain management is a critical tool in measuring patient satisfaction. Nurses/physicians have a duty to help in pain management for patients. There are different techniques that healthcare facilities can employ in patient pain management. One of the best but controversial methods of pain management is using opioids or medical marijuana. Yet, since patient satisfaction is directly tied to their experiences with pain, higher levels of pain is often associated with poor patient satisfaction. When a healthcare facility fails to effectively manage pain in patients, the facility quickly loses reputation as many patients begin to question their approach to pain management.


  • Bonnie, R. J., Schumacher, M. A., Clark, J. D., & Kesselheim, A. S. (2019). Pain Management and Opioid Regulation: Continuing Public Health Challenges. American Journal of Public Health, 109(1), 31–34. doi: 10.2105/ajph.2018.304881
  • Miclette, M. A., Leff, J. A., Cuan, I., Samet, J. H., Saloner, B., Mendell, G., Bao, Y., Ashburn, M. A., Bachhuber, M. A., Schackman, B. R., Polsky, D. E., & Meisel, Z. F. (2018). Closing the gaps in opioid use disorder research, policy and practice: conference proceedings. Addiction Science & Clinical Practice, 13(1). doi: 10.1186/s13722-018-0123
  • Wood, E., Simel, D. L., & Klimas, J. (2019). Pain Management With Opioids in 2019-2020. JAMA, 1. doi: 10.1001/jama.2019.15802
  • Scarborough, B. M., & Smith, C. B. (2018). Optimal pain management for patients with cancer in the modern era. CA: A Cancer Journal For Clinicians68(3), 182-196.