Skip to main content
. 2026 Mar 19;13:1752781. doi: 10.3389/fmed.2026.1752781

Table 3.

SNPMC item importance and weights.

Dimension Item Mean of importance SD CV Factor loading Weight Score
Dimension A: routine pain assessment • A-1 conduct pain assessment when a patient reports pain 4.96 0.21 0.04 0.706b 0.0117 1
• A-2 conduct pain assessment before administering analgesics 4.87 0.34 0.07 0.775b 0.0076 1
• A-3 conduct pain assessment after administering analgesics 4.83 0.39 0.08 0.790b 0.0052 0.5
• A-4 conduct pain assessment upon patient admission or transfer to another department. 4.87 0.46 0.09 0.766b 0.0076 1
• A-5 conduct pain assessment during each shift. 4.57 0.73 0.16 0.702b 0.0026 0.5
• A-6 pain location 5.00 0 0 0.751b 0.0076 1
• A-7 pain intensity 5.00 0 0 0.777b 0.0076 1
• A-8 temporal characteristics of pain (e.g., onset and duration) 4.96 0.21 0.04 0.775b 0.0044 0.5
• A-9 nature of pain 5.00 0 0 0.752b 0.0076 1
• A-10 factors aggravating or alleviating pain 4.96 0.21 0.04 0.716b 0.0044 0.5
• A-11 impact of pain on the patient's quality of life (e.g., sleep) 4.87 0.34 0.07 0.707b 0.0031 0.5
• A-12 use validated and reliable pain assessment tools 5.00 0 0 0.705b 0.0196 2
• A-13 select a self-report pain assessment tool for patients able to communicate 4.91 0.29 0.06 0.696b 0.0148 1.5
• A-14 use objective pain assessment tools for patients unable to communicate 4.83 0.39 0.08 0.652b 0.0088 1
• A-15 conduct pain assessment based on patient feedback, incorporating a physical examination when necessary 4.87 0.34 0.07 Excluded 0.0114 /
• A-16 empathize with the patient's feelings 4.52 0.59 0.13 0.511b 0.0044 0.5
• A-17 conduct individualized assessments based on the patient's clinical condition, age, communication level, and cognitive function 4.96 0.21 0.04 0.612b 0.0083 1
• A-18 continuously monitor the patient's pain condition 4.87 0.34 0.07 0.596b 0.0059 0.5
• A-19 reassess pain regularly using appropriate tools 4.83 0.39 0.08 0.640b 0.0035 0.5
• A-20 document the pain assessment tools used and assessment results 4.83 0.39 0.08 0.627b 0.0035 0.5
Dimension B: assessment and management of movement-evoked pain and unexpected pain • B-1 assess movement-evoked pain before and during functional exercises 4.96 0.21 0.04 0.411d 0.0107 1
• B-2 assess movement-evoked pain when the patient reports pain interfering with functional activities 5.00 0 0 0.417d 0.0214 2
• B-3 Use the Functional Activity Score (FAS) as the assessment tool for movement-evoked pain 4.96 0.21 0.04 0.626d 0.0107 1
• B-4 for FAS grade a: guide the patient in proper functional exercises 4.91 0.29 0.06 0.696d 0.0107 1
• B-5 for FAS grade B: administer analgesics as prescribed and guide functional exercises 4.91 0.29 0.06 0.690d 0.0107 1
• B-6 for FAS grade C: report to the physician and adjust analgesic treatment per medical orders 4.7 1.06 0.23 0.670d 0.0054 0.5
• B-7 when uncontrolled pain occurs 4.96 0.21 0.04 0.446d 0.0231 2
• B-8 when sudden severe pain occurs 4.96 0.21 0.04 0.406d 0.0231 2
• B-9 when progressively worsening pain occurs 5.00 0 0 0.405d 0.0462 4.5
• B-10 monitor vital signs and observe potential complications (e.g., massive bleeding) and comorbidities. 4.96 0.21 0.04 0.427d 0.0239 2.5
• B-11 conduct physical examination when necessary 4.78 0.42 0.09 Excluded 0.0119 /
• B-12 report to the physician and follow medical instructions for management 4.96 0.21 0.04 0.292d 0.0239 2.5
Dimension C: pharmacological pain management • C-1 administer analgesics as prescribed 4.91 0.29 0.06 0.659a 0.0184 2
• C-2 ensure oral opioids are properly administered 4.78 0.52 0.11 0.642a 0.0066 0.5
• C-3 use transdermal analgesic formulations correctly 4.83 0.39 0.08 0.648a 0.0109 1
• C-4 evaluate analgesic efficacy at appropriate intervals based on the administration route 4.83 0.49 0.10 0.697a 0.0109 1
• C-5 monitor respiratory depression and sedation levels when using opioids, while monitoring constipation, nausea, vomiting, and urinary retention; report any abnormalities to the physician 5.00 0 0 0.654a 0.0368 3.5
• C-6 monitor gastrointestinal side effects and liver/kidney function when using NSAIDs; report any abnormalities 4.96 0.21 0.04 0.672a 0.0184 2
• C-7 monitor for depression, ataxia, dizziness, drowsiness, and respiratory depression when using neuropathic pain medications (e.g., pregabalin) 4.96 0.21 0.04 0.619a 0.0184 2
• C-8 identify the cause of analgesic adverse reactions and rule out other contributing factors 4.91 0.29 0.06 0.650a 0.0047 0.5
• C-9 administer preventive medications as prescribed and evaluate efficacy 4.87 0.34 0.07 0.709a 0.0029 0.5
• C-10 for vomiting: report to the physician, monitor electrolyte imbalances, and rule out bowel obstruction, gastric dilation, or increased intracranial pressure 4.91 0.29 0.06 0.711a 0.0047 0.5
• C-11 for bloating and constipation: encourage early mobilization, provide abdominal massage, and implement prescribed treatments 4.87 0.34 0.07 0.770a 0.0029 0.5
• C-12 for urinary retention: apply warm compresses; use enemas, Traditional Chinese Medicine (TCM) therapies, or catheterization as ordered 4.74 0.45 0.09 0.751a 0.0020 0.5
• C-13 for excessive sedation or respiratory depression: immediately report to the physician, discontinue opioids/sedatives, and assist with emergency treatment 5.00 0 0 0.733a 0.0075 1
• C-14 evaluate the effectiveness of adverse reaction management 4.91 0.29 0.06 0.729a 0.0047 0.5
Dimension D: patient-controlled analgesia (PCA) management • D-1 secure tubing and ensure proper device function 4.96 0.21 0.04 0.762a 0.0342 3.5
• D-2 instruct patients to press the PCA button when experiencing pain, and preemptively press 5–10 min before activity 4.91 0.42 0.08 0.753a 0.0171 2
• D-3 conduct shift handovers and double-check the PCA pump's status, tubing condition, dosage, and ineffective attempts 4.91 0.29 0.06 0.718a 0.0171 2
• D-4 evaluate vital signs, level of sedation (LOS), and analgesic effects every 4–8 h, monitoring for complications such as numbness or progressive muscle weakness 4.91 0.29 0.06 0.685a 0.0171 2
• D-5 report inadequate analgesia to the physician or acute pain service (APS) 4.87 0.34 0.07 0.655a 0.0086
• D-6 identify and address common PCA issues (e.g., alarms, tubing blockage, empty medication reservoirs) 4.87 0.34 0.07 0.699a 0.0086 1
Dimension E: non-pharmacological pain management • E-1 apply non-pharmacological measures independently for mild pain 4.52 0.95 0.21 0.731a 0.0086 1
• E-2 combine non-pharmacological measures with analgesics for moderate to severe pain 4.83 0.39 0.08 0.741a 0.0259 2.5
• E-3 provide individualized non-pharmacological pain interventions based on patient condition and preferences 4.83 0.39 0.08 0.717a 0.0052 0.5
• E-4 assist the patient in adopting pain-preventive functional positions 4.74 0.54 0.11 0.746a 0.0034 0.5
• E-5 utilize non-pharmacological interventions such as deep breathing, massage, distraction, cold/heat therapy, or relaxation training 4.65 0.57 0.12 0.757a 0.0025 0.5
• E-6 incorporate Traditional Chinese Medicine methods (e.g., auricular acupressure) as appropriate 4.35 0.83 0.19 Excluded 0.0011 /
• E-7 provide psychological support and sleep guidance when necessary 4.57 0.79 0.17 Excluded 0.0017 /
• E-8 evaluate intervention effectiveness and adverse reactions at appropriate intervals 4.74 0.75 0.16 0.685a 0.0034 0.5
Dimension F: pain education • F-1 educate patients on the importance and timing of reporting pain 4.96 0.21 0.04 0.764a 0.0152 1.5
• F-2 teach patients to use appropriate pain self-assessment tools 4.91 0.29 0.06 0.768a 0.0097 1
• F-3 explain the adverse effects of pain and the importance of pain assessment 4.83 0.49 0.10 0.760a 0.0061 0.5
• F-4 educate patients on postoperative pain complications and the need for timely reporting 4.91 0.29 0.06 0.764a 0.0203 2
• F-5 emphasize early mobilization and pain control during functional activities 4.96 0.21 0.04 0.761a 0.0406 4
• F-6 explain medication usage and potential side effects 4.83 0.39 0.08 0.774a 0.0121 1
• F-7 provide instruction on PCA device operation and related precautions 4.87 0.34 0.07 0.736a 0.0170 2
• F-8 teach non-pharmacological techniques and related precautions 4.70 0.76 0.16 0.758a 0.0061 0.5
• F-9 highlight the importance of patient and family involvement in pain management 4.78 0.67 0.14 Excluded 0.0087 /
• F-10 provide instructions on medication use and precautions 4.83 0.49 0.10 0.743a 0.0344 3.5
• F-11 explain the necessity and methods of non-pharmacological interventions 4.65 0.71 0.15 0.740a 0.0172 2
• F-12 educate patients on when to seek prompt medical attention for inadequate pain relief, complications, or unexpected pain 4.83 0.39 0.08 0.726a 0.0344 3.5
Dimension G: professional development competencies • G-1 use the SBAR (situation–background–assessment–recommendation) model for communication between healthcare providers 4.74 0.69 0.15 0.453c 0.0068 0.5
• G-2 clarify roles of multidisciplinary pain management team members and seek assistance as needed 4.70 0.56 0.12 0.551c 0.0048 0.5
• G-3 demonstrate basic triage skills 4.61 0.58 0.13 Excluded 0.0024 /
• G-4 participate in multidisciplinary team (MDT) discussions on pain-related issues 4.65 0.49 0.10 0.773c 0.0035 0.5
• G-5 apply evidence-based practices (e.g., literature review) in pain management nursing 4.70 0.47 0.10 0.829c 0.0307 3
• G-6 explore and implement new methods/technologies in pain management nursing 4.61 0.50 0.11 0.852c 0.0154 1.5
• G-7 understand the content of pain management quality improvement indicators and audit methods. 4.78 0.52 0.11 0.832c 0.0083 1
• G-8 participate in data collection and analysis for quality improvement projects 4.83 0.49 0.10 0.846c 0.0131 1.5
• G-9 propose recommendations to improve pain management practices 4.61 0.58 0.13 0.828c 0.0053 0.5
• G-10 proactively analyze the causes of pain and determine its etiology from a holistic care perspective 4.83 0.39 0.08 0.772c 0.0038 0.5
• G-11 proactively implement nursing interventions to alleviate patients' pain 4.91 0.29 0.06 0.695c 0.0060 0.5
• G-12 provide constructive recommendations to physicians 4.74 0.45 0.09 0.642c 0.0024 0.5

SD, standard deviation; CV, coefficient of variation.

a, b, c, and d correspond to Factor 1, Factor 2, Factor 3, and Factor 4, respectively, in the exploratory factor analysis.

Italicized items indicate those deleted in Phase 2 (Measurement Validation and Application).