| # | Question Content | N | L0 | L1 | L2 | L3 | L4 | L5 | L6 | L7 | L8 | L9 | L10 | Num | Den | Rate | Low | High |
| Patient Pain Assessment |
| 2 | How much pain are you having right now? | 11 | 0 | 1 | 2 | 2 | 3 | 2 | 0 | 0 | 0 | 0 | 1 | 78 | 121 | 64.5% | 55.9% | 73.0% |
| 100% | 0.0% | 9.1% | 18.2% | 18.2% | 27.3% | 18.2% | 0.0% | 0.0% | 0.0% | 0.0% | 9.1% | | | | | |
| 3 | Please indicate the worst pain you have had in the past 24
hours? | 11 | 0 | 0 | 0 | 2 | 0 | 2 | 3 | 2 | 2 | 0 | 0 | 57 | 121 | 47.1% | 38.2% | 56.0% |
| 100% | 0.0% | 0.0% | 0.0% | 18.2% | 0.0% | 18.2% | 27.3% | 18.2% | 18.2% | 0.0% | 0.0% | | | | | |
| 4 | Please indicate the average level of pain you have had in the past 24
hours. | 11 | 0 | 0 | 2 | 2 | 3 | 2 | 1 | 0 | 0 | 0 | 1 | 73 | 121 | 60.3% | 51.6% | 69.0% |
| 100% | 0.0% | 0.0% | 18.2% | 18.2% | 27.3% | 18.2% | 9.1% | 0.0% | 0.0% | 0.0% | 9.1% | | | | | |
| Has Pain Affected Patient Activity in the Past 24 Hours |
| 5A | During the past 24 hours, pain has interfered with
your general activities. | 11 | 0 | 0 | 1 | 0 | 4 | 3 | 1 | 1 | 1 | 0 | 0 | 67 | 121 | 55.4% | 46.5% | 64.2% |
| 100% | 0.0% | 0.0% | 9.1% | 0.0% | 36.4% | 27.3% | 9.1% | 9.1% | 9.1% | 0.0% | 0.0% | | | | | |
| 5B | During the past 24 hours, pain has interfered with your
mood? | 11 | 2 | 0 | 0 | 1 | 3 | 2 | 0 | 1 | 2 | 0 | 0 | 73 | 121 | 60.3% | 51.6% | 69.0% |
| 100% | 18.2% | 0.0% | 0.0% | 9.1% | 27.3% | 18.2% | 0.0% | 9.1% | 18.2% | 0.0% | 0.0% | | | | | |
| 5C | During the past 24 hours, pain has interfered with your
walking ability? | 11 | 0 | 0 | 0 | 1 | 3 | 1 | 3 | 1 | 2 | 0 | 0 | 60 | 121 | 49.6% | 40.7% | 58.5% |
| 100% | 0.0% | 0.0% | 0.0% | 9.1% | 27.3% | 9.1% | 27.3% | 9.1% | 18.2% | 0.0% | 0.0% | | | | | |
| 5D | During the past 24 hours, pain has interfered
with your relations with the others? | 11 | 2 | 0 | 1 | 1 | 2 | 4 | 0 | 0 | 1 | 0 | 0 | 80 | 121 | 66.1% | 57.7% | 74.5% |
| 100% | 18.2% | 0.0% | 9.1% | 9.1% | 18.2% | 36.4% | 0.0% | 0.0% | 9.1% | 0.0% | 0.0% | | | | | |
| 5E | During the past 24 hours, pain has interfered with your
general sleep? | 11 | 0 | 0 | 2 | 1 | 3 | 2 | 0 | 1 | 2 | 0 | 0 | 69 | 121 | 57.0% | 48.2% | 65.8% |
| 100% | 0.0% | 0.0% | 18.2% | 9.1% | 27.3% | 18.2% | 0.0% | 9.1% | 18.2% | 0.0% | 0.0% | | | | | |
| 5F | During the past 24 hours, pain has
interfered with your other activities that are needed to recover from illness? | 11 | 0 | 0 | 0 | 1 | 3 | 5 | 1 | 0 | 1 | 0 | 0 | 67 | 121 | 55.4% | 46.5% | 64.2% |
| 100% | 0.0% | 0.0% | 0.0% | 9.1% | 27.3% | 45.5% | 9.1% | 0.0% | 9.1% | 0.0% | 0.0% | | | | | |
| Patient Satisfaction with Pain Management |
| 6 | Select the phrase that indicates how
satisfied or dissatisfied you are with the result of your pain treatment overall. | 11 | | 0 | 0 | 0 | 2 | 9 | 0 | | | | | 53 | 66 | 80.3% | 70.7% | 89.9% |
| | | 100% | | 0.0% | 0.0% | 0.0% | 18.2% | 81.8% | 0.0% | | | | | | | | | |
| 7 | Select the
phrase that indicates how satisfied or dissatisfied you are with the way your nurses
responsed to your report of pain. | 11 | | 0 | 0 | 1 | 1 | 6 | 2 | | | | | 49 | 60 | 81.7% | 71.9% | 91.5% |
| | | 100% | | 0.0% | 0.0% | 10.0% | 10.0% | 60.0% | 20.0% | | | | | | | | | |
| 8 | Select the phrase
that indicates how satisfied or dissatisfied you are with the way your physicians responsed to your report of pain. | 11 | | 0 | 0 | 1 | 0 | 6 | 3 | | | | | 51 | 60 | 85.0% | 76.0% | 94.0% |
| | | 100% | | 0.0% | 0.0% | 10.0% | 0.0% | 60.0% | 30.0% | | | | | | | | | |