title: Assessing pain as a fifth vital sign in long-term care facilities: Recommendations from the field.
abstract: In long-term care facilities, pain management is complex because dementia, delirium, and other reasons for residents' altered communication ability are a significant barrier to pain assessment. The purpose of this study was to explore the status of implementation of pain as a fifth vital sign in a sample of long-term care facilities. A three-round Delphi survey was used to obtain consensus from personnel in 60 long-term care facilities in NY State. Findings are presented in terms of recommendations related to pain criteria, assessment methods, frequency of pain assessment, responsibility for pain assessment, monitoring strategies, education, documentation, and pain management education. The results of this study highlight many important considerations in the treatment of pain as a fifth vital sign in long-term care facilities. Evidence-based practice will be facilitated by further research related to underexplored aspects of pain assessment and management, and further attention to care delivery systems that support continued knowledge acquisition and the implementation of best practices.
authors.affiliation: Yale University School of Nursing, New Haven, CT 06536, USA.
authors.forename: Sheila L
authors.initials: SL
authors.lastname: Molony
authors.forename: Mia
authors.initials: M
authors.lastname: Kobayashi
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Holleran
authors.forename: Mathy
authors.initials: M
authors.lastname: Mezey
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D003697:Delphi Technique; D005260:Female; D005851:Geriatric Nursing; D006801:Humans; D008134:Long-Term Care / Q000592:standards*; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D010147:Pain Measurement / Q000379:methods*; D017410:Practice Guidelines as Topic