title: Methods of pain assessment in residents of long-term care facilities: a pilot study.
abstract: OBJECTIVE
  Structured programs for routine pain assessment and treatment are necessary to optimize care for residents of long-term care facilities (LTCFs). A pilot study was designed to develop, implement, and evaluate a system for pain assessment and monitoring in a LTCF. Additional goals were to determine whether a verbal and/or non-verbal tool adequately assess pain in residents of LTCFs and whether the pharmacologic therapy for pain changes with the implementation of a pain assessment and monitoring system.
  
  
  METHODS
  Quantitative, nonexperimental design using two pain assessment tools.
  
  
  METHODS
  The study was conducted at a LTCF in a rural midwestern setting.
  
  
  METHODS
  The study population for phase I included residents on any pain medication (regularly scheduled or as needed) on the secure dementia unit. The target population for phase II consisted of residents on any pain medication on an open unit.
  
  
  METHODS
  Training was provided to the nursing staff on how to use two pain assessment tools, one verbal (colored visual analog scale) and one nonverbal (observed pain target behaviors), and documentation. In addition, a continuing education program on pain assessment and management in elderly residents and barriers to pain management in LTCFs was offered to medical providers.
  
  
  METHODS
  Evaluation with the colored visual analog scale (CVAS) occurred twice daily. Pain target behaviors were monitored throughout the day and recorded by nursing staff at the end of each shift. All residents in the study population were monitored daily for six months.
  
  
  RESULTS
  Most of the residents on both units were unable to use the verbal tool; however, the nonverbal tool was used successfully for all residents studied. On the dementia unit, the use of pain medications increased, and pain target behaviors decreased during the study period; on the open unit, the use of pain medications remained stable, and pain target behaviors decreased.
  
  
  CONCLUSIONS
  These data suggest that an increase in awareness of pain may facilitate an improvement in the assessment and management of pain in residents of LTCFs. The feasibility of the nonverbal pain monitoring method shown in this study has positive implications on quality of care issues if generalizable to a larger population.
authors.affiliation: Augsburg College, Minneapolis, MN 55454, USA. alexander@augsburg.edu
authors.forename: Beth J
authors.initials: BJ
authors.lastname: Alexander
authors.forename: Paula
authors.initials: P
authors.lastname: Plank
authors.forename: Mary B
authors.initials: MB
authors.lastname: Carlson
authors.forename: Peggy
authors.initials: P
authors.lastname: Hanson
authors.forename: Kristi
authors.initials: K
authors.lastname: Picken
authors.forename: Kay
authors.initials: K
authors.lastname: Schwebke
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000451:nursing; D005568:Forms and Records Control; D006801:Humans; D008134:Long-Term Care; D015146:Midwestern United States; D009633:Nonverbal Communication; D009735:Nursing Homes; D009737:Nursing Records; D010146:Pain / Q000188:drug therapy / Q000451:nursing / Q000517:prevention & control*; D010147:Pain Measurement / Q000379:methods* / Q000451:nursing; D010865:Pilot Projects; D012647:Self-Assessment; D012985:Software Design