Pain assessment as intervention: a study of older adults with severe dementia.
OBJECTIVE
The communication impairments that characterize severe dementia make pain assessment challenging. As such, pain problems often go undetected. Our goal was to determine whether systematic pain assessment leads to improved pain management practices and decreases nursing stress in comparison with a control condition.


METHODS
We adopted a 3-month comparative longitudinal design. Nursing staff regularly assessed dementia patients' pain through the use of the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC). A second group of nurses completed an attention-control measure for a control group of patients. In addition, nursing staff regularly completed measures of work stress to investigate the effects of the workload associated with systematic pain assessment on nurse stress.


RESULTS
Regular use of the PACSLAC improved pain management practices over time as reflected in increased usage of analgesic medications (prescribed on "as needed" basis) in comparison with the control group. As pain interventions increased, a corresponding decrease in observable pain behaviors (as reflected on the PACSLAC assessments that were completed by the nurses) was observed. In addition, nurses who used the PACSLAC reported decreased distress and burnout over time.


CONCLUSIONS
This investigation provides strong support for both the importance of systematic pain assessment in long-term care and for the clinical utility of the PACSLAC in improving pain management practices and decreasing caregiver distress.
Fuchs-Lacelle
Shannon
S
Department of Psychology and Centre on Aging and Health, University of Regina, Regina, SK, Canada.
Hadjistavropoulos
Thomas
T
Lix
Lisa
L
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D017028:Caregivers / Q000523:psychology; D003704:Dementia / Q000150:complications* / Q000523:psychology; D005260:Female; D005853:Geriatrics; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D009723:Nurse-Patient Relations; D010146:Pain / Q000150:complications* / Q000451:nursing; D059408:Pain Management; D010147:Pain Measurement / Q000379:methods* / Q000451:nursing; D011594:Psychometrics; D011795:Surveys and Questionnaires