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.
We adopted a 3-month comparative longitudinal design. Nursing staff regularly assessed dementia
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.
Regular use of the PACSLAC
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.
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.