Fuchs-Lacelle Shannon, Hadjistavropoulos Thomas, Lix Lisa
Department of Psychology and Centre on Aging and Health, University of Regina, Regina, SK, Canada.
Clin J Pain. 2008 Oct;24(8):697-707. doi: 10.1097/AJP.0b013e318172625a.
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 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.
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.
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.
严重痴呆所特有的沟通障碍使得疼痛评估具有挑战性。因此，疼痛问题常常未被察觉。我们的目标是确定与对照情况相比，系统的疼痛评估是否能改善疼痛管理措施并减轻护理压力。
我们采用了为期3个月的比较纵向设计。护理人员通过使用《沟通能力有限的老年人疼痛评估清单》（PACSLAC）定期评估痴呆患者的疼痛。另一组护士对对照组患者完成一项注意力控制措施。此外，护理人员定期完成工作压力测量，以调查与系统疼痛评估相关的工作量对护士压力的影响。
随着时间的推移，与对照组相比，PACSLAC的定期使用改善了疼痛管理措施，这体现在按需开具的止痛药物使用增加上。随着疼痛干预措施的增加，观察到可观察到的疼痛行为相应减少（如护士完成的PACSLAC评估所反映）。此外，使用PACSLAC的护士报告随着时间的推移痛苦和倦怠感有所减轻。
这项调查为长期护理中系统疼痛评估的重要性以及PACSLAC在改善疼痛管理措施和减轻护理人员痛苦方面的临床效用提供了有力支持。
