Department of Psychology and Centre on Aging and Health, University of Regina, Regina, SK, Canada.
Department of Computing Science, University of Alberta, Edmonton, AB, Canada.
JMIR Mhealth Uhealth. 2020 Apr 22;8(4):e17108. doi: 10.2196/17108.
Pain is often underassessed and undertreated among long-term care (LTC) residents living with dementia. When used regularly, the Pain Assessment Checklist for Seniors With Limited Ability to Communicate (PACSLAC) scales have been shown to have beneficial effects on pain assessment and management practices and stress and burnout levels in frontline staff in LTC facilities. Such scales, however, are not utilized as often as recommended, which is likely to be related to additional record-keeping and tracking over time involved with their paper-and-pencil administration.
Using implementation science principles, we assessed the introduction of the PACSLAC-II scale by comparing two methods of administration-a newly developed tablet app version and the original paper-and-pencil version-with respect to the frequency of pain assessment and facility staff feedback.
Using a case series approach, we tracked pain-related quality indicators at baseline, implementation, and follow-up periods. A quasi-experimental design was used to evaluate the effect of the method of administration (ie, paper-and-pencil only [n=18], tablet only [n=12], paper-and-pencil followed by tablet app [n=31], and tablet app followed by paper-and-pencil [n=31]) on pain assessment frequency and frontline staff stress and burnout levels. Finally, semistructured interviews were conducted with frontline staff to obtain perspectives on each method of administration.
The implementation effort resulted in a great increase in pain assessment frequency across 7 independent LTC units, although these increases were not maintained during the follow-up period. Frontline staff reported lower levels of workload in the paper-and-pencil followed by tablet app condition than those in the paper-and-pencil only (P<.001) and tablet app followed by paper-and-pencil (P<.001) conditions. Frontline staff also reported lower levels of workload in the tablet-only condition than those in the paper-and-pencil only condition (P=.05). Similarly, lower levels of emotional exhaustion were reported by frontline staff in the paper-and-pencil followed by tablet app condition than those in the paper-and-pencil only (P=.002) and tablet app followed by paper-and-pencil (P=.002) conditions. Finally, frontline staff reported higher levels of depersonalization in the paper-and-pencil only condition than those in the tablet app only (P=.008), paper-and-pencil followed by tablet app (P<.001), and tablet app followed by paper-and-pencil (P<.001) conditions. Furthermore, narrative data from individual interviews with frontline staff revealed a preference for the tablet app over the paper-and-pencil method of administration.
This study provides support for the use of either the tablet app or the paper-and-pencil version of the PACSLAC-II to improve pain-related quality indicators, but a reported preference for and lower levels of stress and burnout with the use of the tablet app method of administration suggests that the use of the tablet app may have more advantages compared with the paper-and-pencil method of administration.
长期护理（LTC）机构中患有痴呆症的居民的疼痛常常被评估不足和治疗不足。当定期使用时，有限沟通能力老年人疼痛评估检查表（PACSLAC）量表已被证明对疼痛评估和管理实践以及LTC 设施一线工作人员的压力和倦怠水平具有有益的影响。然而，这些量表并没有像推荐的那样经常使用，这可能与随着时间的推移进行额外的记录保存和跟踪有关。
我们使用实施科学原理，通过比较新开发的平板电脑应用程序版本和原始的纸笔版本两种管理方式，评估 PACSLAC-II 量表的引入，以比较疼痛评估的频率和设施工作人员的反馈。
使用病例系列方法，我们在基线、实施和随访期间跟踪了与疼痛相关的质量指标。采用准实验设计来评估管理方式（即仅纸笔[ n = 18]、仅平板电脑[ n = 12]、纸笔后平板电脑应用程序[ n = 31]和平板电脑应用程序后纸笔[ n = 31]）对疼痛评估频率以及一线工作人员压力和倦怠水平的影响。最后，对一线工作人员进行半结构化访谈，以获取他们对每种管理方式的看法。
尽管在随访期间未维持这些增加，但实施工作导致 7 个独立的 LTC 单位的疼痛评估频率大幅增加。一线工作人员报告，在纸笔后平板电脑应用程序的情况下，工作量比仅纸笔（ P <.001）和平板电脑应用程序后纸笔（ P <.001）的情况下低。一线工作人员还报告说，在仅平板电脑的情况下，工作量比仅纸笔的情况下低（ P =.05）。同样，在纸笔后平板电脑应用程序的情况下，一线工作人员报告的情绪衰竭水平低于仅纸笔（ P =.002）和平板电脑应用程序后纸笔（ P =.002）的情况下。最后，一线工作人员报告说，在仅纸笔的情况下，人格解体程度比仅平板电脑（ P =.008）、纸笔后平板电脑应用程序（ P <.001）和平板电脑应用程序后纸笔（ P <.001）的情况下高。此外，对一线工作人员进行的个人访谈的叙述性数据显示，他们更喜欢平板电脑应用程序而不是纸笔管理方式。
这项研究支持使用 PACSLAC-II 的平板电脑应用程序或纸笔版本来改善与疼痛相关的质量指标，但使用平板电脑应用程序的报告偏好和较低的压力和倦怠水平表明，与纸笔管理方式相比，使用平板电脑应用程序可能具有更多的优势。
