title: Perception of barriers to postoperative pain management in elderly patients in Polish hospitals with and without a "Hospital Without Pain" Certificate - a multi-center study.
abstract: BACKGROUND
  In 2005-2050, the global population of elderly people will increase by 12%. This will lead to increased demand for such healthcare services as hospital care or surgical interventions. Pain in elderly patients is a substantial problem. Insufficiently controlled postoperative pain continues to be a widespread phenomenon. Pain management in Poland is usually based on nursing care supervised by an anesthesiologist or surgeon. The aim of the study was to identify barriers to effective nurse-controlled analgesia in postoperative pain management in elderly patients in hospitals with and without a Hospital Without Pain certificate.
  
  
  METHODS
  The study was conducted after the approval of the study protocol by the Independent Bioethics Committee for Scientific Research of the Medical University of Gdansk. The study project was multicenter and was conducted from July 2012 to December 2013. The research was questionnaire-based and used the Polish version of the Nurses' Perceived Obstacles to Pain Assessment and Management Practices questionnaire. The project included 676 nurses from hospitals awarded the Hospital Without Pain Certificate and 926 respondents from hospitals without the certificate.
  
  
  RESULTS
  After calculating the overall average result in particular groups, healthcare system-related problems were first among the barriers hindering pain management in elderly patients M = (C = 3.81, N/C = 3.87). Patient-related barriers were second (M = 3.77). Physician- and nurse-related barriers took the subsequent positions, with very similar scores M = (C = 3.47, N/C = 3.44) and M = (C = 3.46, N/C = 3.44), respectively.
  
  
  CONCLUSIONS
  The greatest barriers to pain management in elderly patients are related to the healthcare system. Nurses from Hospital Without Pain certified hospitals devoted significantly more time to relieving pain through non-pharmacological methods.
authors.affiliation: Department of General of Nursing, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Wioletta A
authors.initials: WA
authors.lastname: Mędrzycka-Dąbrowska
authors.affiliation: Anesthesiology and Intensive Care Unit, District Health Center, Malbork, Poland.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Dąbrowski
authors.affiliation: Clinical Emergency Department, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Basiński
authors.affiliation: Nursing Department, Pomeranian University, Szczecin, Poland.
authors.forename: Dorota
authors.initials: D
authors.lastname: Pilch
keywords: advanced age; barriers; nursing care; pain management