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Communication with dying patient in the ICU from the perspective of nurses
Jordánová, Hana ; Kutnohorská, Jana (advisor) ; Votroubková, Michaela (referee)
Author: Hana Jordánová Institution: Institute of social medicine LF UK in Hradec Králové Nursing care department Name of theses: Communication with dying patients in the ICU from the perspektive of nurses Head of theses: doc. PhDr. Jana Kutnohorská, CSc. Number of pages: 78 Number of attachments: 2 Year of defense: 2014 Key words: Communicetion, stages of dying, dignified dying, intensive care The thesis is focusing o communication with the dying patient in an intensive care from the nurse perspective. Thesis are consists of two main parts, theoretical and practical. Theoretical part describes the various components of general communication and communication and specifics of the dying patient. This part also describes problems of dying in intensive care. Theoretical part aso focus on ethical problems that can be communicate with the dying patient. The empirical part focuses on the detection of communication and nurses emotional skills in communication with the dying patient. The focus of thesis is quantitative research, reached by anonymous questionnaire. The research sample consisted of nurses working in the intesive care unit. Based on the analysis of the research were identified difficulties and suggested solutions in communicating with dying patients.
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Securing the patient in postoperative care.
JORDÁNOVÁ, Hana
Current status: Safe process treatment should be provided to every patient in every hospital. Nurses should work to avoid security violation, especially in the surgical field, associated with irreversible changes in the treatment process. Perfect mastery of these measures assures patient safety. Risk prevention, safety of the patient and the medical personnel require the involvement of all members of the multidisciplinary team (Pokojová, 2011; Škrla and Škrlová, 2003). Objective of the research: to map the attributes of postoperative care in the safe treatment of patients. To determine whether nurses master preventive measures in safe patient care and whether they ensure compliance with the principles of safe care in practice. Methods: the research analysis was chosen to be based on qualitative research method. Data acquisition was performed in semi-structured interview with nurses, supplemented with hidden observation. The participation in the interviews was voluntary and anonymous. Audio data was recorded from the interviews and transcribed verbatim. The observation aimed to determine whether nurses respect the principles of safe care for patients in the postoperative care. Research cohort: consisted of general nurses who worked at the surgical wards and recovery room. The research was conducted in one of the hospitals of South Bohemia. Twelve nurses were interviewed. The interview and hidden observation were focused on patient safety in the postoperative period. The interviews were performed at nurse day-time rooms of individual surgical wards, some of them outside the hospital. All nurses met the criterion to be a provider of nursing care for post-operative patients at surgical wards and recovery rooms. The interviews were finished when reaching the theoretical saturation, when the answers and hidden observation of the respondents started to repeat the already acquired data, i.e. after twelve interviews and observations. Results: The nurses working in surgical wards and recovery rooms are exposed to a considerable mental and physical strain. This profession is very demanding and requires not only theoretical knowledge, but also manual dexterity in practice. Nurses are involved in the care process in a considerable extent. Therefore, it is important that the care was good and safe. In the treatment process, the nurses sometimes do not comply with relevant standards and the requirements for safe treatment. It is essential to follow the identification bracelets to avoid patient mismatch, thus endangering patients' health. Some nurses checked the identification bracelets thoroughly, but there were also nurses who ignored these rules too much and gamble with the patients' health. Medication errors are the most common cause of patient injury. The risk of medication errors increases also due to improper storage of hazardous drugs. In our investigation, the medication was repeatedly stored at a different place (not returned back to the original area), poorly stored or left freely available to anyone. If the physician records are illegible, the nurses solve the issue rather by guessing or asking an assistance from colleagues in the department. This area also includes replacement of medication by nurses if the prescribed product is not available at the ward, without consulting a physician first. The negligence in the use of protective equipment during dressing changes is alarming. Possible transmission of nosocomial infections. Poor or little use of disinfectants. Conclusions: Treatment of patients in the early and late postoperative care is one of the high risk parts of the hospitalization of patients at healthcare facilities. In this period, patient monitoring and risk prevention are essential. It includes pain control, the care for surgical wounds, safe patient identification, prevention of adverse events in both medication administration and patient falls, the compliance with hand hygiene ...
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The issue of Nursing Care for the Patients with fractured Humerus.
JORDÁNOVÁ, Hana
Primary theoretical basis: The fractures of humerus are mostly results of hit or fall (15). The cure of humerus fractures is developing not only because of material options, but also thanks to medical technology development. (20). Purpose of the work: Main purpose of this bachelor work was to find out through qualitative research, if nurses have theoretical knowledge in the nursing care of the patients with fractured humerus. To this goal was defined research question: Do nurses have knowledge about nursing care for patients with fracture of humerus? Related investigation was about patients, with humerus fracture, preference needs during the time of hospitalization, according to his self-care deficit. To this goals were defined research questions: How big is the deficit rate in self-care with humerus fracture? Which patient's needs are on the first place during humerus fracture? Quantitative research with patients revealed Research questions were defined subsequently: How high is appearance of humerus fracture according to age? How high is appearance of humerus fracture according to hobby? How high is appearance of humerus fracture according to unsports or other leisure activities? Methodics: Empirical part of bachelor work was written on mixed research basis. Quantitative research was realized using data collection from Traumacentrum České Budějovice, a.s. patient's documentation. Research included 152 patient respondents. Qualitative research was realized using half structured interviews, on which participated nurses from Traumacentrum Nemocnice České Budějovice, a.s. and patients with humerus fracture here hospitalized. The research group consisted of six patients and six nurses. Data collection took place since May 2013 to June 2014. Results: From nurse research results came out following categories: Preoperative patient care, Post-operative patient care, Rebandage specifics, Rehabilitation factors, Complications and symptoms. In preoperative patient care five of six nurses focus on pain, sensitiveness, and perfusion. In post-operative on the other hand all nurses observe coverage and pain. In complication category were mostly recorded infections, nervus radialis harm and compartment syndrome. By nervus radialis harm all nurses recorded posibility of limb functional changes. As rehabilitation factors in this category five nurses mentioned as effect of infection, pain and size of the wound. By patients came out following categories: Self-care activities: Dressing, Day routine, Motions on the bed, Hygiene, Toilet, Eating, Preferred needs. In category dressing four patients can't put on T-shirt. Regarding category of eating, here all patients recorded complications with holding the food tray. Preferred needs category reveals that all six patients values family relationships. In quantitative part of work thanks to data collection formed these graphs: Percentage: Participation of patients, Average age, Age categories, Participation of age categories, Influence of activity on injury formation. As percentage participation was found out that 68% of patients are women in average age of 58 years. These data by men are 32% and 54 years. The injury is mostly appeared considering age in women category in the age of 66-70, in 9,21%. In men category in the age of 61-65, in 4,61%. Hobby injury appeared more in men category 8,55%, in women category are more frequent leisure activity injuries, 64,47% . Conclusion: From research result we can say the nurses have great knowledge. However in all categories are knowledge gaps leaving space for knowledge supplement. Patients mostly fumble with self-care activities deficit in all spheres, this category and family relationships are most preferred categories. In qualitative research is obvious that women are twice more hospitalized with humerus fracture.
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