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Problem of sepsis in the intensive care unit
Škrabánková, Hana ; Marková, Eva (advisor) ; Jankovcová, Kateřina (referee)
The aim of the thesis was to determine the microbial colonization at the injection site of central venous catheter and its possible influence to maintain the lowest incidence of catheter sepsis. The culture results of skin swabs and taken blood cultures from two groups of patients were compared with each other using qualitative analysis methods. Those were Intensive Care Unit patients with established central venous catheter. The result was the discovery of microbial colonization of the skin and the representation of different pathogenic strains at the site of a central venous catheter for both established groups. Further showed that the higher the risk of microbial colonization with symptoms of catheter sepsis was seen where patients have central venous catheter established for longer period of time and have been treated under home parental nutrition program with stoma. The recommendation is the continuous education of health professionals to act in accordance with the latest preventive treatment recommendations, and the emphasis is mainly placed on hands cleaning and disinfecting as the hands of health professionals are one of the most common and risky way of transmission of pathogenic strains with potential nosocomial infection formation. Aseptic principles must be repeatedly communicated to all...
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Practical use of the document "The Adaptation Process Plan for Nurses in Intensive Care Unit" in the Czech Republic and its comparison with the practice in the United Kingdom
Skřivanová, Eva ; Di Cara, Veronika (advisor) ; Hladká, Petra (referee)
The Adaptation Process Plan document should serve as a tool for ensuring that the adaptation process of a new employee to an intensive care unit is properly led. It is also supposed to help with feedback and evaluation of the level of the newcomer's skills. The main goal of this thesis was to find out how effectively the Adaptation Process Plan document is currently used for nurses in intensive care units in the Czech Republic. We furthermore aimed to ascertain how the plans are filled in, whether their individual parts are filled in on a regular basis, as well as whether the parts which have been graded as insufficient are explained again to the employee. Last but not least, we tried to compare how the document is used in the Czech Republic and in the United Kingdom. The qualitative research was carried out by interviewing three nurses who have completed the adaptation process to intensive care units - one in the United Kingdom and two in the Czech Republic. The results show that according to our research group, the Adaptation Process Plan document is not effectively used in the Czech Republic, especially in comparison with the United Kingdom. The ways of filling in the document differ in these countries, particularly with regard to its regularity and thoroughness. The parts which had been graded...
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Multidisciplinary Cooperation and the Role of a Nurse in Patient Care Affected by Blast Syndrome
KOPULETÁ, Martina
Blast injury is a very serious lesion caused by the shock wave resulting from an explosion. Further secondary injuries can arise from burying under debris, pieces of shards from the explosive cover, at burning, poisonous gases created by chemical reactions during detonation. The injuries often happen to be fatal and the percentage of people who survive it depends on the fact how far from the epicentre they were situated. If the individual is very close, there is almost no chance to survive, if, however, the individual is situated further from the epicentre, a few tens of meters, the chance is higher. It is so called mass disaster, which includes more injured people at an explosion. Therefore it is necessary for nurses and the hospital staff to know what the procedures are at this incident and how to take medical and nursing care of higher number of such patients suffering from blast injury. The care itself is extremely demanding, since the injured are often in critical condition. The aim of this diploma thesis, the topic of which is multidisciplinary cooperation and the role of a nurse when taking care of the patients suffering from blast injury, was to find out the information based on the latest Czech and foreign literature and create a compact overview of the knowledge of this issue, for it is necessary to have this knowledge to carry out nursing care of such patients. The second aim of this diploma thesis was to map the role of a nurse in details when taking care of a patient suffering from blast injury. This aim was stated for the reason of the demanding character and complexity of nursing care at urgent reception and anaesthesiology and resuscitation unit because the nurses at these units are placed demands on high qualification and requirements. This diploma thesis was purely elaborated as theoretical thesis based on Czech and foreign sources. The given pieces of information were obtained from a great deal of professional and scientific publications, monographs, professional journals and internet sources for each chapter. The first part of the thesis was dedicated to the description of the given issue, pre-hospital care and classifying algorithms that are used at mass health losses in such way so that the injured people have a higher chance to survive. The crisis management at hospitals, the reception of the injured, the care at the urgent unit and finally the follow-up care at the anaesthesiology and resuscitation unit are worked out in the following part. Thereafter the theoretical part focuses on nursing care at the critical care department where the nursing care of a patient suffering from blast injury is described as well as the duties of a nurse. The needed competences of a nurse working at the urgent unit, anaesthesiology and resuscitation unit are also defined in this chapter. According to the valid Czech legislation, only specially trained nurses for intensive care should take care of the patients with blast injury because the extent of their competence for intensive care is many times higher than general nurses have. The last chapter deals with team and multidisciplinary cooperation among the doctors and hospital staff as well as the cooperation concerning the pre-hospital care of the emergency services at emergency incident, for their active and quality communication are the keys for good and well done work with the least consequences.
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Nurse's role in the nutrition of patients in intensive care
VACKOVÁ, Veronika
This bachelor thesis is divided into two parts theoretical and empirical and the purpose of this thesis is to deal with the topic of the nurse´s role in the nutrition of patients in intensive care. In the theoretical part of the thesis, complex issue of the nutrition ensure of intensive care patients is summarized. We have been dealing not only with the common concept of the nutrition on the intensive care units and the role of the nutrition therapist but also with the characteristics, causes and diagnosis of the malnutrition as the most serious issue in the nutrition field. In the thesis, the types of a nutrition support in the intensive care have been also defined as well as the indication, contraindication, types of serving, complications, types of medicines, monitoring and the related role of the nurses. The practical part provides with the results of the research, which have been found by using a qualitative research method. The main purpose of this bachelor thesis was to emphasize the role of the nurse by the handing enteral and parenteral nutrition and also a description of the cooperation with the nutritional therapist on the associated intern and neurological unit of intensive care at České Budějovice hospital. At the basis of above mentioned, two objectives have been stated. At first, our task is to find out the way how is the right handing of the nutrition to the intensive care patient by the nurse secured. The second task is finding out the way of cooperation of the nurse and the patient while securing the nutrition of the patients in the intensive care unit. For the first task, four research questions have been established, for the second task have been established one research question. For the high-quality data network, the method of hidden monitoring for keeping authenticity has been used. As a consequence of the insufficient amount of data to the reaching of the second task, half-structured interview has been chosen instead. Research dataset consisted of thirteen records of sighting and one interview on the above mentioned intensive care unit. As a basis for analyses, three observation sheets were made, into these sheets were then during the observation information assigned. Each sheet consisted of single points planned in accordance to theoretical part. The nurse follows these points when securing the patient´s nutrition. Remaining information, not included in observation sheet were written into the notes section or were included into the information about the performing of the particular point. The results were analyzed by using an open-coding. There are six categories coming out from the analyses, which are connected with securing the education, information providing, keeping an obstacle-free approach complications preventing, using tools, nurse´s cooperation with the patient and deciding processes during work performance. In the results, there is a conclusion of the analysis with illustrative examples to find. The sequence of the results is presented according to sequence of categories during performing. In each category, the results are evaluated according to research tasks stated. We believe, that the obtained information, which map the activities of the nurses when securing the nutrition at the intensive care unit patients and the acquainting the cooperation with the nutrition therapist helps in the future to the awareness of the potential weaknesses and following correction. The results may become inspiration for more detailed analysis of this topic.
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Nursing patients suffering in delirium at ICUs (Intensive Care Units)
VANIŠOVÁ, Štěpánka
Delirium is a very common and serious health complication which mostly affects elderly patients and is associated with multiple negative effects, such as prolongation of hospitalization, increase in financial expenses, higher mortality and more frequent need for further institutional solutions. Care for patients with delirium means increased mental and physical exertion for the nursing staff and is also more time-consuming. This bachelor thesis addresses the issues of nursing care for patients affected by delirium. It has three objectives. The first objective examines the specifics of nursing care for patients with delirium on selected surgical critical care units. The second objective examines the way nurses manage communication with patients affected by delirium, and the third objective maps the knowledge nurses have of care for patients with delirium. There are four research questions assigned to the objectives and they are based on the set objectives. The empirical part of this thesis used qualitative research method. It is based on a semi-structured interview, which was conducted with nurses working in intensive care units of surgical disciplines. The answers were analysed and then categorized. The research survey was complemented by participant observation of the nursing staff who took part in the interview. The research survey has found that the majority of surveyed nurses did not have the correct approach to patients affected by delirium. Nursing care for these patients was influenced by their mood. In some cases, there was an excessive use of restraints and disregard for the Restriction of patient's movement policy. The nurses who participated in the interview had good knowledge of proper communication methods with patients affected by delirium but in some cases did not use them in practice. They had less knowledge in the fields of prevention and nursing interventions of delirium. The results show that nurses lack theoretical and practical experience required to deal with this very common and serious health complication. This bachelor thesis could serve as a basis for organizing a seminar on this issue for nurses.
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Delirium Tremens Patient in Intensive Care.
ŽÁKOVÁ, Magdaléna
This bachelor thesis concerns with problematics of nursing care with patients in the Intensive Care Units. Delirium tremens is the most serious stadium of alcoholic withdrawal syndrome and it starts when alcoholics stop drinking alcohol. This state is life endangering and it is necessary to hospitalize the patients in the Intensive Care Units or in the Anesthesiology Resuscitational. Nurses are supposed to know their competence, specific activities and interventions, which leads to the prevention of starting the complications. In case of some complications they should know the solution. There is a term "intensive medicine" explained at the beginning of this thesis. The problematic of alcohol addiction, characteristics of the patient with delirium all the specifics of nursery care included are given in the biggest part of this work. There is a part about delirium tremens, where all the causes of start, symptoms, demarcation of the patients' problems with nursery care and recommendations for medical measures. There is some more part where the clinical statuses connected with delirium are described. The problematic of patient's physical limits is summarized in another part of the bachelor thesis. Patients' consciousness and impairment of consciousness are described at the end of the thesis. I set up two targets: Target 1: To find out, what problems the nurses meet at their work during treatments of patients with delirium tremens. Target 2: To chart nursery care specifics for patients with delirium tremens. There were two questions asked. The first question: What problematics nurses deal with during patients with delirium tremens treatment? Question 2: What are the specifics of delirium tremens nursery care? In the empiric part of this thesis, a qualitative research was used. The semi structured dialogue and patient's casuistry with delirium tremens diagnoses hospitalized in the Anesthesiology Resuscitational Unit. The dialogue was guided by nurses working in the Intensive Care Units and in the Anesthesiology Resuscitational Unit in the hospital Tábor a. s. These nurses were chosen on purpose and they had to fulfill the common intensive care conditions. They also treated a patient with delirium tremens. Every nurse got a number which she got according Authentication method of coding. Then I numbered all the lines, where the nurses' answers were listed and on which I referred later to. The important information in the dialogue (on the basis of them were codes created) were highlighted via the "Paper and Pencils" method. Technology showdown led to creating four categories, which were enhanced by subcategories. Both of the questions were answered using the research. Nurses cited the characteristics of a patient with delirium tremens and problematics parts in their treatment. They showed the knowledge in hazardous fields and in prevention as well as in complication solving. The research shows that the nurses in intensive care are focused on the satisfaction the basic physiological needs. The nurses showed their orientation in nursery care and in the interventions in the patients' care. They also proved they know the specifics, which are connected to the patients' physical limit. On the basic of the analysis were found, that nurses have problems with some activities, which could be removed by the sufficiency of this problematics information. An Interdisciplinary seminar about the patient with delirium tremens in the Intensive Care Unit problematics, which you can find attached to the thesis, is the practical output of my bachelor thesis. (Attachment no 6).
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Working conditions of nurses in acute beds.
ŠVECOVÁ, Markéta
This thesis is called "Working conditions of nurses at acute medical units." The intensive care medicine was chosen as the main focus of research. It pervades all branches and it became a very interesting multidisciplinary part of medicine. Another subject is non-medical staff, as demands made on them are really high. First, the thesis deals with intensive care medicine and relates it with nursing. Then it describes the role of nurses, mentions their system of education, changes which has happened and the peculiarities for intensive medicine. The operation of second internal clinic of General University Hospital in Prague from the nursing point of view including related internal and legal regulations is described in more detail in the empirical part, for better understanding wider context. Out of consideration for the fact that a coronary unit (whose staff are the research sample) is on the verge of offering resuscitation and higher intensive care, it is also aimed at and its specifications too. Individual factors making working execution harder can be influenced, although partly they are determined by a human factor and have their limits whose exceeding or change can become a problem. The diploma project investigates the working conditions of nurses at acute medical units because that is what can be both positively and negatively affected and it is measurable. A qualitative enquiry in the form of non-standard interview was used for collecting the data. Overall fifteen nurses working at acute medical units of General University Hospital in Prague were addressed. Their personal situation is briefly outlined, but the main focus follows the aims in the thesis, i.e. findings of the nurses' opinions at acute medical units on their working conditions; findings of which factors make their working conditions difficult; ways of eliminating these factors and how to improve the quality of nursing. Altogether ten research questions were formulated so that interviews with respondents could be categorized and analyzed. The thesis came to the conclusion that improvement in the area of working conditions while providing nursing at acute medical units is possible. Most suggested solutions are not able without the help of management, or are dependent on it fully. However, even today the provided nursing care is at an excellent level.
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Nursing care of patients with acute respiratory failure
NĚMCOVÁ, Kateřina
Acute respiratory failure is a state when the respiratory tract suddenly is not able to carry out its functions. The disorder can be both at the inflow of the air into the respiratory tract or at the point of the gas exchange between the alveoli and the blood. The most severe form of acute respiratory failure is the acute respiratory distress syndrome-ARDS. It is necessary to treat acute respiratory failure immediately when it appears because it can cause serious damage to the organism or death. The treatment requires securing the respiratory pathway. A theoretical knowledge of the possible causes of the origin and development of ARDS, and its treatment using artificial pulmonary ventilation helps to correctly understand the problems of this illness. Nursing care is essential while treating severe respiratory failure. The care is highly specialized in this case. The nurses participate in the securing of respiratory pathway, beginning and progress of artificial pulmonary ventilation and the process of weaning of mechanical ventilation. The aim of this bachelor's thesis is to determine the basic terms and issues of acute respiratory failure. This is necessary to properly understand the case and the subsequent treatment of respiratory failure with mechanical ventilation. The study deals with defining and comparing particular guidelines of the complex nursing care of the patients with acute respiratory failure. This project was defined because of the continual development and improvement of the care of critical status patients. This thesis, entitled "Nursing Care of Patients with Acute Respiratory Failure," expounds on its topic only as a theoretical work based on both Czech and international scientific resources. Knowledge of particular parts of the thesis was obtained from various scientific and professional books, magazines and Internet resources of professional associations. The Czech authors most frequently cited are MUDr. Pavel Dostál PhD. MBA, who is focused on the issue of artificial pulmonary ventilation, and MUDr. Bronislav Stibor, who is dedicated chiefly to ARDS and revitalizing methods. Based on the studied literature, basic theoretical terms and issues were expounded concerning acute respiratory failure and acute respiratory distress syndrome. Particularly emphasized was the artificial pulmonary ventilation. The theoretical part gradually joins the part dealing nursing care of those patients suffering from acute respiratory failure. The part contains every guideline concerning the most recent developments and the latest innovations in the field of nursing of the critically ill. After studying the scientific sources, it was concluded that there were some differences regarding each authors´ guidelines. The guidelines differed from each other only slightly. Each guideline is mentioned in the thesis and analyzed at the end of the thesis. There is a comparison of competences of general nurses and specialized nurses for intensive care. According to Czech law, the patients with the failure of a vital function should be treated by specialized nurses. The range of permitted treatment attended by an intensive care nurse is plentiful when compared to general nurses. If the only one student carried out one of the proposed guidelines from my thesis and was able to use them at work, she or he would help to improve the complex treatment at intensive care units and my study would fulfil its propose.
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Airway management from the perspective of nurses in intensive care
SLANINOVÁ, Barbora
This bachelor work deals with the possibilities of establishing an airway that can perform nurses for intensive care. Breathing is one of the basic and very important life functions necessary for life. In today's advanced medicine is a wide range of opportunities to ensure the airways, or at least encouraged to perform proper function. Securing the airway is a very important part of the pre-hospital emergency care, but also on the wards in the hospital. The theoretical part of my bachelor is engaged a complex provision of the respirátory tract. The first section deals with the short description of the anatomy and physiology of the respiratory breathing. In other chapters describe airway. The following chapters were directly aimed at ensuring the airway, which were distributed to provide the tools, equipment and without indications for collateral. U airway management devices without describing the revision of the oral cavity, head bent backward and triple maneuver, shot in the back and the Heimlich maneuver. The practical part was focused on determining whether the sisters were higher competence in the provision of respiratory and how intensive care nurses provide their throughput. The research was conducted using quantitative research using an anonymous questionnaire at the hospital in České Budějovice a.s. and in the sand. The questionnaire able be completed only by workers who have graduated from specialty anesthesia resuscitation and intensive care. The questionnaire was printed and included 20 questions. Each question was displayed in a graph. The total number of questionnaires that were distributed, 100, 82 of them returned, but only 61 were fully completed and could be used. Research suggests that nurses who studied ARIP received enough informatik and practical experience during their studies. Specializing mostly work on anestesiology and resuscitation wards and intensive care units. At your workplace have aids, such as laryngeal mask airways and endotracheal tube. The vast majority of respondents have difficulty securing and aspirations in securing the airway. Sisters during their practice provide respiratory laryngeal mask and Combitubus, countless assisted by endotracheal intubation, but its remit would not want to have this power, because of its difficulty. Finally, it is important to note that to achieve the set objectives, where it was found that nurses stand to increase their competence, but only with some performance and throughput. Respiratory ensured by the air ducts and laryngeal masks.
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Hemodynamic monitoring in the intensive care - preparation of educational materials for newly hired nurses
MELICHAROVÁ, Jaroslava
This diploma thesis focuses on the monitoring of hemodynamics in intensive care units; the main objective was to create an educational material for newly employed nurses. This educational material should facilitate the adaptation process of nurses at Anaesthesiology-Resuscitation Units (AR) or Intensive Care Units (ICU).The diploma thesis is divided in two parts: theoretical and empirical. The topics covered by the theoretical part include the concept of intensive care, the technical equipment, the scope of work of intensive care nurses, anatomy and physiology of the cardiovascular system, cardiovascular system monitoring, hemodynamic monitoring, adaptation of new nurses at the workplace, and the possibilities of educational methods aimed at newly employed nurses. The empirical part was conducted as qualitative inquiry in the form of interview. The interviews were semi-standardised and they were held at the AR unit in the České Budějovice Hospital. The subjects were the nurses from the RES 1 and RES 2 stations. The first part of the research inquiry consisted in interviews with the nurses at the Anaesthesiology-Resuscitation unit. The interviews were not taped, due to the respondents' request. All the answers were carefully recorded and immediately transcribed and processed to prevent any inaccuracy of information. The results were organised in charts according to the categorisations, in a well-arranged manner. The second phase consisted in creating the educational material for the newly employed nurses and the third phase concluded the project by distributing the educational materials at the hospital unit where the interviews were conducted. The nurses could therefore assess whether the educational material meets their requirements and will be useful in practice. The respondents were interviewed again and the results were subsequently also organised in charts.The results of the research inquiry show that the nurses at the Anaesthesiology-Resuscitation Unit in the České Budějovice Hospital perceive the correct hemodynamic monitoring as important, that they know what hemodynamic monitoring is and are aware of the monitoring possibilities. The nurses of this unit perform both invasive and non-invasive monitoring of hemodynamic parameters. The basic task is measuring the central venous pressure and arterial pressure. Other parameters are monitored by the doctors with the application of the Swan-Ganz catheter. The most frequently used monitors are PICCO, Lidco, Vigileo and Vigilance. All interviewed respondents agreed that their only help during the adaptation process was the manufacturers' materials and the advice from the nurse-trainers. A small part of the respondents was trained directly by the company distributing the monitors. The final phase of the research inquiry revealed that the nurses like the new educational material but they are afraid that it will end up collecting dust as the other materials supplied by students. The interviews established that it is easier to directly communicate the necessary information to the new nurses along with practical demonstration than to recommend an educational material for studying of at least the theoretical part.
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