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Specifics of nursing care in dialysis children
BUDÍNOVÁ, Eva
Dialysis treatment is demanding for adult patients let alone for children. The families can have financial problems and the relations within the family are disrupted. The school attendance of children on dialysis is affected by the treatment. Because of the insertion of a peritoneal catheter and the necessity to wear a mouthpiece among other children the children can feel "different". The aim of the thesis is to determine the needs of child patients on dialysis and the views of their families regarding the illnesses and the dialysis treatment. A further goal was to examine the life of the dialysed children and their families with regards to social elements and how the dialysed children perceive the treatment. We have set down five questions. How do the dialysed children and their families adapt? How does dialysis of the child patients affect their families? How do the dialysed children perceive their illness? What information do the children have about their medical condition? What is the difference between the children with inherent and acquired illness? A qualitative research was used to assess the data acquired by semi-structured interviews. Two sets of questions for the dialysed children and their parents were created for the interviews. The interviews helped to find out how the children spend their time and how they perceive their regular visits to the dialysis centres and the process of dialysis itself. The questions for parents focused on issues regarding family, personal and social situations and the life of their dialysed children. The first research group was composed of 8 children of different ages and the criterion for including them into the group was their treatment by elimination methods. The second research group was formed by 8 parents who regularly accompany their children to the dialysis centres. The research group thus represented 53 % of the possible respondents in the Czech Republic. The chapter on data categorization defines several issues that were most problematic for the respondents. The information acquired from children and parents show that the children in the chronic dialysis program and their parents are subject to involuntary changes in their lives. The changes affect the social inclusion of the children, relations within the family; the school attendance of the children is limited due to their visits of the dialysis centres or hospitalisations. The children are separated from their families, peers and the financial situation is of the family is also affected as the mother often has to stay at home and take care of the child. There are, of course, efforts to improve not only the results of the treatment but also the subjective perception of the patient. The results of the research indicate that the children treated by peritoneal dialysis have thanks to better time options more opportunities to join a collective e.g. in school. An interesting fact is that the children often handle the dialysis process better than their parents because they support their children who rely on them. This thesis should help not only the medical staff in everyday contact with dialysed patients but can also serve as a basis for improvement in other areas of care of chronically ill children. Chapter Recommendations for practice lists sets of activities that with the help of the whole team of doctors and non-doctors contribute to the treatment. The care must always revolve around the question "What can I do to help"? The most important areas are psychical suffering of the children and their families, the dialysed patients? discomfort, dietary restrictions and problematical areas of care.
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The usage of psychosocial services in hemodialysis centres
HACKLOVÁ, Lucie
Chronic disorder of kidneys is a gradual progression from the state of health to the state of a disease, resulting in permanent failure of excretory, regulatory, and hormonal (metabolic) functions of kidneys. During a kidney failure water and electrolyte imbalance, retention of catabolites, and metabolic acidosis occur; there is a shortage of substances produced in kidneys. A complex metabolic disorder occurs, whose clinic corelate is a uremic syndrom. Conservative treatment consists in adjusting or positive influencing of metabolic deviations through a diet and medication. However, if the conservative treatment is insufficient, it is necessary to proceed to some of the blood purifying methods {--} hemodialysis, peritoneal dialysis. These methods are then followed by kidney transplant. Dialysed people have an abnormal life, as a vitally important organ of theirs does not work and is replaced by an apparatus. Patients are faced with many stresses and bans {--} they have to be on a diet with liquid restrictions, they have to take remedies regularly, due to dialysis days they are time limited, their appearance is often changed, they suffer from sexual disfunction, their sickness rate is high, etc. A successful transplant is a great white hope for the patients, but it also has its medical contraindications, therefore it does not concern all the dialysed patients. Thus a big occurence of depressions and suicides among patients cannot be a surprise. Besides medical care it is then necessary to focus on psychological care and social recovery. However, the results of a questionnaire research did not prove the occurence of psychological problems among the clients of dialysis centres. It proved true that the clients of centres are not interested in using psychosocial services, which was the third hypothesis.Further it came out that the clients are not well informed about social services and social benefits. Thus the second hypothesis was confirmed {--} The clients of centres do not know psychosocial services. The first hypothesis {--} Psychosocial workers are not used by hemodialysis centres {--} was also confirmed. The teams of the centres miss a psychologist absolultely and only one centre has a social worker.
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Health Related Quality of Life (HRQoL) of dialysis patients, with regard to age
VANCLOVÁ, Romana
The dissertation entitled ?Health Related Quality of Life (HRQoL) in Dialysed Patients with Respect to Age? contains a theoretical and practical part. The theoretical part describes chronic kidney disorder and the treatment of this disease. It mentions the causes, repercussions and complications of this disease. It also suggests the form of treatment as the method of replacing the function of the kidneys which includes haemodialysis, peritoneal dialysis and transplantation. I have attempted to elaborate their principle, history and current form, benefits, negative aspects and complications. The practical part describes the actual research. Health Related Quality of Life (HRQoL) was ascertained in a group of patients undergoing haemodialysis at one dialysis centre. Questionnaire SF 36 was used which allows for a quantified assessment of the quality of life in eight domains. The results were statistically assessed and clearly depicted using tables and graphs. The quality of life was compared in the monitored group with the general population and also based on age and gender. The results found show a reduced quality of life of dialysed patients compared with the standard population. A difference was also found in the assessment of the quality of life in some age groups. No difference in results was proved with regard to gender.
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Education of patients in dialysis programme
PINKASOVÁ, Eva
Kidney diseases belong among the most serious ones. It is difficult for a person suffering from this kind of disease to accept his/her state of health and to learn to live with it. Education in nephrology is indispensable and it is an important means to improve the quality of life of a dialyzed patient. The education is provided by the physician and the nurse. The nephrological nurse informs the patient and his family, educates and trains him/her in order to achieve optimal rehabilitation and the patient's independence. This bachelor thesis deals with education of clients in dialysis programme. The research survey was a quantitative one, to collect data anonymous questionnaires were applied questioning nurses and patients at nephrology departments. The research was carried out in chosen hospitals of the South Bohemian Region, in Písek, Tábor and Prachatice. The clients were distributed 110 questionnaires in total, 65 (100%) of which were used for the research. Nurses of the hemodialysis centers were offered 27 questionnaires, of which 15 (100%) were applied. This paper has set two goals, the first of which was to determine whether nurses provide education of dialyzed patients applying written material. The second goal aimed at finding out whether dialyzed patients are satisfied with the level of care provided by the education. These goals have been fulfilled. Three hypotheses were set. The first hypothesis presumed that nurses at hemodialysis center carry out the education solely by means of written materials. This hypothesis was not confirmed, for nurses apply also other forms of education. The second hypothesis presumed that dialyzed patients are positive about the written materials at the dialysis center. This hypothesis was confirmed. More than one half of patients, 35 out of 65, said they were provided information by means of written material and they considered this method comprehensible. The third hypothesis presumed that within education at the hemodialysis center the patients' questions were always answered. This hypothesis was also confirmed. The research has shown that nurses at hemodialysis centers educate patients by means of written material and they also discuss the issue with patients. Dialyzed patients are satisfied with the level of education and they consider the information received comprehensible and they are given enough time for questions and have a sufficient feedback. By means of this education the patients get new knowledge, new skills and a different view on the hierarchy of values. The right understanding and attitude to his/her state and treatment are necessary. Respecting the process of treatment, respecting the diet the patient may slow down the disease and delay the artificial replacement of lost kidney function. It is therefore very important to keep education of dialyzed patients in mind.
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The influence of stress in dialyzed patients of the level and role the nurse in this issue
JANOUŠKOVÁ, Jaroslava
Stress and stressful situations influence us throughout our whole lives. Great and longterm stress can cause many health complications. Dialysis alone is a great stress in dialyzed patients. To every day stress causing agents a number of restrictions is added in connection with dialysis. Especially the change of lifestyle has an impact on private life and the life of the whole family. Dialyzed patients suffer from an increased level of stress permanently. The nurse plays in important role in these situations as she gets in close contact with the patient. She can by means of communication and her attitude influence the process of treatment and the quality of the patient's life. The main goal of the research survey was to determine the influence of stress in dialyzed patients, what role the nurse plays in this issue, the importance of her attitude to dialyzed patients and whether the stress has also an impact on nurses. Qualitative research method was applied. Non-standardized interview with randomly chosen patients and nurses from the same hemodialysis center. The interviews were prepared in case reports. The research has shown that dialysis is a stress for patients and it influences to a certain degree their private lives as it has become an indispensable part of their lives for a long time. The quality of life of dialyzed patients is influenced not only by the process of treatment but also the family background and the attitude of nurses. A nurse is considered by most patients indispensable. The nurses are, according to patients, compliant, emphatic and sensitive. The research has further shown that nurses working with these patients are also influenced by their stress. Patients tend to pass their problems they do not what to deal with on their own on nurses and they expect help, which is an enormous stress on nurses as they realize dialysis is for these patients a lifelong issue. In order to provide quality care for dialyzed patients, it is necessary nurses stay emotionally uninvolved and still maintain a good feeling from a well done work. A self-possessed nurse can help a patient more that a workplace with top equipment and the best experts.
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