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FRAGILITY AS A TOPICAL NURSING PROBLEM
ŽÁKOVÁ, Jaroslava
Introduction: Frailty within geriatrics is still more viewed as a current problem in the world than in the Czech Republic and it is more commonly mentioned. We can say that in the Czech Republic this problematic is still developing, updates and is trying to find its place in nursing as such. Objective: The objective of the presented thesis is to find out if frailty is perceived as a current problematic in the current geriatric nursing. Further, we focused on the geriatric nursing and specifics of nursing care in this field; on what is the awareness of medical staff at aftercare department about geriatric frailty and in which way, within nursing care, they apply their gained knowledge in practice. Methodology and research sample: To achieve the set objective the qualitative research conducted using the technique of semi-structured interview with nurses at aftercare department was used. The basis of this interview was 24 open questions which were predetermined and are documented in attachments (attachment 1) of the thesis. During the interview these questions were extended as needed by additional questions. The interviews were conducted with 10 general nurses at aftercare department of one unnamed South Bohemian hospital. The analysis of interviews was done using open coding paper-and-pencil and the individual information were classified into categories and subcategories. The results grant us comprehensive overview on the nursing care at aftercare departments within the geriatric nursing, utilization of knowledge of nurses about geriatric frailty within their practice and whether nurses perceive the concepts such as geriatric patient, geriatric syndromes and the already mentioned geriatric frailty. It was found out that some addressed nurses at aftercare department of one unnamed South Bohemian hospital never heard some of the mentioned terms and never registered them during their practice either. Other nurses say that they only heard those terms during their college studies, but they also agree that they never met them during their practice. Despite that, all nurses were able to accurately and aptly characterize the terms geriatric patient, geriatric syndromes and geriatric frailty based on their experience and knowledge. Furthermore, it was proven that they realize frailty during the care for patient and can apply their knowledge in nursing care. Conclusion and practical use: The results of the submitted thesis will serve as a template for educational seminar.
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Spiritual needs of patients through the eyes of nurses at departments of aftercare and long-term care.
JEHLÍKOVÁ, Aneta
The theoretical part of this bachelor thesis is primarily concerned with topics of spiritual needs and spiritual care. The first chapter inquires into the holistic concept and the needs of people with illnesses. What is the need and what are the main characteristics of particular basic needs is described there. The second chapter engages in the spiritual care, but there are also other terms mentioned; the pastoral care or the hospital chaplain, for instance. The past of the spiritual care is not omitted either, as it reaches into the remote history. The last chapter is concerned with departments of aftercare and longterm care and these terms are explained there. Information about nurses' work at such departments is provided, as well. The research part of the thesis addresses the research aim that is defined in this way: To learn how nurses at departments of consecutive and long-term care perceive the idea of spiritual need, if they recognize particular spiritual needs and how they react to them. To learn the overall spiritual needs standard and organization at individual departments. Methodologically, because of the research aim, qualitative research design has been chosen and the data has been collected through semi-structured interviews, individually with respondents. The research uncovered that nurses have a basic awareness of spiritual care and spiritual needs but they still miss some knowledge. For example, many nurses believe that spiritual care serves only to believing patients. Another finding reveals that nurses are able to rightly react on spiritual needs of the patient and they agree on the process of spiritual needs' fulfilment. The thesis offers a complex insight into nurses' view of spiritual care. The output of the thesis is an information material for nurses and patients.
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The use of rateing scales in the department of subsequent care
JINDRLOVÁ, Lenka
Current Situation: Rating scales help nurses judge the patient´s health condition objectively. Via rating scales it is possible to state the areas of a patient´s needs and plan interventions leading to solutions of his or her problems. In after-care departments, patients who have already had their basic diagnosis set and their health-condition stabilized, are hospitalized. In this department, nursing care as well as rehabilitation nursing, physical and mental activization, nutrition care, rehabilitation, and professional ergotherapy, are provided (Doležalová, 2011). The aim of this research was to determine the range of use of rating scales in after-care departments, to describe the content of individual rating scales, to find out about the nurses´ perspectives on the advantages of rating scales for practical use, and to evaluate the complexity of nurses´ work with rating scales. Methodology and Research File: The research was implemented via the method of a qualitative survey using in-depth interview, rating scale content analysis, and nursing documentation content analysis. Interviews were carried out with five nurses working in the after-care department. Content analysis was focused on 5 rating scales used by the nurses when planning nursing care, and 10 chosen complex pieces of nursing documentation. The results prove clearly that the nurses use Bartel´s test of basic every-day activities to evaluate the patient´s self-sufficiency when carrying out everyday activities. Norton´s redesigned scale serves the determination of decubitus formation, risky factors of a fall to identify the risk of the fall, evaluation of nutritional status to determine malnutrition risk, and pain evaluation and monitoring. Screening is carried out in all patients accepted at the department up to 24h after having been accepted, at a change of health- situation in a patient, and in regular intervals once a week. Pain is evaluated daily. The nurses´ point of view is positive towards the first screening, but rescreening is evaluated negatively by the participants, especially in self-sufficient patients. The results also prove that nurses´ work with rating scales is incomplete and not complex. It was found out that formal recording requirements were not followed, concerning corrections of record errors, marking all points in rating scales and a correct point sum. Re-screening is not always done in regular intervals, nursing intervention planning in relation to the observed risks and re-screening are insufficient. Conclusion and Practical Use: The results of the submitted qualitative research may not be generalized. To verify our conclusions it would be suitable to implement a quantitative study the aim of which would be to evaluate the complexity of rating scales, based on a wider file of closed or open pieces of nursing documentation. With regard to findings of an incorrect evaluation of rating scales, there was an expert seminar held in the after-care department, through which the nurses were introduced to rating scales, their use and working with them. Survey result presentation was a part of the educating programme.
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The issues of patient´s self-sufficient after cerebrovascular accident at ward of subsequent care
MACHKOVÁ, Marcela
Cerebrovascular accident is a serious destructive condition with suddenly formed infliciton of cerebral blood vessel. There might appear obstruction and taper of them or defect on wholeness of vascular wall which result into hemorrhage to brain tissue. Sings of this condition might be termporary with physical and psychical changes or fatal which end up with serious paralysis, unconsciousness or even death of individual. Cerebrovascular accident problematics is currently a big challenge for the entire society, because progressiveness of European society´s aging is likely to bring increase in total amount of this disease´s causes. The first important step in problematics of the disease is to reduce the risk of stroke by consistent prevention; general lifestyle changes; blood pressure controls and treatment; lipid, coagulation factor and heart disease observation and compensation. The second step, when speaking about already formed disease, is to start well-timed and complex therapy which provides the patient with distinctly higher chance of better final clinical status without permanent harm. After overcoming the acute phase in neurology department the patient carries on with another therapy acorrding to seriousness of his/her condition in rehabilitation or aftercare department. Therapeutic, nursing and rehabilitation care should be set to contain all aspects of lost self-sufficiency encouragement and should be oriented mainly on person who has, even after stroke, his/her own needs, motivations, leisure time activities and skills. The bachelor thesis starts with medical part which describes brain anatomy, deals with epidemiology and stroke history. More detailted stroke characteristics and disease itself are defined by etiology, clinical picture, diagnostics and treatment. This part is then ended up with stroke consequences, factors influecing patient´s recovery, patient´s needs and self-sufficiency after stroke. Multidisciplinary team and aftercare deparment create an independent chapter and after this starts a new chapter interested in the role of nurse and needed nursing interventions, evaluation techniques during basic needs saturation of patients after stroke. Therapeutic rehabilitation creates almost the last important part of the bachelor thesis, on which depend gradual recovery and patient´s future life quality after this desease. The recovery part includes physiotherapy, occupational therapy, speech-language pathology, neuropsychology, spa treatment and prosthetic security of patient. Then, the whole thesis is ended up with patient´s preparation on release into home environment. The first set aim is to find out patient´s needs to reach the maximal functional independence and self-sufficiency after stroke according to previously studied sources. The second aim is to find out the nurse´s role in the encouragement of patient´s self-sufficiency and the third aim is to find out nursing interventions in the encouragement of patient´s self-sufficiency after stroke according to previously studied sources. The whole bachelor thesis is mainly taken as theoretical. It tries to insight into problematics of all needs, self-sufficiency encouragement and patient´s maximal functional independence after stroke according to previsously studied sources and information obtained from consultants, physiotherapists and general nurses. Then, the thesis deals with the role of nurse and nursing interventions in patient´s self- sufficiency encouragement on aftercare department to satisfy his/her essential needs of life without someone else´s help after the disease. After a gradual improvement of functional disability, the whole life quality and the independence of patient, it is necessary to follow all nursing, medical and rehabilitation procedures very carefully without their neglect with a sufficient amount of medical staff and specialized doctors.
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Attitudes of nurses to nursing care for terminally ill clients in the long term care Departments
SCHMIDOVÁ, Žaneta
Terminal phase means gradual and irreversible failure of vital functions and organs ending in death. This state directly precedes death. We can understand terminal stage as dying itself. "Nevertheless the term dying must in no case be reduced to terminal phase" (Kelnarová, 2007, p. 10). It is the most demanding phase for a nurse and the whole team caring about a dying patient (Theová, 2002).This thesis deals with mapping nursing care of clients at terminal stage and the possibilities of coping with the care of dying clients and their family members for nurses.The research part was elaborated in the form of qualitative research. The aim was to obtain high quality data to given topic. The technique of semi structured in-depth interview was chosen as the most suitable method. Each respondent was given a number. Lines were subsequently numbered to enable references. The data were analysed by the paper-and-pencil method and four categories were created. Ten subcategories were created within the given categories. The information obtained was processed in schemes. The interviews were performed from February to April 2014.The research sample consisted of six nurses working at a long-term care department. The nurses were intentionally chosen in various categories to get the most objective possible data. There was also one man working at the position of a nurse.The respondents' answers showed that nurses working at the long-term care department have basic knowledge of the issue, are able to get oriented in the problems of dying, the terminal stage length, are able to describe the frequency of meeting with a dying client. The nurses cope well with satisfying the needs of terminally ill clients, they do not omit any of the needs. The nurses are capable of having holistic approach to clients. They take the demands of the care about a dying client as a part of their work, they make no difference and care about a dying person as of any other client at their department. They describe their experience with the dying and their families, they only describe communication with a dying client and his/her family as problematic and sometimes they are not sure whether they act correctly and are afraid of hurting someone. They communicate with such a client and his/her family according to their best conscience and they hope that their approach is the right one. The research has also shown that the nurses are able to prevent the burnout syndrome, they understand that they have to care about themselves, they must like their work, have positive approach to life. They perceive burnout syndrome as a problem, they try to prevent it and if they feel symptoms of inconvenience and dissatisfaction with their job they try to find the better aspects and not to give up. Except for one respondent, who describes herself as burned out. This is however given by the respondent's personality itself.The research shows that nurses have sufficient knowledge of the problems of terminally ill clients at their department, that they are able to provide quality nursing care. They however admit that sometimes they are not completely sure whether they treat a client correctly not to hurt him/her in given situation. After this fact was discovered a brochure was prepared giving nurses instructions for general approach to dying clients and help them minimize negative impact on a client.
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Prejudice of some geriatric patients and their relatives against hospitalization at the long-term care unit of the Tábor hospital.
BIDMONOVÁ, Alena
Basic theoretical background The opening parts deals with the issues of old age and characterize aging and old age in general. It specifies changes and needs of the old age, acceptance of the old age and describes a senior as a patient. The next part describes communication in general and specifics of communication with seniors and their relatives. The theory is then focused on the most frequent old age diseases, their specifics and on nursing care typically provided at a long-term care unit. Special attention is paid to nursing rehabilitation, palliative care and treatment of patients with pains. An insight into approach of a nurse to provision of nursing care to seniors is also important. The other part deals with health-social services provided to patients at the long-term care unit (LTC). Chapters on personality of a nurse caring about geriatric patients, on nursing ethics and the basic points of Seniors' Rights Charter close the theoretical part. The aim of the thesis The first aim of the thesis is to find out the reasons why geriatric patients refuse hospitalization at aftercare wards. The second aim is to determine why patients' relatives are afraid of hospitalization at LTC. The third aim is to determine whether the reasons for refusing hospitalization are substantiated or whether they are just baseless prejudice. Applied methods Qualitative research form, the method of interview was applied to the research. Data collection was performed by means of semi-structured interviews with geriatric patients and their family members. Three areas of interviews were applied to the research. The patients were first asked at the beginning of hospitalization. The second interview was performed with the same patients after some time of hospitalization, when they were already able to assess quality of the care provided. The third area of research questions was aimed at senior's family members during hospitalization at LTC. The interviews were analysed and categorized. The selection of respondents was intentional, oriented at patients and their families that first refused hospitalization at LTC for some reasons, but finally they were hospitalized. The research sample consisted of 6 patients and 6 members of their families. Results The results of the research have shown that geriatric patients mostly refuse hospitalization at long-term care units as they do not know the nature of the department. Patients themselves refuse hospitalization more often than their family members. Patients have incorrect ideas of the department caused by ignorance or maybe based on negative experience of people around them. Only when the respondents had used to the new environment of the LTC and had got familiarized with it they were able to assess the nursing care quality independently. The respondents and their families appreciated individual approach of the healthcare staff, complex nursing care, rehabilitation care, services of social workers as well as voluntary activity performed at the LTC. Already during hospitalization the patients admitted that they had had negative prejudice against long-term care unit not backed by negative personal experience. Respondents' families did not refuse hospitalization; they mostly welcomed it because of provision of care, professional rehabilitation, self-sufficiency improvement and compensation of health condition of their senior. Conclusion This bachelor thesis focuses on the problems and specifics of the care of geriatric patients that a nurse of a long-term care unit faces every day. Particular outputs from the thesis will be integrated into a lecture for LTC staff that will be presented at an operation meeting. The results may help the healthcare staff of the long-term care unit as feedback for continuous improvement of healthcare quality.
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The treatment of pain in patients in terminal stage on the ward of follow-up care from the nurse point of a view
KUNEŠOVÁ, Martina
This bachelor's thesis is focused on chronic pain in dying patients at the aftercare department. The theoretical part focused on chronic pain description and its division, chronic pain treatment possibilities, characterization of a terminal stage and work done by nurses at the aftercare department. This part is supposed to present the most important information concerning chronic pain in dying patients. The practical part provides results of a gualitative research. This research had four objectives. The first objective was to identify the benefits of nursing care provided to dying patients with chronic pain in palliative care. The second objective focused on the attitude of nurses towards the patients in the terminal stage. The third objective was to identify the nursing methods used during the provision of care to a patient with pain in palliative care. The fourth objective was to assess the knowledge of nurses working at the aftercare department regarding the up-to-date treatment of pain in palliative care. Four research questions were established based on these four goals: What is the benefit of nursing care in treatment of pain in palliative care? What is the attitude of nurses towards the patients in the terminal stage? Which new nursing methods possibilities can palliative care provide to patients with pain? What information on treatment of pain in palliative care do nurses have? The research was performed using an in-depth structured interview, which is a method of the gualitative research. The research samlpe consisted of eight practice nurses working at the Aftercare Department in Nemocnice České Budějovice a. s. The interview was aimed at information on benefits of nursing care, the attitude of nurses towards dying patients, nursing procedures used and also knowledge of the nurses working at the aftercare department. The interviews were recording in writing. The records were analysed and coded using an open coding method. Six categories were established as follows: Nursing care procedures in treatment of chronic pain in dying patients, Effectiveness of chronic pain treatment in dying patients, Benefits of nursing care, Attitude of nurses towards dying patients with chronic pain, Collaboration with families and Nurses' knowledge. It was found out during the research that the benefit of nursing care is enormous, the care brings satisfaction of patients, safety, communication, sufficient amount of information, ensuring of basic needs, contact, information on current changes in the state of health, offer of better care, psychological support, better collaboration between nurse and a patient and a family, and also promixity of personnel. Thereforte, I think it is possible to consider the nursing care to be very beneficial. Furthermore, the following attitudes of nurses towards the dying patients were discovered: Trust or distrust of nurses in ability to display pain, active interest by nurses, approach to patients and communication. The research also discovered the following nursing procedures used in treatment of chronic pain in dying patients: positioning, heat application, cold application, massages and refraining from needless manipulation. The knowledge of nurses regarding the current treatment of pain in palliative care contains extensive information on principles of analgesic and opiate administration, which are applied by the nurses working at the aftercare department. A practical output of this thesis is a handbook called Administration of Opiates and Usage of Intoxicants Record, which is intended for use by practice nurses.
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Orientation nurses to clients´needs or the technical equipment and the parameters ot the clients as a nursing problem
HOUSEROVÁ, Renata
Focus of nurses on clients' needs, technical equipment and client´s parameters as a nursing staff problem. People´s needs can be satisfied individually in different ways, depending on each person´s age, sex and disease, so that this disadvantage can be correctly and adequately removed and relieved with the aim to ensure a quality life of a particular person. The objective of this thesis was to find out the difference between the satisfaction of the clients´ needs in the Long-term care units and Intensive care units. Then it was necessary to recognize the nurses´ focus on the clients´ needs at these units, and to discover how the nurses actively identify and satisfy these individual needs of the clients. In this study we focused on both physiological and psychosocial needs which the nurses try to satisfy using nursing processes. The research was conducted by means of a qualitative research using interviews and hidden monitoring. The clients and nurses from the hospital in Tábor were interviewed, and the interviews were completed and verified by observation. The nurses´ focus on the needs and the satisfaction of the needs is dependent on the unit, which made the greatest difference based on the findings of this study. The nurses from the Intensive care unit shall always satisfy basic physiological needs of the clients without seeing in it any extra work. However, they do not satisfy the clients´ psychosocial needs as it is a short-term hospitalization, and the psychosocial needs are not priority at the given moment, therefore, the nurses may postpone them for a later time. On the other hand, the nurses from the Long-term care unit, which is a long-term hospitalization, shall satisfy both physiological and psychosocial needs, when the clients admitted to the unit are not at risk for life any more. Here higher needs such as safety and surety have to be satisfied, and the nurses of this unit deal with them more intensively than the nurses of the Intensive care units. This research resulted in the fact that each unit has its own specificity in satisfying the needs of its clients, which stems from the actual health of a client. Therefore, the nurses shall always take into consideration the health of the diseased client, ensure that the physiological needs of the client are met, and in addition they shall satisfy the higher needs which are priority at that moment.
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Possibilities of grave and restful dying on the longterm ill department in Hospital České Budějovice Inc.
KRATOCHVÍLOVÁ, Eva
The work deals with the topic of palliative care and the background of such wards, as well as of the possibilities to provide such care. Dying is inseparable part of life. Peaceful and dignified dying is burdened with problems within hospitals. The principles of palliative care are difficult to apply even in wards where it can be supposed that considerable percentage of patients of such wards is indicated for such care. Such ward is also the ward of subsequent care. The theoretic part describes the significance of palliative medicine, the general view on dying, as well as stages of dying which the dying person and his or her family passes are described here. Further there is information of hospices, dying from the point of view of lay public and from the point of view of a health care worker. The research was performed in form of non-standardized interview with selected 15 nurses working in the ward of subsequent care at least 3 years and ready to hold a conversation on that topic. The research confirmed that the nurses in wards of subsequent care have knowledge of the specifics of nursing care for dying people, but they feel need to go on educating themselves further in that topic. All of them state that the problems of palliative care are very topical in this ward. Further it was found out that this ward is not technically equipped with single-bedded rooms and dignified rooms for communication with the family. All nurses think that this topic should be paid more attention.
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The level of nursing at LTU (Long-Term Unit) in České Budějovice
SCHAFFELHOFEROVÁ, Lucie
Abstract The occupation of a nurse belongs to those most responsible, most exhausting but most humanist professions. A nurse searches, addresses problems of patients and seeks for solutions together with other health care staff. However attention has to be paid on nurses themselves, as demands on nurse profession are still growing at present, which brings higher negative stress, felt not just by nurses, but by all employees of health care facilities. The theoretical part of this thesis includes observation from the České Budějovice Hospital, general information about the profession of a nurse, like for example competences of nurses, their education or registration. The next part deals with physical as well as physical stress. The theoretical part is closed by a chapter on motivation. The research was performed in compliance with the Nursing Care Quantification Method at the After care ward of the České Budějovice Hospital. My work was aimed at finding the level of load on nurses and their subsequent performance, and assessment of the number of nursing staff missing at the 2nd after-care ward of the Hospital České Budějovice a.s. There were three hypotheses set down. Hypothesis 1 confirms that the load of a nurse of the 2nd after-care ward of Sector B of the Hospital in České Budějovice is at least 500 minutes per nurse. Hypothesis 2 confirms that the performance of a nurse of the 2nd after-care ward of Sector B of the Hospital in České Budějovice is at least 130 per cent. And Hypothesis 3 has confirmed that there should be at least three more staff members at the morning shift at the 2nd after-care ward of Sector B of the Hospital in České Budějovice. The research result show that the nurses on the after-care ward are strongly overloaded. The findings of the work will be handed over to the Nursing Care Manager of the České Budějovice Hospital as a tool for optimization of personnel policy at the after-care ward.
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