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Kompetence sester při podávání léčivých přípravků na pracovištích intenzivní péče
HECZKOVÁ, Jana
Medication management is important and very complex part of health care, which is ensured by many healthcare professionals. Intensive care specifics include not only extensive pharmacotherapy but also the administration of medication that can directly and very promptly affect vital signs. This fact brings huge demands on safety during providing care. Traditionally, it is assumed the medication is prescribed by physician, and the nurse ensure administration based on physician?s detailed written prescription. However, activities related to this part of healthcare are currently much more complex. The nurses are expected to be fully competent to fulfil their role in this area at the point of graduation, even in the specialized environment. In addition, it seems that the formal nurses? competencies in medication management are not, in spite of heavy regulation, clearly specified. Although the close relationship between medication management and quality of provided healthcare is obvious, the role of nurses including expected and required demands of current practice have not been analysed in detail yet. The aim of the thesis was to analyse the competencies and nursing role in medication management at intensive care units.Mixed methods design was chosen. Quantitative techniques were used to analyse extent of education and nurses? knowledge in this area, and qualitative techniques were used to analyse current practice and requirements on competence of nurses. There is no difference in formal nurses? clinical competencies in the field of medication management in the Czech Republic depending on the level of education. There is also no difference in extent of pharmacology education during qualifying study at diploma and degree level. However, the current practice in medication management at intensive care units is hugely multifaceted. In some respects its demands greatly exceed the expectations that can be derived from formal set of nurses? clinical competencies in medication management. Although the previous medical doctor?s prescription, especially in case of medication with systemic effect, is considered to be the necessity, the experience of administering this medication in certain circumstances without previous medical doctor?s prescription has been also described. Patient assessment and dose titration of certain medication according to its effect or e.g. laboratory values were described as relatively common part of complex nursing care at this type of workplace, as well as adherence to specific procedures during administration. Particular procedures were workplace related and varied among units but the importance of quality of care was emphasized. The administration of topical medication in specific circumstances, such as eye, oral or skin care in patients with decreased level of consciousness, was perceived more as basic nursing care than medicine administration. However further research will be necessary to verify the extent of this practice. The nurses? knowledge in medication management varied according to the specific topic, but also according to the level of education or previous work experience including previous practice at intensive care environment, although formal competencies in medication management do not differ. Due to the complexity of the medication management and increasing demands on the competence of all healthcare professionals including nurses, it is essential to consider a fundamental revision of the formal nurses? competencies to be necessity at least in this area. Consequently, it could be possible to address the scope, form and content of nursing pharmacology education so that set requirements are met.
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Prevention of Complications in Patients with Secured Airways
Trojáková, Miluše ; Heczková, Jana (advisor) ; Srpová, Daniela (referee)
The thesis reviews airway management practices in intubated a tracheostomised patients. Patients requiring mechanical ventilation have their airways secured mostly by endotracheal or tracheostomy tubes. Such patients are in a great risk of developing serious complications. One of the most common is the ventilator-acquired pneumonia (VAP). Currently, VAP represents a major problem not only in the Czech Republic but globally. In the USA, VAP is the most common nosocomial infection and represents 25% of all ICU infections. VAP complications lead to deterioration of the patients' condition, extend the total duration of hospitalization and some present a mortality risk. The VAP mortality rate has been reported to be 20-50%. Moreover, VAP complications lead to an increase in health care costs. The goal of the thesis is the comparison of the state of the art scientific knowledge, clinical guidelines and current clinical practices. The thesis describes the practice in the highly specific nursing aktivity - airway management, using case studies. My research took place at ARO (ICU - intensive care unit). The first case study involves an intubated patient, the second one a patient with the tracheostomy tube. The analysis has shown that the clinical practice guidelines of the ARO department are being followed...
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Safety process in anesteziology care and perioperative care
Benáková, Miluše ; Heczková, Jana (advisor) ; Kordulová, Pavla (referee)
Patient safety is one of the top priorities of anesthesia and perioperative care in the operating room. The patient safety is greatly compromised due to administered medication and the actual operating performance in the perioperative care. The risks of anesthesia and the operational performance are many, starting with the fall of the patient, the possible wrong- site, wrong-procedure, wrong-patient errors, adverse reactions to administered medication, difficult airway management or an unexpected perioperative bleeding. Patient harm in hospital care leads not only to increased costs for additional treatment, prolongation of the hospitalization time, but also significantly affects the subsequent quality of life. Most adverse events are preventable, since most of them are caused by susceptible factors, such as incomplete or incorrect information or the lack of communication between the members of the operating team. Due to the increasing number of such adverse events around the world, including those of the most serious, The World Health Organization has created a program called The Save Surgery Saves Lives, whose aim was the identification of key risk areas in ensuring the safety of patients. On the basis of the identified risk areas the Surgical Safety Checklist was introduced in 2008. It is aimed...
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Motivational and demotivational factors in the profession of a general nurse
Hanousková, Jindřiška ; Heczková, Jana (advisor) ; Di Cara, Veronika (referee)
This thesis discusses the motivational and demotivational factors that influence the work of nurses and their sense of satisfaction. The aim of the research is to map the motivational and demotivational factors that affect work performance of the Kolin Regional Hospital. The research's chose quantitative method was done by survey. The questionaire and it's contents were prepared by the author. The creation of the questionaire was based upon several similar surveys. Based on the author's research, it was found that interpersonal relationships among nurses were among the most powerful motivational factors; conversely, dysfunctional interpersonal relationships were the strongest motivational factors for changing employers. Another one of the strongest motivational factors was positive feedback from the patients. Since the research was quantitative in nature and covered the entire hospital, it is the author's opinion that the study should be repeated periodically and further focus on individual departments to better determine motivational and demotivational factors that affect work performance and overall job satisfaction. It is also suggested by the author that further research be conducted to compare outcomes of both employees and employers. keywords: nurse, research, motivation, demotivation,...
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Nursing care of a patient with the thoracoabdominal aneurysm
Holanová, Marcela ; Heczková, Jana (advisor) ; Hrenáková, Eva (referee)
(AJ) The theme of my Bachelor's thesis is a Thoracoabdominal aortic aneurysm (TAAA). It is a very serious disease of the descending aorta, which arises weakening or damage of the vascular wall and can endanger the patient's life. Surgical intervention is necessary once the size of the dilation is 5 cm or more. Aneurysm rupture is a life-threatening condition, often leading to death. Surgical intervention of this disease can be done in highly specialized centres only. The primary target of this document is to present the TAAA disease, its diagnostics, cure and care from the patient's admission to his/her discharge. The secondary target is to identify the factors that affect the course of convalescence. The practical part of this thesis is composed in the form of a qualitative research, as a case study of a female patient admitted for the TAAA surgery, and by analysis medical records during the entire hospitalization. Another part of research is an observation and an unstructured interview with nurses taking care of the patient. As there is only a very few literature for nurses related to the care of the TAAA patients, I have written an educational manual at the ending part of this document, which will be available for the needs Department of Vascular Surgery Homolka Hospital (NNH). In this...
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Living donor kidney transplantation
Stöcklová, Lucie ; Heczková, Jana (advisor) ; Nejdlová, Tereza (referee)
Kidney transplantation is still the most succesful method of kidney failure treatment. Transplantations from living donors get ahead of transplantations from cadaveric donors due to better results. Transplantations from living donor can be planned and have less complications. Indisputable advantage is the possibility to perform transplantation before the onset of dialysis-premptively, which provides up to twice better patient survival compared to survival on dialysis. The empirical part is elaborated using the case study describing hospital stay of living kidney donors which describes the postoperative and specific nursing care of kidney transplant recipient. The aim of this thesis is to get to know nursing algorithms in the care of patients after kidney transplantation in intensive care unit and to give comprehensive review of kidney transplantation. keywords: Kidney transplantation - predialysis - living donor - nursing procedures - intensive care - care of kidney transplant recipient
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Best practice in wound care
Pelikánová, Markéta ; Heczková, Jana (advisor) ; Kratinová, Zuzana (referee)
The topic of this Bachelors' Thesis is "Best Practices in Wound Care". The thesis focuses on acute and chronic wounds. It sets the following objectives: The main objective of the research was to evaluate the current practice of general nurses in surgical departments of regional health hospitals in the Usti region. The research was focused on the ways of education regarding the dressing material innovations, participation in conferences and seminars and eventually on its frequency and benefits. Subsequently the thesis addresses the issues of wound healing. In this part of the thesis the goal was to evaluate the current practice of care for acute and chronic wound and to compare it with the best practices in this field. The thesis is divided into two parts: theoretical and empirical. The theoretical part deals with the wound characteristics, describes wound classification, causes, healing and healing complications. Then it describes acute and chronic wounds, while it is focused also on the dressing materials and subsequent wound treatment. The empirical part was conducted using quantitative research method. The research was executed using an anonymous questionnaire. The respondents chosen are general nurses working in surgical departments of Regional health hospitals in the Usti region. The total...
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Nursing care of the patient with post-dural-puncture headache in obstetrics
Drahokoupilová, Milada ; Heczková, Jana (advisor) ; Kulhavá, Miluše (referee)
The topic of my thesis has been decided on the basis of my profession as an anesthesiology nurse at the Clinic of Gynecology and Obstetrics, in which I come into contact with pain of mothers very often. The effort of medical staff is to relieve women from the pain as much as possible. Pain relieving methods include the application of epidural analgesia for labor. In the Czech Republic, like in other countries in the world, we have experienced 20 years of a steady rise in the use of this method. However, regional analgesia has its complications. One of them is the post-dural-puncture headache, which is relatively frequent in obstetrics (about 1% of all neuroaxial methods). This complication can have serious consequences for patients without adequate treatment, nursing care, adequate communication and psychological support. My bachelor theses provides insight into this issue. The work consists of two main parts and is processed as a case report. The theoretical part is a review of methods of regional analgesia pain relieving. I describe the difference between epidural and spinal analgesia and possible complications. Most of the space is given to the main complication - post-dural-puncture headache. I will focus on specific psychological problems in the puerperium that is associated with complications...
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Prevention of perioperative hypothermia
Miketová, Štěpánka ; Heczková, Jana (advisor) ; Hakenová, Renata (referee)
Perioperative hypothermia, defined as a core body temperature lower than 36řC, is associated with increased perioperative complications and prolonged hospitalization. The aim of this thesis is to analyze measures that are taken to prevent perioperative hypothermia at the Orthopedic Clinic of one Czech hospital and compare them with the current recommendations of the American Society of PeriAnesthesia Nurses, Association of Operating Room Nurses and the National Institute for Health and Care Excellence. The study included 223 patients who underwent a planned orthopedic surgery and who were more than 18 years old. As a method of data collection I chose studying the medical documentation. The obtained data were processed quantitatively. The recommended body temperature range 36.5-37.5řC before leaving an operating room had total of 60.55% of cases. Neither one patient has been no action in terms of prevention of hypothermia. Body temperature was taken in 22.4% of cases at the beginning of and during the surgery. Except for a cotton sheet, which was used in 100% of patients, no additional measures were taken in 18,4% of patients. Thermal insulation was used in 41,7% of patients, in-line warming system of infusion fluids in 65% of patients, forced air warming system in 17.9% of patients, and disposable...
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Mentally challenging moments of intensive care's nurse
Myslivcová, Klára ; Heczková, Jana (advisor) ; Kratinová, Zuzana (referee)
The profession of general intensive care nurse is specific in its high demands on physical, technical, ethical and mental abilities of each individual. The thesis focusses on the mental stress of the nurse, analyses potentially high-risk professional situations the nurse encounters and proposes methods for their management. The topic of mental stress and its handling has, and will, have important impact on the field. The goal of the thesis is to map the psychologically challenging situations that all of the 129 nurses approached in a smaller local medical facility considered as difficult to handle and thus have impact on their ability to cope with a demanding job. The situations are defined and evaluated using predefined hypotheses. The results of an anonymous quantitative questionnaire clearly show that the largest levels of stress and discomfort are caused by situations which are "directly connected to medical care provided by the general intensive care and accident and emergency nurse". The least discomfort is perceived in situations described as "indirectly connected to intensive care / A&E nurse duties", such as irregular working patterns and work during public holidays. The results are presented in a graphical form. We conclude by observing that unlike large-scales studies that commonly...
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