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The comparison of chronic wound treatment in general physician's practice and in surgical outpatient treatment
ŠUPLEROVÁ, Michaela
Current state: The treatment of chronic wounds is a complex process which is applied in the form of different interventions by nurses in the general practitioner's office for adults and nurses from the surgical outpatient clinic. The treatment is influenced by different equipment used in particular offices, by the presence or absence of the interest in implementing modern methods and, of course, by poor participation of health insurance companies as regards the problem in question. The treatment of chronic wounds should be accomplished by completing all the phases of the nursing process. It is necessary to seek for motivation towards further education in this field. Pursuing moist wound healing is mostly cheaper as it makes the treatment shorter, which leads to patient's satisfaction. Objectives: The objective of the thesis was to evaluate the nursing process applied during the treatment of chronic wounds in the general practitioner's office for adults and the surgical outpatient clinic, as well as observe the influence of education on the nurse's professional performance regarding this treatment. The research included the analysis of the competencies of nurses in the treatment of chronic wounds and the treatment methods chosen by the nurses to benefit the patient. Last but not least, we observed the circumstances of the admission of a nurse specialist as a GP's partner for chronic wounds treatment, and the obstacles to moist wound healing implementation in the GP's office for adults and the surgical outpatient clinic. Methods: To compare the treatment of chronic wounds in the general practitioner's office for adults and the surgical outpatient department we carried out qualitative research investigation. Data collection was based on in-depth interview with prepared open questions. The interviews were recorded by voice recorder, transcribed literally and subsequently analysed. When analysing the transcripts, we used the method of open coding, by the technique "pencil and paper". The text of the dialogues was reduced and segmented into individual codes. On the basis of similarity, the codes were classified in analytical units. The categories were classified into schemes by means of SmartArt programme in Microsoft Office Word. The results were interpreted with the use of the open cards technique. The first group of respondents consisted of nurses from a practitioner's office for adults and a private surgical outpatient department. The other group comprised practitioners for adults and surgeons treating outpatients. Research sample: The research sample consisted of 12 respondents from three medical facilities in České Budějovice. In the first set there were three nurses working in the practitioner's office for adults and three nurses working in the surgical outpatient department. The second set comprised three women MDs for adults, two surgeons treating outpatiens and a woman surgeon. The intentional selection was dependent on respondents' willingness to participate in the research and it ceased when the state of theoretical saturation was reached. Results: The research investigation showed that modern moist healing of chronic wounds is mostly implemented in the offices of practitioners rather than in surgical outpatient clinics. The surgical department is aseptic and they want to minimize the risk of possible infection. Apart from moist healing the surgeons use other modern healing methods such as laser biostimulation, biostimulatory polarized light and instrument-aided lymphatic drainage. The education of the nurses involved in chronic wounds treatment is not provided within academic courses. Just two nurses completed university education whereas the other nurses get acquainted with current information at commercial presentations provided by pharmaceutical representatives. These nurses lack the capability of objective assessment of basic and specific parameters of the wounds and of subsequent treatment.
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