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Management of multidisciplinary care in patients with inflammatory bowel disease.
KALMÁROVÁ, Diana
The diploma thesis deals with the management of multidisciplinary care for patients with inflammatory bowel diseases and is divided into a theoretical and a practical part. The theoretical part focuses on inflammatory bowel diseases, their characteristics, etiology and pathogenesis, diagnosis, treatment and psychosocial side of the disease. Another part of the theoretical part is the characteristics of management in nursing, nursing managers, the nursing profession itself, the multidisciplinary team in health care, the issue of competencies and the need for a multidisciplinary approach in the case of inflammatory bowel disease. The first aim of the thesis was to map the role of individual medical and non-medical staff involved in the care of patients with inflammatory bowel diseases, the second goal to find out how cooperation among these workers work and the third objective to identify dispensaries in patients with IBD outside hospital care. For the empirical part of the diploma thesis, a qualitative research survey was chosen, and semi-structured interviews were used as the method of data collection. Five variants of interviews were created, for nurses, doctors, nutrition therapists, psychologists and patients diagnosed with inflammatory bowel diseases. The research was conducted at the Clinical and Research Centre ISCARE in Prague and at the General University Hospital in Prague with the prior consent of the management of these facilities, except for patients who were contacted through patient groups and a psychologist who worked in his private outpatient facility. Based on interviews with nurses, doctors and a nutritional therapist, we were able to find out that as far as IBD centres are concerned, care is really interconnected and individual experts work as a multidisciplinary team led by doctors of various specialties, nurses, ostomy nurse, nutritional therapist. and a social worker. An exception is the representation of a psychologist, who unfortunately is not part of the team and there may be a problem with his / her availability, which was pointed out by some of the interviewees in the interviews. From the results of the research survey, we also managed to find out that patients have various options for better management of the disease, which are most often recommended to them by their attending physicians, but also by nurses. Nurses working in IBD centres are well versed in this issue and know the supportive options for patients with IBD. However, a problem in cooperation was found and appeared on the part of nurses, who in some cases take a passive attitude to education from an ostomy nurse, who is also an important member of a multidisciplinary team. Furthermore, based on research, we found that patients with IBD are often anxious and may have trouble trusting the nursing staff, so the main task of the nurse caring for such patients is to be more aware of these diseases, to know the supportive options, and to be able to educate clients. Respecting and understanding cooperation with other professionals are is important.
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The cooperation of a nurse with nutritional therapist during the care of a patient with an ulcerative colitis.
KALMÁROVÁ, Diana
The aim of this bachelor thesis is to examine the cooperation of a nurse and nutritional therapist while taking care of the client with diagnosed ulcerative colitis. The paper is divided into a theoretical and practical part. In the theoretical part the author deals with the anatomy and physiology of the colon, the characteristics of ulcerative colitis, its etiology and pathogenesis, clinical picture, complications, diagnosis, treatment and special measures regime. Here, it discusses nursing care for clients with ulcerative colitis, preparation of a client for an endoscopic examination and client´s informative education. The final chapter of the theoretical part focuses on the multidisciplinary team, workplace relationships and after that nurse and/or nutritional therapist competences. The qualitative research was carried out for the empirical part of the thesis. The selected method of data collection was semi-structured interviews with nurses, nutritional therapists and patients with ulcerative colitis. These clients were deliberately selected providing that they have been currently or lately hospitalized in the inpatients departments due to the deterioration in health concerning ulcerative colitis. Interview questions designed for nurses regarded the availability of a nutrition therapist for their department, co-operation with this specialist, educational materials available along with the way the nurse educates the patient and nurses' knowledge of the issue. Nutrition therapist questions focused on their collaboration with nurses in inpatient departments, information transmission, clients´ education and their feedback collection. At the interviews with clients we determined dieting and raising awareness of the diet, the source of the acquired information and the interest of nurses to improve the nutrition of each client while hospitalized. On the basis of respondents' answers, we successfully worked out responses to research questions. Research question no. 1 how nurses collaborate with nutritional therapists in the care for patients with ulcerative colitis in the inpatient department- emerged that nurses in these departments did not come in contact with nutritional therapists at all, so they could not cooperate so that the exchange of essential information would take place only by reading through the client's medical record. Furthermore, from nurses' and clients' statements, the way a nurse primarily educates a client with ulcerative colitis in terms of nutrition is commonly just done by giving out printed information brochures or leaflets available at the department. The prime source of nutrition information for clients is usually their physician while diagnosing. Clients can learn more thanks to nurses, nutrition therapists and they also search for information themselves. Four out of five respondents claimed they still do not have enough relevant information about their diet. Attention must be given to ensure clients get to reliable information sources in order not to be a subject to the misleading information presented on the Internet and therefore for instance stick to improper diets. Education provided by nurse and nurses' knowledge in this field can thus have a direct impact on client´s health as much as the collaboration with a nutritional therapist, which could help the nurse to test the client's knowledge of nutrition therapy education. The acquired knowledge can demonstrate the importance of multidisciplinary collaboration not only in the care of clients with diagnosed ulcerative colitis but also the significance of nurse´s education, which is often needful support and safety for the client during his hospitalization.
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