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The issue of invasive accesses in intensive care
ŠILHÁN, Daniel
In intensive care, invasive procedures represent an essential condition in the care of critically ill patients. In particular, the knowledge and skills in providing and taking care of them are crucial. The main objectives were to map the knowledge of non-physician medical staff in the intensive care environment regarding selected invasive procedures. Further, to identify the differences in adherence to recommended procedures in intensive care across different types of nursing education, and eventually, to determine the effect of the length of work experience on compliance with recommended procedures. The set objectives were achieved by means of a quantitative research survey using online questionnaires distributed among fellow healthcare professionals who had worked in intensive care for longer or shorter periods. The respondents were general nurses, with or without specialization in intensive care, and paramedics. Based on the results of the conducted research, several conclusions can be drawn. It was found that the research sample did not demonstrate adequate knowledge regarding the selected invasive procedures. The median value of the provided questionnaire was 60.6%, which is significantly less than the intended 70%. Furthermore, it has been shown that there were differences across different types of nursing educational attainment. Respondents with a high school diploma achieved the worst results on average (56.1%). People with a master's degree performed best on average (64.7%). Therefore, it can be concluded that adherence to recommended invasive procedures in intensive care depends on the education of the staff. Finally, the length of work experience of healthcare professionals did not prove to be a significant factor influencing adherence to recommended invasive procedures in intensive care.
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Prevention of selected healthcare associated infections in intensive care
VITÁMVÁS, Tereza
The diploma thesis is about the issue of prevention of selected infections associated with healthcare in intensive care. Within the framework of theory, three large chapters were introduced and explained in more detail. The first chapter deal with intensive care, history of intensive care in our country and in the world. The distribution of intensive care and the education and competences of specialist nurses in intensive care. Another large chapter was focused on securing patients in intensive care. We focused on securing the patients airways, bloodstream and urinary tract. The last major chapter deal with healthcare-associated infections. As this was a very broad and complex topic, we only focused on a few selected healthcare-associated infections. Specially, these were ventilator-associated pneumonias, bloodstream infections and urinary infections. In the empirical part of this dipmola thesis was qualitative data processed using diagrams, in the case of quantitative data it was graphs. To collect data, non-standadized questionnaire was used, which was distributed among the respondents online, and then observational survey conducted in the intensive care units of the regional hospital was used. The aim of the work was to map current situation in compliance with recommended procedures in the care of invasive inputs in intensive care units. Furthemore, to map the current situation in the oservance of procuders in the care of the respiratory tract with regard to the occurence of infections associated with healthcare. And the last goal was to map the knowledge of nursing staff working in intensive care units in the fiels of prevention of helathcare associated infections. The output of the work is proposal to solve and identifield shortcomings in practice.
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Risk management of ventilator dependent patients
JANČOKOVÁ, Nikola
Current state: Therapeutic and nursing procedures in intensive care are undergoing great development, which emphasizes the providing of highly specialized nursing care. The goal of the thesis is to evaluate the risks related to the respiratory system in patients with secured airways on artificial lung ventilation. Methodology: A qualitative research method in the form of interviews and observation was used. Ten interviewed nurses worked at Anaesthesiology and Resuscitation Departments of selected hospitals in the Vysočina Region. The participant observation was carried out in the same departments and was aimed at nurses providing nursing care to patients with artificial lung ventilation. The selection of research samples was intentional. The size of the samples was determined by data saturation. Results: The survey revealed differences in the nursing care of the airways of patients with artificial lung ventilation. Nurses underestimate the risks associated with patients' artificial lung ventilation, mainly the risk of ventilator-associated pneumonia. Nurses clean the hygiene of oral cavity at different intervals. In some cases, they do not perform mechanical teeth cleaning and do not normally use chlorhexidine oral antiseptics. Before endotracheal aspiration and prior to pressure measurement on the obturation cuff, nurses do not normally perform subglottic region. Differences were found in the intervals of replacement of the tracheostomy cannula. The recommended procedure of pulling the aspiration catheter prior to aspiration was not followed in any of the observations. Conclusion: Overall, differences in the observance of recommended nursing care procedures were identified between nurses. The practical outcome of the thesis is an information material intended for nurses, containing interventions related to airway care and FMEA analysis.
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Nursing care for a child with gastroschisis
NEŠVAROVÁ, Kristýna
The Master's thesis deals with the topic of nursing care for children with gastroschisis. It is a birth cleft defect of abdominal wall during which the baby's intestines extend outside. The theoretical part introduces the specifics of the prenatal and neonatal period and also deals specifically with gastrointestinal tract defects. However, the theoretical part is mainly focused on the topic of gastroschisis and explains the differences in comparison with omphalocele, describes the aetiology of the defect, its symptomatology, incidence and prognosis. It highlights the principles of prenatal care and methods of labour management. It introduces a prediction of intestinal damage in newborns with gastroschisis. The theoretical part of the thesis also mentions the possibilities of prevention and counselling and the principles of postnatal care not only for newborns with gastroschisis, but also for the mother of the child. An equally important section of the theoretical part is the overall surgical treatment of gastroschisis, an important part of which is quality nursing care provided by nurses. The empirical part of the paper is introduced with a case report of a boy who was born with prenatally diagnosed gastroschisis at a specialized clinic. The research part of the thesis also seeks to find out what knowledge nurses from intensive care units, intermediate care units and other paediatric and neonatal wards have about the principles of care for newborns with gastroschisis. Another research goal is to find out how cooperation between nurses who care for children with gastroschisis and parents of these children works in practice. Last but not least, the aim of the research was to determine the prognosis of gastroschisis in the lives of these children. A qualitative survey research was used to achieve the research goals. Data collection was performed using unstructured interviews with nurses who care for newborns with gastroschisis. Data was assessed using open coding and ATLAS.TI. The output of this thesis is an educational brochure, which contains an educational process for mothers caring for a child with gastroschisis.
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Use and limitations of the Tobii device on patients with thermal injuries
Drobná, Veronika ; Bakalář, Bohumil (advisor) ; Macík, Miroslav (referee)
Name and surname of the author: Bc. Veronika Drobná Institution: Third Faculty of Medicine, Charles University Title: Use and limitations of the Tobii device on patients with thermal injuries Supervisor: MUDr. Bohumil Bakalář Year of defense: 2024 Keywords: eye tracker, burn injuries, intensive care, tracheostomy, communication with patient The thesis is based on the implementation of the innovative communication aid Tobii Dynavox PCEYE5 (Tobii) in the intensive care unit of the Burn Medicine Clinic at the Královské Vinohrady University Hospital. It is eye tracking that can help improve communication for patients with secured airways. The aim of the thesis was to determine the use of the device, its limitations or negative effects, and also to map the experiences and opinions of the staff. The theoretical part introduces the issue of thermal injuries, communication with patients in intensive care, and presents the Tobii device. The empirical part is processed using quantitative methods and is divided into two parts. The first part of the research analyzes the epidemiological data of hospitalized patients, focusing on patients who used the communication aid. The second part was carried out through a questionnaire survey. Its aim was to map the nurses' attitudes towards the aid, find out how many of...
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Prevention of catheter infections in patients in the need of critical care
SVOBODOVÁ, Alžběta
Current status: The term sepsis refers to a systemic inflammatory response to the presence of an infection. The highest mortality rate associated with bloodstream infection is linked to severe septic shock. The most commonly used invasive bloodstream inputs include peripheral and central venous catheter, arterial catheter also included are PICC and Midline catheter an alternative method of securing the venous system in intraosseous entry. The aim of this study was to describe the spectrum of nursing practices that minimize the risk of catheter infections related catheter infections and to evaluate the skills of nurses in the area of vascular access care. Methodics: Qualitative research methods using semi-structured interviews and participant observation were employed for data collection. The research was conducted in selected hospitals of the Vysočina Region and the South Bohemia Region. It was a deliberate selection. Nurses working in intensive care units (i.e. anesthesiology and resuscitation departmen and unit critical care) were approached. Covert observation was conducted to ascertain compliance with nursing standards and uncover errors in the care of invasive vascular access. The size of the research sample was determined by theoretical data saturation. Results: The survey shows that the interviewed general nurses have sufficient knowledge in the field of catheter infections to reduce their incidence. Participant observation, specifically peripheral venous cannula insertion, revealed that nurses do not check the expiration of the necessary equipment for this procedure. Furthermore, there was a lack of hygiene and epidemiological precautions and disposal of the needle from the cannula in the sharps box. There was evidence of not using a sterile table but only sterile instruments, improper hand hygiene and use of personal protective equipment when treating a central venous catheter. Conclusion: The outcome of this diploma thesis is a set of recommendations for non medical healthcare personnel.
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Training of non-technical skills as a prevention of errors in intensive care
SVÁROVSKÁ, Tereza
The main goal of this work was to map the current state of training in non-technical skills. Training in non-technical skills can contribute to improving the safe care of critically ill patients in intensive care units, where situations are often demanding, stressful, and tense. Maximum concentration, precise commands, and teamwork are necessary in these work-places. The theoretical part establishes the foundations for understanding concepts such as intensive care, non-technical skills, or simulation-based education and their relevance. The research was conducted with students in the Advanced Nursing Specialization in Intensive Care, who, thanks to simulation-based education, are aware of acquiring non-technical skills and practice them in specific simulated scenarios. The second research sample consisted of nursing staff working in intensive care units, who are exposed to stressful situations daily, and therefore should know and use the basics of non-technical skills to per-form their duties in order to prevent as many errors as possible, which can have fatal consequences. The objectives of the work focused on mapping the current situation in the training of non-technical skills in intensive care units and in student education. Another goal focused on the experiences and subjective feelings of healthcare professionals and students with training in non-technical skills in crisis situations within intensive care and during simulation-based education. The final goal aimed to identify methods and techniques of training in non-technical skills that are most effective for healthcare workers and students in intensive care, considering their specific needs and obstacles. The research was conducted using qualitative inquiry method, employing semi-structured interviews with nursing staff and students undergoing simulation-based education, along with non-participant overt observation during the mentioned simulation-based education.
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Pre-hospital and intensive care for patients after a stroke
KULHAVÝ, Jakub
The thesis is divided into two main parts (theoretical and empirical) and deals with prehospital and intensive care for patients with stroke. The thesis has a total of three objectives. The first objective was to map selected aspects of the process of providing prehospital emergency care to patients suspected of having an acute stroke. The second objective was to describe the course of intensive nursing care for patients after a stroke, and the third objective was to determine the differences in nursing care between patients with ischemic stroke and hemorrhagic stroke. The empirical part focused on studying medical and, primarily, nursing documentation. The obtained data were processed using a quantitative research method based on retrospective data analysis, which was then interpreted. The data was recorded in record sheets created specifically to adhere to the predetermined objectives and hypotheses. The contribution of the thesis is primarily its unusual approach to the issue, addressing at the same time both prehospital and intensive care for patients after both ischemic and hemorrhagic strokes. The results indicate that crucial aspects of prehospital care include correct and rapid diagnosis, assessment of vital functions, consultation of the condition of a patient with a stroke physician and rapid transportation to the nearest appropriate medical facility. The course of intensive care focuses primarily on continuous monitoring of vital functions and their potential stabilization combined with comprehensive nursing care, which depends on the level of self-sufficiency of a patient and includes all care for basic human needs, primarily aimed at restoring the patient's ability to manage basic daily activities. In summary, it could be said that patients with hemorrhagic stroke required more demanding and comprehensive nursing care compared to patients with ischemic stroke.
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Acute postoperative complications in surgical intensive care units
HLOBILKOVÁ, Magda
The master's thesis addresses the issue of acute postoperative complications in the conditions of surgical intensive care units from the perspective of a nurse. The thesis consists of theoretical and empirical sections. The theoretical section focuses on the issues of surgery, intensive care units, and acute postoperative complications. The empirical section includes the research's objectives, methodology, and results. Three objectives were set to elaborate on the master's thesis. First objective: To determine the relationship between the length of practice, the highest level of education attained, and nurses'orientation on the issue of acute postoperative complications. Second objective: To determine nurses' interest in education regarding acute postoperative complications. Third objective : To map the most common acute postoperative complications in surgical intensive care units. The research part of the master's thesis is addressed through a combined research approach involving nurses from surgical intensive care units with different lengths of practice and the highest levels of education attained. The research was conducted in four South Moravian and Zlín hospitals. The quantitative part of the research was carried out through non-standardized questionnaire surveys. The research sample consisted of 138 respondents. The qualitative part was conducted through semi-structured interviews with 10 nurses. Several conclusions can be drawn from the research that was conducted. A statistically significant relationship was observed between nurses' orientation on the issue of acute postoperative complications, length of practice, and the highest level of education attained. With increasing length of practice, nurses' orientation also increases, as does the level of highest education attained. Participating nurses show interest in education on the issue, which the employer does not sufficiently compensate. The most common acute postoperative complications in surgical intensive care units, from the nurses' perspective, are pain and acute bleeding. The output of the diploma thesis is a proposal for the content of a seminar to increase nurses'orientation in specific acute postoperative complications.
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History and development of intensive care
KADLECOVÁ, Eva
The thesis deals with the history and development of intensive care with emphasis on the Czech lands. Its aim is to describe the historical development of intensive care and nursing in the Czech lands with an emphasis on aspects (such as new techniques, devices, etc.) that have determined this process. The core of the thesis consists of three main chapters. The first one establishes the basic premises of the work, focusing on the definition of intensive care, the history of medicine, and nursing. The second main chapter analyzes the beginnings of intensive care in an international context, emphasizing the influence of Florence Nightingale on the emergence of intensive care and the reflection of her work in the Czech lands. The third chapter describes the history and development of intensive care and nursing in the Czech lands, with this exposition being divided into chronologically arranged subchapters. The thesis is primarily based on historical sources (primarily contemporary publications and journal articles reflecting the discourse of the time) and professional literature. The communist Czechoslovakia period is reflected as an important period when contact between Czechoslovak medicine and Western knowledge was significantly limited, and intensive care as well as nursing were heavily ideologically conditioned, leading to lagging behind the West in many aspects.
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