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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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The role of nurses in the care of chronic wounds by using alternative methods and materials of moist wound healing
SKŘÍŠOVSKÁ, Martina
This bachelor?s thesis deals with the actual classification of wounds and the issue of the chronic wound treatment. In the preface of the theoretical part of the thesis, the term wound is defined and the wounds are subcategorized in the terms of their pathological traumatological origin. In the next chapters, the process of the wound healing is analysed from molecular biological aspect, the terms acute and chronic wound are defined and newly introduces the term non-healing wound for the chronic wound. In the special part, the particular pathological-surgical types of chronic wounds are described from their molecular biological, surgical anatomical and therapeutic point of view. Next, the paper specifies risky factors influencing wound healing process aiming their therapeutic influenceability. These factors are further divided into the system ones and the local ones. The thesis continues with the analysis of the therapeutic and nursing possibilities in the chronic wound treatment describing traditional bandages including sterile pieces of gauze and disinfectant solutions for the materials of the moist wound healing. This is followed by the chapters discussing modern methods of the debridement of the chronic wound such as ultrasonic hydrotherapy, negative-pressure wound therapy or larval therapy. Each chapter describes both the indications and the contraindications for the use of these methods, their advantages and benefits for the patient, aiming the role of the nurse in the chronic wound healing process using these methods. The end of the theoretical part of the thesis is devoted to the nutritional support and the systemic enzymotherapy, which ensures a sufficient energy intake to the organism and both all the macronutrients and micronutrients necessary for building the body tissues. The empirical part of the thesis is in the form of a qualitative research focused on the documentation of the role of the nurse in the care of the patients with a single type of the chronic wound ? more precisely the patient after laparotomy with an extensive resection of the digestive system and a subsequent secondarily healed chronic wound. The method of using case studies was used to accomplish this goal. The record of the chosen group of the patients and the process of the systemic therapy with the support of the cardiovascular, ventilatory and nutritional functions regarding the surgical performance is acquisited and it is completed with the description of the local therapy of the chronic wound, with the description of the role of the nurse in the healing process and with the enclosed photo documentation. Casuistries describe the regression, the stagnation or the progress of the wound healing process; they map the role and the participation rate of the nurse in this process and the use of alternative equipment in this process and the art of improvisation. The summary of the results brings up the conclusion that the scientific and technological progress opens up new possibilities to the patient with the chronic wound and introduces modern technological procedures into the chronic wound therapy though there is a group of patients after laparotomy surgeries with the conducted extensive resection of the digestive system and with the subsequent anastomosis dehiscence, which is contraindicated for the use of these methods. These patients are left to depend on the holistically provided care of a multidisciplinary team with irreplaceable role of the nurse. Biopsychosocial needs of the patient puts great demands on the nurse regarding both the personal and the professional side. The reasoning at the end weighs up and suggests the possibilities of the participation of the nurse in the preoperative preparation of the patient for the planned resection of the digestive system mainly in the form of the education in the support of the nutritive functions and the systemic enzymotherapy.
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Care for chronic wounds from the perspective of nurses in home care agencies in the Czech republic
NACHTNEBLOVÁ, Tereza
This bachelors? thesis is investigating problems with treatment of chronic wounds from perspective of nurses in home care agencies. First half of this theory is dedicated to wounds. Here you can find categories of wounds. This work is mainly dedicated to the investigation of chronic wounds, the exact division of most common chronic wounds and their stage placement in accordance with classification. Very important is also prevention of development of these chronic wounds. Here the most important intervention is the observation of high-risk factors. Furthermore, we described the different stages of the healing of the wound, their differentiation and progression. During treatment it is necessary to document the progress of the wound. A whole chapter is dedicated to this, so we can clearly understand what knowledge about the wound is important and which way to correctly document the wound. Continuity of healing of the wound determines the course of treatment in accordance with the colour of the base of the wound. The course of healing should go from black colour to pink, indicating a positive course of treatment. The factors influencing the treatment are separated into two categories ? internal and external. The main component of this chapter is about the treatment of chronic wounds and contemporary dressing techniques. The second part of this theory is dedicated to the characteristics of home care agencies. It is interesting to note the history of home care and the circumstance in which the idea of caring for the patient in their home environment begun. At present, a multidisciplinary team plays major role in the home care of a client. The home care provides all aspects of the care for the client and also meets all the requirements of the attending physician. This bachelor?s thesis has two goals: goal no. 1 ? to map the education of the nurses in home care in the area of healing of the wounds. Goal no.2 ? to find the most common methods of treatment of chronic wounds for home care agencies. To reach the goal, quality research was chosen with the help of informative interviews. The first subjects of research were nurses working in regional charity Ceske Budejovice and APD Alice in Ceske Budejovice. The second research subjects were nurses in Regional charity in Znojmo. There were 8 interviews in total conducted with the nurses in home care agencies. Research question one investigates which courses home care agency nurses attend. Based on the research that was carried out I found that nurses attend courses of their choice on average three times a year. Every year they attend a course dedicated to chronic wounds treatment and they know where to seek those courses from. I also discovered the important fact that all employers found those programmes. The research question two investigates which methods of treatment are most commonly used in chronic wound treatment. On the bases of the investigation I found that the nurses prefer the use of contemporary materials, which brings great deal of benefits not only for the client but also for the nursing staff. The most commonly mentioned advantages are ? less frequent change of dressings, faster healing of the wounds, gentler change of the dressing and most importantly satisfied patient. Furthermore, I discovered a problem in using contemporary moist dressing materials. The nurses often found that the attending physician does not agree with this course of treatment and refuses to prescribe these materials. That is why most patients have to fund these themselves. Overall the nurses agreed that the treatment of chronic wounds with contemporary dressings brings the client benefits. The given goals of this bachelor?s thesis were accomplished. The nurses in home care agencies are regularly educating in the area of treatment of the wounds. The most common method in treating chronic wounds in home care agencies is moist bandage method.
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Use of modern methods in treatment of chronic wounds
LEPIČOVÁ, Zuzana
Healing and treatment for chronic wounds are big problems and they affect overall states and fate of patients who are immobile after heavy injuries in consequence of some diseases or because of penetrating wounds. Prevention and treatment flowing from profound knowledge of anatomy, skin physiology, pathology and patho-physiology of defects origins and of healing process is currently taking a big step forward in treatment for refractory wounds. The thesis is divided into two parts. The theoretical part deals with skin anatomy and physiology, pathology and patho-physiology of origins of defects, healing processes and proper treatments of wounds, especially chronic wounds such as ``diabetic foot syndrome{\crqq}, venous and arterial ulcerations and decubital ulcers. Preventative measures against decubital ulcers are described. Documentation of refractory wounds, 3 phases of healing and continuum of healing are described in detail. Re-bandages, the local wound care, are the most significant factor of treatment. Re-bandages follow standard procedures, which involve make-ready of patients, preparations of wounds for re-bandages, preparations of instruments and make-ready of attending staff. Good re-bandage assistance is crucial. Modern treatment methods include various new types of wound cleanup (from the mechanical one, chemical one and autolysis to the enzymatic one, with the use of larva therapy, for example) as well as the usage of very effective ``moist healing{\crqq} methods. Various contact - not adhesive bandages, foams, alginates, hydro gels, antiseptic bandages, dressings with active Carbon, hydrocolloids, hydro adherent dressings, hydro fibres, bandages with active AG ions, chitosin, dressings with hyaluronic acid, collagen bandages, dressings with iodine, mupirocin, or honey. The practical part is dedicated to qualitative research, in a way of non standardised interview. There were two thesis objectives: To map the usage of modern treatments for refractory wounds and to enlighten general nurses in this field. 15 nurses, who deal with chronic wounds, from various emergency wards and hospital wards took part in the interviews. Information was collected from February 2010 to April 2010 and it was elaborated into 15 casuistries. The result of analysed answers was digested into a table. In the Discussion I analysed the particular answers and set 3 hypotheses for each domain. Domain 1: H1: Modern treatments for healing of wounds are not systematically used at most units. H2: Monolithic systems for usage and indication of modern methods do not exist at most units. H3: Statistics of chronic wounds existence is not kept at many units. Domain 2: H1: Trainings are organised by medical facilities in collaboration with distributing companies but their capacities do not satisfy the interest of applicants. H2: Most nurses declare good knowledge of chronic wound healing phases and of continuum of healing. H3: Neither managers of medical facilities nor health insurance companies have sufficient knowledge regarding the ``cost {--} benefit{\crqq} of chronic wound treatments. The Conclusion summarise the whole thesis. The importance of follow up treatment and rehabilitation for subsequent fate of afflicted patients and their families is underlined in this part.
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