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Working conditions of nurses in acute beds.
ŠVECOVÁ, Markéta
This thesis is called "Working conditions of nurses at acute medical units." The intensive care medicine was chosen as the main focus of research. It pervades all branches and it became a very interesting multidisciplinary part of medicine. Another subject is non-medical staff, as demands made on them are really high. First, the thesis deals with intensive care medicine and relates it with nursing. Then it describes the role of nurses, mentions their system of education, changes which has happened and the peculiarities for intensive medicine. The operation of second internal clinic of General University Hospital in Prague from the nursing point of view including related internal and legal regulations is described in more detail in the empirical part, for better understanding wider context. Out of consideration for the fact that a coronary unit (whose staff are the research sample) is on the verge of offering resuscitation and higher intensive care, it is also aimed at and its specifications too. Individual factors making working execution harder can be influenced, although partly they are determined by a human factor and have their limits whose exceeding or change can become a problem. The diploma project investigates the working conditions of nurses at acute medical units because that is what can be both positively and negatively affected and it is measurable. A qualitative enquiry in the form of non-standard interview was used for collecting the data. Overall fifteen nurses working at acute medical units of General University Hospital in Prague were addressed. Their personal situation is briefly outlined, but the main focus follows the aims in the thesis, i.e. findings of the nurses' opinions at acute medical units on their working conditions; findings of which factors make their working conditions difficult; ways of eliminating these factors and how to improve the quality of nursing. Altogether ten research questions were formulated so that interviews with respondents could be categorized and analyzed. The thesis came to the conclusion that improvement in the area of working conditions while providing nursing at acute medical units is possible. Most suggested solutions are not able without the help of management, or are dependent on it fully. However, even today the provided nursing care is at an excellent level.
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Nursing care of patients with acute respiratory failure
NĚMCOVÁ, Kateřina
Acute respiratory failure is a state when the respiratory tract suddenly is not able to carry out its functions. The disorder can be both at the inflow of the air into the respiratory tract or at the point of the gas exchange between the alveoli and the blood. The most severe form of acute respiratory failure is the acute respiratory distress syndrome-ARDS. It is necessary to treat acute respiratory failure immediately when it appears because it can cause serious damage to the organism or death. The treatment requires securing the respiratory pathway. A theoretical knowledge of the possible causes of the origin and development of ARDS, and its treatment using artificial pulmonary ventilation helps to correctly understand the problems of this illness. Nursing care is essential while treating severe respiratory failure. The care is highly specialized in this case. The nurses participate in the securing of respiratory pathway, beginning and progress of artificial pulmonary ventilation and the process of weaning of mechanical ventilation. The aim of this bachelor's thesis is to determine the basic terms and issues of acute respiratory failure. This is necessary to properly understand the case and the subsequent treatment of respiratory failure with mechanical ventilation. The study deals with defining and comparing particular guidelines of the complex nursing care of the patients with acute respiratory failure. This project was defined because of the continual development and improvement of the care of critical status patients. This thesis, entitled "Nursing Care of Patients with Acute Respiratory Failure," expounds on its topic only as a theoretical work based on both Czech and international scientific resources. Knowledge of particular parts of the thesis was obtained from various scientific and professional books, magazines and Internet resources of professional associations. The Czech authors most frequently cited are MUDr. Pavel Dostál PhD. MBA, who is focused on the issue of artificial pulmonary ventilation, and MUDr. Bronislav Stibor, who is dedicated chiefly to ARDS and revitalizing methods. Based on the studied literature, basic theoretical terms and issues were expounded concerning acute respiratory failure and acute respiratory distress syndrome. Particularly emphasized was the artificial pulmonary ventilation. The theoretical part gradually joins the part dealing nursing care of those patients suffering from acute respiratory failure. The part contains every guideline concerning the most recent developments and the latest innovations in the field of nursing of the critically ill. After studying the scientific sources, it was concluded that there were some differences regarding each authors´ guidelines. The guidelines differed from each other only slightly. Each guideline is mentioned in the thesis and analyzed at the end of the thesis. There is a comparison of competences of general nurses and specialized nurses for intensive care. According to Czech law, the patients with the failure of a vital function should be treated by specialized nurses. The range of permitted treatment attended by an intensive care nurse is plentiful when compared to general nurses. If the only one student carried out one of the proposed guidelines from my thesis and was able to use them at work, she or he would help to improve the complex treatment at intensive care units and my study would fulfil its propose.
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Airway management from the perspective of nurses in intensive care
SLANINOVÁ, Barbora
This bachelor work deals with the possibilities of establishing an airway that can perform nurses for intensive care. Breathing is one of the basic and very important life functions necessary for life. In today's advanced medicine is a wide range of opportunities to ensure the airways, or at least encouraged to perform proper function. Securing the airway is a very important part of the pre-hospital emergency care, but also on the wards in the hospital. The theoretical part of my bachelor is engaged a complex provision of the respirátory tract. The first section deals with the short description of the anatomy and physiology of the respiratory breathing. In other chapters describe airway. The following chapters were directly aimed at ensuring the airway, which were distributed to provide the tools, equipment and without indications for collateral. U airway management devices without describing the revision of the oral cavity, head bent backward and triple maneuver, shot in the back and the Heimlich maneuver. The practical part was focused on determining whether the sisters were higher competence in the provision of respiratory and how intensive care nurses provide their throughput. The research was conducted using quantitative research using an anonymous questionnaire at the hospital in České Budějovice a.s. and in the sand. The questionnaire able be completed only by workers who have graduated from specialty anesthesia resuscitation and intensive care. The questionnaire was printed and included 20 questions. Each question was displayed in a graph. The total number of questionnaires that were distributed, 100, 82 of them returned, but only 61 were fully completed and could be used. Research suggests that nurses who studied ARIP received enough informatik and practical experience during their studies. Specializing mostly work on anestesiology and resuscitation wards and intensive care units. At your workplace have aids, such as laryngeal mask airways and endotracheal tube. The vast majority of respondents have difficulty securing and aspirations in securing the airway. Sisters during their practice provide respiratory laryngeal mask and Combitubus, countless assisted by endotracheal intubation, but its remit would not want to have this power, because of its difficulty. Finally, it is important to note that to achieve the set objectives, where it was found that nurses stand to increase their competence, but only with some performance and throughput. Respiratory ensured by the air ducts and laryngeal masks.
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Hemodynamic monitoring in the intensive care - preparation of educational materials for newly hired nurses
MELICHAROVÁ, Jaroslava
This diploma thesis focuses on the monitoring of hemodynamics in intensive care units; the main objective was to create an educational material for newly employed nurses. This educational material should facilitate the adaptation process of nurses at Anaesthesiology-Resuscitation Units (AR) or Intensive Care Units (ICU).The diploma thesis is divided in two parts: theoretical and empirical. The topics covered by the theoretical part include the concept of intensive care, the technical equipment, the scope of work of intensive care nurses, anatomy and physiology of the cardiovascular system, cardiovascular system monitoring, hemodynamic monitoring, adaptation of new nurses at the workplace, and the possibilities of educational methods aimed at newly employed nurses. The empirical part was conducted as qualitative inquiry in the form of interview. The interviews were semi-standardised and they were held at the AR unit in the České Budějovice Hospital. The subjects were the nurses from the RES 1 and RES 2 stations. The first part of the research inquiry consisted in interviews with the nurses at the Anaesthesiology-Resuscitation unit. The interviews were not taped, due to the respondents' request. All the answers were carefully recorded and immediately transcribed and processed to prevent any inaccuracy of information. The results were organised in charts according to the categorisations, in a well-arranged manner. The second phase consisted in creating the educational material for the newly employed nurses and the third phase concluded the project by distributing the educational materials at the hospital unit where the interviews were conducted. The nurses could therefore assess whether the educational material meets their requirements and will be useful in practice. The respondents were interviewed again and the results were subsequently also organised in charts.The results of the research inquiry show that the nurses at the Anaesthesiology-Resuscitation Unit in the České Budějovice Hospital perceive the correct hemodynamic monitoring as important, that they know what hemodynamic monitoring is and are aware of the monitoring possibilities. The nurses of this unit perform both invasive and non-invasive monitoring of hemodynamic parameters. The basic task is measuring the central venous pressure and arterial pressure. Other parameters are monitored by the doctors with the application of the Swan-Ganz catheter. The most frequently used monitors are PICCO, Lidco, Vigileo and Vigilance. All interviewed respondents agreed that their only help during the adaptation process was the manufacturers' materials and the advice from the nurse-trainers. A small part of the respondents was trained directly by the company distributing the monitors. The final phase of the research inquiry revealed that the nurses like the new educational material but they are afraid that it will end up collecting dust as the other materials supplied by students. The interviews established that it is easier to directly communicate the necessary information to the new nurses along with practical demonstration than to recommend an educational material for studying of at least the theoretical part.
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Invasive monitoring in intensive care
CUPER, Tomáš
Invasive monitoring is a repetitive, durative observation of physiological functions of a patient and functioning of apparatuses which serve as support of these functions. It is thus an active, repetitive and continuous process when both the patient and the medical apparatuses are regarded. The human factor is thus essential and vital. The reason for application of the invasive monitoring during an intensive hospital care is above all the ability to support physiological functions of a patient, at the same time, it serves to timely detect divergences in physiological values; it very often effectively helps in further decision-making of medical interventions, and clarifies the effectiveness of patient´s treatment. The theoretical part of this bachelor thesis deals with the issue of invasive monitoring in intensive hospital care. The beginning of the thesis provides an explanation what actually the invasive monitoring means, and clarifies and characterises intensive medicine and monitoring in general. The individual types of invasive monitoring are divided according to areas of basic living functions in cardiovascular, respiratory, and central nervous system. With every type of invasive monitoring comes an explanation and clarification of it, further, generally indicated and contraindicated statuses are provided, along with instruments and the way monitoring is applied. The theoretical part is concluded by a chapter that deals with general nursing care. The practical part focuses on mapping of the most often used types of invasive monitoring given critically ill patients in Anaesthesiology and Resuscitation wards, and Urgent Admittance wards in hospitals of the area of South Bohemia, and the region of Carlsbad, and mapping of knowledge of staff of Anaesthesiology and Resuscitation and Urgent Admittance in the particular regions given invasive monitoring. The research was implemented by a quantitative method using a printed standardised questionnaire. The amount of data was collected in March 2014. The target group of the research was a team of general nurses and paramedics, who work in Anaesthesiology and Resuscitation wards and Urgent Admittance wards. The anonymous questionnaire was handed out 100 exemplars for hospitals in South Bohemia, and 100 exemplars for hospitals in the region of Carlsbad. In South Bohemia, there were picked the hospitals in České Budějovice, Jindřichův Hradec, Písek, Prachatice, and Tábor, there. In the region of Carlsbad, there were picked the hospitals in Cheb, Carlsbad, and Sokolov, there, to fill in the questionnaire. There took part 141 respondents in the research. The total amount of responses out of 200 exemplars (100%) of the questionnaire thus reached 70, 5%. The questionnaire contained the total of 28 questions, out of which the opening 4 were stratification-like, question nr. 5 was closed, question nr. 6 were half-open and the remaining 22 questions were dealing with knowledge of respondents in the issue of invasive monitoring in intensive care. The results were progressed by the statistic programme SPSS into well arranged tables, and the set hypotheses were statistically evaluated with help of X2 square test. The goal of this bachelor thesis was to map the most often used types of invasive monitoring with critically ill patients in Anaesthesiology and Resuscitation wards, and Urgent Admittance wards in hospitals of South Bohemia, and in region of Carlsbad. This goal was fulfilled. The next goal was to map knowledge of invasive monitoring given staff of Anaesthesiology and Resuscitation wards, and Urgent Admittance wards in hospitals of South Bohemia, and in region of Carlsbad. This goal was fulfilled too. Statistically evaluated questionnaire proved that the workers have the knowledge in the area of treatment, hemodynamic values, as well as techniques in taking care of critically ill patients in Intensive Care wards.
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Basal stimulation in pediatric intensive care units
SOUKUPOVÁ, Alena
This diploma thesis deals with basic stimulation, specifically in intensive care units. Basic stimulation is a holistic method that approaches the patient as a whole. It views patients as individual beings with specific needs that make them different from others. We use basic simulation to enable people with physical or mental disabilities an easier integration in life. When taking care of patients within the framework of basic stimulation, we take their habits, manners of communication as well as experience into consideration. We make use of everything that an individual perceives as pleasant and is used to. When using the elements of basic stimulation we stimulate the individual whom we thus enable to perceive his or her bodily boundaries and surroundings, we facilitate his or her communication with the surrounding world and his or her return to becoming aware of his or her own ?I? ? of who I am actually. The objective of our thesis was to find out whether nurses working at paediatric intensive care units apply methods of basic stimulation in their profession and what attitude they adopt to it. Further, we investigated whether the parents of hospitalised children have information about basic stimulation, and again, we were interested in the attitude parents adopt to this method. To achieve our objectives, we chose both the quantitative method, by means of an anonymous questionnaire that we handed out to nurses at paediatric intensive care units, and the qualitative method, by which we obtained information from the parents of hospitalised children by means of a semi-structured interview. Our respondents were the above nurses from paediatric intensive care units and the parents of hospitalised children. We have found out from our results that despite the fact that basic stimulation is not applied by all nurses we interviewed, it is a widely used method in the care of patients and it brings quality results in care. The nurses adopt, in most cases, a very positive attitude to this method. They find improvement and calming in their patients. Although basic stimulation is a frequently applied method, some parents of hospitalised children have not heard of it. The parents got involved in the care of their children with pleasure, also when elements of basic stimulation was applied. The nurses were very often willing to teach the parents these elements. The parents regarded basic stimulation in nursing as very beneficial and observed its positive effect on their children.
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The profession in intensive care and its impact on the lifestyle of nurses
ŠVECOVÁ, Radka
The diploma thesis has been focused on the issue of nurses working within intensive care and on the impact of performing a job in this branch on their lifestyles. The jobs of nurses working within the intensive branches clearly belong among the demanding ones. A nurse often becomes a witness of dying patients while there is hardly any chance of curability and stabilization of their conditions. All of that and many other factors affect her personal and professional life, as well as her current lifestyle. To perform her job at as high level as possible, a nurse must be motivated and directed by management of the health centre, she must be educated enough in her branch and the job should be a hobby for her, where she must feel certain and safe and the job should satisfy her. This diploma thesis has defined three following intentions. The first one highlighted mapping of a lifestyle of nurses working within intensive care. The second one was determination of psychical load of nurses working within intensive care. The third one included comparison of lifestyle of nurses working within intensive care and lifestyle of nurses working at standard wards. There were 4 hypotheses defined for the investigation survey. The first one analyzed if a job within intensive care affects diet of the nurses. This hypothesis proved true. The second one, if nurses working within intensive care consume more alcoholic drinks than the sisters working at standard wards do. This hypothesis did not prove true. The third one examined whether nurses working within intensive care smoke tobacco products more than the sisters working at standard wards do. This hypothesis proved true. And the fourth and the last hypothesis analyzed if a job within intensive care is psychically demanding for the nurses. This hypothesis proved true.
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Attitude between paramedic and nurse in the prehospital urgent care and hospital urgent care
GRÜNN, Jan
The title of the bachelor?s thesis at hand is the Relationship between paramedics and general nurses during pre-hospital emergency care and hospital emergency care. The objective of the thesis was to find out how the general nurses and paramedics perceive the process of getting further education needed for work in the pre-hospital emergency care and hospital emergency care. The theoretical part deals with the current state of the Emergency Medical Service (EMS), its organisation, funding, and division. Next, the thesis provides characteristics of the professions of paramedic and general nurse, especially with regard to their educational background, how they get their qualifications, their competences, and with regard to legal relations these professions enter into. The practical part employed the method of quantitative research. Anonymous questionnaire was used as the method for collecting data. The target research group comprised of paramedics and general nurses that work at EMS Dispatch Centres of the Region of South Bohemia or at the Departments of Anaesthesiology and Resuscitation in the hospitals based in the Region of South Bohemia. This bachelor?s thesis introduces two hypotheses. The first one reads: ?University-educated paramedic needs more work experience for work at a Department of Anaesthesiology and Resuscitation than a general nurse with ARIC (Anaesthesiology, Resuscitation and Intensive Care) education.? The second one is as follows: ?General nurse education is more suitable for work in pre-hospital emergency care than that of paramedic.? At the beginning of writing this thesis, the competences of paramedics and general nurses were completely different. Due to the changes in laws and amendments to the law which defines these competences that came into effect in the meantime, the possibilities of getting further education have seen changes, too.
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Integration of parents into the care of critically ill child from the perspective of nurse
MULAČOVÁ, Romana
Nowadays the parental presence in the pediatric intensive care units (PICU) is quite common. Building a fellowship between parents and health care staff and high quality parents' integration into the care is a very demanding process. First of all, the success of this process largely depends upon the nurse. It is the very nurse who leads, educates, supports and also professionally integrates parents into their child's care. In addition, critically ill child's care in cooperation with parents is complicated by a high parental stress level, child's serious condition and high professional and technical requirements posed to the nurse. The graduation thesis concentrates on the parents' integration into the care of a critically ill child from the nurse's point of view. The goal of this thesis was to describe the general conditions of parents' integration into the critically ill child's care and to map the actual state of the cooperation within the nurse ? parent ? critically ill child relation from the nurse's point of view. Other goals included the analysis of nurse's feeling of readiness for work with parents of critically ill children, and elaboration of a booklet concerning the initial introduction of an intensive care and resuscitation unit for infants and older children for better parents' awareness. In the research part of the thesis a qualitative research was used. The data collection technique was a semi-standardized interview. A research sample was represented by seven nurses working in the sphere of the critically ill children care in four selected hospitals in the Czech Republic. The study took place in the period starting May 2011 till July 2011. The research results revealed that the parental integration conditions are not quite optimal. First of all, in this sphere the nurses pointed to a limited accommodation capacity for parents, lack of supporting services and unsatisfactory site layout of the intensive care units. The nurses expressed their readiness to the closer cooperation with critically ill children's parents in the basic nursing sphere, mostly, thereafter, in the sphere of hygiene care. The parental cooperation in the special-care sphere was accepted rather negatively by the respondents. As the research results show, most of the nurses consider the work with parents psychologically very demanding and during their school education they had never been prepared for it by anybody. Findings flowing from the research results gave birth to the information booklet that is a basic informational and educational material for parents of children admitted to the intensive and resuscitation care unit for older children and infants in Hradec Králové University Teaching Hospital. It also represents a detailed instruction for a similar material for other facilities of this type and, last but not least, it facilitates the whole process of initial parents' education for nurses. This graduation thesis can also assist in the education of children's nurses, help students and nurses working with critically ill children's parents understand the "Family-centered care" principles and their practical introduction.
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Nursing care of patients with bleeding to the GIT.
HOLZÄPFELOVÁ, Soňa
Gastrointestinal bleeding is a symptom of numerous diseases that might be serious. Acute GI bleeding is the most frequent abdominal incident and has been occurring more and more often recently. Acute bleeding in the upper GI tract is a very urgent state affecting circulation stability. The bleeding may have adverse consequences. This is why a quick intervention and immediate bleeding stoppage are very important here. The aim of the thesis was to determine the principles of nursing care for patients with GI bleeding and what may be provided to a patient with acute GI bleeding within nursing care. Two research questions were set: 1 - What are the principles of nursing care for patients with GI bleeding? 2 - What may be provided to a patient with acute GI bleeding within nursing care? The thesis was elaborated by means of qualitative research. The technique of interview was used for data collection. Non-standardized interview was applied to patients. Individual case studies of the patients were elaborated from the information obtained. Semi-standardized interview was chosen for nurses, from which individual case studies were elaborated. We had the opportunity to use an analysis of nursing documentation of the Gastroenterological Department of the České Budějovice Hospital. The research has shown that nurses mostly have sufficient information on the principles of nursing care for patients with upper digestive system bleeding. From the patient answers we found that awareness of their needs was essential. This is why an informational brochure compiled upon request of the patients is an output of my thesis. A presentation for nurses describing insertion of an esophageal probe is the second output.
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