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Assesment of quality of postoperative analgesic care
Rákosová, Andrea ; Burišková, Klára (advisor) ; Hakenová, Renata (referee)
Introduction: The acute postoperative pain management is recently a concern of many expert committees and professional associations. The evidence of an increased interest in this issue is the Practice Guidelines for Acute Pain Management released by American Pain Society. According to these recommendations, the pain should be monitored as a fifth vital function. As a logical consequence of modern trends of pain management, Czech Society of Anaesthesiology and Intensive Care Medicine issued guidelines for acute pain management in postoperative setting. This paper is an attempt to describe and evaluate the quality of postoperative analgetic care after total knee and hip replacements in a selected institution's department.………………………………..…………………………………… Methods: The aim of our empirical survey was to assess the level of quality of postoperative care and analgesia in the selected department. We focused mainly on the question of pain trivializing from the nurses side, their approach towards patients suffering from acute pain and, finally, the level of patient's awareness of pain intensity assessment systems and treatment options. Using the quantitative research methods, we evaluated the differences in perceiving of postoperative pain treatment quality from patient's and nurse's point of view. The survey...
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The development of job descriptions theatre nurses across half a century
Kalašová, Veronika ; Prošková, Eva (advisor) ; Kordulová, Pavla (referee)
Bachelor thesis is focused on the history of the profession operating nurses, from 1953 to the present, primarily on the development and changes in workload of operating nurses at this time period and educational possibilities. The theoretical part explains the basic concepts of the theme, such as perioperative care, job descriptions of the staff in the operating theatre, operating theatre equipments et cetera. The thesis is focused on the differences development in the workload and competencies of the operating nurses throughout the entire period, and the increasing need to understand the technical equipment in the operating theatre and its operation. The aim of this thesis is to map the development in the education and legal regulation for the operating nurses. The second objective is to determine the differences in the character of the operating nurses' work nowadays and 50 years ago. Bachelor's thesis is theoretical and practical nature. To meet the goals and answer research questions was chosen the form of qualitative research, studying of archival documents and the period literature, which has been within the options complemented with structured interviews with witnesses (nurses, even. doctors, and other health care professionals). Keywords: perioperative care, operating rooms, theatre nurse,...
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Ethical problems in perioperative care and their impact on patient safety
Wichsová, Jana ; Holmerová, Iva (advisor) ; Munzarová, Marta (referee) ; Fontánová, Anna (referee)
The dissertation examines the ethics of staff in perioperative care. The aim was to analyze the errors that occur during surgery, to determine the participants in perioperative care who commit these mistakes, and to analyze the reasons why these errors occur. The theoretical part deals with the concept of security from different perspectives of patient safety in surgery, and the international guidelines that direct it. The situation in the Czech Republic in terms of care for patient safety in surgery is also described. One chapter deals with the autor's internship in operating rooms in Sweden. Using the results of observations, the empirical part of the dissertation analyzes the actual behaviour of staff in perioperative care during surgery against the binding documents that ensure safe perioperative care. It also sets out the reasons that lead to non-compliance of health and safety regulations in perioperative theatres. In conclusion, I suggest steps that would help to improve the situation. Key words Perioperative care, safety, security, pacient pafety, medical ethics, nursing ethics
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Hemodynamics in the early stages of the critical illness and in the perioperative setting
Beneš, Jan ; Kasal, Eduard (advisor) ; Málek, Jiří (referee) ; Kroužecký, Aleš (referee) ; Adamus, Milan (referee)
Beneš J.: HEMODYNAMIKA V ČASNÉ FÁZI KRITICKÝCH STAVŮ A PERIOPERAČNÍ MEDICÍNĚ - Využití méně invazivních monitorovacích prostředků k cílené hemodynamické péči ABSTRACT Hemodynamic instability occurs very often in critically ill patients and during the perioperative period. Insufficiency in the preload, contractility and afterload contribute in major part to this phenomenon. Hemodynamic monitoring allows clinicians to recognize and to intervene early the underlying cause. Due to new technologies development in recent years it is possible to provide continuous monitoring of hemodynamic parameters with diminished invasivity. Hemodynamic optimization and goal directed therapy show treatment benefit in some groups of critically ill patients and mainly during the perioperative period. Aim of hemodynamic optimizations is to attain the best obtainable hemodynamic conditions with use of fluid loading and inotropic support. In many studies in recent years goal-directed therapy was associated with morbidity and mortality reduction. According to the results of our clinical research hemodynamic optimization using stroke volume variation and minimally invasive device based on the pressure wave analysis is feasible and show the same results as other works with more invasive devices. Key words Hemodynamic monitoring,...
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The workload of nurses in perioperative care
POLÁKOVÁ, Ivana
The basic theoretical background: It is known that the profession of nurses is very physically and mentally challenging. Otherwise, it is not even for nurses in the operating room. The work of nurses in operating rooms is highly specialized and demanding profession that requires specific skills and knowledge primarily because the operating rooms is very specific and puts high demands on the technical and material equipment, flawless organization work and to perfect the principles of antisepsis and asepsis. It's about challenging, diverse activities, including the preparation of operating material, devices, apparatus, instruments and sterilization. The correct execution of all these activities, the profession ranks between occupation with time pressure, physical stress and irregular rhythm of life and professions, in which psychological and physical depletion of reserves means not only a danger to themselves, but also the health of the patient. The objectives of the work: To meet the main intent of the work were established two objectives. The first goal is to find out what type of workload for nurses in perioperative care predominates. The second goal is to compare the differences of the workload for novice and long - term working nurses in perioperative care. Hypothesis: Depending on the set objectives have been identified four hypotheses. H1: the incidence of psychological burden for nurses in perioperative care predominates over the occurrence of physical exertion. H2: for nurses working less than three years in perioperative care is the presence of psychic load higher than for senior sisters. H3: for nurses working for more than three years in perioperative care is the presence of physical load higher than the sisters with less length of practice. H4: the workload of nurses in perioperative care does not differ from the standard, based on the Meister´s method of assessing workload. Methodology: Research method of quantitative inquiry of research using the techniques of a standardised questionnaire, supplemented by their own questions. The questionnaire was completely anonymous and respondents ' participation in the research was voluntary. Were used two standardized questionnaires. The first questionnaire was elected from Maister, which assesses the impact of work on the psyche of the individual. The second questionnaire was used as a working activity from Baecky, which is used to measure physical activity. The target group were the nurses working in the perioperative care. In total, were interviewed across nine hospitals of the Czech Republic. All selected Hospital have agreed to perform the research investigation to this thesis. The results obtained were statistically processed. Conclusion: The work provides information about what type of workload predominate for nurses in perioperative care and about the differences of the workload for starting and working nurses in perioperative care. The results of the thesis can be used by medical facilities to identify the workload for nurses in perioperative care and by the perioperative nurses. From the above results, it is clear that the issue of mental and physical loads primarily nurses in the operating room is a very current topic, and it is important to deal with manifestations of this load. In addition to this thesis was created, information material on the prevention of the workload and the methods of its elimination.
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Peroperative nurse work demands
VELÁTOVÁ, Simona
My thesis has two parts. Part One explains the concept of "perioperative nurse" and her competences set forth in the Decree no.55/2011 Coll., on the activities of healthcare workers and other professional workers. The following chapters discuss the working environment of perioperative nurses, job principles of perioperative nurses, preparation of the operating room, treatment and preparation of instruments and technical equipment. Theory Part One is concluded by the chapter that explains the concept of perioperative care. Part Two is focused on education and training of perioperative nurses. It provides historical information, conditions and opportunities for specialized training of perioperative nurses. The last chapter deals with lifelong learning. Objectives of the Thesis The first objective was to map the range of activities performed by perioperative nursesduring selected types of surgery. The second objective was to identify differences in perioperative nurses' activities during standard and laparoscopic surgery. The last objective was to identifyopportunities for further training of perioperative nurses. The method of qualitative research was used. Research data were collected from non-standardized in-depth interviews. The research covered perioperative nursesof three operating rooms in the Hospital of České Budějovice a. s., namely surgery, urology and gynaecology. The research was carried out in collaboration with 3 perioperative nurses of each of the above mentioned operating rooms. Responses were recorded in writingand interviews with individual nurses were numbered followed then by verbatim transcriptionof interview data. The evaluation and analysis of interviews were categorized and categories were supplemented with subcategories. The results of research focused on duties of perioperative nurses show that perioperative nurses' workencompasses many duties they have to performandfollow. The duties of perioperative nurses include activities before, during and after surgery. They smoothly follow one after another and have a predefined sequence. The Scrub Nurse and CirculatingNursejointly perform most activities. Checking was identified as the most frequent activity of perioperative nurses. Checking on the patient, checking on instruments, checking on equipment / devices, but no surgery check-listsare used in the workplaces fornow. For laparoscopic surgery, no great differences in activities were mentioned by perioperative nurses. There would only be some additional activities related to deployment, checking and control of devices. The spatial arrangement must ensure safety of the patient as well as personnel. The operation and control of devices and equipment is very challenging for perioperative nurses in terms of their technical skills and competences. The research concerning opportunities for further training of perioperative nurseshas showed that perioperative nurses prefer specialized training. As another method to refresh their knowledge, participation in workshops was mentioned by perioperative nurses. No other activities are pursued. The purpose of my thesis was to describe activities (duties) performed by perioperative nurses in their daily routine work and establish how they learn and addnew information and knowledge. Perioperative nursesmanage theactivities / operation of operating rooms. They are required to be familiar with the technique and operating procedures and faultlesslyhandle various types of instruments. Professional knowledge supports a smooth course and good quality results of surgery. All of that requires continuous control, training and expanding their knowledge. This thesis points out the need for employer'sinvestments in training and more proactive approach of perioperative nurses to lifelong learning. The research results could provide the basis for preparation of a lecture for perioperative nurses.
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Care of adolescents before and after operation of phimosis using classification systems NANDA, NIC and NOC
KOŽÍŠKOVÁ, Zlata
This thesis focuses on the issue of nursing care for adolescent boys who have undergone phimosis surgery. The nursing care is then evaluated according to the NANDA, NIC and NOC classification systems. The theoretical part deals with topics such as adolescence, phimosisa disease of the external genitalia of a man, preoperative and postoperative care for boys with phimosis, and the classification taxonomy of the NANDA, NIC and NOC classification systems, which represent the comprehensive standardized, but still evolving, nursing language. Available Czech and foreign literary sources were used for the compilation of the theoretical part of the stated subject. The empirical part of the thesis was processed using qualitative and quantitative research methods: content analyzes, modelling, thought experiment, structured and semi-structured interviews, and qualitative data analysis. Four objectives were defined. The way adolescent boys perceive and experience the bio-psycho-social aspects of the problems that the pre-op and post-op period brings, has been assessed using the NANDA, NIC and NOC classification systems. There were 46.66% of respondents with higher education, 53.34% of respondents with secondary education, and eight adolescent boys who had received phimosis surgery, all of whom contributed to the assessment. It was found that adolescent boys initially addressed their physician regarding the phimosis problem, because they had a sense of trust and anonymity, but also to some degree because of necessity. It is surprising that young men with this type of personal problem rather speak to their mothers. When it comes to peer relationships, the boys confide the problem to their peers, but they do not ask them for help in this area. The boys named the internet as the main source of information. The following assessments were made using the Fehring methods for determining the weighted scores. Out of 13 nursing diagnoses within the NNN classification systems there were 112 major and minor characteristics (41.18%) selected by the university educated respondents, 80 major and minor characteristics (29,41%) selected by by the secondary school educated respondents, and nine major and minor characteristics (3.31%) were selected by the adolescent boys. Out of the 15 nursing interventions published in the Nursing Interventions Classification (NIC), 203 major and minor characteristics (55.31%) were chosen by the university educated respondents and 235 major and minor characteristics (64.03%) were chosen by the secondary school educated respondents. Out of the 11 expected nursing outcomes published in the Nursing Outcomes Classification (NOC), 39 major and minor characteristics (15.42%) were selected by the university educated respondents, while 34 major and minor characteristics (13.44%) were selected by the secondary school educated respondents. By implementing the NANDA, NIC and NOC classification systems in nursing care one can expect to find solutions that help the professionals in nursing care to apply the nursing process effectively, and that allow nursing care to focus more on the individual needs of patients and to be improved in all areas.
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The role of perioperative nurses in the safety procedure in the operating theatre.
VÁCOVÁ, Jana
Preoperative safety procedure is a departmental safety goal laid down by the Ministry of Health of the Czech Republic. The providers of health care directly controlled by the Ministry of Health of the Czech Republic are obliged to putpreoperative safety procedure and its documentation into practice, other health care organizations are recommended this implementation. However, the Ministry does not specify the formof this procedure nor its process in the operating room, there is no uniform documentation prescribed and last but not least, it is not clearly laid down which person of the operational team is responsible for the correct implementation of this procedure. The goal of the research is to map the preoperative safety procedure in the operating theatres in selected hospitals, to compare the process of the preoperative safety procedures in the operating theatres among the addressed hospitals, to describe the competencies of perioperative nurses during the preoperative safety procedures in the operating theatres in the selected hospitals and to find out the attitude of the perioperative nurses to the preoperative safety procedure. In the selected hospitals the safety procedure is introduced and implemented in different ways. The preoperative safety procedure in the operating theatres is introduced as an administrative act, but not as a practical tool to improve patient safety. The competences of perioperative nurses in preoperative safety procedures are not clearly specified in all of the respondent hospitals. The perioperative nurses adopt entirely positive approach to that, in most cases they believe it is important for ensuring the safety of the patient.
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Perioperative documentation in Czech republic
KOHOUTOVÁ, Michaela
Now that the nursing process, along with good-quality nursing documentation, is being introduced into all areas of patient care, the need arises to document work of perioperative nurses in the operating theatre. Perioperative documentation is entirely different from nursing documentation, not only in terms of processing but also in terms of scope.This thesis consists of two parts: Theoretical and Empirical. The Theoretical focuses on the general issue of medical documentation used at the various hospital departments. The aim of the work was to (1) map current situation in the area of perioperative documentation at selected hospitals; (2) ascertain which components perioperative documentation is composed of; (3) find the opinion of nurses on the use of perioperative documentation; and (4) set up perioperative documentation. The research part of the thesis was a combination of quantitative and qualitative survey. For the quantitative survey, questionnaires were prepared and distributed to perioperative nurses working in operating theatres of hospitals throughout the Czech Republic. Two hypotheses were proposed. 1. Perioperative documentation is maintained at operating theatres. 2. Nurses consider perioperative documentation useful. Qualitative examination consisted in comparative analysis of perioperative documentation folders. The research set consisted of six perioperative documentation folders obtained from hospitals throughout the Czech Republic. Answers to the following three questions were sought: (1) Is perioperative documentation used at operating theatres? (2) Which parts is perioperative documentation composed of? (3) Does perioperative documentation comply with applicable legislation? The results were analyzed and processed into tables and graphs. The results show that nurses use perioperative documentation at operating theatres. From the research it follows that the processing of the perioperative folders is not fully compliant with applicable legislation. Although mandatory data are included in the vast majority of perioperative folders, the nursing process, as the information which is most important for nursing care, is missing from all of the perioperative folders analyzed. Despite this, nurses consider perioperative documentation useful, not only from the medical aspect but also from the legal, financial and informative aspects. The results of this research may stimulate creation of a unified model of perioperative documentation. This work may also serve as information material for students of medical disciplines.
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Specifics of Perioperative nursing Care of Seniors from the Point of View an Anaesthesia Nurse
VRÁNOVÁ, Magdaléna
The theoretical part of the thesis is focused on nursing care of seniors during perioperative period from the point of view of an anaesthesia nurse. It is divided into a general and a special part. The general part deals with nursing care approach to a senior, with psychosocial aspects of hospitalization, his/her needs, communication barriers and educational specifics. It also covers the issues of operation in old age, psychosomatic changes and their consequences for anaesthesia care. The theory in the specialized part is divided into preoperative, intraoperative and postoperative care in relation to anaesthesia administration.The first goal of the bachelor thesis was to examine the importance of anaesthesia department from senior?s view. The second goal was to determine the importance of anaesthesia department from the view of an anaesthesia nurse and the third goal was to map nursing care of a senior at an operation theatre in relation to anaesthesia.Qualitative research form, the questioning method was applied to information collection. Non-standardized interview with general nurses and seniors was the data collection technique. The research results show that an anaesthesia department is beneficial from seniors? view.It has also been found that nurses consider the anaesthesia department useful particularly for seniors. The benefit for the nurses themselves has still certain imperfections, particularly in sharing information on nursing care with an anaesthesia nurse. The research in nursing care at the operation theatre shows that anaesthesia nurses participate in the continuity of perioperative care of a senior just partially. They are aware the specifics of care about seniors in intraoperation period and differentiate satisfaction of the needs. The thesis might serve as educational material for nurses involved in perioperative care and nurses in specialization education. Documentation was elaborated from the conclusion of the empirical part upon the found drawbacks, particular ideas of the nurses and in compliance with the procedures recommended by the informed public. A brochure Anaesthesiology Guide was elaborated to make cooperation between a nurse and a senior easier.
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