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Nursing care for patient with polytrauma
SKLÁŘOVÁ, Lucie
Multiple traumas mean a present injury of at least two body systems. The patient with the multiple traumas is, because of the threatening failure of one or more organs, alternatively systems, placed on the intensive care unit. The nursing of the patient is therefore systematic, continual and its part is the monitoring of the conditions and saturation of basic needs. The nursing care on the intensive care unit is dependent on their health conditions and it permanently changes. A nurse usually takes over the whole care of the patient and they are dependent on her. Therefore the nurse must know all the patient´s needs and provide them regard to their self-sufficiency. Self-sufficiency is the level of independence during the daily routine. To its evaluation we use Barthel test of basic daily activities. In literature the word self-care is used as an identical term. The empiric part of the bachelor thesis is focused on self-sufficiency, self-care of a patient and activation of the nurses. The goal of the research is to find out the difference in the amount of care for a patient with multiple traumas on the Intensive care unit and a standard ward in connection with the level of self-care. To fulfil the goals three research questions were set. The research questions are: How do the nurses judge the self-sufficiency of a patient with multiple traumas on the intensive care unit and a standard ward? How do they provide the nursing care at a patient with multiple traumas in a standard ward? How do they provide the nursing care at a patient with multiple traumas on the intensive care unit? The qualitative research with the help of semi-structured interview was used to answer the questions and fulfil the goals. The research was taken on the traumatologic intensive care unit and in the standard ward. 5 respondents and one patient were from the intensive care unit and other 5 respondents and two patients were from the standard ward. The answers for the first research question were identical at all respondents. The evaluation of the patient´s self-sufficiency is according to Barthel test. The answers of most respondents point at the fact that the test in not practical and suitable. The results of the second and third research question can be comprehended in one conclusion. Regarding the fact, that the nurses from the intensive care unit and the standard ward made comments in the same way. The nursing care is always provided regarding the self-sufficiency of a patient. They support a patient mentally to make him more self-independent. They use different accessible tools for practice. With the help of the research questions we reached the goals. We found out that the difference in the extent of provided care is in the amount of activities which are done by nurses for the patient on the intensive care unit and in the standard ward. The nurses provide a patient with more activities logically on the intensive care unit. It is due to the conditions of a patient which are acute at the beginning. Even though, the nurses try to activate a patient as much as possible. By contrast, the nurses in a standard ward have the chance to increase patient´s self-sufficiency in more activities. They endeavour patients to be self-sufficient in hygiene, catering, walking and excretion. In these activities patients should be helped by physiotherapists. As it is agreed by the nurses from the intensive care unit as well as the nurses from the standard ward, this approach does not really work and so the only ones who activate a patient are the nurses and hospital attendants. The work should serve the nurses to clarify the importance of multiple traumas and deepen their knowledge of discussed problems.
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Proximal Femoral Fractures - Nurse Problem with Aging of Population
ŠTECÁKOVÁ, Martina
This bachelor thesis deals with the nursing issue of proximal femoral fracture in the context of aging of population. Recently there has been an increase in the number of cases of proximal femoral fracture in the elderly people above all. Age and general state of health influence significantly the entire postoperative period and self- sufficiency of the patient. The objective of the thesis was to research factors related to proximal femoral fracture, to find out about mobility and at the same time about self-sufficiency of the respondents before and after the trauma. Then, to point out the areas of self-care in which the client has the largest deficit, how the client manages the individual areas and whether his own efforts and efforts of the nursing staff can help him to return to the normal life. These objectives were achieved in the thesis. Four hypotheses were set. Hypothesis 1: Proximal femoral fracture in clients above 65 occurs more with women than with men, was verified. Hypothesis 2: Proximal femoral fracture occurs most frequently with clients living alone after the fall at home, was also verified. Hypothesis 3: Clients who are fully mobile and self-sufficient before the trauma, usually return directly to their original environment immediately after the discharge from the trauma department, was not verified. Hypothesis 4: Self-care in hygiene in the postoperative period is the most difficult task for the respondents, was not verified. The theoretical part deals with anatomic structure, vascular and neurological supply of proximal femur. The other part describes particular types of fractures together with clinical picture and treatment possibilities. Then old age with all its aspects is described. An important area is the nursing part, focused on preoperative preparation and postoperative care. To verify the hypotheses, quantitative research was chosen. A standardized interview was designed for patients. An anonymous questionnaire was designed for nursing staff. Further on, content data analysis was applied. The results of the work point to the deficit in the area of self-care, which influence ability of the elderly to return to the normal life. If nursing staff and physiotherapist were familiarized with these results by means of a workshop initiated by the management of the Clinic of Orthopaedics and Traumatology, it might lead to the improvement of the nursing care and it also might become a stimulus for more intensive rehabilitation. Mapped self-care deficits will be then used to create educational material to facilitate the provision of particular services by home care agencies that will compensate for these deficits when the patient returns to his home.
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The Satisfaction of Patients with Peritoneal Dialysis in the Provision of Nursing Process
JANSOVÁ, Miroslava
Peritoneal dialysis is a method of treatment of chronic renal failure. The principle of this method is the exchange of substances between blood and dialysis solution soaked into the abdominal cavity. The absolute indication for the dialysis is the impossibility to establish vascular access for hemodialysis. It is primarily indicated for patients as a treatment for cardiovascular diseases which may cause hemodynamic instability during extracorporeal circulation. Individual preferences of the patient also play an important role. The contraindications are extensive adhesions in the abdominal cavity and inflammatory bowel diseases. This method has recently become common practice at most dialysis centers. It provides patients with more freedom as well as more independence from a medical center and its staff. The qualitative data collection technique was used for the research survey. The qualitative research took the form of non-standardized interview. The research group consisted of six patients from dialysis centers and hospitals in Tábor and České Budějovice. Objective 1 was to find out whether peritoneal nurses provide patients with sufficient information. The research has shown that the patients had been informed about the method before as well as during the treatment. Objective 2 was to find out how nurses support the patients´ self-care. The research has shown that the nurse had supported patients´ self-care by providing them with information regularly, checking during the exchange of dialysis solution and by reeducating them. Objective 3 was to find out whether a nurse helps to reduce social isolation of patients with peritoneal dialysis by providing a health visiting service. The research has shown that patients had highly praised this service, feeling encouraged to become more active thanks to the health visiting service. The work of nurses caring for these patients is rather independent and individualized. The success of treatment largely depends on high quality work of a nurse, on her educational and communication skills. We hope that the results obtained will be an example for other health professionals caring for these patients. The brochure could help patients with renal failure to decide when selecting a method of treatment.
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Post-operative self-sufficiency monitoring of a polytraumatic patient
STRAKOVÁ, Lucie
The therapy of patients with polytrauma takes a lot of time. Associated complications can often occur. In the course of recovery after numerous operations is dramatically limited the dynamics of patient, his survivability capacity to shift for oneself is low. In this period is very important to be engaged in the regularly self-sufficiency training, every day activities, fitnessand breathing exercises. The well-timed post-operative mobilisation and a self-sufficiency training help to improve a general health conditition. It is necessary to support motivation and self-confidence of patient.
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Client{\crq}s motivation {--} a part of everyday nursing activities
KREJČOVÁ, Martina
If clients are to be motivated, they have to be made desirous of achieving an objective, confident of their abilities, and capable of imagining the possibilities opened up to them after the objective is accomplished. This Bachelor paper aims to find out how the clients of senior-citizen facilities are motivated for self-care. Degenerative changes encountered in seniors often deteriorate their self-care performance. The older the people get, the more difficult it seems for them to find reasons why they should keep themselves active. A nurse, therefore, has to encourage in them the proper attitude through which the seniors will be able to maintain or even improve their level of self-reliance. This paper is to map the motivation mechanisms at work in the clients of senior-citizen facilities operating in the Region of South Bohemia and to examine the way in which the nurses motivate the clients for self-care and self-reliance. The data were generated through a qualitative survey of two different non-standardized types of interviews. The first type of interview was carried out with nurses working at the nursing homes at Kaplice, Máj and a senior-citizen facility of the Staroměstská Center of Social Services. The second type of interview was conducted with randomly selected clients of the facilities. The survey revealed the way in which the nurses motivated the clients for self-care, as well as the motives, both personal and factual, behind such efforts encountered in the clients. Moreover, the nurses` attitudes were investigated about how the nursing process could be used to motivate the clients for self-care, and the clients` needs were examined as they related to the self-care motivation induced by the nursing process. Conclusions of the paper can provide a source of information for both managers of the facilities and the nurses delivering the care. Future investigation should seek a method in which the nursing process can better motivate the clients for self-care, and possibly it should focus on the nursing documentation. Nurses providing care at the senior-citizen facilities strive to motivate the clients to resume their self-assistance capabilities and keep the capabilities workable. The clients appreciate their efforts.
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