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Lifestyle of patients with peripheral arterial disease before and after surgery
REZKOVÁ, Helena
Theoretical background: Peripheral arterial disease is a serious disease of Loir limb arteries which originates from atherosclerosis. The theoretical part deals with the lifestyle. There are mentioned basic risk factors of chronic forms. Further described are the pathophysiology changes generated on the basis of atherosclerosis and related causes for the origin of the disease. Subsequently there are explained methods of classification, developed clinical symptoms, diagnosis and therapy. This section also looks at the role of a nurse in the care of patients with peripheral arterial disease. Objectives: The aim of this work was to evaluate how patients with peripheral arterial disease changed their lifestyle after invasive vascular surgery. There were provided the following research questions: How do patients with peripheral arterial disease approach to the prevention of risk factors? What is in patients with peripheral arterial disease the main impuls for the possible change of their lifestyle? What influences surgery patient's attitude to risk factors for peripheral arterial disease? How crucial is a lifestyle change in patients after surgery for peripheral arterial disease? Methods: The theoretical part is processed using expert sources. The empirical part of the theses was processed using qualitative research. The chosen technique for data collection was semi-structured interviews with patients, with prepared open questions. The research was done in several phases - the first interview was conducted at the patient admission department (before surgery), followed by the next phase after three months, and 6 months after surgery. The interviews were recorded on a prepared form, then transcribed into electronic form and analyzed by open coding method. Results: The research showed that surgery can sometimes be triggered by changes in the patient's lifestyle. The first interviews in the preoperative period focused on how respondents felt, what was their lifestyle before surgery for atherosclerotic changes of the lower extremities. One of the questions was focused on patient knowledge about risk factors for the development of PAD and possible prevention. The second phase of interviews took place 3 months after the surgery. It dealt with the question about the respndents´ lifestyle, the respondents in the postoperative period, whether there were any changes. Some positive changes occurred in eating and there were some changes in doing physical activity. The third stage was carried out six months after surgery, again in order to detect changes in lifestyle. Minor changes came in smoking habits, the issue of diet and physical aktivity. Questions were also focused on the psychological level. We found out who helped patients and what was most motivating in implementing changes. In the conclusion/summing up question the patients marked themselves ow they managed to make a change. Conclusion: The number of patients with peripheral arterial disease and other cardiovascular diseases is increasing. The basis is the start to modify risk factors, namely tobacco use,dietary habits, physical activity. The medical staff members participate on changes in patients´ lifestyle by appropriate education. The problem occurs when the patient despite the support of close people can not cope to carry a twist in their life. There should a medical staff member offer a professional help to deal with this important step. Practical use: The aim is to draw attention to the expansion of education about lifestyle changes for patients diagnosed with PAD also in the postoperative period. Patients who are released to home care should receive enough information that would convince them to change their attitude towards their health, and that surgery is only one of the ways to prevent further attacks and complications. Results can improve communication with patients and focus on increasing their awareness and possibly offer assistance.
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Nursing care management of patients after intrapleural chemical pleurodesis
KIESEWETTEROVÁ, Renáta
The pleurodesis is a treatment method for patients suffered from the symptomatic malignant pleural effusion. The goal of the pleurodesis is to close a pleural area by connection of visceral and parietal pleura in order to reduce or terminate production of pleural effusion. The sterile talc powder is the world's most used agens within a practice. After a parental analgesic is the powder (as a sllury) either applicated into a pleural cavity through the chest drainage or surgically dispersed over the treated (via abrasion, decortication) pleural space during the thoracoscopy/thoracotomy. This diploma thesis focuses on the treatment technique of bedside talc-pleurodesis through the chest drainage. The nurse has an irreplaceable role in the whole process from a preparation of patient to assistance by intrapreural application, to care of patient after the operation or serves as a physical support during potential complications. The aim of the presented work is to detect priorities in nursing care and find out whether patients need increased care after intrapleural therapy. The qualitative research method was chosen for the analysis where semi-structural interview with open questions were used. We created case reports analysed with the adaptive model of Callista Roy as well. The research sample contained patients chosen with respect to specialization of researched problem. We set two basic focal stimuli according to the analysis of respondents´ reactions. These stimuli serve as a basis for determination of priority parts of the nursing care by patients after bedside pleurodesis. We defined the need to be without pain and the need to ensure safety and certainty as a central focus of the nursing care. Among secondary fields of nursing care were identified sleep disturbances and limited mobility, which leads to reduction of self-care in getting dress, hygiene as well as in defection and miction. We found out within the second goal identical intensity of the nursing care before and after bedside talc-pleurodesis. This statement is based on comparison of interventions before and after aplication analysed via adaptive model by Roy. Nevertheless, causes of interventions were modified to a certain extent. The main goal of diploma thesis was to map requirements for high-quality nursing care related to bedside talc-pleurodesis via chest drainage. The work should extend theoretical basis not only for nurses in clinical practice.
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Nursing care in a hygienic and epidemiological regime from the patient's perspective.
KŘEPELOVÁ, Lenka
Considering contemporary lifestyle and possibility of travelling imported infections accrued and some illnesses come back that have not occurred nearly at us more. Not only haemorrhagic fevers and other highly infectious illnesses but also hospital multiresistant bacterial strains that mean high risk for patients constitute a threat. The number of nosocomial infectious grows still. The patient is in the case of suspicion or already diagnosed infectious illness isolated and treated in the infectious department or in the tribal department in the room with increased hygienic-epidemiologic regime. The patient is saved in a single room, the possibility of visits is reduced and the staff uses personal protective equipment. The man is holistic being and it can come due to isolation to lack of satisfaction of his/her bio-psycho-social needs. The aim of this thesis is to identify unsatisfied bio-psycho-social needs of patients in increased hygienic-epidemiologic regime and to describe changes in needs of the patient depending on the time of hospitalisation. The theoretic part describes the problematics of infectious illnesses, system of the care for the patient with infectious illness and changes in human needs in the period of the illness. The empiric part of the thesis deals with unsatisfied bio-psycho-social needs of isolated individual through quantitative research. The research suite was made up of 10 patients who were hospitalised in the room with increased hygienic-epidemiologic regime. The survey was carried out in the Hospital Jihlava by semistructured interview and the results of the survey were processed by opened coding by method paper and pencil. It is emphasized that the most needs of the patient have biological, psychical, social and even spiritual aspects. The rate of satisfaction with caregiving depends on the health condition and personality of the patient. Not small influence has the length of the hospitalisation, too. It was found out during the survey that the patients have not enough information about specifics of the care in the infectious department and that is why there is often a misunderstanding of necessity of barrier measures. It is possible to avoid useless misunderstanding through timely and suitable education. It was created an educational material with the title "Guide for patients hospitalised in the infectious department of Hospital Jihlava" for this purpose. Employees of the infectious department of Hospital Jihlava were informed with results of the research during a workshop, too.
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The need for security and safety in connection with a planned surgery with the patient's perspective and nurses
BOHDALOVÁ, Jaroslava
A planned operation performance always affects patient´s needs for assurance and safety. It is important to provide necessary information connected with the planned operation performance itself so that the patient can feel assure and safe. The key role for the patient and her/his needs for assurance and safety is in general nurse´s hands because she is the closest person to the patient and can help to inspire her/his needs for assurance and safety with konfidence best through the aid of her knowledge and skills that she should have as well as through the aid of her attitudes. The target of the thesis was to find out how a planned operation performance affects patient´s needs for assurance and safety and how a general nurse inspires patient´s needs for assurance and safety connected with a planned operation performance with confidence. The following research questions were stated: How does a planned operation performance affect patient´s needs for assurance and safety? How does a general nurse affect patient´s needs for assurance and safety connected with a planned operation performance to inspire her/him with confidence? What is insufficient in filling patient´s needs for assurance and safety before a planned operation performance? How can a general nurse help a patient control her/his fear and state of anxiety related to a planned operation performance? The method qualitative research with the use of depth interview was used to figure out the investigation. The respondents were willing to record the interview which were verbally rewritten and then subjected to the contents analysis by the method paper and pencil. From the research it is clear that a planned operation performance affects patient´s needs for assurance and safety in a negative way disregarding to her/his previous experience. Patient´s worries and negative feelings can be eliminated by a general nurse who treats her/him as equal, taking up an individual approach, informing her/him about all performances and proceedings, having a calming and welcoming way of communication, using empathy and listening as well as trying to meet patient´s wishes according to her possibilities. The research reveals the advantage of patients´ readiness for planned operation performances. Patients can learn it in the framework of educational proceeding in the out-patients´ department at the same time when they learn that they are going to be operated. The research also shows that general nurses do not have enough knowledge in the sphere of therapeutical communication. The results indicate that it would be suitable to start educating patients as soon as it is known how their disease will be solved and treated in order to reduce the negative impact of surgical treatment to patients´ needs for assurance and safety. General nurses should complete their knowledge and skills to be able to help patients to cope with their difficult life-situation. On the basis of the research investigation and after the consultation with the senior nursing officer, the training course will be organized. The topic of the training course will concentrate on communication with patients before planned operation performances with a view to therapeutical communications and therapeutical interviews. Other discovered facts, for example, the lack of information provided to patients and possibilities regarding better patients´ readiness for planned operation performances will surely be solved by the hospital management.
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Patients satisfaction with the provided services. An important indicator of the quality of health care facilities.
MALANÍKOVÁ, Jana
My master's thesis which topic is "Satisfaction of patients with the services provided. An important indicator of quality of medical equipment " is mainly focused on satisfaction of patients with the services provided in the Hospital České Budějovice, a.s. Furthermore, the mapping focused on overall satisfaction with care in the already mentioned Hospital České Budějovice and on exploring whether patients evaluate the quality of information provided by a medical doctor in this hospital affirmatively and whether they are satisfied with care of local nurses. The satisfaction of patients is an important indicator of the quality of care provided, which has an impact on their status of basic human needs. One main purpose was determined: Monitoring the satisfaction of patients with the services provided in the Hospital České Budějovice, a.s. and this purpose was fulfilled. Quantitative research was executed, to its realization the interview method was used. By means of the technique of standardized anonymous questionnaires on the basis of the above-mentioned purpose,the 3 following hypothesis were verified: 1) Patients are satisfied with the overall care in the Hospital České Budějovice, a.s. 2) Interviewed patients evaluate the quality of information provided by a medical doctor in the Hospital České Budějovice, a.s. affirmatively 3) Interviewed patients are satisfied with the care of nurses in the Hospital České Budějovice, a.s. I processed the data to confirm or refute the pre-established hypotheses. The evaluation of the data was carried out using statistical nonparametric methods, Chi-square test and the chosen level of significance of p=0.05. The results of the research have been clearly processed into the tables and graphs. The program Microsoft Office Excel 2010 was used to process the results.
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Pick´s disease and the specifics of the nursing care of a patient with this disease
KOPKAŠOVÁ, Lenka
Pick's disease is a degenerative-atrophic process that primarily affects the frontal and temporal lobes of the brain. Besides Alzheimer's disease, it is a lesser known form of dementia which affects people of younger age. Although the exact range of Pick's disease occurrence varies in the literature, the average reported age is between 50-60 years. The disease can change eating habits, cause emotional swings, inappropriate behaviour and sloppy appearance of the patients. The behaviour to others is often selfish, the patients are unable to listen to others and ignore their surroundings. Pick's disease is also characterized by inappropriate sexual behaviour. Globally, the number of dementia patients is still growing and according to expert guesses the increase will continue. Nursing care for patients with dementia is therefore becoming a very actual topic as dementia is called a quiet epidemic of our century. Nurses in their departments quite frequently encounter patients suffering from dementia of various origins at different stages of disability and the staff at healthcare facilities often regard these people as a burden. The aim of this thesis, which is called Pick's Disease and Specifics of Nursing Care for Patients with this Disease, is, based on the theoretical knowledge, to map definitions and diagnosis of Pick's disease, to define the needs of such a patient, and to list the most common problems in the nursing care. It focuses on people with dementia within medical facilities. For proper understanding of the problem, the thesis starts with the anatomy and physiology of the brain and the description of cognitive functions which are affected by the dementia syndrome and the definition of dementia. Based on the studied literature, dementia is divided according to various criteria. It has been found out that dividing dementia is not entirely uniform, but the essential facts and overall opinions of the authors do not diverge. Pick's disease belongs to a group of frontotemporal dementia and its position in this group has changed over time, as it is recorded in the literature. The thesis includes recommendations resulting from the studied literature in the approach to patients with dementia and emphasizes personal communication with the patients and empathetic and humane approach. Although medicine cannot prevent dementia, an early diagnosis of a specific type of dementia and correctly targeted treatment can increase the quality of life not only of the patients but also of their families. I have chosen this topic because I find it very current and interesting. During my nursing practice at the Surgery Department and Aftercare Department, I have met patients suffering from dementia and I did not know how to properly and efficiently communicate with them. For the theoretical part of my work, the methods of explanation, synthesis and induction on the basis of Czech and foreign information sources have been used. The most frequently quoted Czech authors in my thesis are doc. MD. Roman Jirák, PhD., the head of the center for diagnosis and therapy of Alzheimer's disease at the psychiatric clinic of the General University Hospital in Prague, the 1st Medical Faculty of Charles University. This thesis can serve as an informational and educational source both for nurses and the general public who may experience the disease within their families. It would be considered a great success if it helped nurses or family members to diagnose Pick's disease or other dementia at an early stage.
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Constipation - problem of immobile patients
HULIČKOVÁ, Tereza
My thesis deals with constipation in immobile patients. The research was carried out by collecting data using the questionnaire method. The questionnaires were focused on immobile patients of all ages hospitalized in any units in the České Budějovice hospital, Inc. The objective of this thesis was to survey the drinking regimen and eating habits in immobile patients and to analyze their impact on the development of constipation. I set three hypotheses: The first hypothesis suggests that immobile patients´ alimentation does not include an increased requirement for dietary fiber. My research shows that patients´ diet at home contains more fruits, vegetables and whole meal bread. A diet therapist hardly ever comes to see hospitalized immobile patients. Most patients are not on any diet which would limit the intake of particular nutrients. The first hypothesis was confirmed. The second hypothesis suggests that immobile patients do not observe the drinking regimen. The research data analysis shows that patients´ fluid intake is the same no matter if they stay in hospital or at home {--} it is about 1- 2 litres a day. The fluid intake depends on patients´ age, weight and health condition. It is possible to say that immobile patients observe the drinking regimen. The second hypothesis was not confirmed. The third hypothesis suggests that immobile patients do not have enough privacy while they pass stool. They feel ashamed and these feelings also raise the constipation development. There is a lot to improve in this respect, the nursing staff should be aware of the fact that immobile patients need more intimacy at passing bowel motion. It is not surprising that most immobile patients feel the lack of privacy in hospital. In my opinion not enough attention is paid to the question of privacy in hospitals. This has a negative impact on patients´comfort. Patients´ diet should include more dietary fiber. Individual consultations with a diet therapist are advisable for patients. The nursing staff should also focus on the patients´ drinking regimen. The right diet and drinking regimen may contribute to constipation prevention. The empathetic, holistic, psychological and sensitive approach to patients should improve patients´ condition and alleviate their pain. Each nurse should make her best to prevent patients from feeling undignified in hospital.
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Communication as a Part of Everyday Nursing Care at ICUs.
FROLÍKOVÁ, Miloslava
Communication as a Part of Everyday Nursing Care at ICUs Bachelor?s Thesis, worked up and focused on the topic of ?Communication as a Part of Everyday Nursing Care at Intensive Care Units? is engaged in problem area of contemporary communication. In the work?s theoretical section we have dealt with general characteristics of both verbal and non-verbal communication as well as an appropriate communication at the intensive care units with adult or children patients has been described inclusive particularities thereof and its contingent difficulties, too. This section also involves a concept of basal stimulation and its subsequent integration into the nursing attendance at the intensive care units. The work also deals with a nurse?s role within education of the ICU in-patients? family. Objectives and hypotheses are introduced in further section of the Bachelor?s Thesis. The first objective was aimed at identification of possible differences while using communication skill at the ICUs of various medical scopes. The second objective was focused on finding out of prospective utilization of the basal stimulation concept for the purpose of nursing attendance as a communication chance. The third objective set a goal to identify what communication way was preferred by the ICU nurses while providing nursing care. Pursuant to these objectives of the Thesis hypotheses were defined. Hypothesis 1 (H1) anticipated that the communication skill was differentiated according to the scope of the intensive care unit. Hypothesis 2 (H2) supposed that an important element affecting any communication was medical performances frequency. Hypothesis 3 (H3) assumed that the important element affecting any communication was frequency of nursing interventions. Hypothesis 4 (H4) envisaged that time necessity while providing nursing attendance at the ICUs influenced the efficiency of the basal stimulation application with patients. Hypothesis 5 (H5) anticipated that verbal communication was preferred more with patients at the ICUs according to the medical scope. A quantitative method was used for the research investigation of the Bachelor?s Thesis by help of interrogatory investigation. Nameless questionnaires were set and distributed to nurses at the intensive care units of various scopes in the Faculty Hospital Plzeň . It was found out through the research investigation that hypothesis 2 (H2), hypotheses 4 and 5 (H4, H5) were confirmed and hypothesis 1 (H1) and hypothesis 3 (H3) weren?t confirmed. However, all three objectives were fulfilled. At the end of the Bachelor?s Thesis it is especially recommended for providing nursing care at the intensive care units regardless of their medical scope to respect any intimacy of the patients while executing nursing interventions and any efforts to get higher quality of communication skill at treatment of an unconscious patient, to provide education both of theoretical but first of all practical elements of the basal stimulation concept with the nursing staff.
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Nutrition in hospitals as part of comprehensive nursing care
ZELENKOVÁ, Klára
A nutrition of high quality should be an integral part of the complex therapy in all hospital facilities, disregarding these premises results in the decrease of the whole quality of the nursing care. A complex nursing care detects actual and potential health problems, determines priorities and defines the role of the nurse providing those. Nothing but a highly qualified and plan-based nursing care enables the nurse to satisfy the patients´ / clients´ needs. The purpose of this Bachelor thesis is to discover and determine the demands of the clients hospitalized in hospital facilities for alterations of the nutrition system, to map clients´ satisfaction with the food served and to find out , if the meals served in the hospital facilities complies with the clients´ needs. The research was realized in the Hospital Strakonice, inc.c. in the internal, surgery and gynaecological ward, in the form of a questionnaire inquiry. Six hypotheses have been determined, of which 5 were confirmed and one was refuted. The first hypothesis tested, whether the clients hospitalized in hospital facilities would appreciate an alteration in the nutrition composition. On the basis of a questionary investigation, the hypothesis was comfirmed. The second hypothesis estimated, if the clients hospitalized in hospital facilities would appreciate the possibility of the choice of the meals, according to the results, it is obvious that this possibility is welcomed by the clients and thus this hypothesis was confirmed. The aim of the third hypothesis was to find out, whether the clients are satisfied with the food served. The results point out to the fact, that for the most of the respondents, the taste, satiety and quantity of individual meals was inconvenient, the results concerning the satisfaction with the temperature of the served meals proved the patients´/clients´ satisfactuion. The third hypothesis was confirmed, because the larger part of the answers proved the dissatisfaction with the food served. The four hypothesis, whether the clients have different demands on the served meals according to their age categories was, after detailed comparison of the results, confirmed and the results point out to a definite difference with the older and with the younger respondents. The fifth hypothesis estimated, whether the clients evaluate the served food as inadequate to their needs. From the results it is obvious, that the sufficiency is superior to the insufficiency and therefore, the fifth hypothesis was not confirmed. The sixth hypothesis evaluated, if the clients have the need to provide themselves with the food outside the hospital facility, from the results it is evident that the clients really have this need and the sixth hypothesis was proved and confirmed. I will hand deliver the results achieved to the head nurse of the Hospital Strakonice, inc.c. and together we will try to realize these alterations that would increase the satisfaction of the patients/clients with the nutrition and meals in this hospital.
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