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Costs of providing nursing and rehabilitation care in institutions of social services.
SKRUŽNÁ, Andrea
The dissertation themed "Costs of providing nursing and rehabilitation care in institutions of social services." maps out current issues in provision of health care in the residential facilities of social services. The dissertation focused on analysis of expenses for provision of nursing and rehabilitation care in residential facilities of social services. The theory part is divided into five chapters. In the first chapter, I deal with the social services in the European Union and in the Czech Republic. Further, I describe the system of long-term care. The second chapter focuses on residential facilities of the social services, their division by types and specification of their basic activities. In the third chapter, I describe funding of the residential facilities of the social services, where I focus on description of each funding source. The fourth chapter is focused on health care in the residential facilities of the social services. I describe author's expertise of general nurse in the social services, the list of tasks of health care for the expertise, conditions for indication of health care, the ways for payments of health care by health insurance companies, and audits of the reported health care conducted by the health insurance companies. The last chapter deals with the issues related to per os administration of drugs in the residential facilities of the social services. The practical part of the dissertation consists of my own quantitative research. Described is methodology for data collection; in addition, the research set is characterized, and the research implementation description is given. Results of obtained data were processed in two chapters where structure of users of facilities as well as health care provided to the user was described in a statistical way using tables and graphs. Thereafter, discussion on results obtained was made. The research survey was performed in Senior House in Roudnice nad Labem (hereinafter referred to as "the facility") in November 2013, where data was collected for period from 18 to 24 November 2013. The facility provides social service of senior house and social service of a house with a special regime to its users. At the moment of the research, there were 129 users, of which 95 received health care from health care employees of the facility. Two hypotheses were defined for the dissertation. The hypothesis No. 1 is: The number of health care professionals in the residential facilities of the social services corresponds to time demands for health care indicated by a general practitioner. The hypothesis No. 2: Administration of medical therapy per os as indicated by a general practitioner is the most frequent health care service provided to the users of the residential facilities of the social services. The research confirmed both hypotheses. I can see importance of results of the dissertation particularly in that they outlined how the medical care in the residential facilities of the social services is currently provided. The processed results of the provided health care could then serve as one of the grounds in making a draft for transition of funding of the health care in the residential facilities of the social services from performance-based to flat-based model. The dissertation could also be used as the grounds for training of health care professionals of the residential facilities of the social services in the field of indication, provision, and reporting of health care provided to users of the residential facilities of the social services.
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Quality of life of seniors hospitalized in long-term care.
DOLEJŠOVÁ, Markéta
The basic theoretical basis: According to demographic development the average and maximum lifespan prolongs. Therefore global population spends a bigger part of adulthood in their old age. This phenomenon is irreversible and brings significant changes into global geriatric nursing and we need to take note of the care that is provided to old patients. The seniors form an irreplaceable and a more and more considerable part of population, they create a varied group with individual needs, priorities and demands in sickness as in health. It is the very polymorbidity of senior patients which is often the reason for a long-term hospitalization. Nowadays, for these purposes more and more beds are built in long-term care facilities (LTCF) which are officially defined as specialized medical institutions which provide care to patients whose health states cannot be substantially improved by any medical treatment as they worsen without a continuous care. The life quality of seniors and the quality of the provided care in these facilities are the main long-term care level indicators. The goals of the thesis: 1) Ascertain the life quality of seniors hospitalized in long-term care institutions. The research questions: 1) How does the hospitalization of seniors in LTCF influence their subjectively perceived quality of life? 2) In which areas do seniors hospitalized in LTCF feel the difference of life quality in LTCF and at home? 3) How are the patients in LTCF satisfied with the quality of health care? 4) Within the rise of seniors' life quality in LTCF, in which areas should the nurse improve the provided care? Methods employed: For the empirical part of the thesis the qualitative analysis of gathered data method was used. The data accumulation was implemented by semi-structured interviews with clients-patients hospitalized in LTCF. The instructions for the interviews were adopted from a QOL Research Unit life quality model of the university in Toronto. This model emphasizes the individual's relations towards the surroundings and the possibilities of maintaining and improving skills. It is divided into 3 categories - existence, togetherness and adaptability. Interview transcriptions create a part of the thesis on an enclosed CD. For illustrative purposes, the results of the research were transformed into mind maps using the XMind software. There are also annotations with respondents' quotations concerning individual map as a part of the thesis. The results: The analysis of in-depth interview gathered information brought several factors which are highly subjective and have a logical level of individuality. The results concerning the research of the seniors' life quality dimensions are more or less in agreement with the basic division found in professional literature. However, they bring a further view on these dimensions and introduce subjective opinions, wishes and evaluation of seniors who found themselves in unknown environment of LTCF. The positive influence of nurses, which often impact the satisfaction of seniors in a medical institution, proved its importance. However, it was the area of communication skills of medical staff which was mentioned as lacking or insufficient. Also the fields of free time activities, seniors' adaptation in LTCF and social isolation were found to be neglected. Conclusion: The long-term care becomes, thanks to demographic development, the most rapidly evolving kind of health care. The emphasis on life quality of hospitalized seniors, as their biggest consumers, should be a matter of course for every medical and social facility. The contribution of the thesis is in detailed mapping of the issue of life quality in LTCF, warning against lack in health care and the neglected fields of life quality.
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