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Factors of discontent among nurses and their impact on care quality at a cardiac surgery department.
ERETOVÁ, Zuzana
Occupation of a general nurse belongs to demanding jobs in terms of professional preparation and performance. A nurse is expected to cope with professional activity, working with modern technology, administrative work, to bear the physical and mental load of her profession, to be able to influence and direct patients? feelings and behaviour and finally to be able to cope with professional as well as family problems she is faced to. All this is often dealt with in continuous operation on shift basis at various specialized workplaces. Questions how nurses working at a cardiac surgery department are satisfied or dissatisfied at their jobs, how the work experience length affects their satisfaction, whether possible discontent among nurses may affect quality of the nursing services provided by them and how the hospital management reduces the factors of discontent, became the subject of my thesis. The research was performed at the IKEM in Prague. Quantitative as well as qualitative research methods were used for data collection when mapping the problems in question. The quantitative part involved a questionnaire both, for general nurses working at the cardiac surgery department, aimed at investigation into the discontent factors involved in their occupation, and for the patients undertaking treatment at the cardiac surgery department, to examine their satisfaction with the nursing care. Analysis of the collected data was then performed. An interview with representatives of the hospital line, middle and top managements was the instrument of the qualitative research. It was focused on the question how they proceed in elimination or reduction the discontent factors. The following facts were found out by the quantitative research. Increased physical and mental load, non-cooperating patients and care about more patients at the same time, extensive administration related to patient care, insufficient remuneration, lack of communication from doctors and superiors, lack of auxiliary staff, projection of occupation to private life or the problem of sleeping after a night shift are the most frequent discontent factors. Despite the above negative factors nurses are satisfied with their jobs regardless the length of experience. The indentified factors of discontent do not affect quality of the care provided by the nurses. The qualitative research results show that personal talks, active interviews and direct communication from the staff are the most frequent methods the management uses to map staff satisfaction. The management representative is able to work herself on elimination or reduction of the discovered factors of discontent within her competences, which happens most often. She may also cooperate with the chief nurses or ward sisters. Unless she is able to solve a problem, it is passed to the authorized persons competent to deal with it (health care manager, social-legal department, HR department). The hospital director is also informed on the most serious cases. The management hardly ever cooperates with physicians on elimination or reduction of the discontent factors. The most important aspect of solving the problem of discontent factors is its subject, which affects the solution method, whether it is to be dealt with by an individual or the whole team. They inform the head physicians or the ward chief consultant on serious problems. The course of the problem solution is communicated to the employees by the ward sisters or chief nurses personally, orally.The goals of the thesis have been met, the set hypotheses have been refuted, and the research questions have been answered.
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Monetary Policy and Macroprudential Policy: Rivals or Teammates?
Malovaná, Simona ; Frait, Jan
This paper sheds some light on situations in which monetary and macroprudential policies may interact (and potentially get into conflict) and contributes to the discussion about the coordination of those policies. Using data for the Czech Republic and five euro area countries we show that monetary tightening has a negative impact on the credit-to-GDP ratio and the non-risk-weighted bank capital ratio (i.e. a positive impact on bank leverage), while these effects have strengthened considerably since mid-2011. This supports the view that accommodative monetary policy contributes to a build-up of financial vulnerabilities, i.e. it boosts the credit cycle. On the other hand, the effect of the higher bank capital ratio is associated with some degree of uncertainty. For these and other reasons, coordination of the two policies is necessary to avoid an undesirable policy mix preventing effective achievement of the main objectives in the two policy areas.
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Dance as a means of integration adults with intellectual disability
KRAUMANNOVÁ, Eva
The goal of the bachelor thesis called Dance as a means of integration adults with intellectual disability was to create, implement and evaluate a dance course focused on the development of social competences in adults with intellectual disability. The thesis deals with adults with intellectual disability and with a leisure activity focused on dancing. There is some space for the development of social competences in adults´ leisure time. In response to the current situation of leisure activities proposition for adults with intellectual disability. I found it beneficial to found a dance group of adults with intellectual disability, and at the same time a group of individuals intact in places unfamiliar to them. Based on an activity which may be implemented amusingly it is possible to develop an individual´s personality as well as his or her social competences, which become a presumption of a successful integration, universally. The bachelor thesis consists of four chapters.The first chapter defines the term ´intellectual disability´. Further on the attention is paid to the characteristics of the target group, i.e. adults suffering from a slight and medium mental retardation. Further on, the disability´s impact onto the human psyche as well as social area is described. In the second chapter the term ´dance´is defined and then the description of its usefulness within the leisure, artistic and therapeutic areas is given. In the third chapter the presumptions for a successful integration are described. In the conclusion of the theoretical part there is an interconnection made between the target group and the activity for developing social competences. The theoretical part of the bachelor thesis is continued with a practical part, the fourth chapter. It is a programme of a six-month course which I have set together based on the analysis of expert literature and my experience gained during the leadership of dance lessons and working with adults with intellectual disability. The programme will include work methods and an evaluation of partial activities. The six-month course was held in the school year of 2015/2016 and 6 intellectually disabled adults took part in it. Students of the University of South Bohemia joined the course. Partial goals were set for individual dance lessons and the activities were set so that they would develop social competences in participants non-violently and in the greatest extent possible. The course was implemented in the IN Civic Association facilities. To evaluate the activity and find out the progress within the area of the participants´ social competences, several development fields have been set. Several chosen social competences were divided into evaluation scales. The participants were evaluated at the beginning of the course and then again, six months later. The evaluation method chosen was my own observation. I focused on the evaluation of my own working, on group evaluation and the evaluation of each individual. Evaluation was also done on the part of each course participant, too. Dance lessons and activities connected have proven to be a suitable means for developing social competences in intellectually disabled adults. In five participants the values have risen in 5 10 out of 17 competences observed. A recourse occured in a participant who was going through a difficult life situation during the last two months of the course. Values have risen dramatically and in all participants in the area of group cooperation. Five participants made a progress in establishing and keeping eye contact and in starting a conversation. One participant has made a progress in the area of group performance, another one has made a progress in the area of independence and another one started to call the other participants by their names, as opposed to the beginning of the course. In general, the members of the group became more self-confident.
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Oxygen therapy after cardiothoracic surgery from the point of view of nurses and patients
VRCHOTOVÁ, Klára
Cardiac surgeries are very serious surgical procedures with considerable specific features. This bachelor thesis focuses on oxygen therapy from the viewpoints of nurses and patients. Its theoretical part describes physiology of breathing and the oxygen therapy as such. It describes individual sources of oxygen and indications for oxygen administration. It also describes principles to be observed during oxygen administration. Specific aids are used for oxygen administration, particularly oxygen masks or oxygen goggles. Quality pulmonary rehabilitation is also necessary to make oxygen therapy more effective. Pulmonary rehabilitation is particularly important for patients after a cardiac surgery and it should be practiced even before the surgery. This approach is critical because in the post-surgery period the therapy makes it possible for the patient to breathe and to expectorate properly. Pulmonary rehabilitation is practiced with patients by general nurses at the cardio surgery ward, as well as by physiotherapists. There are various techniques available to determine efficiency of oxygen therapy and pulmonary rehabilitation. The techniques may be classified as invasive and non-invasive; the most frequently used non-invasive method is pulse oxymetry and the most frequently used invasive technique is blood collection for ABR. Two objectives were set for the thesis. The first objective was to map knowledge of nurses about how to provide care to patients treated with oxygen therapy. The second objective was to determine how the patients feel after a cardiac surgery. Two hypotheses and two research questions were formulated. The first hypotheses were: Nurses working at the resuscitation care station have more knowledge about oxygen therapy than nurses working at the intermediate care station. The second hypothesis was: Nurses working at the resuscitation care station have more knowledge about pulmonary rehabilitation than nurses working at the intermediate care station. The first research question was: How do the patients feel during oxygen therapy and pulmonary rehabilitation? The second research question was: How are the patients after a cardiac surgery informed about oxygen therapy and pulmonary rehabilitation? In the research part of the bachelor thesis I have used both quantitative and qualitative research methods. Quantitative processing of data was used for questionnaires filled out by nurses working in the hospitals Nemocnice České Budějovice a.s., Nemocnice na Homolce in Prague and in the faculty hospital Královské Vinohrady in Prague. The method was used for evaluation and assessment of knowledge of nurses working at the resuscitation and intermediate care wards. Quantitative methods were used for processing of data obtained through semi-structured interviews with patients after a cardiac surgery. The data were transcribed and coded using a pencil and paper method. The data were categorized based on the identified codes. Two categories were created: oxygen therapy and pulmonary rehabilitation. Each of the categories was further divided into three sub-categories. Two categories were created for the research oxygen therapy and pulmonary therapy. Three sub-categories were subsequently created for the oxygen therapy and the pulmonary therapy. The quantitative research has shown that the knowledge of nurses about oxygen therapy is higher among the nurses working at the resuscitation care ward. However, the situation is different in case of their knowledge about pulmonary rehabilitation. In this case the knowledge of nurses working at the intermediate care ward was higher. The processed data from the qualitative research have shown that patients do have sufficient information about post-surgery oxygen therapy, as well as about pulmonary rehabilitation. For all patients in the post-surgery period after a cardiac surgery the frequency of pulmonary rehabilitation was higher than 1 per day.
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Sepsis in intensive care, precautionary measures on the part of nursing personnel and department management
JANOUŠKOVÁ, Ludmila
Sepsis represents a serious medical, but also social problem. Hundreds of thousands of patients die from serious sepsis and septic shock every year. Patients with serious sepsis are treated at intensive care units and their treatment is long, costly and low efficient. These are the reasons why prevention of sepsis focused on prevention and effective treatment of nosocomial infections or timely solution of another problem, e.g. a shock is so much stressed. Nosocomial infections affect about 30 per cent of patients at intensive care units and may cause serious diseases, sepsis or even death. This thesis deals with the possibilities nurses have to influence sepsis, particularly by adherence to aseptic procedures and prevention of nosocomial infection, which might consequently develop in nosocomial sepsis. Combination of quantitative and qualitative methods was used for the research. There were two goals set for the quantitative research. 1. To find whether obstacles occur in adherence to proper aseptic procedures in nursing work as prevention of nosocomial infection occurrence and subsequent septic conditions in patients hospitalized at intensive medicine workplaces. 2. To map the weak points in adherence to proper aseptic procedures in nursing work in intensive care. The goals led to hypotheses H1 Obstacles obstructing thorough adherence to proper aseptic procedures in nursing work exist in intensive care. H2 Non-adherence to aseptic procedures occurs in nursing work at intensive medicine workplaces as a consequence of lack of time for particular interventions. The research sample consisted of nurses from the intensive care workplaces ARD and ICU from 8 hospitals. Questioning method through the questionnaire technique was used for data collection. 342 questionnaires were distributed in total. Hypothesis 1 was refuted, hypothesis 2 was refuted. We found that no obstacles obstructing adherence to proper aseptic methods occur, we mapped the weak points in adherence to proper aseptic procedures in nursing work in intensive care. There were two goals set for the qualitative research. GOAL 3 To find what measures preventing occurrence of nosocomial infection and subsequent septic conditions in patients hospitalized at intensive medicine workplaces are taken by department managements. GOAL 4 To find out how department management deals with possible occurrence of nosocomial infection and subsequent septic conditions in patients hospitalized at intensive medicine workplaces. The following research questions were set. 1. What are the measures preventing occurrence of nosocomial infection and subsequent septic conditions in patients hospitalized at intensive medicine workplaces taken by department managements? 2. How does department management solve possible occurrence of nosocomial infection and subsequent septic conditions in patients hospitalized at intensive medicine workplaces? The research sample consisted of 5 departmental nurses and 5 head nurses from intensive care workplaces from the same hospitals where the quantitative research took place. The research was performed by semi-standardized interview. The research questions were answered. A manual for nurses called ?Recommendation for nurses in prevention of nosocomial infection and nosocomial sepsis not only at intensive care units? was elaborated upon study of these issues and the performed research. A thought map for department management illustrating prevention and solution of nosocomial infection and nosocomial sepsis was also elaborated. Both the document and the research results will be provided particularly to the managements of the hospitals that took part in our research. The thesis may also be helpful to nurses, students and other interested people to gain overall insight into the issue.
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A historical view of the army nurse profession.
PAVLÍKOVÁ, Andrea
The thesis deals with the profession of a military nurse. We can assert that the official study of military, non-medical health-care related qualifications and its use in practice not only for military purposes dates back to the fifties of the last century. However, women as health care professionals, consequently in uniforms, have always been an actual issue. The development of health care activities always existed, however, we must not neglect influence of scientific and medical findings. The historical timeline of development of medical care in the battle field was recorded and ranges from pre-historical healing. The way of Christian medicine was negatively influenced by the Catholic Church. The dark period of the Middle Ages had actually wrested medical performance from the hands of specialists and the suffering were left to the "tender" mercies of the priests. The following part of the thesis concerns modern medicine where enlightenment reforms were exercised. Some of the original six-month courses for military surgeons were organised in this period of time; they weretransformed into Military Surgical Academy, out of which the famous Josefinum originated. A expression of humanity which supported a form of health care of war veterans was demonstrated by constructing buildings for invalid people. The second half of the nineteenth century is characterized by the phenomenon of the presence of nuns in military hospitals. This study goes further in depth of professionally organized healthcare right in the battle field, which dates back from the era of wars in the Crimea.This stage describes the transformation of caring into nursing which requires the necessity of specialized preparation of persons providing nursing practice. In addition, Henry Dunant engraved himself into the history of the profession of a nurse, as the founder of the Red Cross, who first trained health care professionals for working within armed intentions of the state. The continuation of this action sketches out the process of providing first aid in principal armed conflicts of the twentieth century. It describes the functioning of commander operated military health service of that time. WWI drove Czech medical staff to both sides of the front where they provided medical help to the injured. Nurses of the WWII already performed their duties in uniforms as the rightful members of the army. The thesis also mentions post-war usage of military health care professionals in secret foreign missions and their specialized erudition.Last but not least, it marginally discusses contemporary possibilities of modern health care service of the Army of the Czech Republic. The goal of the endeavours of writing this thesis was to chart out clearly the development of the profession of a military nurse within the historical context, focusing mainly on women coming from Czech regions. In order to make the history background concerning specific female participants of the world war conflicts understandable to the reader, this paper reports, in broader extension, peculiar medical and nursing findings, already from the era of prehistoric civilisations. The history study method were applied for the purpose of the theoretical thesis. The methodology is based on searching, studying, sorting and the consecutive systematic objective describing of the events from the past times with the intention to propose comprehensive report on the subject given. It was necessary to study inexhaustible amount of sources to obtain awareness of historical connections. Factual information was derived by analysing of primary and mainly secondary documents. The thesis sketches out histories of military health care and the profession of a military health care professional stemmed from the exploration of appropriate written sources and conclusion of the basic findings. The intentions of the work are not only to clarify the past but also to contribute to solutions of every-day issues.
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Role of the nurse in screening for depression in the elderly.
VRZALOVÁ, Monika
The diploma thesis deals with problems of depression in older people. Mainly the work is focused on identifying and analyzing the role of nurses in screening for depression in older people in primary care, acute care, long-term care and home care. This thesis was focused on theoretical direction and was used the method of design and demonstration. In this thesis was set one main goals with five research questions. The main goal was to identify and analyze the role of nurses in screening for depression in the elderly. RQ 1: What is the role of the nurse in screening for depression in the elderly? RQ 2: What is the role of the nurse in the primary care in screening for depression in the elderly? RQ 3: What is the role of the nurse in screening for depression in hospitalized patients in acute care? RQ 4: What is the role of the nurse in screening for depression in seniors in long-term and home care? RQ 5: What rating scales and methods are used in screening for depression in the elderly? The thesis introduce the concept of depression. The following are specified the causes of and the important factors that affect depression in the elderly. It also deals the differences in the clinical symptomatology of depression in old age. It explains possibilities and various barriers in the diagnosis of depression. Another chapter introduces complete geriatric examination, diagnostic classification systems, possible screening methods and scales for detection of depression in the elderly population. It also deals methods of pharmacological and non-pharmacological treatment and its possible complications associated with older age. By reason of increased suicide rate caused by depressive disorder the issue of suicidal behavior in the elderly is introduced. The next chapter deals with the nursing process, which is used by nurses in practice. It consists of the evaluation of the patient's health condition, making nursing diagnosis, creating nursing plan and subsequent implementation and evaluation. The nursing process is also needy for providing quality care. The nursing process in the stage of nursing diagnosis, introduces possible nursing diagnosis for a patient suffering from depression, which are based on the latest classification. Finally is described the role of nurses in screening for depression in the elderly in different health facilities and their contribution to the timely evaluation of depression in the elderly. This chapter introduces the role of nurses, nursing screening and collaboration with a physician. The role of nurses in screening for depression in different medical facilities is based on the first phase of the nursing process of assessment. On the basis of objective and subjective information, the nurse will assess the overall health and mental condition of the patient. Primarily, it was investigated what is the role of the nurse in screening for depression. On the basis of content analysis and synthesis it was necessary to used and processed domestic and foreign literature. A number of relevant sources are the results of various studies and Meta-analyzes, mostly from abroad, but also from the Czech Republic. The thesis can serve as a basis for nurses. The result of this thesis is to create e-learning material available for students in the Faculty of Health and Social Sciences of South Bohemia in Ceske Budejovice in the tutorial called Moodle.
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Coping strategies in children´s fear and pain in relation to nursing care
PROCHÁZKOVÁ, Zuzana
For the nurse, taking care of hospitalized children is important not only pediatric nursing knowledge, personal and social preconditions, but also the theoretical and practical competency of methods and techniques, which are used for identification and effective influencing of pain and fear. The aim of this thesis was to identify the main sources of fear of the hospitalized preschool and young school age children and to find out the effective methods and principles of the cooperation with children, alternatively with their accompanying parents in order to moderate the fear of the small patient. Then the thesis tried to chart the nursing diagnostic and evaluation procedure of the pain and get the most used nursing methods of non-pharmacological pain relief. To obtain the necessary data, the qualitative research was used with a semi-structured interview as a research instrument. The first research group consisted of 12 nurses, the second group consisted of 12 children ´s patients of preschool and young school age. The majority of the asked nurses thinks, that children´s patients are afraid especially of non-familiar environment, then of the awaited pain and of the solitude without parents. However, the most patients said, that they were afraid especially of pain, then of non-familiar environment, restriction of their needs, hostile attitude of the medical staff and of the other neighbouring patients. They were also frightened of the death and of the darkness. Most reported nurses mean, that the most effective solution of the children ´s fear is the friendly attitude of the medics. They also mentioned the fact of taking the focus off the fear and the presence of the parents is also beneficial. The nurses ´ answers were in conformity with patients opinion in two fields - friendly attitude of the medics and taking the focus off the fear. Then the children mentioned abiding of their specifics in connection to falling asleep and the demand of beying treated by the same sister or by few same sisters. All respondents also talked about the benefit of parents presence. Regarding the principles of the cooperation, nurses answered the importance of united medical procedures, especially the proper way of information transfer. Then the respondents nurses mentioned the psychical and emotional support for children and their accompaniments, the atmosphere of confidence and the value of well done education. Also the need of calm, silence and privacy was stated. Unlike nurses, children and their parents regarding to principles of the cooperation prefer the psychical and emotional support, then the importance of enough information was mentioned. The fourth research question bears on the methods used for children pain monitoring. The nurses said, that the intentional interview with the patients or with the parents was used as a main technique, that was stated by patients as well. Research question number five said: What are the most used nursing methods of non-pharmacological pain relief at children? Most responded nurses mentioned the distraction of children attention from the painful incentive, then the importance of physical methods, relief position and purposeful preparation for the unpleasant intervention. Nurses also named the helpful contribution of the parents, relaxing exercises and the method of imagination. Regarding the pain treatment, it was noted, that all patients prefered the analgesic therapy. Then they quoted the distraction of their attention from the painful incentive, the friendly attitude of the medics, using the ice compress and the relief position. In the pain acute phase, children required mostly calm, comfort and privacy. All children also considered the presence of parents as very helpful. The theoretical and empirical part of the thesis are suitable for being studied by nurses taking care of children and it can be helpful for nursing quality improvement at children ´s wards in hospitals.
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Gluten-free diet - reality in school facilities
JIRÁČKOVÁ, Marie
The topic of this bachelor thesis is gluten-free diet - reality in schools facilities. The goal of this work was to determine the number of school cafeterias in the Vysocina Region which provide gluten-free meals, to evaluate awareness of the canteen staff about preparation of the gluten-free diet and to describe the cooperation between the school cafeteria and family of the pupil with gluten-free diet. School meals are important to provide optimal intake of nutrition during the time the child spends in school, to establish proper eating habits and to better integrate the child into the group of its peers. Gluten-free diet is a necessary medical precaution especially for those with coeliac disease, in which case gluten can lead to villous atrophy, and for those with gluten allergy for whom gluten intake can cause anaphylactic shock. Adherence to the gluten-free diet is recommended also to those with non-coeliac gluten sensitivity diagnosis, although gluten causes only short-term complications, usually intestinal. The method of quantitative and qualitative research was used to make this thesis. The research sample consisted of 8 school cafeterias from the Vysocina Region which provide gluten-free meal to their pupils. Awareness about gluten-free diet principles of the managers of the cafeterias or of the cooks responsible for preparation of gluten-free meal was determined by means of semi-structured interviews. The calculation of the two-day menu of each cafeteria by means of the Nutriservis Profesional program was also part of this thesis. The results were compared with the recommended daily intake of energy, proteins, fat, and saccharides for pupils of elementary and secondary schools. The results of the quantitative research show that gluten-free diet is provided by only a small percentage of school cafeterias in the Vysocina Region. The qualitative research prove sufficient awareness of the cooks about gluten-free diet, with awareness of those cooks directly responsible for preparation of gluten free meals being at much higher level. It was also determined that the cooperation with parents of pupils with gluten-free diet is a usually one time occasion limited to an arrangement of nonperishable gluten free meal packages.
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Role of physical activity in the prevention of childhood obesity
VRTALOVÁ, Jana
The thesis deals with physical activity in the prevention of childhood obesity. It is focused on children, namely pupils of the eighth and ninith grades of elementary school. Obesity is responsible for more human lives than both of the world wars and if we want this epidemic of obesity and problems associated with inactivity minimized, we have to start where it is most efficient and that is with children. The main objective is to explore physical activity in a selected group of pupils. Partial aim is to determine the prevalence of overweight and obesity in the investigated group of students using somatometric measurements in the selected location. Another objective is to determine how many of childrens parents did sports in the past or actualy do sports. The final goal is to prepare educational material for students about the importance of physical activity. The work is divided into two parts theoretical and practical. The theoretical part was compiled as a secondary data analysis. Sources of data and information originated from the Czech Republic and abroad in the form of scholarly books, journals and electronic resources. The contents of the theoretical part is focused on explenation of terms such as obesity, its consequences, complications, ways to prevent obesity, physical activity, appropriate kinds of physical activity and its effects on the human body. Distinctive part is the chapter dealing with the myths of obesity some of them are really surprising. The second part is practical part and includes its own research. The investigation was conducted in a primary school Komenského alej in Žatec for pupils of the eighth and ninth grades. File featured 107 pupils. The research was conducted as a quantitative survey complemented by measurements of somatometric indicators. The data were collected using a custom non-standardized questionnaire. The questionnaire contained 14 questions and two columns separated by line for recording the exact weight and height. We checked these data at pre-agreed periods.
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