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A survey of attendance care for high-risk patients and patients with decubitus in choice facilities in the Czech Republic and in the Federal Republic of Germany
LANGOVÁ, Petra
Current situation: Even at the present time of the 21st century, decubitus is still considered to be a serious health complication which attacks all age groups of patients and reduce their quality of life (Boughen, 2012). Aims: The main aim of the research was to find out if the nursing treatment of patients who are at risk of pressure ulcer development or patients suffering bedsores in the Czech Republic is comparable to the treatment provided to similarly ill patients in Germany. Procedure: In order to find out necessary data, the quantitative research method was selected, during which an anonymous questionnaire both in Czech and German languages was issued and consequently submitted to general stuff nurses working at standard hospital departments. Research area: During the research survey, the general stuff nurses working in internal, surgery and rehabilitation departments in three Czech hospitals and two German hospitals. Results: The survey results showed that in the Czech Republic the Norton Scale for predicting the pressure ulcer risk is used most often, while in Germany the Braden Scale is most frequent method. The respondents, however, are equally convinced that regular inspections of skin as well as active searching for causation factors are far more suitable and helpful. Moreover, the survey revealed that the German colleagues determine the risk of developing bedsores by using the scale more frequently compared to the nurses in the Czech Republic. Significant differences in statistics were obvious in the frequency of the individual treatment interventions, especially in the areas of turning and repositioning the patient according to Bobath concept, self-dependence training, the skin assessment, as well as in the area of education. The research results showed the fact that Czech nurses statistically far more often use antiducubitus tools and materials, which are considered unsuitable or are not recommended by foreign guidelines. It was as well obvious from the research survey that the Czech nurses use compensational tools and devices when treating their patients more often compared to German hospitals. The survey results further showed that the choice of local therapeutic material used in particular working places vary considerably. While there is a more numerous utilization of materials containing silver and Tender Wet hydro-active super absorb cushions in the Czech Republic, stuff nurses in Germany prefer transparent polyurethane covers, secondary absorbing covers and polyurethane foams. Conclusions and suggestions for the practice: As far as the material availability is concerned, we are still far behind the advanced countries. However, we excel in quality as well as in the professional qualification of the nursing stuff. Prevention measures in the area of pressure ulcers are on the same level. Suggested changes and recommendations are: Suitable choice of the equipment, tools and devices. Immediately start with the self-dependence training within the rehabilitation treatment exercises and to use suitable compensational aids and utilities. It is as well advisable to create an individual body movement plan. To engage the whole multi-discipline team in the treating process for the patient. To educate the patient correctly. To ensure precise treatment documentation. Not to focus only on the assessment scale for prediction pressure ulcer risk but to carry out regular inspections of skin and search for the causation factors actively. To carry out the fading hyperaemia test in practice. Not to confuse sitting in a wheelchair and mobilisation. Verify and legalise the recommended procedures with the support of audits on pressure ulcer prevention and treatment.
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The awareness of primary care nurses about wet healing wounds
SEDLÁKOVÁ, Dana
The method of wet healing wounds is one of the most modern way how to take care of long term cureless wounds. In the past nurses nad doctors were use to heal chronic woulds with help of dry dressings, but today we have many possibilities how to improve the quality of nursing care. The application of moist healing is highly efficient for both sides. Pacients donť have to suffer from pain for long time, re-bandages are much less hurtfull. One of the biggest advantages is that the manipulation with this modern material is so easy, that pacient is able to make re-bandage on his own. Most modern wound dressings are designed to optimize a moist wound environment and have become very good at this task. The wound fluid contains many growth factors and nutrients that assist in the proper healing of superficial wounds. Wounds that are kept moist have fewer pathogenic bacteria than overwet wounds The method of wet wound healing is helpful for pacients who suffer from chronic, open, nonhealing wounds. The work with title The Awareness of Primary Care Nurses about Wet Healing Wounds is splitted into two parts. The theoretic part of the bachelor work tries to include the complex theme of wound healing, with a view to way to advantagases of wet wound healing. Some parts of these work also discuss the awarness of primary care nurses, the cooperation between nurses and patients and the area of primary care. Results of nursing research are compiled in the experimental part of work. In the course of the research was used the quantitative method of collecting data with the technique of list of questions. The nurses which were asked to fill the questionary were from west of our country, concretely from Cheb, concretely from Cheb, Sokolov and Karlovy Vary. The research was made in offices of practicals doctors for adults and for children, on surgical units, by the dermatologist ambulances and in the home care centres. In connection with task of the bachelor work four targets were set together with five hypotheses to perminent confirmation or negation. The autoress tryed to find out if nurses who are working in primary care area have some knowledges about moist healing of wounds and if they are able to apply these knowledges in their profession. In conclusin there are the most important facts, which were ascertained and proposal on possible solution. The autoress thinks, that bachelor work could serve as an informative material for nurses and for students and at the same time could be also used as a motivation for nurses who want to provide the best care for patients at the same time.
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Use of modern methods in treatment of chronic wounds
LEPIČOVÁ, Zuzana
Healing and treatment for chronic wounds are big problems and they affect overall states and fate of patients who are immobile after heavy injuries in consequence of some diseases or because of penetrating wounds. Prevention and treatment flowing from profound knowledge of anatomy, skin physiology, pathology and patho-physiology of defects origins and of healing process is currently taking a big step forward in treatment for refractory wounds. The thesis is divided into two parts. The theoretical part deals with skin anatomy and physiology, pathology and patho-physiology of origins of defects, healing processes and proper treatments of wounds, especially chronic wounds such as ``diabetic foot syndrome{\crqq}, venous and arterial ulcerations and decubital ulcers. Preventative measures against decubital ulcers are described. Documentation of refractory wounds, 3 phases of healing and continuum of healing are described in detail. Re-bandages, the local wound care, are the most significant factor of treatment. Re-bandages follow standard procedures, which involve make-ready of patients, preparations of wounds for re-bandages, preparations of instruments and make-ready of attending staff. Good re-bandage assistance is crucial. Modern treatment methods include various new types of wound cleanup (from the mechanical one, chemical one and autolysis to the enzymatic one, with the use of larva therapy, for example) as well as the usage of very effective ``moist healing{\crqq} methods. Various contact - not adhesive bandages, foams, alginates, hydro gels, antiseptic bandages, dressings with active Carbon, hydrocolloids, hydro adherent dressings, hydro fibres, bandages with active AG ions, chitosin, dressings with hyaluronic acid, collagen bandages, dressings with iodine, mupirocin, or honey. The practical part is dedicated to qualitative research, in a way of non standardised interview. There were two thesis objectives: To map the usage of modern treatments for refractory wounds and to enlighten general nurses in this field. 15 nurses, who deal with chronic wounds, from various emergency wards and hospital wards took part in the interviews. Information was collected from February 2010 to April 2010 and it was elaborated into 15 casuistries. The result of analysed answers was digested into a table. In the Discussion I analysed the particular answers and set 3 hypotheses for each domain. Domain 1: H1: Modern treatments for healing of wounds are not systematically used at most units. H2: Monolithic systems for usage and indication of modern methods do not exist at most units. H3: Statistics of chronic wounds existence is not kept at many units. Domain 2: H1: Trainings are organised by medical facilities in collaboration with distributing companies but their capacities do not satisfy the interest of applicants. H2: Most nurses declare good knowledge of chronic wound healing phases and of continuum of healing. H3: Neither managers of medical facilities nor health insurance companies have sufficient knowledge regarding the ``cost {--} benefit{\crqq} of chronic wound treatments. The Conclusion summarise the whole thesis. The importance of follow up treatment and rehabilitation for subsequent fate of afflicted patients and their families is underlined in this part.
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