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Previously expressed wishes of the patient from the point of view of pre-hospital care
OBŮRKOVÁ, Kateřina
The bachelor thesis entitled Previously Expressed Wishes from the perspective of pre-hospital care consists of two parts, a theoretical and a practical part. Three thesis objectives were chosen for the topic. The first objective was to find out the awareness of paramedics about the issue of Previously Expressed Wishes. The second objective was to find out the ethical perspective of paramedics on the issue of Previously Expressed Wishes. The third aim was to map the number of cases where a paramedic encounters a patient who has written down a Previously Expressed Wish in pre-hospital care. Based on the previous objectives, three research questions were subsequently established. The first research question focuses on the depth to which paramedics are aware of the issue of the Previously Expressed Wishes. The second question explores the paramedic's ethical perspective on the issue. Whether the predominant view is positive or rather negative. The third research question ascertains the amount of occurrence of patients in pre-hospital care. Whether one is more likely to encounter such a patient in hospital or pre-hospital care. In the theoretical part, concepts related to the issue of Previously Expressed Wishes are explained. The theoretical part deals with ethics, pre-hospital care, paramedic codes and the actual Previously Expressed Wish. The practical part of the study was prepared in the form of quantitative and qualitative research. In the quantitative research, responses were obtained through an online questionnaire. The questionnaire contained twenty closed questions and only one open question. The last open question included a request to leave a contact and a follow-up interview to enable qualitative research. Ten respondents participated in the qualitative research. The data collected was very positive. Many respondents knew a great deal of information regarding the issue of Previously Expressed Wishes. The prevailing attitude was positive. The whole research was conducted at the regional centres of the Vysočina region. The bachelor thesis can serve to provide insight and greater understanding of the concept of Earlier Expressed Wishes. Nowadays, the issue is not abundant in pre-hospital care, but over time things may change.
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Point-of-care tests and ultrasonography in pre-hospital care and on the emergency department
SÝKOROVÁ, Barbora
This bachelor thesis thoroughly explores how healthcare professionals perceive the utilization of point-of-care tests (POCT) and ultrasound in pre-hospital care andon the emergency department. The aim is to understand their attitudes and opinions on the practicality, reliability, and effectiveness of these diagnostic methods in both areas of care. Additionally, it focuses on gaining a deeper understanding of their experiences and evaluations to contribute to optimizing the provision of care outside hospital settings and in acute situations. The theoretical part of the thesis provides detailed descriptions of individual point- of-care testing analyzers, their specific advantages and disadvantages. For interest, the historical development of these bedside monitors is also mentioned. The theoretical part does not omit point-of-care ultrasound, which is focused on its direct application in practice. The research investigation of the thesis is dedicated to qualitative research based on semi-structured interviews with professionals working in the field care (Emergency Medical Services, Air Ambulance Services) and in the Emergency Department. From each area, there is at least one representative who is a physician, and the other is a nurse or a paramedic. The course of the interviews included 14 open-ended questions, which were divided into two categories. The first category contained 4 questions regarding the dentification details of the respondents such as workplace, job position, level of education and length of practice. The second category included 10 questions focused on the respondents' attitudes towards the use of POCT and POCUS in their daily practice. We are interested in their actual use in situations where rapid and accurate diagnosis is crucial for providing healthcare.
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Pre-hospital and intensive care for patients after a stroke
KULHAVÝ, Jakub
The thesis is divided into two main parts (theoretical and empirical) and deals with prehospital and intensive care for patients with stroke. The thesis has a total of three objectives. The first objective was to map selected aspects of the process of providing prehospital emergency care to patients suspected of having an acute stroke. The second objective was to describe the course of intensive nursing care for patients after a stroke, and the third objective was to determine the differences in nursing care between patients with ischemic stroke and hemorrhagic stroke. The empirical part focused on studying medical and, primarily, nursing documentation. The obtained data were processed using a quantitative research method based on retrospective data analysis, which was then interpreted. The data was recorded in record sheets created specifically to adhere to the predetermined objectives and hypotheses. The contribution of the thesis is primarily its unusual approach to the issue, addressing at the same time both prehospital and intensive care for patients after both ischemic and hemorrhagic strokes. The results indicate that crucial aspects of prehospital care include correct and rapid diagnosis, assessment of vital functions, consultation of the condition of a patient with a stroke physician and rapid transportation to the nearest appropriate medical facility. The course of intensive care focuses primarily on continuous monitoring of vital functions and their potential stabilization combined with comprehensive nursing care, which depends on the level of self-sufficiency of a patient and includes all care for basic human needs, primarily aimed at restoring the patient's ability to manage basic daily activities. In summary, it could be said that patients with hemorrhagic stroke required more demanding and comprehensive nursing care compared to patients with ischemic stroke.
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Evaluation of ECG in prehospital care
GROSSMANN, Matyáš
This bachelor thesis deals with the issue of ECG evaluations in pre-hospital emergency care by a paramedic. The thesis is divided into two parts, theoretical and practical. The theoretical part focuses on the definition of a paramedic and his/her competencies, instrumentation, and anatomy of the cardiac conduction system. Furthermore, it describes the methods of ECG evaluations, types of arrhythmias and their treatment in pre-hospital emergency care. The major objective of the thesis was to map the ability of paramedics to interpret the waveforms of ECG recordings. The practical part of the bachelor thesis was based on a quantitative research investigation carried out in the form of non-standardized questionnaires. The research sample consisted of 51 paramedics from the Region of South Bohemia. The research took place from March to April 2023, with the participation in it being entirely voluntary. The collected data were subsequently analysed and compiled into graphs, which were completed with a commentary. The knowledge in interpretation of ECG waveforms was mapped by a series of 24 questions in which the respondents could obtain a total of 35 points. The high knowledge of the respondents is demonstrated by the fact that three quarters of the respondents achieved 80 percent or more correct answers. Two hypotheses were determined in the research part. The first hypothesis suggested that the knowledge in interpreting ECG waveforms is affected by the length of experience. The respondents working in emergency medical services for 0-3 years had the highest score (median 93%). However, the result of the Kruskal-Waliss test revealed no statistically significant difference between the four groups compared (p = 0.51). The second hypothesis assumed that the knowledge in interpreting ECG waveforms is influenced by the type of previous workplace. The respondents who had worked in the accident and emergency department before joining the emergency medical service were the most proficient in ECG assessment and interpretation (median 96%). Here again, the Kruskal-Wallis test revealed no statistically significant difference between the four groups compared (p = 0.31). The obtained results can provide useful information for the possible implementation of an educational seminar for paramedics.
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Communication of paramedic with patients with panic attack and anxiety in the prehospital care
KLEINOVÁ, Elena
Departures for anxious patients and patients having a panic attack are a relatively common case when it comes to prehospital care. Correct attitude and communication style are crucial for primary care and stabilization of such a patient. The theoretical part of this work is dedicated to the issue of states of anxiety and panic attacks, their symptoms, causes of emergence and ways of possible intervention in premedical care. It further covers communication with a patient and psychological intervention. The aim of this work was to find out about the awareness of paramedics concerning panic attacks and states of anxiety, how do they perceive those patients, how do they gain knowledge and skills in the area of communication with anxious and panic patients and how do they use these in action. Looked into were also the methods, with which paramedics achieve psychological stabilization of the patient, how do they handle such cases and how do the patients react to this. There was also an emphasis on communication and its influence on the patient. Research was done qualitatively in a form of semi-structured interviews, which were conducted with paramedics of the South Bohemia and Karlovy Vary regions. Set goals were fulfilled by the research. It has been shown that each of these case sis very individual, for this reason it was often difficult for the paramedics to form their answers to be generally valid. When it comes to knowledge and handling the situations alone, the paramedics draw on their own experiences, because their awareness in this area has shown itself to be very superficial. Despite this, their practical and communication skills are on a very good level. I firmly hope that both the theoretical and practical information contained in this work will find their use and will eventually serve the paramedics or anyone else, to whom it may be useful in any way, either to gain information or practical use. I believe, that modern technological possibilities, such as programs offering practical methods for effective providing of first psychological aid, will find their use even in the field of premedical care.
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Death and palliative care in pre-hospital care
NOVOTNÝ, Jan
The bachelor thesis entitled Death and Palliative Care in Pre-hospital Care reports on the interaction of death per se, but also deaths of patients in the care of paramedics. Furthermore, the thesis intersects the medical field called palliative care, which serves as an important agent in the care of patients in the terminal phase of their existence. The subject of death is a entirely timeless topic that has been, is, and always will be with us. Four research objectives were defined: namely to find out the attitude of the paramedic towards the dying of patients in pre-hospital care, to find out how paramedics cope with deaths of patients in pre-hospital care, to find out what communication techniques are used by paramedics with dying patients and their relatives or with bystanders in pre-hospital care and the last research objective was to find out what knowledge paramedics have in palliative care during pre-hospital care. The first, theoretical part deals with the perception of death from the Middle Ages to the present, the discipline of Thanatology and its subgroups. The chapter touches on euthanasia and describes communication, palliative care and its specifics. The second, practical part used qualitative research by conducting semi-structured interviews to gather in-depth data. The interview was conducted with paramedics belonging to the regional centre of Jindřichův Hradec. With the help of open coding and subsequent categorization, the data was analyzed and interpreted using the "show one's cards" technique. According to the analysis, all paramedics perceived death as an inevitable, natural fact, with this group divided by the fact of armouring themselves over their practice. Another finding projected the validity of debriefing as an appropriate factor after a mentally challenging ambulance despatch. Regarding communication, paramedics were not sure about the suitability of the methods used, which stems from the absence of the seminars in question. Awareness of the term palliative care was generally sufficient, but insufficient for the subsequent specification of the therapy. There has been an inconvenience in working with mobile hospice care, or pain alleviation, which is not officially defined and operates on a referral basis.
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Behavioral problems of a patient in a pre-hospital care.
DUŠKOVÁ, Petra
The Bachelor thesis concerns problematic behaviour of patients in pre-hospital care, the paramedics in South Bohemian region were questioned. The theoretical part describes different types of causes and expressions of problematic communication. In detail it concerns alcohol and addictive substances, which are the main cause of aggressive behaviour. The theoretical part also presents a legislative support which regards the paramedics´ work. The practical part ascertains how many paramedics have dealt with patients´ problematic behaviour in pre-hospital care, or more precisely with an aggressive behaviour. The paramedics were questioned whether they have felt prepared for this kind of behaviour, whether they would like to gain a further education in this particular area and whether they have felt a sufficient support in legislation.
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Measuring body temperature in pre-hospital care
DEJMEK, Michal
The thesis deals with the problematic of measurement of body temperature in the prehospital emergency care. The theoretical part focuses on the physiology of thermoregulation, on the generation of heat in the body, on its expenditure and on the control of body temperature. Furthermore, it deals with measurement of body temperature, its classification, places for measurement and description of the individual types of thermometers. The conclusion of the thesis is focused on the pathological conditions connected with the body temperature, which we can meet with in prehospital emergency care. The individual conditions are analyzed from pathophysiology to treatment. The empiric part is divided into two parts. In the first part, two thermometers are compared, how they differ in measured values and further, the results are statistically compared. The research sample was made up of random patients in prehospital emergency care. In the second part of the research, the method of qualitative research based on semi-structured interviews was used. The first objective was to find out which options of body temperature measurement do paramedics have in ambulances. The second objective was to map the experience of paramedics with monitoring of body temperature in the prehospital emergency care. The research sample was made up of 5 professional paramedics from the South Bohemian Region and Vysočina Region. The results were categorized into 13 categories. From the results of the research is apparent that there is a significant statistical difference between the used thermometers, which differ from each other in measured values. The second part of the research shows that paramedics consider the current state to be insufficient for the reason that they do not have thermometer with a larger temperature range available. All respondents agreed they would welcome having a thermometer with a larger temperature range in their ambulances.
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Use of capnometry in emergency care
CIMICKÝ, Vít
The first half of the theoretical part of the work is focused on the physiology of respiration and the effect of carbon dioxide in the human body. The second half of the theoretical part focuses on defining the concept of capnometry, how it is measured and also on the states in which it is used. For specific conditions, it is described why it is used and what limitations it has. The practical part consists of the survey and the results that came from it. The survey was conducted through a semi-structured interview containing eleven questions. Six non-medical health professionals, who represent various positions at the Medical Rescue Service of the South Bohemian Region, joined the interview in April 2022. The aim of the research was to map the frequency and regularity of the use of capnometry in prehospital emergency care. The research answered all the researched questions. Objectively, the goal of the work was only partially fulfilled, based on a small amount of data obtained. However, these data are very similar and supported by recurring arguments. The analysis of the results showed a low frequency and a high rate of irregular use of capnometry in prehospital care. The main reason is the low and irregular occurrence of conditions requiring capnometry measurements.
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The first treatment of a newborn after delivery in pre-hospital care
KOFROŇOVÁ, Erika
The bachelor's thesis discusses the treatment of a newborn after birth in pre-hospital care. In order to elaborate the bachelor's thesis, four objectives were defined. The first objective was to find out how paramedics prepare themselves for taking care of the newborn. The second objective was to record how they handle the situationS psychologically when it comes to the newborn care at fieldwork itself. Furthermore, the third objective ascertained the procedure of the newborn treatment by paramedics in pre-hospital care. Last but not least, the fourth objective was to explore the procedure of a premature newborn treatment. Four research questions were chosen for the research part of the thesis. The first research question dealt with how paramedics prepare themselves for taking care of newborns. The second research question carried out how stressful treating a newborn is for paramedics. The third research question examined the process of treating a newborn. The last research question discusses the treatment procedure in case of the premature newborn. This work highlights the importance of education and implementation of the defined procedure of the newborn treatment in pre-hospital care, as well as the implementation of the most essential interventions which leads to the correct adaptation of the newborn to the new environment. The bachelor's thesis is divided into a theoretical and a practical part. The theoretical part is divided into five main chapters. The first chapter deals with the legal definition of the emergency medical treatment services, pre-hospital emergency care and the profession of a paramedic itself. The competences of a paramedic as well as further educational possibilities are discussed here. In the second chapter, the issue of the childbirth is introduced alongside the labour process itself, its classification, and particular stages. It is complemented by the process of the childbirth and the treatment of the newborn in a health facility as well. The third chapter deals with the childbirth in pre-hospital care. The fourth chapter discusses the various complications that can arise during the birth. The last one describes the care of the pathological newborn and the process of a resuscitation. In the second part of the thesis a qualitative research was applied. The research sample consisted of 8 paramedics who had encountered a newborn after the birth at least once.
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