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Nursing care management for orthopedic outpatient clients from the nurse's point of view.
VOPÁLKOVÁ, Milena
In view of the fact that clients with locomotor system difficulties (who often have impaired mobility, are in pain and have difficulties finding their way in a new environment and situation) come to the orthopaedic outpatient department, we consider it worthwhile to look at the comprehensive nursing care of these clients. The task of the healthcare personnel at this moment is to provide support, assurance and safety to the client and his family, and to allow him to gain sufficient information, skills and habits to restore and maintain his health. A total of three goals were laid out in this thesis. Our first goal was to map out the features specific to the management of nursing care for clients of the orthopaedic outpatient department from the nurse's aspect. The other two designated goals concerned elucidation of the means for detecting and dealing with nursing care problems and needs of clients of the orthopaedic outpatient department. Qualitative and quantitative research methods were used in order to meet the goals of this thesis. In the qualitative research investigation there was a semi-structured interview with five informants who work in selected orthopaedic outpatient departments of the South Bohemian Region as paramedical staff. The interviews with the informants were recorded on a recording device, and this was followed by transposition and data analysis using coding. The results were summarised in structured categories and sub-categories. Two orthopaedic outpatient departments were intentionally selected. One site was a private orthopaedic outpatient department, and the other was an outpatient department that was part of a medical facility. We used a quantitative research investigation to gain feedback for the provided nursing care in the orthopaedic outpatient departments. Using surveys with respondents who attended the selected orthopaedic outpatient departments. We were interested in their perspective and satisfaction with the provided nursing care and instruction. A total of 160 respondents, exactly one half from each orthopaedic outpatient department, were asked to fill in a questionnaire. Based on the results of the qualitative investigation it is clear that the greatest burden faced by nurses of the orthopaedic outpatient departments is the lack of time to provide comprehensive nursing care. It was discovered that nurses spend most time on specific professional tasks, assisting doctors, satisfying the most immediate needs of clients and, in particular, administration. However, they spend the least time on prevention and instruction. It was discovered that nurses most often note a lack of self-care, movement and activity in clients of the orthopaedic outpatient departments, along with pain, fear and lack of information. The quantitative investigation showed that there were no statistically significant differences between the selected outpatient departments in the resolution of current needs and approach of nurses. In the matter of time for answering questions, instruction and subsequent satisfaction of respondents of the selected orthopaedic outpatient departments, we can say that there exist statistically significant differences between the private orthopaedic outpatient department and outpatient department that is part of the healthcare facility. A summary of the findings from the research survey allows us to state that it is unavoidable to focus more on the comprehensive nature of the provided nursing care, including instruction, in nursing care management for clients of orthopaedic outpatient departments. The output of this work is a draft concept for functional orthopaedic instruction nurses which will be submitted to nurses of the orthopaedic outpatient departments as a suggestion for expansion of instruction centres for patients.
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Nursing Care of Klients with Fractured Distal Femur
VOPÁLKOVÁ, Milena
The name of this Bachelors thesis is "Nursery Care of Patients with Fractured Distal Femur". With view to the lengthening of the populations age, increasing popularity of adrenalin sports and development of traffic we can expect an increasing number of this serious type of injury, and therefore it is time to address the issues of nursery care of the clients with this type of fracture. Fracture of the distal part of femur often happens suddenly and unexpectedly and the client has to deal with a health problem, which brings about a lot of changes as regards his/her health, psychic and social situation. The purpose of this thesis is to map the nursing specifics and nursing problems experienced by clients with a fractured distal femur from the nurses point of view. Through an analysis of a research survey we will summarize the thesis outcomes and determine the specifics of possible complications under the nursery care of such clients. Hence, the thesis contains two fundamental parts: theoretical and empirical. The theoretical part deals with the historical development of nursing and care provided as regards these fractures, the anatomy of lower limbs and causes of such fractures. It also addresses the basic classification of such fractures, principles of an osteosynthesis therapy, education, nursing and rehabilitation care. The empirical part includes a research survey with two predetermined goals mapping the specifics and complications within the nursing care of clients with a distal femur fracture. With view to the fact that various specifics and complications within the nursing care in the period before and after surgery were ascertained, they were categorized as pre-surgery and post-surgery specifics and complications. The research survey found out that one specific is differing pre-surgery nursing care of the clients with a fractured distal femur, mainly provided that stabilisation of the fractured part is executed by means of a skeletal traction or a patch traction or through a knee brace. The ascertained nursing complications are related to such immobilization interventions. According to the interviewed nurses the nursing procedure is even more diverse, mainly as regards the injured clients mobility and the nursing care. Other specifics of the nursing care are monitoring of locomotion and sensitivity of the traumatized lower limb, antidecubitus care, aself-care deficit and a possible risk of the lever action impact on the distal femur when moving on the bed. Specifics of the post-surgery nursing care regarding clients with a knee brace are: monitoring of locomotion and sensitiveness of the lower limb, correct manipulation with the knee brace, care of the locomotion, a risk of the lever action impact on the osteosynthesis area mainly when the client is sitting on the bed with lowered limbs or doing exercise on the motor splint. Nursing complications ascertained during the post-surgery period are mainly an oedema and a haematoma of the surgical wound place, urine and faeces emptying disorders, inadequate relief of acute pain, decubites under the knee brace or on the heels, long-term deficit of the clients self-care due to the traumatic consequences and other possible complications as described in this thesis. Outcomes of this thesis are two simple mind maps, which are a part of this thesis. The first mind map shows the nursing care specifics as regards a client with a fractured distal femur and the second describes the most frequent complications and interventions of a nurse within the nursing care as regards a client with a fractured distal femur. The outcomes of this thesis can serve as an information material for traumatology unit nurses and also for nurses working in other complements.
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