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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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Management of nursing care of the patient with intracranial hemorrhage
LESÁKOVÁ, Barbora
The diploma thesis deals with a problematic of management of the nursing care by a patient with intracranial hemorrhage. Most of the patients who survive intracranial hemorrhage stay permanently reliant on the care from others. That is why it is so important for this care to be as qualitative as possible and to have a fluent continuity. The aim of the thesis was to find out what is the role of a nurse by the patient with intracranial hemorrhage, then also find out, if the nurses know the warning signs of a worsening state of such patient, how do they cooperate with his/her family and what are the possibilities of the following care. In the empirical part of the diploma thesis, qualitative-quantitative research was used. For a complex view on a management of nursing care, the chosen technique of research was semi-structured questionnaire with patients with intracranial hemorrhage and non-standardized questionnaire with nurses who take care of these patients. For the quantitative part of the research, two hypotheses to two aims of the diploma thesis were set. Both hypotheses weren't proven by statistical methods. For qualitative research, four research questions were set. The respondents described the role of a nurse, especially in helping the patient, in rehabilitation and in also her role in educating the patient. Addressed respondents agreed on appropriate and swift reactions of the nurses in case the state of the patient starts to worsen. The cooperation of nurses and families is according to the patients without problems. It showed in the interviews with respondents, that there is a problem with insufficient awareness of the patients about the existing possibilities of following care. The outcome of the diploma thesis is a coherent educational material about nursing care by a patient with intracranial hemorrhage, which can serve to either the students or the nurses taking care of these patients.
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