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FRAGILITY AS A TOPICAL NURSING PROBLEM
ŽÁKOVÁ, Jaroslava
Introduction: Frailty within geriatrics is still more viewed as a current problem in the world than in the Czech Republic and it is more commonly mentioned. We can say that in the Czech Republic this problematic is still developing, updates and is trying to find its place in nursing as such. Objective: The objective of the presented thesis is to find out if frailty is perceived as a current problematic in the current geriatric nursing. Further, we focused on the geriatric nursing and specifics of nursing care in this field; on what is the awareness of medical staff at aftercare department about geriatric frailty and in which way, within nursing care, they apply their gained knowledge in practice. Methodology and research sample: To achieve the set objective the qualitative research conducted using the technique of semi-structured interview with nurses at aftercare department was used. The basis of this interview was 24 open questions which were predetermined and are documented in attachments (attachment 1) of the thesis. During the interview these questions were extended as needed by additional questions. The interviews were conducted with 10 general nurses at aftercare department of one unnamed South Bohemian hospital. The analysis of interviews was done using open coding paper-and-pencil and the individual information were classified into categories and subcategories. The results grant us comprehensive overview on the nursing care at aftercare departments within the geriatric nursing, utilization of knowledge of nurses about geriatric frailty within their practice and whether nurses perceive the concepts such as geriatric patient, geriatric syndromes and the already mentioned geriatric frailty. It was found out that some addressed nurses at aftercare department of one unnamed South Bohemian hospital never heard some of the mentioned terms and never registered them during their practice either. Other nurses say that they only heard those terms during their college studies, but they also agree that they never met them during their practice. Despite that, all nurses were able to accurately and aptly characterize the terms geriatric patient, geriatric syndromes and geriatric frailty based on their experience and knowledge. Furthermore, it was proven that they realize frailty during the care for patient and can apply their knowledge in nursing care. Conclusion and practical use: The results of the submitted thesis will serve as a template for educational seminar.
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The issues of patient´s self-sufficient after cerebrovascular accident at ward of subsequent care
MACHKOVÁ, Marcela
Cerebrovascular accident is a serious destructive condition with suddenly formed infliciton of cerebral blood vessel. There might appear obstruction and taper of them or defect on wholeness of vascular wall which result into hemorrhage to brain tissue. Sings of this condition might be termporary with physical and psychical changes or fatal which end up with serious paralysis, unconsciousness or even death of individual. Cerebrovascular accident problematics is currently a big challenge for the entire society, because progressiveness of European society´s aging is likely to bring increase in total amount of this disease´s causes. The first important step in problematics of the disease is to reduce the risk of stroke by consistent prevention; general lifestyle changes; blood pressure controls and treatment; lipid, coagulation factor and heart disease observation and compensation. The second step, when speaking about already formed disease, is to start well-timed and complex therapy which provides the patient with distinctly higher chance of better final clinical status without permanent harm. After overcoming the acute phase in neurology department the patient carries on with another therapy acorrding to seriousness of his/her condition in rehabilitation or aftercare department. Therapeutic, nursing and rehabilitation care should be set to contain all aspects of lost self-sufficiency encouragement and should be oriented mainly on person who has, even after stroke, his/her own needs, motivations, leisure time activities and skills. The bachelor thesis starts with medical part which describes brain anatomy, deals with epidemiology and stroke history. More detailted stroke characteristics and disease itself are defined by etiology, clinical picture, diagnostics and treatment. This part is then ended up with stroke consequences, factors influecing patient´s recovery, patient´s needs and self-sufficiency after stroke. Multidisciplinary team and aftercare deparment create an independent chapter and after this starts a new chapter interested in the role of nurse and needed nursing interventions, evaluation techniques during basic needs saturation of patients after stroke. Therapeutic rehabilitation creates almost the last important part of the bachelor thesis, on which depend gradual recovery and patient´s future life quality after this desease. The recovery part includes physiotherapy, occupational therapy, speech-language pathology, neuropsychology, spa treatment and prosthetic security of patient. Then, the whole thesis is ended up with patient´s preparation on release into home environment. The first set aim is to find out patient´s needs to reach the maximal functional independence and self-sufficiency after stroke according to previously studied sources. The second aim is to find out the nurse´s role in the encouragement of patient´s self-sufficiency and the third aim is to find out nursing interventions in the encouragement of patient´s self-sufficiency after stroke according to previously studied sources. The whole bachelor thesis is mainly taken as theoretical. It tries to insight into problematics of all needs, self-sufficiency encouragement and patient´s maximal functional independence after stroke according to previsously studied sources and information obtained from consultants, physiotherapists and general nurses. Then, the thesis deals with the role of nurse and nursing interventions in patient´s self- sufficiency encouragement on aftercare department to satisfy his/her essential needs of life without someone else´s help after the disease. After a gradual improvement of functional disability, the whole life quality and the independence of patient, it is necessary to follow all nursing, medical and rehabilitation procedures very carefully without their neglect with a sufficient amount of medical staff and specialized doctors.
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The treatment of pain in patients in terminal stage on the ward of follow-up care from the nurse point of a view
KUNEŠOVÁ, Martina
This bachelor's thesis is focused on chronic pain in dying patients at the aftercare department. The theoretical part focused on chronic pain description and its division, chronic pain treatment possibilities, characterization of a terminal stage and work done by nurses at the aftercare department. This part is supposed to present the most important information concerning chronic pain in dying patients. The practical part provides results of a gualitative research. This research had four objectives. The first objective was to identify the benefits of nursing care provided to dying patients with chronic pain in palliative care. The second objective focused on the attitude of nurses towards the patients in the terminal stage. The third objective was to identify the nursing methods used during the provision of care to a patient with pain in palliative care. The fourth objective was to assess the knowledge of nurses working at the aftercare department regarding the up-to-date treatment of pain in palliative care. Four research questions were established based on these four goals: What is the benefit of nursing care in treatment of pain in palliative care? What is the attitude of nurses towards the patients in the terminal stage? Which new nursing methods possibilities can palliative care provide to patients with pain? What information on treatment of pain in palliative care do nurses have? The research was performed using an in-depth structured interview, which is a method of the gualitative research. The research samlpe consisted of eight practice nurses working at the Aftercare Department in Nemocnice České Budějovice a. s. The interview was aimed at information on benefits of nursing care, the attitude of nurses towards dying patients, nursing procedures used and also knowledge of the nurses working at the aftercare department. The interviews were recording in writing. The records were analysed and coded using an open coding method. Six categories were established as follows: Nursing care procedures in treatment of chronic pain in dying patients, Effectiveness of chronic pain treatment in dying patients, Benefits of nursing care, Attitude of nurses towards dying patients with chronic pain, Collaboration with families and Nurses' knowledge. It was found out during the research that the benefit of nursing care is enormous, the care brings satisfaction of patients, safety, communication, sufficient amount of information, ensuring of basic needs, contact, information on current changes in the state of health, offer of better care, psychological support, better collaboration between nurse and a patient and a family, and also promixity of personnel. Thereforte, I think it is possible to consider the nursing care to be very beneficial. Furthermore, the following attitudes of nurses towards the dying patients were discovered: Trust or distrust of nurses in ability to display pain, active interest by nurses, approach to patients and communication. The research also discovered the following nursing procedures used in treatment of chronic pain in dying patients: positioning, heat application, cold application, massages and refraining from needless manipulation. The knowledge of nurses regarding the current treatment of pain in palliative care contains extensive information on principles of analgesic and opiate administration, which are applied by the nurses working at the aftercare department. A practical output of this thesis is a handbook called Administration of Opiates and Usage of Intoxicants Record, which is intended for use by practice nurses.
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Nursing care about patient in terminal stage at the ward follow-up and in Hospic.
PETROVICOVÁ, Eva
The bachelor thesis called "Nursing care of the patient in the terminal stage at the aftercare department and at a hospice" deals with the issue of nursing care for patients in the terminal stage at the aftercare department (AD) and at the hospice. Caring of a dying person is still a current topic, since each one will die and before the inevitable moment occurs, we will wish that it happens with dignity. The aim of the work was to examine the differences in nursing care and meeting the needs of patients in the terminal stage at the AD and in a hospice. To prepare the thesis, a qualitative research with the help of unstructured interviews with general nurses and patients in the terminal stage, who only complemented for less strain information from nurses. The talks took place in Strakonice Hospital and The Hospice of St. John Neumann of Nepomuk in Prachatice. Research file was made up of three general sisters and three patients from the aftercare department and three general sisters and three patients from the hospice. Patients with whom the interviews were conducted at the aftercare department were familiar with their own diagnosis, so the interview could be more open. Patients at the hospice were acquainted with their own diagnosis as well. Afterwards, the records have been processed into categories according to the research questions. The results show that among these facilities there are a lot of differences in the provision of nursing care and meeting the needs of patients in the terminal stage. The first research question related to the differences in nursing care of patients in the terminal stage. This area showed the differences in the current day mode, especially in times of waking of the patients, hygiene and breakfast. In addition, a difference in the area of food and fluid intake appeared. The second question dealt with ways how to control pain at the patients in the terminal stage. At the hospice, prevention from pain is at first place. Either with the help of analgesics, opiates or dispensers. From the conversations with nurses and patients from the AD there is an apparent lack of control of pain. The third question touched the issue of communication of nurses with patients in the terminal stage. From conversations with patients (AD and hospice) the feeling of a lack of communication arises. Nurses stop at the patients and talk, but some of the patients would welcome more opportunities to have a conversation. At the hospice, the presence of the nurse attendants or nuns is of benefit to patients. The fourth question related to the psycho-social needs. These needs, including the spiritual one, are fully provided at the hospice. The patients mentioned the students help, mass celebration or volunteers who fill a day. This fact is presented in contrast to the AD, in which patients can fill a day only with the visits that are allowed continually at both facilities. Spiritual care is adequately provided there as well. The fifth question dealt with communications of staff with relatives of the patients. At both institutions this occurs frequently. The nurses involved the family in the care of the patient and talks about the family as important. They highlight the need to know the patient's background and home. The final question discussed how they farewell the deceased. At the AD it occurs in a hospital room, whereas at the hospice with more dignity in a farewell room, which is decorated. The deceased is dressed in festive clothes that nurses request from the family before the death. The bereaved are also supported afterwards by the hospice staff through meetings or by sending cards. This bachelor thesis could serve as a learning resource for students with the major of General Nurse, but also for the general public or as a guide to those who care of their relatives in the future. I believe that knowledge of the bio-psycho-social and spiritual needs is an essential part of the comprehensive care about the dying.
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