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Procedural Pain Relief in Premature Neonates
DUDARCOVÁ, Terezie
This Bachelor's thesis deals with the topic of procedural pain management in preterm newborns. Procedural pain is caused during medical procedures. Long-term exposure to pain has a variety of consequences, which is why it is very important to pay attention to the procedural pain prevention management. The first aim of the thesis was to explore the possibilities of assessing procedural pain in premature neonates. The second aim was to map the available methods of procedural pain management, followed by the final goal to identify the possibilities of involving mothers of premature neonates in the procedural pain prevention management. The research part of the paper was based on a qualitative investigation by means of questioning and observation. Data collection was carried out using in-depth interviews with paediatric nurses and mothers of premature neonates. Next part of the research involved observation of paediatric nurses during painful procedures. The information obtained was logged in observation sheets. Research has shown that there is currently a great effort to reduce the number of painful procedures that preterm newborns have to undergo. It was found that when evaluating procedural pain, all circumstances must be taken into account and not evaluated only according to a given scale. According to the research, the most effective of the non-pharmacological methods of pain relief is direct contact between mother and child. Pharmacological methods of pain relief are used in rare cases. It was also confirmed that there is currently a great effort to involve parents in the care of preterm newborns, but this needs to be further intensified and fathers need to be engaged more, for example. The results obtained from the research can be used in the education of paediatric nurses. An educational leaflet for mothers has also been developed.
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Educational needs of mothers with newborn twins
ŠIMEČKOVÁ, Tereza
Introduction: Despite the declining trend of multiple pregnancies, twins are encountered quite frequently. Caring for two children at once can be very challenging, and for this reason support from both partner and family, as well as from health care professionals, is important. Nurses responsibilities include educating mothers about newborn care, with safety and breastfeeding playing a major role with newborn twins. Objectives of the work: The first goal was to determine the specifics of nursing care in newborn twins. The second goal was to discover the educational needs of mothers of newborn twins. The third goal was to reveal the most important areas in which the mother needs to be educated and the fourth goal was to find out if there is a difference in educational needs from the perspective of mothers and nurses working in the newborn unit. Methodology: The research part of this work was done in the form of qualitative analysis and semi- structured interview with nurses of neonatology unit and mothers of newborn twins was used for data collection. The interviews were conducted from December 2022 to March 2023. All interviews were recorded on a recording device after consent and then transcribed into Microsoft Word. The analytical software ATLAS.ti was used to analyse, code and generate individual charts. Subsequently, the data were broken down into units, which were assigned appropriate codes, which were further grouped into categories that captured contexts with a direct link to the research questions. Subsequently, the categories and subcategories were processed into clear diagrams. Results: The research showed that the specifics of nursing care for newborn twins clearly include breastfeeding, which has countless benefits for both the newborn and the mother. The areas in which the mother needs to be educated include the aforementioned breastfeeding, but most importantly safety. Among the educational needs of mothers, we can again include breastfeeding and a supportive, empathetic approach from nurses. Differences in educational needs from the perspective of the nurses include practical education with practice and subsequent observation of the mother to see if she is doing the activity well and subsequent re-education. Mothers, on the other hand, would appreciate if another family member participated in the education. Conclusion: The results show that mothers of newborn twins are educated in the same way as mothers with a single newborn. The emphasis is mainly on safety, so that the mother does not leave the children unattended or leave one unattended while she takes care of the other. Breastfeeding is also an important area, with mothers of twins preferring tandem breastfeeding, which means that the mother breastfeeds both babies at the same time. This bachelor thesis can be used in improving the care of mothers with newborn twins and in the teaching of future paediatric nurses.
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The specifics of care for a newborn baby of a drug-addicted mother
PEKÁRKOVÁ, Barbora
The neonatal abstinence syndrom occures in newborns of addicted mothers to any kind of drug. The drugs may be soft (legal) or hard (illegal). The manifestation of neonatal abstinence syndrom is mostly of neurological symptoms, such as seizures, restlessness and tremble. The neonatal abstinence syndrom can also be manifested by gastrointestinal, respiratory and termoregulation problems. Neonatal abstinence syndrom begins to manifest within 24 to 72 hours after birth and the most conclusive examination drug testing is from newborn's meconium. The newborns are assesed by the Finnegan score and if the result is higher than eight points, the neonatal abstinence syndrome can be diagnosed. The first goal was to reveal and describe the differences in care between a newborn of a drug-addicted mother and a physiological newborn, second goal was to specify nursing problems of a newborn of a drug-addicted mother and the third goal was to concretize the role of the nurse in a care of a newborn of a drug-addicted mother. The research part of this work was processed by the qualitative research method, using semi-structured interviews. The interviews took place in june 2022. Five interviews were recorded on a recording device and three interviews were written down on a paper due to dissapproval of said nurses to record the interviews. All interviews were transcribed into Microsoft Word programme. The ATLAS.ti programme was used to analyse, code and create schemes. The data was split into parts and codes were added to the said parts. The codes were put into categories related to the research questions. Afterwards, the schemes were made from said categories and subcategories. Based on data collected from the research we can say that the most common nursing problem in a newborn with neonatal abstinence syndrom is restlessness, crying, tremor, scream, sleep deprivation, instability of temperature, gulping and vomiting. Futhermore, the analysed data showed that the role of a nurse in taking care of a newborn with NAS are mainly "nurse as a provider of nursing care" and "nurse as a educator". The main differences in care between the newborn of a drug-addicted mother and a physiological newborn are in nutrition, contact with mother, when it also depends on her presence and the condition of the baby, in participation of other profesionals. There are hardly any differences in education, but it also depends on the condition of a baby and its needs. In conclusion, the most common nursing problems in a baby with neonatal abstinence syndrom are neurological problems, following the problems with sleep, temperature and nutrition. The nurse is mainly in a role of a nurse educator and provider of a nursing care. The differences in care between the baby with NAS and the physiological baby depend on the presence of its mother, the condition of the baby and its gestational age. The differences are mostly in nutrition and the participation of profesionals, for example the child protect services. The results of this research can be used in improving the quality of care for newborns with NAS, in an education of the future pediatric nurses in Pediatric nursing study programme and in further education of pediatric nurses in NAS in hospital through lectures.
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The care for physiological newborns in the period of postpartum adaptation from the point of view of parents and pediatric nurses.
MUSELOVÁ, Jitka
The bachelor thesis deals with the care of physiological newborns in the period of postpartum adaptation from the perspective of parents and nurses. The work is divided into theoretical and practical part. The theoretical part describes the care of physiological newborns in postpartum adaptation, the physiology of postpartum adaptation of the newborn, the role of nurses and birth plans. The practical part includes the processing and evaluation of the results obtained in the research survey. Two goals were set for the bachelor thesis. The first goal was to describe the key and most frequently discussed points of care for newborns in the delivery room and partly in the area of physiological newborns. The second goal was to identify those parts of care that are most often a source of discrepancies between the perception of parents and health professionals. A semi-structured interview was chosen to meet these objectives. The interview contained 42 questions and was conducted with ten participants. Five pediatric nurses working in the neonatology ward and 5 mothers hospitalized after giving birth at the sextuplet station were selected. Based on the results, it was found that the most common points discussed in newborn care are mainly communication about overall care and procedures. Mothers sometimes have specific wishes regarding decontamination of the conjunctival sac and the form of vitamin K administration to the newborn. The most common discrepancy was found in these points, and despite these the most common points, the examination of the newborn on the mother's chest is mentioned. Mothers sometimes have specific wishes regarding decontamination of the conjunctival sac or administration of vitamin K to newborns, and these areas of care are most often discussed. The research found that the most common source of disagreement between the idea of parents and health professionals is the lack of valid information about the overall care of the newborn.
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The importance of LATCH score in promoting effective breastfeeding
MATĚJKOVÁ, Radka
The LATCH score is a breastfeeding mapping system that supports effective breastfeeding, and it is used to predict the duration of exclusive breastfeeding at six weeks after delivery. Assessments, which begin in the delivery room and continue until the mother and newborn are discharged, are essential. The LATCH system serves as a systematic collection of information about breastfeeding. The rating scale assigns 0, 1 or 2 points to five key areas of breastfeeding. Every letter of the LATCH acronym indicates an area of assessment. With the LATCH scoring system the pediatric nurse can assess maternal and newborn variables, and can easily define areas for intervention and prioritize nursing care at maternity hospital. Our first goal was to reveal the importance of the LATCH score in promoting effective breastfeeding. The second goal was to reveal in which areas of breastfeeding techniques mothers most often make mistakes. The third aim was to describe in which areas of LATCH mothers need more education. And the last goal was to find out what are the specifics of nursing care for mothers and newborns with a low LATCH score.The practical part of the bachelor's thesis was processed using the method of qualitative research using direct observation and the method of questioning through a semi-structured interview. The research group consisted of ten mothers who, during the research period, were hospitalized after delivery in the department for physiological newborns. Mothers were directly observed during breastfeeding on the day after delivery and upon discharge from the hospital. LATCH scores were evaluated during observation. For mothers with a low LATCH score on the first day after delivery, the interventions provided to the mothers were further qualitatively evaluated and their effectiveness verified by the LATCH value at discharge. These mothers were contacted again in sixth week of the child's age, and through a short interview we verified, whether the mothers were still breastfeeding, what problems they had and what was the reason for stopping breastfeeding. The obtained data were qualitatively analyzed with the ATLAS.ti program. Based on the research investigation and the obtained analyzed data, it follows that the LATCH score is important in promoting effective breastfeeding. Nowadays, more and more women want to breastfeed as long as possible. During the analysis of the obtained data, we established three categories. The first category deals with the evaluation of the LATCH score at the first feeding after birth, here it is captured what affects breastfeeding in the first hours after birth by the mother, the newborn and the child's nurse. In the second category, we deal with the most common problems during breastfeeding and their solution by a pediatric nurse. The most common obstacle was the mutual position of the mother and the newborn and the correct latching and sucking of the newborn. The psychological and physical comfort of the mother is also closely related to breastfeeding. Nursing staff, i.e. children's nurses, educate the mother more in LATCH areas, where points are removed, and their goal is for the newborn to leave the maternity ward fully breastfed and for the mother to know everything about breastfeeding in the home environment. The last category is the progress of breastfeeding after six weeks after giving birth. We are interested in whether the mothers are still fully breastfeeding and whether they have had any complications.The results show that the LATCH score is a quick and simple tool for assessing breastfeeding after delivery, during hospitalization and before discharge. This breastfeeding assessment method serves pediatric nurses to effectively evaluate mother and newborn variables, define areas where intervention is needed and determine priorities in the provision of nursing care for the mother and newborn. The results of the research investigation can be used to improve the quality of nursing care...
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The importance and benefits of skin to skin contact in care of extremely premature newborns
NEJDROVÁ, Tereza
Introduction: The term "skin to skin contact" is a term for a method of contact between a mother and her child. The early contact of the newborn with the mother's skin in the shortest time after birth has very positive effects for the newborn but also for the mother herself. In most maternity hospitals, the newborn is placed on the mother's bare abdomen or chest immediately after birth without being dried. This method has a positive effect on the mental and physical needs of the newborn. Children are happier, cry less, gain weight faster, and their body temperature, heart rate, and breathing stabilize. It also matters to his parents. Objectives of the work: Our first goal was to identify the effect of the skin-to-skin method on thermoregulation, lactation, and mental and physical needs in the newborn and also in the mother. The second goal was to find out what possibilities there are to support skin-to-skin contact in severely and extremely premature newborns. The last goal was to reveal the reasons that most often prevent the provision of skin-to-skin contact in severely and extremely premature newborns. Methodology: The research part of the work was processed by the method of qualitative research, using in-depth and semi-structured interviews with nurses. The research group consisted of nine nurses from the Department of Neonatology at the Hospital of České Budějovice a.s.. The interviews were divided into four categories and subsequent subcategories. All data are shown in clear diagrams for individual categories. Results: Based on the obtained analyzed data, it follows that the skin-to-skin contact method has more benefits than risks that would prevent the development of a parent-child bond. At present, the reasons and potential risks that would prevent skin-to-skin contact have rapidly diminished. The research shows that the most serious risk remains the unstable condition of the newborn. The cooperation of the nursing team and the newborn's parents is important. If the child could not be kangarooed, there are alternative methods that help to create an emotional bond between mother and child. The nursing staff allows kangaroo care for fathers if the mother is unable, due to her health condition. Conclusion: As a result, the skin-to-skin method reduces crying and stress in children. Newborns are calmer and sleep better and thrive. This method also strengthens the relationship between mother and newborn. Premature newborns are usually placed in incubators, connected to monitors and hoses, often with respiratory support. All of these factors often make parents feel guilty, failing, disappointed, or lonely. It is important to be able to participate in the care of their newborn. In this way, they also obtain information about the child's health condition. During kangarooing, the emotional bond deepens. The results of the research survey can be used to improve nursing care for premature newborns, as well as in the lifelong education of nurses and in teaching in the field of pediatric nursing. The results will be presented in an article in the journal Pediatrics for Practice.
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Nursing care for paediatric patient after orthopaedical surgeries
WEISSOVÁ, Eva
Abstract Current situation Current range of orthopaedics is not only surgery of musculoskeletal system, but it also deals with diagnostics of congenital defects, injuries, illnesses, metabolism disorders and their after-effects on musculoskeletal system. A paediatric nurse plays a key role in taking care of a paediatric patient after an orthopaedical surgery. She helps children to overcome an unpleasant situation and tries to minimize physical and psychological complications. Cooperation with child's family is essential. Child's pain, suffering and fear can be moderated by proper nursing care. Aim of the work We determined three aims in this diploma thesis. The first aim was to map children awareness before orthopaedical surgeries and during hospitalization. The second aim was to analyse satisfaction of parents during hospitalization. The third aim was to assess the importance of psychological pre-surgery preparation of children and hospitalization of parents in overall perception of child's hospitalization. Methodology A quantitative research by means of a paper and electronical survey was used for the empirical part. The research group was made up of 104 respondents, it means 52 parents and 52 children. Those were parents and children from two selected hospitals and from general public. The surveys were processed statistically afterwards. A descriptive analysis of all the questions was used and four determined hypotheses were tested. Results It was found out that most of the children felt sufficiently informed before and during the hospitalization. It could be claimed that better awareness of a nurse means better feeling of child's sufficient awareness. Furthermore, we found out from the results that most of the parents were sufficiently informed by the nurse and that their overall satisfaction depends on children awareness provided by the nurse. Based on results, nurse education in the area of children care and manipulation with children during hospitalization is very important and leads to satisfaction of both children and parents. Based on other results, a child's hospitalization with a parent is very important because 97% of children said that they were calmer because of the presence of a parent. We can claim this about parents as well, because the presence of a parent is perceived by parents themselves as a very important factor improving the perception of a stay at a hospital. Hospitalization of a parent with a child depends on the age of the child, in which case a child at the age of 5 and less was always hospitalized with a parent. Moreover, it was found that compared to the presence of a parent, parents claim the psychological preparation (talking in form of play or with the help of a therapist) has slightly more important point. That was confirmed by the children as well. We can obviously see from the response that they stand the hospitalization better if they are prepared for the surgery. Conclusion The research has shown that most of the children felt informed enough during the hospitalization and before the surgery. I find the psychological preparation of children for a surgery very important. That was also confirmed both by the children and parents, who consider the psychological preparation to be one of the most important factors. The hospitalization of a parent with a child depends on the age of the children. We trust that this work could serve as a study material for paediatric nurses working at corresponding postoperative departments, besides other things as a study material for students of medical subjects. This diploma thesis can describe given illness or the care of a child after an orthopaedic surgery to both parents and children.
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Outpatient delivery from the point of view of a midwife and child nurse
NOVOTNÁ, Kristýna
This thesis deals with outpatient childbirth, and the opinions of midwives, pediatric nurses and women on this topic. The first goal was to find out the opinions of midwives and pediatric nurses on outpatient birth and the second goal was to find out the reasons that women choose for outpatient delivery. This work is divided into two sections, the theoretical and the practical part. The theoretical part describes the competencies of midwives and pediatric nurses, the process of childbirth from admission to the delivery room, ultimately to the fourth stage of labor. Furthermore we describe the first treatment of the newborn, room-in neonatal care, examination of the newborn by a doctor and neonatal screenings. Furthermore, the theoretical work focuses on outpatient childbirth itself, following the law, and addressing outpatient childbirth complications from the perspective of both the mother and the newborn. The practical section consists of the methodology, results and discussion. The method of data collection was a semi-structured interview, whereby the research included midwives, pediatric nurses, and motherswho experienced an outpatient delivery. Interviews took place in March 2019. If the informant agreed, the interview was recorded, but in case of disagreement, spoken responses were recorded on paper. To maintain anonymity, the informants were designated as DS, PA, and Ž. Based on the obtained data categories and subcategories were created. Two categories were created for midwives and pediatric nurses (Outpatient Childbirth, Care during Outpatient Childbirth), which were subsequently developed into subcategories. Women after outpatient delivery had data divided into four categories (Previous births, Outpatient delivery, Postpartum care, Reactions of neighbors). Two goals were set for this bachelor thesis, on the basis of which three research questions were created. The first question dealt with the view of midwives on outpatient birth. Research has shown that none of the midwives took a negative attitude and are certainly not trying to change women's decisions about having an outpatient delivery. In this case, they are glad that women did not choose to give birth at home, this way the woman is under trained supervision in case of unexpected complications. The second research question examined the opinion of pediatric nurses on outpatient delivery. The research showed that more than half of nurses do not take a negative attitude towards this decision, and only one pediatric nurse doesn't recommend outpatient delivery even in a case of physiological pregnancy. Pediatric nurses educate women about the care of the newborn, necessary post-partum examinations, and where to go and what to do in case any complications occur. The third research question deals with the reasons for women to decide for outpatient delivery. Research has shown that women are most often led to this decision for the need of a more peaceful and their domestic environment, or negative prior experience that involved lack of communication or lack of sufficient information. The women also suffered from frequent staff interference, loss of privacy and the alienating regime of the delivery room, and therefore opted for outpatient delivery. The research showed that the majority of medical staff do not show a negative attitude towards outpatient births and try to reach a certain compromise related to hospitalization and dismissal. It also showed that the interest in outpatient births is risingslightly.
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Multidimensional view on the work of children's nurse in the emergency room of children's ward
PŘÍPLATOVÁ, Iveta
The work of nurses in the outpatient department belongs between discussed topics. The interplay and cooperation of all members of the medical team are especially important. Correct communication between all team members and communication with children and their accompaniment are also a matter of course. The aim of this diploma thesis is to map the work of a nurse in a comprehensive view in the outpatient area of the children's ward, the satisfaction of children and parents in the outpatient area of the children's ward and to suggest possible improvements for the outpatient sphere of the children's ward of České Budějovice a.s. The diploma thesis is processed by qualitatively quantitative investigation using semi-structured interviews, questionnaires and observations. The research group consisted of nurses, doctors, paediatric patients and their accompaniment at the children's ward, paramedics and the general public as well. The interviews were categorized and processed by the method of pencil and paper. Questionnaires were processed statistically. The hidden participating observation was focused on the collaboration and communication of nurses from outpatient department with other nurses, doctors, paramedics, children and their accompaniment; and it was also focused on the satisfaction of the children or their accompaniment at the outpatient department. The results of the work showed that the view of the work of the paediatric nurse is distorted both from the health care professionals and the general public, which means that the nurse is seen mainly as a nursing care provider. The results also showed the necessity of proper communication and knowledge of foreign languages. At the same time, the thesis was used to identify shortcomings or suggestions for changes in the paediatric outpatient department of the České Budějovice Hospital, including the satisfaction of patients and their accompaniment during visiting the department that depends on the time spent in the waiting room. Suggestions for improvement were drawn up, drafted and handed over to the children's ward management.
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Kawasaki syndrome in contemporary society from a nurse´s point of view
MIKEŠOVÁ, Annemarie
Mucocutaneous lymph node syndrome or Kawasaki syndrome is very severe disease.The most common symptom includes a high fever which is probably due to inflammation of blood vessels so-called vasculitis. . Several months old babies to preschool children are the most often affected group of patients. Specific and typical symptoms of Kawasaki disease include long term fever, conjunctivitis, erythema, lymphadenopathy, mucosal changes as red swollen lips and strawberry tongue and multiple rashes.Qualitative and quantitative research was applied in the diploma thesis "Kawasaki disease in the contemporary society through nurse´s eyes". Three basic objectives and three research questions were established in this diploma thesis.
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