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The most frequent nursing diagnoses in senior homes and the possibilities of their solutions.
PĚCHOTOVÁ, Blanka
The objectives of the thesis The objective of the thesis was to map out the most frequent nursing diagnoses used in homes for the elderly and nursing interventions for these diagnoses. The following research questions were chosen for mapping: What are the most common nursing diagnoses of clients in the selected nursing homes? What are the intervention for the most common nursing diagnoses? The methods used For gaining information, qualitative research by the interviewing method using non-standardized in-depth interviews was used. The research was conducted in February 2014 in the G - center in Tábor, a home for the elderly. Interviews were recorded in a notebook and then transcribed. When processing the results, encoding methods for searching for the most common phrases were used, on the basis of which categories and their subcategories were created, summarized in diagrams. The research sample The research sample consisted of 10 nurses from the home for the elderly in the range of 43-57 years, employed as nurses and ward sisters. The interviews were preceded by familiarizing the nurses with the topic of thesis and research purposes, and written consent of the Director of the facility. Results After analyzing the data from the processed interviews, 8 categories were created: The nursing process, using the nursing process, the nursing process in practice, the phases of the nursing process, nursing diagnoses, interventions, documentation of nursing care and care provided. Subcategories were assigned to the individual categories, in which phrases are encoded, and everything is shown in clear diagrams. The interviews revealed that the nurses are aware of the method of the nursing process, which was most often characterized as meeting the needs of the client. This method is used in everyday practice. The evaluation was based on the positives and negatives of this method for both nurses and clients. Conclusion The aim of modern nursing is the high quality of the care provided and the client's active participation in it. It is expressed in the final phase by the satisfaction of their needs with respect to the individual's quality of life, leading to maintaining health and alleviating physical and mental pain. The practical outcome of the Bachelor thesis is a pamphlet of the most common nursing diagnoses and their interventions in a home for the elderly, G center, Tábor.
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Nursing care for a client suffering from Parkinson's disease
SVOBODOVÁ, Pavlína
Current state of the research field: Parkinson's disease is a neurodegenerative disease affecting basal ganglion. Brains of patients suffering from Parkinson's disease are damaged by death of dopamin producing cells in substantia nigra. Cause of this cell death is still unknown. Symptoms of Parkinson's disease include tremor, rigidity, aknesia and bradykinesia, disturbances to posture and gait, hypophonia, dysarthria, micrographia, eye movement abnormalities and decreased blink rate, hypomimia and mental, vegetative, sensoric and sensitive dysfunctions. In diagnosis of Parkinson's disease a medical history collected by a physician in collaboration with a nurse is used. Nurse assists a client with filling a questionnaire regarding nonmotoric symptoms. Furthermore, she carries out a L-dopa test. If symptoms are mitigated after drug administration, the test is considered being positive. Other examinations requiring nurse's assistance are DaTscan and histology. Pharmacological treatment relies on substitution of missing dopamin and hence restoring dopaminergic transfer. Nurse administers Levodopa, dopamin agonists or COMT inhibitors according to physician's decision. In neurosurgical treatment, where deep brain stimulation is used, nurse conducts preoperative and postoperative care. Pharmacological and neurosurgical treatment could be also combined with supportive treatment, about which should a nurse inform a client. Major nursing care complications in Parkinson's disease which are monitored by a nurse includes limited mobility, walking problems, tremor, impaired self-management, stress overload, anxiety, speech disturbances and voice disorders, constipation, urinary incontinence, impaired balance and frequent falls, inappetance and swallowing difficulties. Aims: To map problems in nursing care for a client suffering form Parkinson's disease from client's and nurse's points of view. To map nursing interventions in Parkinson's disease therapy from client's and nurse's points of view. Methods: Qualitative research in form of an in-depth interviews with nurses and clients was carried out. All interviews were recorded as a verbatim copy and coded using pencil and paper open coding method. Created codes were grouped into categories and subcategories. Interviews were carried out in March 2014. Participants: First set of participants comprised of ten nurses caring for Parkinson's disease suffering clients, four of them working at a department of neurology, four at a department of long-term care and aftercare, and two nurses providing a home care. Other set of participants comprised of six clients suffering from Parkinson's disease, five of them were members of Parkinson club České Budějovice, and the last was living in a village near Náměšť nad Oslavou. Results: Using the open coding method three categories, focused on particular topic, each containing several subcategories, were picked from interviews with both participant groups. Categories Nursing care problems, Nursing care and Specific interventions are identified in the first part. In the category nursing care problems nurses mostly agreed on a self-management deficit, movement difficulties, increased fall risk and communication problems. Aktivisation, motivation, rehabilitation, self-management training, regular drug administration and family participation were most frequently mentioned in the category nursing care. In the category specific interventions nurses focused on interventions directly related to particular problems. In the second part of the research categories Every day tasks management, Nursing care and Specific interventions are identified. In the every day tasks management category clients mentioned necessity of other parsons assistance in self-management, and movement difficulty and stiffness are considered being most annoying.
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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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Antidecubital Care as a Nursing Problem
KŘÍŽOVÁ, Monika
This thesis deals with the issue of providing antidecubital care and observes the fulfilment of nursing interventions in the care about non-self sufficient patients. During performing her duties, every nurse encounters the issue of decubitus ulcers formation and with this related antidecubital care. Thus, it can be stated that the occurrence of decubitous ulcers serves also as the indicator of the quality of provided nursing care. A lot of people think that the problem develops particularly in elders, but young people who are bedridden after injuries and accidents are also affected and this complication degrades the quality of their life. The thesis is divided into theoretical and empirical parts. The theoretical part describes the anatomy of skin and its function, decubitus and classification of decubitus ulcers are defined, their localization with characteristics of predilection sites are specified, outlining complications in decubitus ulcers. The theoretical part pursues antidecubital care with the division into subheads on positioning, antidecubital aids, nursing interventions, and the mission of the European Pressure Ulcer Advisory Panel is described. The separate chapter includes the risk assessment of decubitus ulcers formations, as is e.g. Norton scale, etc. The last chapter embraces the specification of conservative and surgical treatment of pressure sores. The aim of the research examination was to determine whether the nurses perceived antidecubital care as a nursing problem and to map the opinions of the nurses relating to antidecubital care. Three research questions were set to achieve the objectives: first, what the pitfalls of nursing care were on the part of the nurses, secondly, what areas within antidecubital care were neglected and finally, how antidecubital care at selected inpatient wards was provided. The research was implemented at the chosen inpatient wards in České Budějovice Hospital, PLC, from the period of February to April 2014. The research file consisted of the general nurses and the medical assistants. A hidden participant observation was conducted and then questionnaires with 15 questions that were closed or semi-closed were distributed to the nurses. 45 questionnaires were handed out, 31 handed back and all 31 questionnaires could be processed. Thus, the total return of the questionnaires was 69%. Questions in the questionnaire were based on the observation criteria. The hidden participant observation was processed and plotted on the observation sheet and then classified according to the given criteria. After delivery, the returned questionnaires were checked and evaluated graphically. All results were processed using Misrocoft Office Excel program, were plotted in graphs with keys and descriptions. By processing and comparing the results, we ascertained that in some fields the opinion of the nurses was different from the practice that was really performed. It could be also caused by the fact that antidecubital care is very time-consuming, demanding and comprises a lot of nursing interventions. Sufficient number of aids with which the ward is equipped is relevant as well, be it preventive aids or medical ones. And last but not least the organization of the care. At present, the time spent on completing documentation is increasing and the time that can be used by nurses for contacting a patient and satisfy his/her needs is decreasing. Nevertheless, the patient´s state and his/her contentment reflect and demonstrate our care. After previous arrangement, the results of our research examination will be communicated to the ward sisters at the selected inpatient wards where the research examination was performed.
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Contribution of children nurse{\crq}s work to community nursing both within the Czech Republic and abroad
PĚTIVLASOVÁ, Alena
My dissertation is aimed at the following questions: System of children care, organization of health-care policy in the Czech Republic, competencies and abilities to children care, document Health for Everybody in 21st Century, community nursing, nurse interventions in particular age categories, and my own research proceedings. The research section of the work contains both quantitative and qualitative research procedures. The data were collected of a questionnaire and semi-structured interview. The examined set of a qualitative research consisted of 9 respondents {--} 5 nurses and 4 medical practitioners for children and youth. The quantitative data were collected with an interview method. The questionnaires were designed for the unprofessional public {--} parents of children who are up to 18. The examined set of the questionnaire research consisted of 73 respondents (100%). The research proceeded from mid June 2008 to the end of July 2008 and its results have been processed into category tables and graphs in the program of Microsoft Office Excel 2007. I especially try to find the opinion of children nurses and children medical practitioners on introduction of a community children nurse in the Czech Republic and specify the functions that a community children nurse can perform in the Czech Republic when working with children community. I also try to find locations at which the community children nurse could work, and obstacles hampering to establish this new working position within the Czech Republic. Last but not least, I am interested in the public interest in the nurse{\crq}s affect to health protection and care for children. So far, there has not been a community nurse position established as an independent community professional in health protection and care for children within the Czech Republic. However, in other countries, community nurses work in the state interest and they form a part of the public health-care system. They are rewarded for their work, which is highly appreciated, from the public budget. Development of the community health-care is a WHO priority, and it has already established its firm position in the Czech health-care conception. As the main advantage of introduction of a community nurse I consider the fact, that both children and parents would have a better chance to use a wider variety of health-care services at school, in their household or at the doctor{\crq}s consulting room. Community nurse{\crq}s activities could help to inform families and to improve the health-care edification level. They could also assist the families that need highly intensive health and social care. Because of independent work of community nurses, nurse{\crq}s profession would become more attractive and nurse{\crq}s social position would improve.
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