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Nursing care for clients with surgical wound healing using vacuum therapy in gyneacological and obstetric practice.
VOPÁLKOVÁ, Natálie
This thesis deals with nursing care for clients with healing of operation wounds using negative-pressure wound therapy in gynaecology-obstetrics practice. Negative-pressure wound therapy is a modern wound-healing method that has spread to other areas of medicine. One of them is the field of gynaecology and obstetrics. The thesis is divided into two parts, theoretical and empirical. The theoretical part contains a description of the history of wound healing and negative-pressure wound therapy, skin anatomy, classification and phases of wound healing and current trends in wound healing. The theoretical part also offers a description of the use of negative-pressure wound therapy in wound healing in gynaecology and obstetrics and the role of the midwife in care for a client using negative-pressure wound therapy. Two goals were selected in the empirical part - to outline the experience of midwives with the use of negative-pressure wound therapy in gynaecology-obstetrics practice and to discover the features specific to nursing care for clients with applied negative-pressure wound therapy. We wanted to find out whether midwives had experience with negative-pressure wound therapy and whether they knew the concrete features specific to nursing care for these clients. Based on these two goals we designated two research questions. What experience midwives have with the use of negative-pressure wound therapy in gynaecology-obstetrics practice, and what features specific to nursing care for clients with applied negative-pressure wound therapy they mention. The research investigation was conducted in a qualitative form using a semi-structured interview. The research cohort consisted of 10 informants working in gynaecology-obstetrics departments. The first research question considered what experience midwives have with the use of negative-pressure wound therapy in gynaecology-obstetrics practice. The research investigation showed that all the informants asked had experience with the use of negative-pressure wound therapy in gynaecology-obstetrics practice, most often for abdominal laparotomies, specifically for operation wounds following abdominal hysterectomies, caesarian sections, wound dehiscenses, and poorly healing wounds in the abdominal area. The second research question was to find out what specific features midwives mention for nursing care of clients with applied negative-pressure wound therapy. The research investigation showed that mobility, hygiene, diet and care for operation wound have specific features for the nursing process for clients with applied negative-pressure wound therapy. So the research investigation showed that all the informants asked were familiar with negative-pressure wound therapy, and they had experience with nursing care for these clients. But only some could describe the preparation of all the necessary aids for first application and dressing of an operating wound with negative-pressure wound therapy. Some informants could not describe the actual process for dressing of an operating wound with negative-pressure wound therapy. They also struggled to name the restrictions that clients have with this therapy and explain their solutions. The reason for this may be the fact that this method for healing non-healing operation wounds is not used routinely and on a day-to-day basis in gynaecology-obstetrics practice.This thesis resulted in two information maps for midwives working at gynaecology-obstetrics departments. The first information map shows the preparation of aids for the first application and redressing of negative-pressure wound therapy, and the second information map shows comprehensive nursing care for clients with applied negative-pressure wound therapy, including instruction. The results of this thesis may also be used as the basis for expert lectures, conferences and seminars for midwives.
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Nursing Care of Patients with Infectious Complications after Total Hip or Knee Endoprosthetic Replacement Nursing Care of Patients with Infectious Complications after Total Hip or Knee Endoprosthetic Replacement
BREJŠKOVÁ, Soňa
Infectious complications belong to the most serious problems after endoprosthesis implantation. Their solution is very demanding for its surgical and psychological aspects with regard to its devastating effects and uncertain prognosis. The percentage of infections complications fluctuates between 0.5 and 2 % nowadays. From nurse?s point of view the care about these patients is very demanding and has its exactly defined specifics. The aim of the thesis was 1: To map the knowledge of the causes of occurrence of infectious complications after TEP of hip or knee joint among nurses. 2: To map the knowledge on nursing care of patients with infectious complications after TEP of hip or knee joint among nurses. 3: To examine adherence to aseptic procedures in caring about patients with infectious complications after TEP of hip or knee joint. Three research questions were set to reach the goals: 1. What is the extent of knowledge of the causes of occurrence of infectious complications after TEP of hip or knee joint among nurses? 2. What is the knowledge of specific care of patients with infectious complications after TEP of hip or knee joint among nurses? 3. What is the extent of knowledge of specific needs of patients with infectious complications after TEP of hip or knee joint among nurses? 4. To what extent nurses adhere to aseptic procedures in caring about patients with infectious complications after TEP of hip or knee joint? Qualitative research was applied to elaboration of the thesis. Semi-structured interviews and involved observation were the data collection methods and techniques. The research was performed at the infectious disease department of the České Budějovice Hospital. The survey was anonymous, the interviews and observation were conducted from 1 to 25 February 2013 . The research has shown that nurses know the causes of infectious complications occurrence after TEP. It is also obvious that nurses are aware of the specifics of nursing care about these patients and they also have theoretical knowledge of the needs. However the analysis of the replies has revealed that nurses have problems with applying some nursing procedures, namely becauseof partial ignorance, uncertainty and impossibility to try some procedures. The results have also shown that all the nurses try to saturate physical needs of patients but not all of them are able to saturate patients? physical needs as they mentioned in their replies and as we could observe. These are particularly drawbacks in communication in the field of motivation, mental support and self care support. We have also found that most of the nurses adhere to aseptic procedures in nursing care of patients with infectious complications after TEP, but the results have also revealed weak points. More than a half of the nurses of the monitored sample fail to perform hygienic disinfection in compliance with the standardized technique and a third of them do not disinfect their hands even before the act. We have found further drawbacks particularly in handling sterile and biological material. The research results have shown that despite lack of information and experience the nurses proved their general knowledge of care about these patients in their replies. However there is still a lot to learn, both theoretically and practically. This thesis was written to bring basic outline of the issue of infectious complications after total endoprosthetic replacement so as it can be used as information material for both, experienced or starting nurses that are in contact with patients with infectious complications after TEP. A multidisciplinary seminar aimed at the issues of infectious complications after total hip or knee endoprosthetic replacement (see Annex 12) is the practical output of the bachelor thesis
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