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Securing the patient in postoperative care.
JORDÁNOVÁ, Hana
Current status: Safe process treatment should be provided to every patient in every hospital. Nurses should work to avoid security violation, especially in the surgical field, associated with irreversible changes in the treatment process. Perfect mastery of these measures assures patient safety. Risk prevention, safety of the patient and the medical personnel require the involvement of all members of the multidisciplinary team (Pokojová, 2011; Škrla and Škrlová, 2003). Objective of the research: to map the attributes of postoperative care in the safe treatment of patients. To determine whether nurses master preventive measures in safe patient care and whether they ensure compliance with the principles of safe care in practice. Methods: the research analysis was chosen to be based on qualitative research method. Data acquisition was performed in semi-structured interview with nurses, supplemented with hidden observation. The participation in the interviews was voluntary and anonymous. Audio data was recorded from the interviews and transcribed verbatim. The observation aimed to determine whether nurses respect the principles of safe care for patients in the postoperative care. Research cohort: consisted of general nurses who worked at the surgical wards and recovery room. The research was conducted in one of the hospitals of South Bohemia. Twelve nurses were interviewed. The interview and hidden observation were focused on patient safety in the postoperative period. The interviews were performed at nurse day-time rooms of individual surgical wards, some of them outside the hospital. All nurses met the criterion to be a provider of nursing care for post-operative patients at surgical wards and recovery rooms. The interviews were finished when reaching the theoretical saturation, when the answers and hidden observation of the respondents started to repeat the already acquired data, i.e. after twelve interviews and observations. Results: The nurses working in surgical wards and recovery rooms are exposed to a considerable mental and physical strain. This profession is very demanding and requires not only theoretical knowledge, but also manual dexterity in practice. Nurses are involved in the care process in a considerable extent. Therefore, it is important that the care was good and safe. In the treatment process, the nurses sometimes do not comply with relevant standards and the requirements for safe treatment. It is essential to follow the identification bracelets to avoid patient mismatch, thus endangering patients' health. Some nurses checked the identification bracelets thoroughly, but there were also nurses who ignored these rules too much and gamble with the patients' health. Medication errors are the most common cause of patient injury. The risk of medication errors increases also due to improper storage of hazardous drugs. In our investigation, the medication was repeatedly stored at a different place (not returned back to the original area), poorly stored or left freely available to anyone. If the physician records are illegible, the nurses solve the issue rather by guessing or asking an assistance from colleagues in the department. This area also includes replacement of medication by nurses if the prescribed product is not available at the ward, without consulting a physician first. The negligence in the use of protective equipment during dressing changes is alarming. Possible transmission of nosocomial infections. Poor or little use of disinfectants. Conclusions: Treatment of patients in the early and late postoperative care is one of the high risk parts of the hospitalization of patients at healthcare facilities. In this period, patient monitoring and risk prevention are essential. It includes pain control, the care for surgical wounds, safe patient identification, prevention of adverse events in both medication administration and patient falls, the compliance with hand hygiene ...
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Patient satisfaction with nursing care at Surgical Intensive Care Units
KRAMAŘÍKOVÁ, Lucie
This diploma paper aims at defining and mapping out patient satisfaction in intensive care units for surgery patients and comparing results in dependence on length of hospitalization and facility. Diploma paper consists of theory and research. Theory is divided into 5 chapters. Empirical part of this diploma paper was carried out using the method of combined research. The first part is created by qualitative research using semi-structured interview, second part comprises quantitative research using non-standardized, structured questionnaire face to face survey. Processed results were arranged into Excel tables and graphs. All research was based on eight dimensions of patient-centered care delineated by the Picker Institute. Qualitative research sample consists of 11 respondents, quantitative research sample comprises 142 respondents. Data collection took place in surgical ward. This diploma paper defines four aims with two related research questions. The first aim is to determine the level of patient satisfaction with postoperative care. The second aim focuses on patient satisfaction with nursing care, the third aim is to define positive and negative factors influencing patient satisfaction in intensive care units and the last aim points at patient satisfaction with nursing care in intensive care units in relation to the type of facility and length of hospitalization. These two quantitative research questions were posed: 1. What are the possibilities to improve patient satisfaction in nursing care? The research survey showed that an area of concern is patient awareness. It is necessary to improve patient awareness after admission to an intensive care unit and during transfer to a standard ward. Pain and insufficient pain relief often occurred. Nurses should cooperate more with doctors in this respect and, above all, monitor patients more and offer alternative ways of pain relief. Other problems were mentioned in relation to bed adjustment possibilities. Despite the fact that nurses were trying to do their best, not all the circumstances could be influenced that way, for example mattress hardness. The last concern area, mentioned by patients, was perceived loneliness. Nurses should conduct considerate and sensitive conversation, create feeling of trust and support patients. The second question: What factors influence patient satisfaction? The results show that it is, above all, nursing staff attitude, followed by patient awareness, pain and sufficient pain relief, intensive unit environment and last but not least bed adaptation. Quantitative part set six presumptions using statistical methods independence test, chi-square test, Yates correction, t-test, and correlation-regression analysis. Questions from the first part of this paper were processed (in percentage) into clearly arranged graphs. Research survey shows that respondents were satisfied with nursing care and nursing staff. Patient awareness during admission to intensive care unit and staff anonymity proved to be the biggest areas of concern. Pain and insufficient pain relief turned out the clear reason for dissatisfaction as well as absence of information about performed surgeries. Conclusion of quantitative research survey showed that there is no statistically significant difference in patient satisfaction according to health-care facility or length of hospitalization.
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