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The Hospice Care Regulation in the Czech Republic
Chmelíková, Nikola ; Angelovská, Olga (advisor) ; Kotrusová, Miriam (referee)
CHMELÍKOVÁ, Nikola. The Hospice Care Regulation in the Czech Republic: Charles University in Prague, Faculty of Social Sciences, Institute of Sociological Studies, Department of Public and Social Policy, 2014. Thesis Supervisor Mgr. Ing. Olga Angelovská The thesis titled "The Hospice Care Regulation in the Czech Republic" is about hospice care in the Czech Republic of its development due to the following important foreign and Czech documents in health and social care. The main reason that leads me to the elaboration of this work is particularly ambiguous and rather one-sided definition of hospice palliative care in the Czech Republic in terms of health care. In the analysis and evaluation, which is the main part of the paper I will draw on already existing documents and data that relate to the topic immediately. Another integral part of the consultation and discussion with experts from the ranks of both health and social services in providing care face barriers that currently has inadequate definition of the operation itself. The aim of the thesis is the analysis of documents and data relating to the regulation of hospice care in the Czech Republic, and their subsequent reflection of professionals who care about the issue of dying deal in their working lives. Keywords hospice care, legislation,...
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Hospice care through the eyes of the general public and health care professionals
Světová, Jana ; Víchová, Jana (advisor) ; Jirkovský, Daniel (referee)
Bachelor's dissertation "Hospic care from laymen's and nurses' perspective" assesses laymen's and nurses' knowledge of hospic and palliative care. The dissertation is divided into two parts - theoretical and empirical. The theoretical part explains basic terminology, forms of hospic care and goals of this dissertational paper including history of hospic movement. It does not omit the conception of death by Elizabeth Kübler Ross and her contribution to the terminal patient's nurse care. This dissertation focuses on legislation and the knowledge of hospic and palliative care among laymen and nurses and then it compares and contrasts the hospic care between the Czech Republic and the world. The empirical part sets the goals and working hypothesis for a research. Prime analysis is based on real data from questionnaires. Research outcomes help to understand the knowledge rate of hospic and palliative care among laymen and nurses.
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Psychosocial aspects of cancer in adults
Škardová, Kateřina ; Arnoldová, Anna (advisor) ; Ventura, Václav (referee)
Anotation: The diploma thesis " The Psychosocial Aspects of Cancer in Adults" deals with problems of the psychosocial aspects of the oncological disease and its command by adults patient.The theoretical part engages in individual phases of disease and its consequences of patient's life. It also deals with basic ethical problems which are connect with this disease. The theoretical-practical part states the basic forms and methods of supportive oncological care and it demonstrates the propsal for its classification. The practical part is elaborated by the form of interviews. The first interview was accomplished with the hospital chaplain woman and the following interviews with oncological female patiens. The main aim of the thesis is to alert to problems of the psychosocial disease aspects whose solution should be the inseparable component of the complex oncological care.
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Barriers in communication between nurse and terminally ill peadiatric patient
IMRAMOVSKÁ, Simona
Nursing care for paediatric terminally ill patients in the Czech Republic is continuously evolving and developing. It is important for the nurses to learn to use suitable communication. Theoretical part of this work includes information on terminal stages of illnesses in children and the corresponding care that should be provided. It further focuses on communication with the child and his/her parents. The theoretical background for this work is the conceptual Callista Roy Adaptation model for nursing applied on a paediatric terminally ill patient. The main aim of this work was to focus on revealing features in nurse communication with a child patient with regard to his/her medical diagnosis. We have focused on mapping medical diagnosis for paediatric patients in terminal stage of their illness that evoke communication barriers in nurses involved with the patients. Further step of this research was obtaining the information about the type of barriers the nurses evolve. Another aim was to create educational material for nurses based on information obtained from the research that would lead to improved communication between the nurse and the terminally ill child. A personal aim was also set in this work to gain necessary information and experience for the starting carrier as a paediatric nurse. Five research questions were posed to reach the aims of this work aimed at identifying communication barriers with regard to medical diagnosis child patient in the terminal stage of the disease, barriers in communication with a child patient in the terminal stage of the disease, evaluation of the quality of nurse communication with terminally ill child patients, use of communication aids in nursing care for these patients and we also wanted to know what changes in the communication with the terminally ill children the nurses experienced since the beginning of their working practice. The practical part is divided into two qualitative research investigations. In the first phase of this research eleven nurses working at paediatric oncology wards and eight nurses from hospice care aimed at child patients participated. Half-structured interview technique was used for the research. Based on the practical aim, second phase of the research consisted of evaluation of the impact educational material created as a result of the first phase of the research had on the nurses. The first phase of the research showed that the communication barriers are evoked in nurses by the following diagnoses: bone tumours, brain tumours and multiple sclerosis. Further barriers found in nurses regarding communication with terminally ill patients included: children above 12 years of age, lack of knowledge about suitable communication and about the patient, unsolved issues with own mortality, fear and embarrassment of possible mistakes and the patient personality. Nurses use many means of communication. Nurses noticed changes in communication that happened during their carrier; they mentioned more reassurance, more knowledge, better assessment of the children and suitable timing. They also feel better during the time of mourning, understanding the role of the parents; they feel more humble and respectful towards life itself. Nurses evaluate their level of communication with child patients very positively and have a will to educate themselves further. The nurses showed signs of psychological load. It was also revealed that a psychologist is not functional or altogether missing in their place of work. The second phase of the research showed that nurses welcomed and appreciated the educational material created for them, they found it useful in their nursing practice, they evaluated it as useful for beginner nurses. Based on this material a children book was purchased for the ward. The recommendation for practice is the use of the Callista Roy Adaptation model for nursing. I have personally gained both wide theoretical knowledge and experience from the interviewed nurses.
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Attitudes of nurses to nursing care for terminally ill clients in the long term care Departments
SCHMIDOVÁ, Žaneta
Terminal phase means gradual and irreversible failure of vital functions and organs ending in death. This state directly precedes death. We can understand terminal stage as dying itself. "Nevertheless the term dying must in no case be reduced to terminal phase" (Kelnarová, 2007, p. 10). It is the most demanding phase for a nurse and the whole team caring about a dying patient (Theová, 2002).This thesis deals with mapping nursing care of clients at terminal stage and the possibilities of coping with the care of dying clients and their family members for nurses.The research part was elaborated in the form of qualitative research. The aim was to obtain high quality data to given topic. The technique of semi structured in-depth interview was chosen as the most suitable method. Each respondent was given a number. Lines were subsequently numbered to enable references. The data were analysed by the paper-and-pencil method and four categories were created. Ten subcategories were created within the given categories. The information obtained was processed in schemes. The interviews were performed from February to April 2014.The research sample consisted of six nurses working at a long-term care department. The nurses were intentionally chosen in various categories to get the most objective possible data. There was also one man working at the position of a nurse.The respondents' answers showed that nurses working at the long-term care department have basic knowledge of the issue, are able to get oriented in the problems of dying, the terminal stage length, are able to describe the frequency of meeting with a dying client. The nurses cope well with satisfying the needs of terminally ill clients, they do not omit any of the needs. The nurses are capable of having holistic approach to clients. They take the demands of the care about a dying client as a part of their work, they make no difference and care about a dying person as of any other client at their department. They describe their experience with the dying and their families, they only describe communication with a dying client and his/her family as problematic and sometimes they are not sure whether they act correctly and are afraid of hurting someone. They communicate with such a client and his/her family according to their best conscience and they hope that their approach is the right one. The research has also shown that the nurses are able to prevent the burnout syndrome, they understand that they have to care about themselves, they must like their work, have positive approach to life. They perceive burnout syndrome as a problem, they try to prevent it and if they feel symptoms of inconvenience and dissatisfaction with their job they try to find the better aspects and not to give up. Except for one respondent, who describes herself as burned out. This is however given by the respondent's personality itself.The research shows that nurses have sufficient knowledge of the problems of terminally ill clients at their department, that they are able to provide quality nursing care. They however admit that sometimes they are not completely sure whether they treat a client correctly not to hurt him/her in given situation. After this fact was discovered a brochure was prepared giving nurses instructions for general approach to dying clients and help them minimize negative impact on a client.
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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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Comparison of nursing care of clients at terminal stage provided in a hospital facility and in a hospice in the view of family members and general nurses.
MACÁKOVÁ, Jana
The bachelor thesis deals with nursing care provided to patients at terminal stage of a disease and possible differences in provision of this care in a hospital and in a hospice. The theoretical part focuses on the issues of palliative care and particularly on the needs of patients at terminal stage and a role of a nurse on their satisfying. The first aim of the thesis was to find out whether family members of patients feel possible difference in provision of nursing care in a hospice and a hospital. The other aim was to examine opinions of general nurses about provision of care of terminally ill patients in a hospice and a hospital. Qualitative research, questioning method was applied. Deep interviews with general nurses and family members of patients at terminal stage were used for data collection. The selection of family members and general nurses for the research sample was intentional. Selection of general nurses was conditioned by the following criterion: to be a general nurse with experience with care of patients at terminal stage from a hospital and a hospice. Selection of family members was conditioned by the following criterion: to be a relative of a patient at terminal stage of an illness who was first hospitalized in a hospital and then transferred to a hospice. The interviews were conducted in the Prachatice Hospital and in St. John N. Neumann Hospice in Prachatice. The data from the interviews were processed into categories corresponding to satisfying the individual needs of patients. The research results show that the general nurses as well as the family members do perceive difference between provision of care to terminal patients in a hospital and in a hospice. The biggest differences are perceived in satisfying psychosocial and spiritual needs of patients. All the nurses agree that more attention is paid to psychosocial needs of patients in the hospice than in the hospital. The difference is particularly seen in lower number of staff and lower time allocation to satisfying these needs of patients in the hospital. The family members perceive these issues uniformly. They are all convinced that no one deals with satisfying psychosocial needs in the hospital while all patients? needs are satisfied in the hospice and even patient?s accompanying family is included in the care. The general nurses as well as the family members perceive the difference in the regimens in hospital departments and in the hospice. They agree that patients in the hospital are subject to the department regimen while the regimen in the hospice is subject to patients? needs and desires. They all also perceive difference in the possibility to be in the hospice with the patient for 24 hours a day. From the point of view of satisfying psychosocial needs of patients the general nurses and family members share the opinion. They agree on the fact that these needs are actively sought for in the hospice and satisfied according to client?s interest. On the other hand attention is not primarily paid to patient needs in the hospital. This thesis could serve as study material for nursing students. I could be also used as informational material to both, experienced or staring nurses dealing with terminally ill patients within their practice. A recommendation for practice in the field of satisfying psychosocial need of clients at terminal stage is the practical output of this thesis.
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Influence of Basal Stimulation on a Possibility of Transition to the Reconciliation Phase according to Elisabeth Kübler Ross
HLAVÁČKOVÁ, Kateřina
While the numbers of incurable patients continues to rise, it follows that the nursing care of incurable and dying people is getting more important. Naturally the dying patient is the most exacting patient of all from the nurses point of view, and needs individual care and empathy. This work of mine is called {\clqq}Influence of Basal Stimulation on a Possibility of Transition to the Reconciliation Phase according to Elisabeth Kübler Ross``. It has been divided into two parts, theoretical and practical. The theoretical part consists of five chapters: The Basal Stimulation which is the art of being in contact with the patient, The Terminal Stage, The Needs of the Dying Person, The Palliative Care, and finally The Usage of Basal Stimulation as part of the Palliative Care. The second practical part consists of qualitative research, which has two goals. The first goal was to assure whether utilisation of the concept of Basal Stimulation influences the adaptation and life of the terminally ill patient in order to focus upon the transition from depression phase to the phase of acceptance. The second goal was to ensure that the influence of Basal Stimulation manifests itself upon the patient in the expression of discomfort in comparison to the effect prescribed medication and common nursing care administered in the hospice. Fundamental research was established upon the following basic questions: 1. Should the application of the basal Stimulation concept influence the transition to the acceptance phase according to Elizabeth Kübler Ross? 2. Should the use of the basal stimulation generally increase the overall comfort ot the terminally ill patient? 3. Whether the concept of basal stimulation assists to deepen the interaction between the patient and his/her nearest next of kin? I chose eight patients whose behaviour and reactions I closely observed. Half of them were cared for utilising the concept of basal stimulation at Jan Nepomuk Neumann Hospice in Prachatice. The second half were cared for in Štrasburk Hospice in Prague using the common nursing practices of that hospice. The observation was carried out with the cooperation of nurses working in both hospices. The results which were obtained were noted for all eight case reports. The case studies compare against the following research the phases of depression to acceptance. For a more complex perception of the observed clients each case study is completed by medical and nursing diagnosis. The results of the entire research lead us to following hypothesis: The presence of the next of kin and their participation in the care of the ill are conducive to holistic care for the dying person just like it is to every human being. I suggest that these results which the research has given should be used in medical schools, in the departments of palliative care for the advancement in the education of health workers who care for dying patients. I also recomend that the basal stimulation concept be applied to the standards of nursing care in the department of palliative care.
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