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Problematics of transferring the patient onto home artificial pulmonary ventilation
HRBKOVÁ, Lenka
Home artificial lung ventilation (DUPV) is very current topic these days. It provides great hope for the possible return of a patient permanently dependent on artificial lung ventilation back to the home environment. Due to injuries or the development of the disease, some patients are permanently dependent on the support of artificial lung ventilation (UPV). Staying at home with the support of DUPV brings many benefits for these patients. The theoretical part of the diploma thesis is divided into six parts. The first part is devoted to a historical view of the development of artificial lung ventilation. The second part describes the respiratory system. The third part is devoted to artificial lung ventilation, where in the subchapters the indications for connection to UPV, physiological goals, clinical goals and also the subsequent intensive care are analyzed in more detail. The third part comprehensively describes DUPV. The subchapters are devoted to indications for connecting the patient to DUPV, there are described organizations dealing with DUPV. It describes the application for the implementation of DUPV, preparation before the patient goes home, provided nursing care and equipment and medical supplies necessary for implementation. The fourth part focuses on an overview of social benefits and the fifth part on the implementation. Two goals were set for the diploma thesis: 1. To find out, with what problems, including artificial nursing care, do patients face with artificial lung ventilation. 2. Identify what problems, including nursing care, patients experience with home artificial lung ventilation. To meet the objectives, three research questions were created: 1. What problems, including nursing care, occur to patients dependent on artificial lung ventilation in the Follow-up Intensive Care unit? 2. What problems, including nursing care, occur to patients dependent on home artificial lung ventilation? 3. What are the changes in the quality of life and nursing care of patients dependent on ventilator in the hospital and patients dependent on ventilator at home? The empirical part of the diploma thesis is processed in the form of a qualitative research survey. The method of semi-structured interview with NIP general nurses of an unnamed district hospital, caregivers and patients at DUPV was chosen. The method of self-observation and examination of decurses was also used. The interviews were conducted on the basis of pre-arranged questions with four nurses, three caregivers and three patients. The "pencil and paper" method and the open coding method were used to analyze the interviews. For grater clarity, the categories and subcategories were visualized in graphic diagrams. They were also used to compile three case studies. The results of the research survey show that general nurses deal with nursing care, respiratory care and also listen appropriately to the needs of patients. The most common problem that was mentioned was the implementation of personal hygiene, due to the mental and physical dufficulty for patients. Furthermore, problems with defecation, immobility and problems with gestures and communication. An unpleasant problem was also the irritation of the airways during suction. Patients 'and carers' responses show that the most common problem is dependence on the carer for personal hygiene and excretion. Also problems with falling asleep. Social isolation and deteriorated possibility of communication are also problems. A change in the quality of life and nursing care of UPV-dependent and DUPV-dependent patients at home was also found. The answer to this question is that a hospital stay is physically and mentally demanding. It has been said that being at home is real luck. The opportunity to be with family and be able to do everything by yourself. I believe that the work could serve to improve the awareness of family members of patients at DUPV. The work could be used to collaborate in a GAIA grant project.
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