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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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Psychic and physical factors in a nurse profession at home care
IMRAMOVSKÁ, Simona
Homecare is given to people in their natural social environment. It is aimed mainly toward sustaining and supporting health, restoring health and improving possibility of self-care, giving palliative care to incurably ill patients and enabling peaceful dying and death. For the nurses to be able to give quality nursing care they need to be in psychic and physical balance. It is important for the nurses to be aware of the consequences of such imbalance and also of the way it influences the quality of their work especially when handling difficult situations (Misconiová; 1995; Paragraph nr. 96/2004 Col.; Komačeková, 2009). First aim was to map psychic and physical factors influencing the work of a homecare nurse. Second aim was to find differences in psychic and physical factors in the profession of nurses working in homecare and in hospital. This study is based on qualitative research using questioning through in-depth interview. Research was conducted in the beginning of February 2014. Methods of direct transcription and open coding were used for data analysis. Two questionnaires were added to the original research examining Psychic stress and Physical activity according to Baecke, evaluating the amount of psychic and physical stress at work respectively. The research group consisted of 6 nurses aged between 33-55 working for homecare agencies in the south bohemian region. Written agreements were obtained from the nurses prior to them being interviewed or be given the questionnaires. Five categories were identified from the analysed interviews: psychic stress, physical stress, handling of stress, consequences of stress and the differences found regarding psychic and physical factors observed in homecare versus hospital environments. Results obtained from the questionnaire estimating Psychic stress show average value at 3.5 which can be regarded as borderline between decreased and increased risk. The analysis of Physical stress questionnaire gave the average of 3.1 corresponding to medium load. Regarding the first aim of this work the results of the questionnaires and interview are showing greater psychic stress felt by the nurses in homecare environment as compared to physical load. The second aim comparing homecare and hospital environments shows less psychic than physical stress in homecare than in hospital environments. Practical output of this bachelor thesis will be a written recommendation for nurses working in homecare aimed toward improvement of their psychic and physical health in connection to their working experience.
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