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Monitoring of Pressure Ulcer Care in the Internal Department.
KURAŇOVÁ, Natálie
The topic of the present bachelor thesis is the monitoring of pressure ulcer care in an internal ward. Pressure ulcers are a significant problem area on many wards and therefore an aspect of patient care that should be given sufficient attention. The first aim of the present study is to map the knowledge of non-medical healthcare professionals in the prevention of pressure ulcers in selected internal wards. The second objective is to map the knowledge of non-medical health workers in the area of pressure ulcer prevention in selected internal wards. The third objective is to map the knowledge of non-medical health care workers in the management of pressure ulcers in selected internal wards. To achieve the objectives, quantitative research in the form of interviewing through a non-standardized anonymous questionnaire was used. The research survey was conducted in three internal wards and three aftercare wards in a South Bohemian hospital in March 2022. A total of 35 closed-ended questions were asked to the respondents. For the research population, 110 questionnaires were distributed with a return rate of 74,5 % (n = 82). Thus, the research population consisted of a total of 82 (100,0 %) male and female non-medical health care workers from the internal wards (n = 41) and the aftercare wards (n = 41). The results showed that there was no statistically significant difference in the knowledge of pressure ulcer prevention between nurses from internal wards and those from aftercare wards. Also, the data confirmed that there was no significant difference in knowledge regarding pressure ulcer prevention between nurses from internal wards and those from aftercare wards. Similarly, there was no statistically significant difference in knowledge regarding pressure ulcer care between nurses from internal wards and those from aftercare wards. No one scored less than half of the possible points in pressure ulcer care. This indicates to some extent that knowledge in the areas studied is at a relatively good level in all wards.
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Skin lesions prevention in perioperative care
POHLOVÁ, Lucie
Thesis objectives: The diploma thesis deals with the issue of prevention of skin lesions in perioperative care. In the theoretical part, the current state of knowledge is presented concerning the pressure ulcers identification due to the persisting real problems in differential diagnostics in clinical practice. Further, the thesis deals with the issue of wet and thermal lesions, which occur also during the perioperative care. In the empirical part of the diploma thesis, the first objective was to find the frequency of documented occurrence of decubital lesions in connection with the surgery in Jihlava Hospital for a period of one year. The second objective of the thesis was to find out whether, and what barriers exist when using specific preventive measures. The last aim of the diploma thesis was to compare the efficiency of preventive measures from the point of view of perioperative nurses and nurses from service units. Three hypotheses were formulated to meet the objectives of the thesis. Method for achieving the objectives: The set objectives were achieved through a retrospective analysis of the hospital information system data and a quantitative questionnaire survey. The study included nurses working in surgery, orthopaedics, traumatology, intensive care units and perioperative nurses in Jihlava Hospital. The total number of respondents was 140. Scientific benefits of the thesis: The research implies that the use of prophylactic aids in pre-operative preparation contributes significantly to reducing the risk of skin lesions. The addressed set of nurses did not indicate any serious barriers to their application and, on the contrary, considered it to be very effective. The results of the thesis can be used in practice, especially in a specific health facility for further care improvement. The findings and conclusions: On the research group we have verified that the declared use of preventive strategies in the area of prevention of lesions in perioperative care differs according to the type and focus of the workplace; (p = 0.000) the least frequent use was declared by the general nurse from orthopaedics, however, the methods used did not differ (p = 0,220). In addition, we found out that there was a statistically significant difference in the opinion on efficiency of prophylactic covering in lesion prevention (p = 0.001, the worst evaluation was by the respondents from orthopaedics) but only 2 respondents stated negative experience with their use.
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Comparison of chosen nursing in prevention of immobility syndrome in a senior nursing home in Germany and the Czech Republic for lying immobile patients.
ČERNÁ, Lucie
As the population is getting older there is increased number of geriatric patients. However there is also increased number of immobile seniors, who are not able to take care of themselves. Comprehensive health and social security is being provided in homes for elderly, which fulfil the role of long-term institutional care. Nurses must be trained for this highly professional and knowledgeable nursing care aimed at geriatric problems. For geriatric clients of home for elderly it´s important realization of prevention, treatment and social measures in the form of an individual approach. That these measures can be implemented it is necessary to evaluate the health status of seniors, their physical performance, self-sufficiency and mental functions in connection with the social situation and to formulate a nursing diagnosis. As a result of long-term bed rest can lead to health complications affecting all body systems, so-called immobilization syndrome. How to prevent secondary damage that threatens the patients White Theo arge already ill is focused rehabilitation nursing. Among rehabilitation resources in the prevention of immobilization syndrome in nursing practice arge included: positioning, verticalization, mobilization. Inseparable part of prevention measures is preventing health complications in case of immobile clients homes for the elderly arge suitably selected positioning aids, mobilizing resources, well-equipped bed with antidekubitus system. In the thesis there were two objectives. To Compare keeping preventive measures which prevent the formation of pressure ulcers and muscle contractures in nursing care for immobile patients in the Czech and German retirement homes. To map out the possibilities of aids in the prevention of complications in immobile clients in the Czech and German retirement homes. Bachelor thesis has been made by using qualitative research. For collection of data was used a method in-depth interviews with four Czech and four German nurses. This method involved non-standardized interviews through open-ended questions that were recorded by dictaphone and transcribed verbatim. The data analysis was carried out by hand coding or using a pencil and paper. By analyzing the data four categories were created, each divided into the home for the elderly in the Czech Republic and the home for the elderly in Germany: 1.Nurses knowledge ,2.Implementation of preventive measures , 3.Equipment for immobile clients, 4.General knowledge related to immobile clients. Research survey found out that there is not a big difference in adherence to preventive measures to prevent the formation of decubitus and muscle contractures in nursing care for immobile patients in Czech and German homes for the elderly and comparable are also the possibilities of using tools to prevent complications in case of immobile clients. The biggest gap in nursing care for clients is bad knowledge of contractures in both homes for the elderly. Also keeping documentation and records relevant to the implementation of preventive measures in the Czech home for the elderly is not satisfactory. Mobilization record is missing and positioning record should be more detailed. We therefore propose the creation of positioning and mobilization recording modeled according to the German retirement home and handing it to the leadership of retirement home in the Czech.
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Antidecubital Care as a Nursing Problem
KŘÍŽOVÁ, Monika
This thesis deals with the issue of providing antidecubital care and observes the fulfilment of nursing interventions in the care about non-self sufficient patients. During performing her duties, every nurse encounters the issue of decubitus ulcers formation and with this related antidecubital care. Thus, it can be stated that the occurrence of decubitous ulcers serves also as the indicator of the quality of provided nursing care. A lot of people think that the problem develops particularly in elders, but young people who are bedridden after injuries and accidents are also affected and this complication degrades the quality of their life. The thesis is divided into theoretical and empirical parts. The theoretical part describes the anatomy of skin and its function, decubitus and classification of decubitus ulcers are defined, their localization with characteristics of predilection sites are specified, outlining complications in decubitus ulcers. The theoretical part pursues antidecubital care with the division into subheads on positioning, antidecubital aids, nursing interventions, and the mission of the European Pressure Ulcer Advisory Panel is described. The separate chapter includes the risk assessment of decubitus ulcers formations, as is e.g. Norton scale, etc. The last chapter embraces the specification of conservative and surgical treatment of pressure sores. The aim of the research examination was to determine whether the nurses perceived antidecubital care as a nursing problem and to map the opinions of the nurses relating to antidecubital care. Three research questions were set to achieve the objectives: first, what the pitfalls of nursing care were on the part of the nurses, secondly, what areas within antidecubital care were neglected and finally, how antidecubital care at selected inpatient wards was provided. The research was implemented at the chosen inpatient wards in České Budějovice Hospital, PLC, from the period of February to April 2014. The research file consisted of the general nurses and the medical assistants. A hidden participant observation was conducted and then questionnaires with 15 questions that were closed or semi-closed were distributed to the nurses. 45 questionnaires were handed out, 31 handed back and all 31 questionnaires could be processed. Thus, the total return of the questionnaires was 69%. Questions in the questionnaire were based on the observation criteria. The hidden participant observation was processed and plotted on the observation sheet and then classified according to the given criteria. After delivery, the returned questionnaires were checked and evaluated graphically. All results were processed using Misrocoft Office Excel program, were plotted in graphs with keys and descriptions. By processing and comparing the results, we ascertained that in some fields the opinion of the nurses was different from the practice that was really performed. It could be also caused by the fact that antidecubital care is very time-consuming, demanding and comprises a lot of nursing interventions. Sufficient number of aids with which the ward is equipped is relevant as well, be it preventive aids or medical ones. And last but not least the organization of the care. At present, the time spent on completing documentation is increasing and the time that can be used by nurses for contacting a patient and satisfy his/her needs is decreasing. Nevertheless, the patient´s state and his/her contentment reflect and demonstrate our care. After previous arrangement, the results of our research examination will be communicated to the ward sisters at the selected inpatient wards where the research examination was performed.
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Prevention and treatment of pressure ulcers in nursing Home for elderly Milevsko
HRYCHOVÁ, Šárka
Background methods: Appearance of decubitus is a main indicator of therapeutic and nursing care quality and is monitored carefully. However, they supervence in despite of high-quality and professional care of nursing staff, because there are factors, which we cannot influence while decubitus emergence. The main purpose of research was to map the preventative and nursing care of clients with the risk of decubitus and with it, find out if the care is in high-quality and possibly debunk absences and deduce a treatment for work experience.Methodics: The research was done by quantitative method, by technique of secondary analysis of data. Analytic studies check if there is a relation among the watched features. The data was received from verified and enclosed nursing documentation of Home for senior citizens in Milevsko from years 2010 and 2011. Procured data was afterwards elaborated by descriptive statistics by Microsoft Excel and SPSS program. Validity of hypotheses was tested via Chí quadrate test. Research aggregate created nursing documentation of Home for senior citizens in Milevsko. This establishment has 36 beds and during the year 2010 and 2011, 85 clients were accomodated here. Consistent with the first research purpose "To map the high-risk factors, which increases the probability of decubitus emergence." was evaluated nursing documentation of 85 clients. Consistent with the second research purpose "To find out, the precautionary measures belittling the risk of decubitus emergence of vulnerability client group." was evaluated by nursing documentation of 54 clients. Consistent with the third research purpose "To map the nursing intervention of clients with decubitus." was evaluated by nursing documentation of 10 clients.Results: From the research, results arose that there was the risk of decubitus emergence at every client of Home for senior citizens in Milevsko according to directory evaluative Norton scale. The final results demonstrated a high percentage 63,4 % clients who were endangered by the decubitus emergence. After one month, a checking evaluation of the risk of decubitus emergence was made according to directory evaluative Norton scale. The results demonstrated the strong depression of the number of clients with the risk of decubitus emergence or at least the depression of risk. The last part of research was focused on watching the nursing intervention of the client group with decubitus and finding the fruitfulness of the decubitus treatment. The result demonstrated that the treatment was in most cases succesfull and that 80% of clients were healed in four month.Conclusion: The important finding for the nursing staff was the assertion that the provided nursing care in Home for senior citizens in Milevsko has a good standard. Simultaneously, some absences were found like deficient resource of nutritive accessoires, damp healing of wounds, and utilities against decubitus in standard goings. The solving of these absences is to increase accessibility and awareness of professional doctors for resource of the necessary amount of nutritive accessoires, damp healing of wounds, and not to let clients with deficient financial resources to be entirely dependent on out of date medical advancement. Also, not to corrupt treatment and precautionary measures. The next important step is to motivate family members and imply them to take care of their relatives. The research was shortened and offered to censored journal for medical and hospital branch Profese on-line to be published.
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Nursing care of patients with pressure ulcers
ŠERIOVÁ, Martina
This dissertation deals with nursing care issues relating to patients with pressure ulcers. The presented topic is quite actual these days, because the number of bedridden patients is constantly increasing, in which the potential risk of the formation of pressure ulcers arise. "Decubitus ulcer is a bedsore, which arises as a consequence of pathological pressure on the predilection place." (Pejznochová, 2010, p. 23). Mostly immobile patients suffer from this disease. Pressure ulcers can be prevented by regular adjust or with anti-decubitus aids. The treating of already existing pressure ulcer today is preferably with the use of modern therapy, the so-called "wet treatment". This dissertation is divided into a theoretical and an empirical part. The theoretical part outlines the formation issue and the assessment of pressure ulcers, the most common place of origin, the defect rating scale, the importance of prevention and subsequent treatment of pressure ulcers. And finally, it describes how the treatment of pressure ulcers is done in hospitals and home care agencies. Two goals were set for the practical part, to describe new methods in the treatment of pressure ulcers and to compare options in the treatment of pressure ulcers in hospitals and home care agencies. To achieve the set goals, a qualitative research was used, which was performed through interviews with nurses from inpatient ward of the hospital of Czech Budejovice, as well as with the nurses from the City Charity in Czech Budejovice and nurses of nursing home care and nursing services ALICE in Czech Budejovice. When interviews were making, two sets of questions were prepared. The research group was consisted of 11 respondents. The respondents came from the dermal ward, ward of internal medicine and aftercare ward. These respondents were identified as respondents under No. 1 to 4. The nurses of home nursing care agencies were signified as respondents from No. 5 to 11. This selection of respondents enables to compare the specific patient care on the wards and in home care agencies. The data were collected from February to March 2013. At the beginning of the research project, five research questions related to the. The first question was concerned of new ways in the treatment of pressure ulcers. The second focused on the nursing care of a patient with pressure ulcers in hospitals. The third question examined the area of nursing care for patients with pressure ulcers in home care agencies. The last two questions were focused on the use of surgical dressings for the treatment of pressure ulcers in hospitals and home care agencies. Based on the survey, it was found that in both institutions proper prevention is ensured, which means the client positioning, nutrition, hygiene and the use of anti-decubitus aids. The research showed the original relieving aids were often replaced by blankets and pillows, as these tools are the more available and fulfil its purpose. The use of surgical dressings on patient units and home care agencies, there is a predominant use of moist therapy and appropriate therapy materials for this purpose. In therapy, this method is considered to be better, because it accelerates the healing of the defect, less surgical dressings are needed and they are less painful for the client. The evaluation of nurses showed that the majority of nurses in home care agencies believe that the agencies are providing better care than in hospital. Certainly nurses from inpatient department think the opposite. Except one respondent, all of the others regularly attend professional seminars, where, within these seminars, new materials and methods of treatment are presented to them. The work will be used for improvements in nursing care of patients with pressure ulcers and will serve as a study material for students in medical fields.
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Monitoring prevalence of pressure ulcers as a quality indicators of nursing care on national level.
MÜLLEROVÁ, Nina
Abstract The diploma thesis is focused on the application of a national methodics for prevalence monitoring and comparison of pressure sores (decubitus ulcers) incidence in health care facilities in the Czech Republic. Pressure sores are a global problem and their incidence should be prevented by preventive measures and high-quality nursing care. However, despite all the provisions, we are not successful in the prevention of their incidence. It is necessary to define standardized quality indicators of the nursing care, to compare the results, and to share the information with specialists, which would result in continuous quality improvement (benchmarking), and to support good practice. In the world the quality indicators monitoring of health care is quite common, in the Czech Republic the process has been only developing. In the area of Czech nursing care only the falls in health care facilities are monitored on the national level. The methodics for the monitoring of pressure sore incidence has not been established yet on the national level. In 2003 the first comparison of four teaching hospitals was carried out in the incidence of pressure sores by means of the method of prevalence investigation. In 2005 the data collection methodics was elaborated during the solution of the grant project IGA MZ Č NO 77723-3. Six teaching hospitals were compared for the prevalence of pressure sores, with division into four specialty groups: internal medicine, surgical, intensive and follow-up care. In 2008 a project of quality and safety of the Ministry of Health was implemented, with a view to elaborate uniform methodics for prevalence investigation and comparison of a standard indicator in the area of pressure sores at the national level, regardless of the type of a health care facility. At the meeting of the Work Group for Health Care Quality of the Ministry of Health of the Czech Republic I recommended to include the indicator in the National Set of Health Care Indicators. The work aims at the verification of the applicability of the new methodics and software in practice, and at the facilitation of their implementation into practice. It is focused on the opinions of the project participants on the developed software, on its application into practice and on the challenges that should be tackled during the implementation into practice. In order to get the necessary information, we have chosen a method of qualitative investigation using a semi-structured interview. Eight respondents, direct participants in the project, were interviewed. According to the results of the interviews, health facilities pay much attention to the pressure sores monitoring. The investigations are carried out by means of an incidence and prevalence method. The monitoring of pressure sores incidence has not been included in clinical information systems yet, and it is carried out in several different ways. The interest in comparison between hospitals (benchmarking) is considerable. The results of the investigation are used above all for the purpose of improvement of measures preventing the incidence of pressure sores, of the improvement of quality of nursing care, and of reducing the workload of nurses. The extent of the economic impact of the pressure sores incidence on health facilities is not clear. If we want to facilitate the application of national methodics of monitoring the pressures sores prevalence to practice and the use of application software, we should ensure adequate awareness of health care managers, training of teams of health professionals, coordinators and editors, who will go on to work with the national methodics. The monitoring of the national quality indicator in the area of pressure sores is another shift in the implementation of goals of the Ministry of Health concerning the quality of care and safety of the patients.
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Antidekubital care and the differencies in nursing of dekubits in selected retiremens homes.
STEJSKALOVÁ, Petra
Population aging is the most characteristic feature of the demographic development of the Czech Republic and other developed countries in Europe. This demographic development will continue in the years to come. It will be enhanced by aging of members of the populous age-group and afterwards in particular by the increasing life expectancy. A large number of clients of retirement homes are immobile and incline to decubitus development. The objective of my work was to find differences in anti-decubitus equipment used in selected retirement homes and to ascertain awareness of nurses working in those facilities in respect of modern means to treat decubitus. I obtained the information by a questioning method, using a questionnaire completed by nurses working in retirement homes in the Region of South Bohemia; for comparison, the questionnaire was completed by nurses from a retirement home in the Region of Central Bohemia. A directed interview with selected seniors was also used. The results of the work may be used for analysis of different approaches, as far as usage of wound healing means is concerned, and for possible creation of a comprehensive conception in the field of application.
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