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Possibilities of evaluating changes by women during the period of menopause and their effects on the quality of life
BELEŠOVÁ, Romana
Menopause is a period, which is perceived as a natural part of female lifecycle. The way how women experience this period is individual, it differs in the intensity of the experience which is influenced by a variety of factors. Among the most important factors belong the biological as well as genetic factors, lifestyle, family environment, relationships between people, job as well as ethnical and cultural influences. The above-mentioned factors contribute to the occurrence of symptoms and changes connected in the life of a female. Standardised tools that are used and helpful in the clinical practice should be reliable, sensitive, and specific to certain symptoms. The objective of this doctoral theses is to map the use of evaluating tools with women in the period of menopause, to analyse symptoms influencing the quality of life, to create educational program for women and to find out if education has an impact on the knowledge of women on the menopause issues. The research was carried out in combination of two research methods - quantitative and qualitative. The quantitative research was designed as a descriptive cross-sectional study. The design of the descriptive qualitative study was used for the qualitative research. For the methodology of the qualitative research the Standards for qualitative research were applied. For the quantitative research a research sample I was set up. It was composed of women with a permanent residence in the southbohemian region in the ages of 45-65. For these respondents three types of questionnaires were designed, the standardised WHOQOL-BREF, WHQ and the unstandardised questionnaire. The data analyses were executed via SASD programmes (Statistical data analyses) and SPSS (Statistical Package for the Social Sciences). The qualitative research was realised in two phases. The first part of the research was carried out before the educational programme was realised and the second part took place 3 month after finishing the educational programme. For the purposes of the qualitative research analyses elements of embedded theory using open and axial coding were applied. There were two research samples that were subject to the qualitative study. The research sample II was composed of women in the ages 45-55. The research sample III composed of midwives working in the primary care. In midwifery in the clinical practice no measuring tools are used to evaluate the quality of life and health of women in menopause. Nowadays the evaluating scales are applied in research studies rather than in the clinical practice. In our quantitative study women evaluated the quality of life primarily as good. While evaluating the individual domains via the WHOQOL-BREF tool, women rated their physical condition the best and on the contrary the environment they live in the worst. When qualifying their health condition based on comparison of individual dimensions using the standardised WHQ tool, women mentioned the vasomotor symptoms as bothering and on the contrary, they rated anxieties/worries as not so bothering. In the qualitative part of the research women qualified the following symptoms as the most frequent: hot flashes, night sweats, mood swings, corrupted sleep, gaining weight, mental and cognitive changes. Conclusion: In the framework of the study based on the results an educational brochure for women was created. The aim of this brochure is to provide information about the problematic of the menopause period, about the symptoms, about the diagnostics, about the therapy and about the regime precautions. At the same time as a part of the research an educational programme for women was prepared. This programme focused on climacteric symptoms, diagnoses, therapy and the use of regime precautions leading to relief from the menopause difficulties. In this field, midwives still play a significant role. Midwives should lead women to accept the positive approach to the issues of menopause period.
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Využití hodnotících a měřících nástrojů pro hodnocení potřeb pacientů s tělesným znevýhodněním
NEUGEBAUER, Jan
Physical disadvantage is a debatable topic regarding terminology,variability,and specifics of care.In connection with this issue,we look at the whole concept in analyzing and satisfying current needs,which differ significantly depending on the type,extent, and reversibility of disadvantage.General needs tend to be constant,but in these patients,the spectrum of needs that have been modified or newly created in connection with the disadvantage is more significantly affected. For careful analysis, the nurses can use the evaluation and measurement tools,focusing on the problematic area(e.g., self-sufficiency or risk factors) or comprehensively on the level of disadvantage.Nurses in the Czech Republic use only instruments specifically evaluating each area separately.Implementing a comprehensive tool could contribute to the improvement of care for patients with physical disabilities in clinical practice.The dissertation aimed to analyze the available evaluation and measurement tools for evaluating patients with physical disabilities in nursing, map the care provided for these patients,and analyze problematic situations present in patients with physical disabilities during hospitalization.We use a mix of methods to process the work using the questionnaire survey technique and the Focus groups method. We create the questionnaire survey for two groups marked as A and B. Research group A had a representative character and consisted of nurses from all over the Czech Republic.Research group B consisted of patients with physical disabilities.Within the data collection, we create two different questionnaires - non-standardized for research set A with a focus on using evaluation tools,work with results,recommendations for practice,and the concept of physical disabilities.We also create a combination of a WHODAS 2.0 and further information focusing on the concept of own body and the quality of life for research set B.In clinical practice, the use of a general standardized tool,especially for fall risk assessment (Conley scale and Morse Fall Scale),pressure ulcer risk assessment (Braden scale and Norton scale),and self-sufficiency assessment (Barthel test,routine instrumental test).As part of the active search for the specific needs of the nurse, she also evaluates the area of activity,motivation, mobility,and nutrition.Respondents do not evaluate sexuality and spirituality adequately in clinical practice,and nurses state that these topics are still taboo and consider it a more suitable alternative for these domains to be provided by other specialists.For the field of assessment, they would welcome in their practice both tools for assessing the risk of pressure ulcers - Waterlow Scale,Knoll Scale or Shannon Scale;fall risk assessment tools - Morse Fall Scale,Conley Scale or Tinetti scale;tools for self-sufficiency evaluation - Barthel test, a test of everyday instrumental activities.In patients with physical disabilities,the most problematic domains currently are urinary incontinence,pain,and the psychological area,focusing on self-esteem and a sense of security and safety.Nurses would like to welcome a more comprehensive tool for assessing the issue of physical disadvantage for use in clinical practice,and they would also welcome educational courses in this area,which will help them understand this issue better.In clinical practice,respondents use standardized and non-standardized tools to evaluate patients with physical disabilities.The respondents would welcome many of the standardized tools in their practice and recommend them for use throughout the Czech Republic.Patients with physical disabilities often suffer from the risk of pressure ulcers,falls,the development of infections,mental health problems,and pain.As a recommendation for practice,we agree with the implementation of standardized tools into clinical practice.WHODAS 2.0 is well-suited for analyzing the level of disadvantage and points to disadvantaged areas.Furthermore,the nurse
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