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Support for direct care by middle management
MATOUŠKOVÁ, Amalia
The thesis deals with the problematic of support of the direct nursing by middle management. Head nurses - middle-level managers are responsible for the quality of the provided nursing care, and therefore their interest is to lead their subordinate nurses in a way, that the quality of the nursing care is preserved or constantly improved and that not only by control activities or material security but mostly by support. The objective of the thesis was to find out how nurses perceive the support from middle management within ensuring good-quality direct nursing care. The objective was fulfilled using quantitative and qualitative methods. Quantitative part of the research was made up of 195 respondents. We have compiled the survey which was distributed to practical and general nurses. It was based on in advance laid down ten hypotheses which were connected with the objective of the thesis. At nine hypotheses was proven their validity and the last, tenth hypothesis was not confirmed. Qualitative part of the research was made up of interviews with seven head nurses which informed us about their view on support of the direct nursing care. The result of the research was finding that head nurses more use the control activity than the supporting one. Despite the fact, they consider the support to be sufficient. The greatest obstacle in the support by a head nurse is lack of motivation. The nurses would welcome having the option of feedback, further education and that the head nurse herself would participate in the direct care. From the perspective of management, we found out using which tools and ways they help subordinate nurses to improve the quality of the direct nursing care. Here they get to conflict of answers of subordinate nurses and head nurses. Head nurses think that they motivate their subordinate nurses, enable them to further educate themselves or if it is possible directly participate in the direct nursing care. They are convinced that subordinate nurses do not lack nothing special in the support and if they do it is probably understanding or their constant presence at the department. The output of the thesis is suggestion of recommendation for support of the direct nursing care by middle management which was made on the basis of analysis of the research.
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Interpersonal relationships and their projections into the quality of nursing care provision in intensive care units
FÜRST, Zdeněk
This thesis deals with interpersonal relationships and their projection into the quality of the provision of nursing care at intensive care units. 3 goals were set for this purpose and 8 hypotheses were subsequently defined and statistically analysed. The above-mentioned goals were achieved by the means of a quantitative research in which the technique of non-standardized questionnaires was applied (valid questionnaires returned: 56.5%). The research sample consisted of 173 intentionally selected respondents from among non-doctoral healthcare workers. The research has shown that positive interpersonal relationships prevail at intensive care units (61.3%). 87.3% of the respondents met their colleagues outside of working hours. Interpersonal troubles occurred among 44.5% of respondents, while interpersonal conflicts were noted among 59.5% of respondents. The occurrence of bullying was noted among 26.6% of respondents. Respondents mostly faced arguing and aggressiveness (22.1%) within the performance of their duties. They also faced offence and humiliation (18.2 %) and slandering (18.2%). The quality of nursing care was defined on the basis of the opinions of the respondents and their ability to cooperate. The proportion of the occurrence of good-quality and poor-quality nursing care does not differ (p = 0.323). The fact that the quality of the nursing care with positive and negative relationships differs (p < 0,001) was a significant finding; negative relationships reduce the quality of nursing care. We consider the issue this research deals with to be topical. The thesis presents an insight into the problems in question and can serve as a basis for further projects. The thesis also points out the importance of the regulation of interpersonal relationships at intensive care units on the basis of empiric data, and urges that interventions positively affecting these relationships be implemented as they can have a desirable impact on the quality of nursing care.
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Self-esteem and confidence of nurses a related to nursing practice
SLIPKOVÁ, Aneta
This thesis is focused on the current status of self-esteem and confidence of nurses while doing the nursing practice. To evaluate current status the general nurses were asked about importance, and if they have enough self-esteem and confidence while doing the nursing practice. Furthermore, I asked questions focused on the problematics of building self-esteem and confidence and how nurses care about their self-esteem and confidence. The thesis is made up of the empirical and theoretical part. Theoretical part is focused on the personalities of general nurses and their formation. Furthermore, this part is focused on factors which affect self-esteem and confidence of the nurses while doing the nursing practice and it also includes the research what the nurses do for their mental health in order for their self-esteem and confidence to be on the appropriate level for doing the nursing practice. The empirical part is made up of one objective. This objective is to determine if the nurses have enough self-esteem and confidence while doing the nursing practice. For the empirical part the technique of semi-structured interview was chosen. Gathered information were processed and divided into nine categories. The results of the research show, that general nurses can, in their own words, say what self-esteem and confidence is and are able to speak about the importance of self-esteem and confidence when doing the nursing practice. Self-esteem and confidence of the nurses is on appropriate level for doing the nursing practice, but their approach to their job is responsible and humble, both for new and experienced nurses. Their self-esteem and confidence while doing the nursing practice is affected by specific factors which are connected to their profession. To achieve the necessary level of self-esteem and confidence, their personal values in their personal life are also important. The research shown that while doing the nursing practice the nurses have more self-esteem and confidence than in their personal life, since they would not be able to do operations and the nursing practice in their best states of mind. Because of that in order for the nurses to have self-esteem and confidence on the appropriate level they should care about their mental health. The interviews shown that nurses try their best to care about their mental health, even though sometimes it is not possible due to high difficulty of their profession. This thesis helps to introduce the problematics of self-esteem and confidence of the general nurses at different departments. This includes personal opinions of nurses on the importance of self-esteem and confidence while doing the nursing practice, factors which affects these personal values and the importance of mental hygiene for doing the nursing practice.
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Good practice of selected nursing procedures
MLEZIVOVÁ, Petra
Introduction Nursing is a independent scientific discipline with one main aim: maintain and support health of population. Nursing care is performed by skilled nurse using nursing techniques. Particular nursing techniques are always modified by current state of health and needs of patient. Together with other disciplines, also nursing must refect changes of the modern age. Nursing practice and theory lead to qualitative changes by implementing of evidence-based practice. Evidence-based practice in nursing is process connecting best nursing experience and expertise of nurses, which together determine the optimal care. Goals of the thesis To complete this thesis, three goals were determined. Firts goal was to find out, what was the source of particular nursing techniques performed by nurses. Second goal was to find out, if "good practise" was used when performing particular nursing techniques. Last goal was to fin out, what was the general knowedge of the "evidence based practise" phrase among nurses. Materials and methods Research investigation of the thesis was performed using the methods of qualitative and quantitative research. Quantitative research was perfefomed using the questionnaires distributed among general nurses working at inpatient wards. Results of research were evaluated using graphs and tables. Pearson´s chi square test was used for statistical processing. Qualitative research was executed using the direct observation method. Six different categories were set. Data were colected to record form, which was later on used for analysis of observed figures. Observation was focused on comprehensive hygienic care, divided into following categories: oral hygiene, care of hospital clothing, bathing of not self-sufficient patient, care of nails, skin and washing the hair. Results Results of the thesis allowed to clarify links between performing the hygiene care and evidence-based practise / good practise. These results can also be used as a contribution on coferences regarding this topic and as a material in teaching the nursing. Using the statistically preocessed data, hypotehsis were evaluated. H1: General nurses perform particular nuring techniques more based on habitual practise of their department than on local professional health care standards. H1 was confirmed. H2: General nurses perform particular nursing techniques more based on habitual practise of their department then on EBN. H2 was confirmed. H3: General nurses with the bachelors or masters degree have better awareness of EBN than nurses witout university degree. H3 was confirmed. Research question was asked - What is the role of EBN in particular nursing techniques? Observation study revealed that EBN is not of high importance in performing nursing hygiene care. Conclusion Thesis could highlight weaknesses in providing hygienic care and evidenced based nursing. It could also inspire all who perform their job with joy and respect and wish all the best for their patients. Last but not least, thesis could inspire all who want to provide fist-rate and safe care and leave the work with self-satisfaction.
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Patient satisfaction with nursing care at Surgical Intensive Care Units
KRAMAŘÍKOVÁ, Lucie
This diploma paper aims at defining and mapping out patient satisfaction in intensive care units for surgery patients and comparing results in dependence on length of hospitalization and facility. Diploma paper consists of theory and research. Theory is divided into 5 chapters. Empirical part of this diploma paper was carried out using the method of combined research. The first part is created by qualitative research using semi-structured interview, second part comprises quantitative research using non-standardized, structured questionnaire face to face survey. Processed results were arranged into Excel tables and graphs. All research was based on eight dimensions of patient-centered care delineated by the Picker Institute. Qualitative research sample consists of 11 respondents, quantitative research sample comprises 142 respondents. Data collection took place in surgical ward. This diploma paper defines four aims with two related research questions. The first aim is to determine the level of patient satisfaction with postoperative care. The second aim focuses on patient satisfaction with nursing care, the third aim is to define positive and negative factors influencing patient satisfaction in intensive care units and the last aim points at patient satisfaction with nursing care in intensive care units in relation to the type of facility and length of hospitalization. These two quantitative research questions were posed: 1. What are the possibilities to improve patient satisfaction in nursing care? The research survey showed that an area of concern is patient awareness. It is necessary to improve patient awareness after admission to an intensive care unit and during transfer to a standard ward. Pain and insufficient pain relief often occurred. Nurses should cooperate more with doctors in this respect and, above all, monitor patients more and offer alternative ways of pain relief. Other problems were mentioned in relation to bed adjustment possibilities. Despite the fact that nurses were trying to do their best, not all the circumstances could be influenced that way, for example mattress hardness. The last concern area, mentioned by patients, was perceived loneliness. Nurses should conduct considerate and sensitive conversation, create feeling of trust and support patients. The second question: What factors influence patient satisfaction? The results show that it is, above all, nursing staff attitude, followed by patient awareness, pain and sufficient pain relief, intensive unit environment and last but not least bed adaptation. Quantitative part set six presumptions using statistical methods independence test, chi-square test, Yates correction, t-test, and correlation-regression analysis. Questions from the first part of this paper were processed (in percentage) into clearly arranged graphs. Research survey shows that respondents were satisfied with nursing care and nursing staff. Patient awareness during admission to intensive care unit and staff anonymity proved to be the biggest areas of concern. Pain and insufficient pain relief turned out the clear reason for dissatisfaction as well as absence of information about performed surgeries. Conclusion of quantitative research survey showed that there is no statistically significant difference in patient satisfaction according to health-care facility or length of hospitalization.
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Nursing Documentation in Selected Countries
ČERNÁ, Simona
This thesis deals with nursing documentation in the Czech Republic and Germany. Nursing documentation is an inseparable but also independent part of medical documentation and the specifications of its keeping is both in the Czech Republic and Germany based on law. Nursing documentation should reflect the level of provided nursing care and serve to promote its quality. In the introduction of the theoretical part the term of nursing documentation based on the law of the Czech Republic and Germany is defined. Due to the fact that nursing documentation is a part of medical documentation itself the term is explained, too. The following part is concentrated on a detailed analysis of single steps of nursing process because it should serve as a basis for the further control work with it. The law defines the minimal requirements for the nursing documentation which is each medical facility due to fulfill. In order to complete the idea of this thesis, two objectives have been set. The first one is concentrated on nurses´ opinion collection about work with documentation in the selected medical facilities in the two selected countries. The next aim is to compare nursing documentation in the selected medical facilities in the two previously mentioned countries. Furthermore, two research questions have been formulated: What is the view of nurses in the Czech Rebublic and Germany in selected hospital departments on work with the documentation? What is the difference in the documentation in the selected departments between the Czech Republic and Germany? The practical part summarizes the results of qualitative research, which have been obtained by a semistructured interview and by the anylysis of the documentation. The first part of the research consists of the interviews with nurses, which have been recorded by indirect transcription and further processed through the open coding method. Additionally, pencil and paper method was used to unify the answers which were followingly organized into categories and subcategories through the technique of opened coding. The second part represents the anylysis of Czech and German nursing documentation. Both research questions have been answered through the proceeding of the research. The research of the first research question shows that Czech nurses see the documentation as neccessary evil, they do not use it an active way. Furthermore, they have answered that recording of all procedures related to the patient is done additionally. However, the German nurses have stated a steady presence of the documentation during the errands. The main reason for that is a possibility of immediate recording after a procedure which allows not only to make the documentation more effective but also provides the safety for the patient. Next, they state they have all the neccessary information with them. In addition, they share the idea that a high-quality nursing care cannot lack high-quality nursing documentation. The main difference between the two hospitals is that the German one performs open nursing documentation audit. This means that the management controls mainly if what has been written has been done, specifically nursing interventions carried out in patients who are still hospitalized. Nevertheless, the Czech hospitals conduct closed nursing documentation audit, which does not force them to use the documentation in a more active way. Next, the majority of the nurses have agreed on rising amount of paperwork.The second research questions have been answered through the analysis of the documentation. This meant a comparison of the documentation in the selected countries. The subject of the analysis was the nursing anamnesis, nursing care plan, its realization and nursing discharge summary. The German documentation for the nurse contains more points they must go through than the Czech one.
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Selected risks in nursing practice
HLADÍKOVÁ, Šárka
Current state: High percentage of risk is associated with providing medical care and therefore it may harm both the patient and the nursing staff (Drahoš, 2007). Objectives: To assess the most frequent risks in nursing care that may harm patients during their hospitalization. Furthermore, the aim is to find out whether the occurrence of these risks changes depending on the type of care provided and also whether the nurses' understanding of the principles of administration of oral medication is affected by the length of their work experience. Methods: The empirical part of this thesis was based on the quantitative research study - data collection method via structured questionnaires. The study was then supplemented by observation of nurses using the audit technique. The research group-participants: The questionnaire was designed for general nurses working in selected wards of Ceske Budejovice Hospital, plc. During the Semester-in-Practice Externship, six nurses in 'The administration of oral medication'audit. Results: The result of the aritmetic mean, results in the nurses stating the risk of fall in patients as the highest risk (3,56), risk of medication error (3.01). According to the addressed nurses from the internal department, the following risks belong to the group of the most significant risks to the patients of the internal department- risk of injury to the patient during hospitalization, risk of nosocomial infection, risk of falls in patient and risk of immobilization syndrome. According to the questionnaire research results, some differences were shown in the knowledge of principles of safe administration of oral medication in connection with the length of work experience of the addressed nurses. Nurses with the longest practise (over 11years) most frequently chose the correct answer in the following parts: expired drug usage and checks, medical refrigeration temperature, preparation and disposal of left-over medication, how to care for tablet splitter, correct action taken when a patient refuses to take medication and filling in the daily medication report. On the other hand, nurses with practise of 5-10 years more often correctly answered questions regarding drug administration system, safe usage of medical trolley cart and optimum storage conditions in medicine fridge. Nurses with the shortest work experience (under 5 years) proved to have the weakest knowledge of administration of oral medication. A conclusion that can be drawn from the audit results is as follows: the most common errors committed by the nurses are usage of generic drugs, lack of hand disinfection, touching medication with bare hands, preparation of meds in corridors instead of at the patient's hospital bed and incorrect drug disposal when the left-over tablets were put back in the packet. Conclusion: From the statistically significant connection between the probability of the risk and the department (type of care), it came to light that risk of injury to patients during their hospitalization, risk of nosocomial infection, risk of falls in patient, risk of immobilization syndrome and risk of aggressive behaviour are more common risks in internal wards rather than in surgical wards. Nurses with work experience over 11 years proved to have the best knowledge of principles of safe administration of oral medication. The audit proved that despite their good knowledge of safe drug administration procedures, the nurses do not always follow these in the workplace. My thesis is a proposal for standard care procedure 'administration of oral medication'.
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Effect of middle management in nursing quality of nursing care
FLANDEROVÁ, Hana
The subject of this thesis is called ?The influence of the middle nursing management on the nursing care quality?. The theoretical part focuses on head nurses, their preferred characteristics, skills, competencies, leadership styles and the way of implementing changes. The component of the theoretical part is also a description of the nursing care quality, and some ways how to achieve it. The practical part focuses on the influence of head nurses on the nursing care quality. For the processing the thesis has been used the combination of both qualitative and quantitative surveys. Our inquiry was conducted in the South-Bohemian hospitals and head nurses were the respondents. During the questioning survey and interviews we have managed to achieve all our pre-defined targets. Through the interviews we have managed to answer all given research questions. We found that all interviewed head nurses have the professional knowledge of the nursing management field. We identified ways of implementing changes to enhance the nursing care quality in practice. The head nurses stated, that nurses accept these changes after a presentation of professional arguments, and that the head nurses are led and supported during the introduction of the changes by top management. The head nurses, interviewed by us, believe that the adoption of changes to enhance the nursing care quality will help to increase the prestige of nursing and support the independence of this field. Based on the evaluation results of the survey we have identified the reluctance of nurses to learn new things as the most common problem in the implementation of changes.
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Standardization of nursing care as an integral part of preparation for the accreditation survey
ŠIMÁČKOVÁ, Alexandra
The Diploma thesis deals with standardisation of nursing care in the context of preparatory work for accreditation survey, i.e. a mutual harmony between standards developed in health care institutions and those developed by the SAK ČR accreditation commission. Standardisation is a process of setting essential rules which should guarantee providing a high quality nursing care. These rules (standards) enable to evaluate the quality of all nursing activities. Nurses should be aware of standardisation process and be actively engaged in it. The theoretical part describes the part of Czech nursing system concept focused on the quality of nursing care, defines the quality itself, maps the systems which help improve the quality of nursing care in health care institutions and refers to the formation of nursing standards. Practical part deals with five aims stated at the beginning: To map the quality of standardisation in nursing care as a preparatory part of accreditation survey. To find out if nursing care in hospitals is carried out through the method of nursing process. To find out if nursing care is supported by properly kept documentation. To find out if the needs of education were considered for all patients. To find out if nurses are aware of the importance of nursing care standardisation. We chose a quantitative research method. To collect the research data we used anonymous questionnaires. Each of the hospitals was given 50 questionnaires, i.e. 250 in total as the research group was made by respondents from the hospitals in Jindřichův Hradec, Pelhřimov, Tábor, Písek a Havlíčkův Brod. 230 completed questionnaires were returned and 204 of them represented then the research group. Within the research, we accomplished the aims stated, and proved these hypotheses: Hypothesis 1 (H1): The hospitals meet all requirements of accreditation survey of nursing care standardisation. H2: Nursing care in the hospitals is carried out through the method of nursing process. H3: Nursing care in the hospitals is supported by properly kept documentation. H4: The needs of education were considered for all patients and recorded in the nursing documentation. H5: The nurses are aware of the importance of nursing care standardisation. The quantitative research resulted into the statement that all hospitals meet the requirements of accreditation survey of nursing care standardisation. Nursing care in the hospitals is carried out through the method of nursing process which is properly recorded in nursing documentation. It was also found out that the needs of education were considered for all patients and properly recorded in the nursing documentation. The nurses are aware of the importance of nursing care standardisation. The facts resulted from the research prove that the quality of nursing care in the chosen hospitals is very high and meets the requirements of accreditation standards. The research findings will be offered to the hospital managements as an educational material for nurses and midwives.
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