The graduation theses is about urinary tract infections and the preventive care that we are able to provide within nursing care of patients with urinary catheter. The theoretical part of graduation theses includes the chapters about general introduction to nosocomial infections, as well as epidemiology, pathogenesis, diagnosis and treatment of urinary tract infections. Furthermore, it relates to their antibiotic therapy and resistence to antibiotics. The main task is the prevention of urinary tract infections. Generally I have focused on the methods of urinary catheterization and their correct indications, the materials and design of urinary catheters, as well as on nursing care of urinary catheters. The thesis includes research aimed at providing preventive measures that are implemented in practice, comparing them to each other and comparison with the current studies and recommendations.. This research provides both positive and negative results. Some of the recommendations for preventive care of urinary tract infections are being followed, other are being omitted. There are also differences between respondents from different departments as well as among the departments. Nursing care procedures are not unified despite of presence of guidelines and standard procedures. keywords: nosocomial...

Introduction: The thesis "Alzheimer's disease and department of intensive care" deals with the specifics and difficulties of nursing care for patients with this chronic and degenerative disease in intensive care units (ICUs). The number of patients with Alzheimer's disease is constantly growing and caring for them in such specific wards is extremely demanding. The purpose of this thesis was to map the most problematic areas in the care provided and propose their solution. Methods and results: The empirical part presents the results of a conducted qualitative research which took place in the form of interviews with 10 general nurses who have experience with such patients. Following a word-for-word transcription of the obtained interviews, the results are summarized in a final discussion. They show that when caring for a patient with dementia, general nurses see the main problems in his decreased ability to cooperate, behavioral changes, which often appear as a result of environment change, and difficult communication. They consider the patient's confusion, his negativism, and the inability to find the right words to be communication barriers. This results in enormous demands on the caring staff's patience. The interviewed general nurses however approach patients with dementia generally positively...

Identifikační záznam: ŠEBESTOVÁ, Marcela. Náhlé příhody břišní v gynekologii pohledem sestry v intenzivní péči. [Acute Severe Abdominal Pain in Gynaecology from the Point of View of a Nurse in the Intensive Care Unit]. Praha, 2011. 68 s., 10 příl. Diplomová práce (Mgr.). Univerzita Karlova v Praze, 1. lékařská fakulta, Ústav teorie a praxe v ošetřovatelství. Vedoucí práce Mgr. Kulhavá, Miluše. Abstrakt Diplomová práce je zaměřena na náhlé příhody břišní v gynekologii pohledem sestry intenzivní péče. Teoretická část je věnována anatomii a fyziologii ženského reprodukčního systému. Velkou část práce zaujímají náhlé příhody břišní v gynekologii a to především mimoděložní těhotenství, tedy stav, se kterým se může setkat každá žena ve svém reprodukčním období. Empirická část práce je věnována kvalitativnímu výzkumu se zaměřením na zjištění spokojenosti respondentek s poskytovanou ošetřovatelskou péčí po operaci mimoděložního těhotenství. Pohled na hospitalizaci ze strany pacientek je velice cenný, protože dokládá výsledky zdravotnické, v tomto případě ošetřovatelské práce jinak, než běžné statistiky. Výzkumný soubor je tvořen pěti ženami v reprodukčním věku, které byly hospitalizovány na gynekologicko-porodnické klinice s diagnózou ektopická gravidita. Práce shromažďuje co nejvíce informací o mimoděložním...

Bakgrund: Patienter med drog- och alkoholmissbruk riskerar många komplikationer till följd av missbruket. Missbruket leder till många dödsfall varje år och är en stor kostnad för samhället. Patienter med missbruksproblematik upplever att de behandlas orättvist i omvårdnaden. Sjuksköterskor anser att omvårdnaden av den här patientgruppen är komplex. Syfte: Syftet är att sammanställa forskning om sjuksköterskors inställning och upplevelser av att vårda patienter med drog- och alkoholmissbruk inom både somatisk och psykiatrisk vård. Metod: En litteraturstudie, med 16 vetenskapliga artiklar, 12 med kvalitativ metod och fyra med kvantitativ metod. Resultat: Resultatet presenterades i olika kategorier som var: ”Att vara osäker”, ”Att känna sig otillräcklig”, ”Att känna sig inkompetent i sin roll”, ”Att kommunicera med patienten” samt ”Att vara ensam eller i team”. Sjuksköterskorna upplevde svårigheter i omvårdnaden med den här patientgruppen. Kunskapsbrist beskrevs i samband med omvårdnaden samt känslor som ångest och stress. En del relationer mellan sjuksköterska och patient baserades på misstro och några sjuksköterskor uttryckte en vilja att förbättra omvårdnaden med den här patientgruppen. Slutsats: Utifrån denna litteraturstudie kan slutsatsen dras att sjuksköterskor kan uppleva brister i omvårdnaden av patienter med drog- och alkoholmissbruk. Bristerna visar sig genom osäkerhet, otillräcklighet, känsla av inkompetens, i kommunikationen med patienten och samverkan i teamet. Utbildning, kunskap, samverkan och engagemang visar sig vara viktiga faktorer som kan påverka kvaliteten på omvårdnaden av den här patientgruppen. Det innebär således att det finns ytterligare behov av att utveckla både kunskapsläget och rutinerna när det kommer till denna typ av vård. / Background: Patients with drug- and alcohol abuse risk various complications related to the misuse. Drug- and alcohol abuse leads to a high yearly rate of death and an important social cost. Patients with drug- and alcohol abuse experience that they are treated unfairly in the care. Nurses consider the nursing care of this patient group to be complex. Aim: The aim of this study was to describe nurses’ experiences in the care for patients with drug- and alcohol abuse, both in somatic and psychiatric wards. Method: A literature review including 16 scientific articles, 12 with qualitative method, 4 with quantitative method. Results: The result is presented in different themes: “To be unsure”, “To feel inadequate”, “To feel incompetent”, “To communicate with the patient” and “To work alone vs in a team”. The nurses experienced difficulties in the care. A lack of knowledge was described and also emotions like anxiety and stress. Many relationships were based on distrust. Some of the nurses expressed a will to ameliorate the care for this patient group. Conclusion: The conclusion of this literature review is that nurses can experience deficits in the care of patients with drug- and alcohol abuse. The deficits manifest through insecurity, insufficiency, a sense of incapacity, in the communication with the patient and in the interplay inside the team. Education, knowledge, teamwork and commitment show to be important factors that can affect the quality of the care for this patient group. This implies that there are additional needs to evolve the knowledge and routines concerning this type of care.

Syftet med studien var att beskriva upplevelsen från vård- och återhämtningstiden hos patienter som vårdats på intensivvårdsavdelning. Metoden som används hade en kvalitativ ansats. Data samlades in via intervjuer med 11 patienter som vårdats på intensivvården från två sjukhus i Sverige. Materialet analyserades genom kvalitativ innehållsanalys. Resultatet blev fyra kategorier och 14 subkategorier. Kategorin Känna trygghet bestod av subkategorierna: Bli väl omhändertagen i vården, Få information och Vikten av stöd. Kategorin Förlust av kontroll innefattade: Sakna vetskap och förståelse, Fragmenterade minnen från vårdtiden, Overklighetsupplevelser samt Känna rädsla, obehag och smärta. Kategorin Stärkas av egna resurser inkluderade subkategorierna: Vikten av positiv inställning, Hoppas och drivas av framsteg samt Bra fysiska förutsättningar och intressen som drivkraft. Kategorin Erfara förändring bestod av subkategorierna: Känna fysisk svaghet, Komplikationer som påverkar ens tillvaro, Vilja leva som tidigare och Tankar kring livet.  Slutsatsen var att god omvårdnad inkluderade patienters behov av att bli sedda, behandlade med omsorg samt minnas och förstå vad som sker. Förståelse bygger på information om den egna sjukdomsbilden, komplikationer och återhämtning. Dessa behov belyser vikten av att i omvårdnaden utgå från patienterna och att integrera dem i vården.   Som vårdpersonal bör vi sträva efter att stärka patienters känsla av sammanhang vilket förutsätter att de är väl insatta i sin sjukdom, vård och behandling samt konsekvenser av det de går igenom.  Personcentrering är viktigt för patienters känsla av sammanhang och därmed deras hälsa och livskvalité under och efter sjukhusvård. / The aim of this study was to describe the experience from the hospital stay and time of recovery in patients admitted to intensive-care unit. The method used had a qualitative approach. Data was collected through interviews with 11 patients who had received intensive-care from two hospitals in Sweden. Data was analyzed with qualitative content analysis. The result was four categories and 14 subcategories. The category To feel secure included the subcategories: Good patient care, Receive information and The importance of support. The category Loss of control comprised of the subcategories: Lacking knowledge and understanding, Fragmented memories of the hospital stay, Experiences of unreality and To feel fear, pain and discomfort. The category Strengthen by their own resources included the subcategories: Importance of positive attitude, To hope and be driven by success and also Good physical conditions and activities as the driving force. The category Experience changes contained the subcategories: Feel physical weakness, Complications that affects your life, Wish to live as before and Thoughts about life.  The conclusion was that good nursing care included patient’s needs to be seen, treated with care and remember and understand what was happening. Understanding was based on information about their own illness, complications and recovery. These needs highlights the importance of basing nursing care on the patient and to integrate them in their own care and treatment. Health professionals should strive to strengthen the patient’s sense of coherence which implies that they are well versed in their illness, care and treatment and consequences of what they are going through. Person-centering is important for the patient’s sense of coherence and thus their health and quality of life during and after hospitalization.

Children heart diseases can be divided into congenital and acquired heart defects. The acquired heart defects can be further divided into acquired heart defects, heart rhythm disorders, including hypertension, inflammatory heart diseases and heart failure. Children heart diseases can occur at any age, even if it is a congenital heart defect that is less severe. The goal of this thesis was to find out the specifics of nursing care of children with heart diseases who are hospitalized at ICU and to find out the most common nursing diagnoses according to NANDA II taxonomy, and their treatment in case of children with heart diseases who are hospitalized at ICU. During the realization of the research part, a qualitative research survey was conducted using semi-structured interviews with the nurses, participant observation and the method of content analysis, which provide a more complex view of the composition of the children with heart disease hospitalized at ICU. The interviews were conducted with the nurses at the children's ICU, where the participant observation and the method of content analysis took place as well. The results of the research show that nursing care differs in the case of cardiologic disordered children and otherwise disordered children in some areas, as well as the needs. In the research part it was found out what the most frequent nursing interventions in case of these children are and how much they differ from the interventions of children with other diseases, who are also hospitalized at ICU. Furthermore, the research shows that nurses have a negative opinion on nursing diagnoses, although they are used in the documentation. This was found not only in the semi-structured interviews with the nurses, but also during the participated observation and the content analysis of the documentation. The research also revealed that some nursing diagnoses are specific to cardiologic disordered children, but, for example, the nursing diagnosis of the risk of infection associated with invasive entry is used in case of all children hospitalized at ICU. The diploma thesis should inform nurses about nursing care in case of children with heart disease hospitalized at ICU.

Introdução: O enfermeiro é um dos profissionais presentes em todos os níveis de atenção à saúde e que participa da maioria das ações desenvolvidas na Atenção Primária à Saúde (APS), o que lhe confere papel estratégico na inovação, reestruturação de serviços e na implementação de atividades dentro do sistema de saúde. Segundo a World Health Organization (WHO), a cada ano cerca de 40 milhões de pessoas necessitam de Cuidados Paliativos (CP); voltado para pacientes com condições crônicas progressivas desde o diagnóstico, e caminhando em conjunto com as terapias modificadoras da doença ou potencialmente curativas, este tipo de cuidado deveria ser ofertado principalmente pelos profissionais que atuam na APS. Objetivos: Propor um rol de ações básicas de enfermagem em Cuidados Paliativos, considerando a integralidade e a longitudinalidade na assistência às condições crônicas de saúde, na Atenção Primária à Saúde, e classificar as ações de enfermagem em Cuidados Paliativos, segundo os níveis de competência básico e especializado. Método: Considerando a inexistência de consensos para a classificação dos níveis de complexidade das ações de enfermagem nos CP, o estudo utilizou a Técnica Delphi com um painel de enfermeiros de CP. Resultados: Das quarenta e oito ações de enfermagem em CP, vinte e três foram classificadas como ações de nível básico e foram subdivididas em quatro categorias, considerando as necessidades de saúde em foco. A discussão dos achados foi realizada sob o prisma do princípio da integralidade do SUS e o atributo da longitudinalidade da APS tomados como marco referencial deste estudo. Considerações finais: A proposição das ações de enfermagem em CP para APS propõe um horizonte para que os enfermeiros da APS possam lidar melhor com a demanda por cuidados paliativos que já está no território, com uma melhor utilização dos recursos e respeitando o princípio da integralidade e o atributo da longitudinalidade. / Introduction: Nurses are professionals present to all levels of health care and which take part in most of the actions developed in Primary Health Care (PHC), which gives them a strategic role in innovation, service restructuring and implementation of new activities within the health system. According to the World Health Organization (WHO) every year about 40 million people need Palliative Care (PC); aimed at patients with progressive chronic conditions since diagnosis, and going along with disease-modifying or potentially curative therapies, this type of care should be offered mainly by professionals working in PHC. Aims: To offer a list of basic nursing actions in Palliative Care, considering integrality and longitudinality in the assistance of chronic health conditions in PHC and to classify nursing actions in Palliative Care, according to the levels of basic and specialized competence. Method: given the lack of consensus on the classification of nursing actions complexity levels in PC, the study used the Delphi Technique with a panel of PC nurses. Results: Of the forty-eight nursing actions in PC twenty-three were classified as basic level actions and were subdivided into four categories, considering the health needs in focus. The discussion of the findings was performed under the SUS (National Health System) integrality principle aspect and the PHC longitudinality attribute taken as the reference framework of this study. Final considerations: Considering that the basic actions in PC were understood in this study, as actions that are of scope of all nurses, this includes the PHC professionals and thus it seems possible to propose a list of nursing actions in PC for PHC, considering the integrality and longitudinality in attending to chronic health conditions.

Estudo exploratório e descritivo de abordagem qualitativa sobre a utilização da CIPESC® nas consultas de enfermagem, como ferramenta para reconhecimento e enfrentamento das necessidades em saúde das crianças. Ancorado na Teoria da Intervenção Práxica da Enfermagem em Saúde Coletiva e nos conceitos de necessidades em saúde sob a perspectiva do materialismo histórico e dialético. Objetivou conhecer as possibilidades e limites da CIPESC® para reconhecer e enfrentar as necessidades de saúde da população infantil; descrever o perfil demográfico e epidemiológico da população curitibana com destaque para os indicadores relativos às crianças, seu crescimento, desenvolvimento e ocorrência de violência infantil; identificar as políticas e os programas de saúde adotados pelo município e o sistema de informação em saúde; analisar o potencial da nomenclatura CIPESC® Curitiba no reconhecimento e enfrentamento das necessidades em saúde, a partir dos diagnósticos e intervenções; verificar as potencialidades e os limites do uso da CIPESC® na consulta de enfermagem à criança. O cenário de estudo foi o município de Curitiba-PR. Os dados foram coletados em fontes primárias e secundárias. Para a coleta dos dados primários utilizou-se da técnica de estudo de caso. Os sujeitos da pesquisa foram 28 enfermeiros da atenção básica do município, que aceitaram participar do estudo por meio de instrumento de coleta de dados pela web, disponibilizado em página própria, desenvolvido em linguagem ASP.NET, com Framework 3.5 e o banco de dados utilizado foi o MySQL 5.1.30. Os resultados mostraram que as condições demográfica, de saneamento básico, educação e políticas de saúde são favoráveis à superação dos agravos à saúde. A organização da atenção à saúde tem alcançado bons indicadores epidemiológicos, mas ainda está pautada em referenciais de risco, na contra-mão do que propõe a saúde coletiva e a epidemiologia social, com consultas individualizadas e focadas nas questões biológicas do sujeito. A CIPESC® mostrou potencialidades para o reconhecimento de necessidades a partir dos diagnósticos e intervenções de sua nomenclatura mas a base representa apenas parte das necessidades expressas pelos indivíduos, não abrangendo uma abordagem integral dos processos de desgaste e fortalecimento. A discussão dos dados possibilitou identificar possíveis causas para os limites da CIPESC® como a adoção da teoria das necessidades humanas básicas como organizadora da nomenclatura, a assistência pautada em referenciais de risco e a formação dos profissionais direcionada ao modelo biomédico de atenção à saúde. A atenção às necessidades em saúde da população infantil ainda permanece como um desafio e um caminho que está sendo trilhado, em passos tímidos, sendo primordial que os processos de trabalho se ajustem às necessidades em saúde da população, utilizando-se da intersetorialidade, interdisciplinaridade, trabalho em equipe; buscando a efetiva transformação da realidade e superação de contradições e tendo as necessidades e vulnerabilidades como objetos de assistência. Todos esses aspectos devem fazer parte do cotidiano dos profissionais de saúde, com práticas consolidadas e direcionadas às transformações que a realidade precisa sofrer. / This exploratory, descriptive and qualitative study on the use of CIPESC® in nursing consultation, as a tool for recognizing and addressing child health needs and was based on the Theory Nursing Praxis Interventions in Collective Health and on the concepts of health needs under the perspective of historical and dialectical materialism. The study aimed to understand the possibilities and limits of CIPESC® (International Nursing Practice Classification in Collective Health) to recognize and address the health needs of the child population; to describe the demographic and epidemiological profile of the population from Curitiba with emphasis to indicators related to children, their growth, development and the occurrence of child violence; to identify health policies and programs adopted by the city and the health information system; to analyze the potential of the nomenclature CIPESC® Curitiba in recognizing and addressing health needs, from diagnosis and interventions; to determine the potentialities and limits of using CIPESC® in nursing consultation to child. The study was carried out in Curitiba, state of Paraná, Brazil. Data were collected from primary and secondary sources. Case study was used to collect primary data. Subjects were 28 nurses from the citys basic health care system, who agreed to participate in the study through a web-based data collection instrument, available at a specific webpage, developed using ASP.NET with Framework 3.5 and using MySQL 5.1.30 database. Results showed that the demographic, sanitation, education and health policies conditions are favorable to overcoming health problems. The organization of health care has achieved good epidemiological indicators, but it is still grounded on risk references, in counter to what is proposed by public health and social epidemiology, with individual consultations and focused on subjects biological issues. CIPESC® showed potential for the recognition of needs from diagnosis and interventions of its nomenclature, but the ground represents only part of the needs expressed by individuals, not encompassing a comprehensive approach of the processes of wear and strengthening. The discussion of data enabled to identify possible causes for the limits of CIPESC®, such as the adoption of the theory of basic human needs as the organizer of the nomenclature, care grounded in risk referencials and training of professionals guided by the biomedical health care model. The attention to child health needs remains as a challenge and a path that is being tread, at timid steps, in great need that the work processes fit the health needs of the population, using intersectoral and interdisciplinary arrangements, teamwork, seeking the effective change of reality and overcome of contradictions, with needs and vulnerabilities as objects of care. All these aspects should be part of health professionals daily practice, with consolidated practices which are directed to the changes needed in reality.

Este estudo trata-se de uma revisão sistemática da literatura e tem como referencial teórico a prática baseada em evidência. Buscou-se identificar e analisar na literatura evidências oriundas de ensaios clínicos controlados e randomizados sobre os cuidados relacionados à aspiração de secreções endotraqueais em pacientes adultos, em estado crítico, intubados e sob ventilação mecânica. Os passos metodológicos desta revisão foram guiados pelas recomendações da Colaboração Cochrane. A busca foi realizada nas bases de dados PUBMED, EMBASE, CENTRAL, CINAHL e LILACS. Das 631 referências encontradas, 17 estudos foram selecionados após a análise dos títulos e resumos. Foi realizada a extração dos dados e análise do risco de viés por dois revisores, para cada estudo selecionado. Os 17 estudos foram publicados no período de 1987 à 2009. Ao todo, foram investigados 2.890 pacientes adultos, intubados e sob ventilação mecânica. Foram encontradas evidências quanto a seis categorias de intervenções relacionadas à aspiração endotraqueal: aspiração endotraqueal baseada em pesquisa x aspiração endotraqueal usual, em um estudo; aspiração endotraqueal de rotina x aspiração endotraqueal minimamente invasiva, em dois estudos; aspiração endotraqueal de sistema aberto x aspiração endotraqueal de sistema fechado, em oito estudos; troca do sistema fechado em 24 horas x 48 horas, em dois estudos; troca diária do sistema fechado x troca não rotineira, em um estudo; e instilação de soro fisiológico x não instilação de soro fisiológico, em três estudos. As intervenções foram realizadas analisando desfechos referentes a alterações hemodinâmicas, alterações dos gases sanguíneos, colonização microbiana e infecção nosocomial, e outros desfechos. Foram encontradas evidências relevantes quanto à prática da aspiração endotraqueal, entretanto, as limitações metodológicas e riscos de viés encontrados nos estudos selecionados reduzem a confiabilidade de tais evidências, demonstrando a necessidade de estudos futuros. Também, foi observada a necessidade da realização de ECCRs que contemplem os demais passos da aspiração endotraqueal e desfechos. / This systematic review of literature used the evidence-based practice as the theoretical framework. This study aimed to identify and analyze in the literature the evidence of randomized controlled trials on care related to the endotracheal secretions suctioning in critically ill adult patients who were intubated and undergoing mechanical ventilation. The methodological steps were guided by the recommendations of the Cochrane Collaboration. The search was conducted in the PUBMED, EMBASE, CENTRAL, CINAHL and LILACS databases. Of the 631 found references, 17 studies were selected after the analysis of titles and abstracts. The data extraction and the analysis of the risk of bias by two reviewers for each selected study were performed. The 17 studies were published in the period from 1987 to 2009. In the total, 2,890 adult patients who were intubated and undergoing mechanical ventilation were investigated. Evidences for six categories of interventions related to endotracheal suction were found: research-based endotracheal suction x usual endotracheal suction, in one study; routine endotracheal suction x minimally invasive endotracheal suction, in two studies; open endotracheal suction system x closed endotracheal suction system, in eight studies; change of closed system in 24 hours x 48 hours, in two studies; daily change of closed system x non-routine change, in one study; and instillation of saline x non-instillation of saline, in three studies. The interventions were performed through the analysis of outcomes related to hemodynamic alterations, blood gas alterations, microbial colonization and nosocomial infection, and other outcomes. Relevant evidences related to the practice of endotracheal suction were found; however, methodological limitations and risks of bias found in selected studies reduce the reliability of such evidences, demonstrating the need for further studies. Also, the need for the realization of ECCRs that address the remaining steps of endotracheal suction and outcomes were observed.

Thesis advisor: Dorothy Jones / The importance of the nurse-patient relationship to the overall well- being of the person has been explored extensively by nurses. What is largely missing from this knowledge developed to date is the patient's perspective. The purpose of this study was to develop a reliable and valid measure of patients' perceptions of feeling known by their nurses during an acute, surgical, hospital admission. The development of the PPFKN Scale was guided by Newman's theoretical framework of Health as Expanding Consciousness (1994) and data from a qualitative descriptive study conducted in 2003 (Somerville). The current investigation focused on the development and psychometric testing of the PPFKN Scale. The four themes that emerged from the earlier qualitative study were used to guide the development of the 85-item scale. This scale was exposed to a panel of nurse experts to establish inter-rater agreement and content validity, item understandability and readability. The revised scale was piloted with five participants who had experienced an inpatient, surgical admission to determine content validity, item readability and understandability. The revised 77-item scale was then administered to 327 surgical inpatients across seven general care units at a large academic urban medical center. A sample size of 296 completed surveys was analyzed. A four-component solution was devised using Principal Components Analysis with Varimax rotation. This four-component solution accounted for 63.3% variance, with a total scale Cronbach's alpha coefficient of 0.99. A component loading cut-off was set at 0.3 and items not loading at this value on the expected component were dropped. This process resulted in a reliable and valid 48 item PPFKN Scale with four components and a total scale Cronbach's alpha coefficient of 0.98. / Thesis (PhD) — Boston College, 2009. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.