This thesis explored the relationship between the discourses of nursing care, the nursing care provision, and the perceived nursing care needs of three highly dependent residents in a residential aged care facility in Australia. Residential aged care in this country has undergone major reforms since 1987 and the nursing profession has struggled with these changes because of the documentation, validation, and accreditation requirements; the inadequate determination of dependency on nursing care for funding; the Registered Nurse (RN) being removed from the bedside to a role of scribe and delegator; the increasing acuity and complexity of the residents' needs; an increase in the turnover of residents; a rise in the nursing staff attrition rate; the delivery of care by untrained and unqualified persons; the RN being accountable and responsible for the care given by 'non-nurses' from a distance; and, the inadequate skill mix and staff to resident ratios provided in these institutions. The interest of this thesis was to research gerontological nursing practice in the context of residential aged care. Residential Aged Care Facilities (RACFs) in Australia that care for the highly dependent elderly were identified in the thesis as disciplinary institutions that used 'subjectivation' as a means to control the efficiency and effectiveness of the labour force and the 'docile' bodies of the residents, whilst at the same time the government rhetoric is that of the quality of life standards and the rights of residents in these institutions. As well as the discourse analysis, an historical overview of the aged care reforms in Australia was undertaken for the period from 1975 to 2006 that demonstrated the effects the reforms have had on the voice of nurses and nursing care in these institutions. This analysis highlighted where nurses have been silenced and found the federal government determining what is nursing care and what is not nursing care, and also who is providing this nursing care. Using a case study approach and discourse analysis each of the three residents was studied using data from five sources namely the resident or relative, a RN, a careworker (CW), the current documentation pertaining to the resident's nursing care, and the non-participant observation of the nursing care provided. These discourses on the nursing care and perceived residents' nursing care needs were analysed using the theoretical base developed from the philosophy and research interest of Michel Foucault (1926-1984), who questioned the apparatus and institutions of Western cultures and searched for discontinuities in the practices of what he termed 'disciplines'. The results of the discourse analysis found nursing care practices that were alarming around the residents' perceived nursing care needs, the documentation of the nursing care provision, and the observed 'actual' nursing care provided. A questionable standard of nursing care was evidenced even though this facility had recently been accredited. A custodial level of mechanistic care was provided to residents in an extremely noisy and public environment within a culture of haste and bustle by unknowledgeable CWs, under the distant gaze of a RN, and the direction of the government documentation requirements. This resulted in unsafe, unethical, unprofessional, and negligent practices, as well as fraudulent, illegal, and dangerously out of date documentation practices. This was ultimately affecting each resident's quality of life, nursing care, and wellbeing and was an added burden on the residents' relatives. Many discontinuities, dissonances, conflicts, and contradictions in nursing practice were uncovered for these three highly dependent residents that may be transferable and similar to other highly dependent residents in this and other institutions. Indeed it may mirror other disciplines that provide care services, such as mental health care, acute care, and disability care provision. The concerns for the nursing profession have epistemological, ethical, and political ramifications for the residents and their relatives, the nurses, the non-nurses doing nursing work, the government, and the industry. Epistemologically new nursing 'knowledges' were being developed that were not resident focussed or based on evidence. Ethically, the legislated rights of residents were not being supported, despite the accreditation, funding, and complaint mechanisms in place - and this has the potential to have punitive ramifications for the industry. Professionally and politically, CWs were identified as non-nurses doing nursing work of a poor standard. This care was not based on accepted nursing practice, but developed through the documentation requirements of the federal government department, the applied constraints, and the CWs themselves. Furthermore, the documentation requirements were found to be a pretence in regard to funding through validation and accreditation, as well as a charade in nursing practice. There is presently a substantial third level of nurses who are identified legally and political as non-nurses doing non-nursing work (known as 'personal' care); but these non-nurses are doing nursing work and are identified by the nursing profession and the public as 'nurses' doing nursing work. These non-nurses who provided nursing care are not educated, licensed, or regulated, and are not accountable professionally to nurses or legally to the public. It is proposed that CWs are in need of licensing under nurses' boards requiring at the very least a minimum of training and education. It is further proposed that documentation requirements resort back to professional nursing documentation; funding be dependent on an predetermined minimum skill mix and staff/resident ratio; and the funding of residents be based on a minimum data set and untied from nursing practice. The professional nursing practice of assessment, planning, implementation, and evaluation of nursing care needs resorting to a nursing domain of knowledge, practice, accountability, responsibility, and documentation. If an acceptable quality of life is to be realised for residents in the residential aged care system, given that highly dependent residents are reliant on quality nursing care that is fundamentally imperative to their very quantity and quality of life, then changes in the residential aged care system and the nursing profession will be necessary. This thesis will contribute to opening up such dialogue between the government, the industry, and the nursing profession in Australia, and it also highlights areas of aged care nursing practice in need of further research.

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.

By 2014 the NHS is expected to make �21 billion in efficiency savings and increase productivity by 6% per annum, while maintaining or improving the quality of care. Given that the cost of the 1.7 million strong workforce represents 60% of the NHS budget, changes are likely. This context of innovation and cost-effectiveness has resulted in an ever greater emphasis to fully engage and support community nursing.

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.

The name and the topic of my thesis is evaluation of the quality of given nursing care. The quality of nursing care as integral part of quality of medical care is gaining ground not only in medics but also in public. Words like quality, standard, audit are commonly used by every nurse but do they know meaning of separate words? Do they know how to ensure high-quality care and how to evaluate it? These and other questions must be answered in order to retrieve possible insufficiencies and thus, to ensure high-quality nursing care. That´s why I chose this topic for my thesis. Theoretical part first characterizes nursing, its aims and organization of nursing care. Extensive part is devoted to quality of nursing care, systems and models to ensure and evaluate the quality. Practical part is focused on research and its interpretation. There were two research units and were created by nurses from surgical wards of Hospital in České Budějovice and Hospital in Jihlava. In order to collect needed data I chose quantitative method, when the way of data collecting was questionnaire. The aim of the thesis was to chart nurses´ knowledge on evaluation of quality of given nursing care through two hypotheses. The hypothesis supposing that nurses working in Hospital České Budějovice know more about evaluation of quality of given nursing care than nurses working in Hospital Jihlava was confirmed. But it is evident from the results that both investigated units have certain reserves. The other hypothesis supposing that more than 80% nurses consider the audits helpful for improving the quality of nursing care was not confirmed. According to the results, for more than half of addressed nurses audit is only stressing matter when hospital management looks for faults in their work. I mean, this opinion results from insufficient knowledge or incorrect understanding of the audit sense. I would like to use the thesis and its results as a base for creating scientific lectures and subsequent presentation. The head nurse asked me to present my thesis and the results at the meeting of head nurses in autumn 2008. I was asked for the results by Jihlava Hospital management as well.

Proper nutrition is essential for every human being, whether healthy or sick. Nutrition is, according to associate docent Kohout, one of the areas that is most neglected in health and social facilities in the Czech Republic. Standardized nutritional care should be established in all hospitals, representing a comprehensive nutritional and qualified solution for clients/patients. The standardized nutritional care involves systematic assessment of nutritional status of a client/patient and a search for clients/patients at nutritional risk. It further includes an appropriate diet according to the needs and capabilities of a client/patient and timely provision of adequate nutritional support to clients/patients who were identified as nutritionally at risk. Finally, standardized nutritional care also includes monitoring and documenting the effects of nutritional therapy, because the effect of individual measures cannot be monitored without proper documentation. The objective is to monitor the process of identification, evaluation and implementation of actions to ensure nutritional care in selected medical facilities from the perspective of the senior nursing management. Another objective is to map how significant quality indicator this is and what problems are seen in creating and maintaining a standard situation. Data collection was carried out by an interviewing technique using questionnaires. Respondents were from hospitals in the Czech Republic where we addressed the members of their senior nursing management. H1 ``The hospitals use established control mechanisms to find out about the nutritional status of compliance with established standards of nutritional care{\crqq} has been confirmed. H2 ``Nutritional screening is performed by nurses on all clients/patients at reception{\crqq} has been confirmed. H3 ``Nutritional screening during hospitalization is repeated only in clients/patients at risk{\crqq} has been confirmed. H4 ``Nurses develop nutritional screening within the cooperation of nurses with a nutritional therapist in the provision of standardized nutrition care{\crqq} has been confirmed, and H5 ``The results of nutritional screening are used by nurses as the basis for the saturation of clients{\crq}/patients{\crq} nutritional requirements{\crqq} has also been confirmed. The second objective was to map how significant quality indicator this is and what problems are seen in creating and maintaining a standard situation. The performance of nutritional screening has become the second most important quality indicator according to the research. As for the problems seen by respondents in relation to creating and maintaining a standard situation, it can be said, on the basis of the research results, that the biggest problems in creating and maintaining a standard situation is the lack of personnel, economic demands and approach of the personnel, their reluctance and disinterest. We attempted to explore the process of identification, evaluation and implementation of actions to ensure nutritional care in selected medical facilities from the perspective of the senior nursing management and then, based the results, to suggest ways of potential improvement of the current situation in the field of clients{\crq}/patients{\crq} nutrition.

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.

Bakgrund: Stress på arbetsplatsen är något som blir vanligare för varje år inom sjuksköterskeyrket. Det är känt att stress har en fysiologisk och psykologisk påverkan på människor. Stress kan delas upp i två delar: stressorer och stressresponser. Sjuksköterskor kan känna av stressrelaterade symtom på grund av stressorer som: störande moment, personalbrist och arbetsbelastning. Sjuksköterskors huvudsakliga arbetsuppgift är omvårdnad och den arbetsrelaterade stressen kan i sin tur ha en effekt på omvårdnadsarbetet. Att ha en kunskap över hur omvårdnaden påverkas är behövs för att utföra ett gott omvårdnadsarbete. Syfte: Att belysa hur sjuksköterskor upplever att stress på arbetsplatsen påverkar omvårdnadskvaliteten.Metod: En litteraturstudie som utfördes med kvalitativ ansats för att förstå olika upplevelser av valt fenomen. Efter att en utförlig urvalprocess skett så kvalitetsgranskades de artiklar som var hämtade från databaserna PubMed, CINAHL och PsycINFO, för att senare analyseras i fem steg. Resultat: Det visade sig att stress på arbetsplatsen hade en påverkan på omvårdnadskvaliteten och i analysen av resultatet fastställdes fem teman: Arbetsbelastning, Hjälpmedel och utrustning, Samverkan inom vården, Sjuksköterskors kompetens samt Arbetsledningen. Tillsammans med tre subteman: Tidspress, Personalbrist och Patienter och anhöriga.Konklusion: Omvårdnaden påverkades av stress på arbetsplatsen samt relaterades till de fem redovisade teman. Den mest omtalade infallsvinkeln var arbetsbelastning som i sin tur påverkades av andra inkluderade teman. Det visades även att sjuksköterskors upplevda stress påverkade omvårdnadskvaliteten, dock beskrevs det eventuella lösningar som bidrog till bättre omvårdnad. / Background: Work-related stress is becoming more common for every year within the nurse profession. It is known that stress has physiological and psychological effects on people. Stress can be divided into two parts: stressors and stress responses. Nurses can experience the stress related symptoms because of stressors as: disturbing elements, shortage in staff and workload. Nurses main task is patient care and the work-related stress can have an effect on nursing. Knowledge of how nursing is affected is needed in order to perform good nursing work. Aim: To describe how nurses experience that stress at the workplace affects the quality of nursing care.Method: A literature review was done with a qualitative design to get a deeper understanding of experiences surrounding the chosen phenomenon. A detailed sampling process was conducted. The articles found in the databases PubMed, CINAHL and PsycINFO were reviewed to address a level of quality and then analyzed in five steps. Results: It was shown that work-related stress had a certain impact on the quality of nursing care and in the analysis of the results five themes were assessed: Workload, Instruments and equipment, Interplay within care, Nurses competence and Work management. Together with three subthemes: Time pressure, Staff shortage and Patients and next of kins. Conclusion: Nursing care was impacted by stress at the workplace which related to the five presented themes. The main approach was workload, which was also linked to the other included themes. It was also shown that nurses experience of stress impacted the quality of nursing care, although it was described that there were possible solutions that contributed to better care.

La revisión crítica titulada “Aspectos de la calidad de atención de enfermería que contribuyen a la satisfacción del paciente durante el tratamiento de hemodiálisis”. Es una investigación secundaria con metodología EBE; tiene como objetivo: Identificar los aspectos de la calidad de atención de enfermería que se relacionan con la satisfacción del paciente durante el tratamiento, lo que permitirá comprender los elementos de la calidad de la atención de enfermería que contribuyen a la satisfacción del paciente. La pregunta clínica ¿Qué aspectos de la calidad de atención de enfermería, contribuyen a la satisfacción del paciente durante el tratamiento de hemodiálisis? a búsqueda recopiló 313 artículos, pero diez de ellos fueron elegidos por la guía de utilidad y validez aparente de Gálvez Toro, quedando tres de ellos para la validación avanzada, de los cuales se seleccionó el artículo “Calidad percibida y su relación con la satisfacción del paciente en tratamiento con hemodiálisis en un hospital público de Perú”, el comentario crítico se realizó con los criterios de validación de Bobenrieth Astete. Como resultado: existen varios aspectos que intervienen en la satisfacción del paciente. Estos incluyen los aspectos tangibles, como las instalaciones y los equipos en la unidad de hemodiálisis, así como la confiabilidad del personal en brindar un tratamiento seguro y efectivo. La satisfacción del paciente también depende de la amplitud de la respuesta del profesional de enfermería a las necesidades y preocupaciones del paciente, así como de su empatía y accesibilidad. / The critical review titled “Aspects of quality nursing care that contribute to patient satisfaction during hemodialysis treatment.” It is a secondary research with EBE methodology; aims to: Identify the aspects of the quality of nursing care that are related to patient satisfaction during treatment, which will allow us to understand the elements of the quality of nursing care that contribute to patient satisfaction. The clinical question: What aspects of quality nursing care contribute to patient satisfaction during hemodialysis treatment? The search collected 313 articles, but ten of them were chosen by Galvez Toro's usefulness and apparent validity guide, leaving three of them for advanced validation, of which the article “Perceived quality and its relationship with customer satisfaction” was selected. patient undergoing hemodialysis treatment in a public hospital in Peru”, the critical comment was made with the validation criteria of Bobenrieth Astete. As a result: there are several aspects that go into patient satisfaction. These include tangible aspects, such as the facilities and equipment in the hemodialysis unit, as well as the reliability of the staff in providing safe and effective treatment. Patient satisfaction also depends on the extent of the nurse's response to the patient's needs and concerns, as well as his or her empathy and approachability.

No description available.