Surgical procedures of gastrointestinal diseases often lead to the creation of an ostomy. The number of clients with an ostomy is increasing as the Czech Republic ranks among the countries with the largest incidence of malignant colon disease. Health care professionals in any field can often encounter the client with a stoma. Therefore, it is essential for them to understand and manage this issue well. Nursing care of such individuals is very extensive and specialized. Nursing team usually focuses only on physical care but other problems associated with stomas are pushed aside. The only highly knowledgeable and qualified expert in this area is a stoma nurse specialist (an ostomy nurse). This thesis deals with the importance of the role of the stoma nurse specialist in the postoperative phase from the perspective of nurses from surgical departments as well as from the perspective of patients with a colostomy. The thesis is divided into theoretical and empirical part. The theoretical part is further divided into four chapters: colostomy, care about stoma patients, life with a colostomy, an ostomy nurse. Two objectives were determined for processing of the empirical part. We used a combination of quantitative and qualitative research to achieve our goals. The first objective was to determine whether general nurses have the knowledge to care for a client with colostomy in the postoperative phase. To obtain data for the quantitative part of the survey the method of anonymous interviews using a questionnaire, in which the research group was formed by general nurses, was selected. The survey results revealed that nurses have sufficient knowledge to treat and educate clients with a stoma. Although not all general nurses encounter colostomy patients, they widely believe the knowledge of this issue is important for the occupation of a nurse. For the quantitative part three hypotheses were selected and tested statistically. Hypothesis 1: General nurses have the knowledge to treat the client with a colostomy. It was confirmed. Hypothesis 2: General nurses have enough knowledge to educate the client with a colostomy. It was confirmed. Hypothesis 3: General nurses positively evaluate the benefits of an ostomy nurse in care for stoma patients in the postoperative phase in the surgical department. It was confirmed. The second objective was to determine the significance of the stoma nurse for clients with a colostomy. For the qualitative part of the survey the method of direct questioning by means of a semi-structured interview with open questions was chosen. The study group consisted of patients with a colostomy. For this part of the survey a research questions was specified: What is the importance of an ostomy nurse for the stoma patient in the postoperative period? We concluded that the ostomy nurse is viewed as an educator, counselor and psychological support. The ostomy nurse is the only one who can provide stoma clients with coherent and comprehensive information they need to live with a colostomy. Both groups of respondents agree that the stoma nurse is the irreplaceable specialist. Shift nurses fail to provide comprehensive care stoma patients need. An ostomy nurse needs to be a part of nursing care not only in the postoperative phase, but also in the preoperative period. There is need for closer cooperation between general nurses and the ostomy nurse. Nurses indicate their willingness to be educated in this area, while preferring seminars, lectures and conferences. The results also led us to create information material Care of the client with colostomy, as the nurses indicated that they would welcome a brief, clear, visual information material.

Background: Managers and health professionals, so-called stakeholders, at the system and clinical level in the acute care chain, are responsible for providing safe and high-quality care encompassing both nursing and medical aspects. In patients with acute abdominal pain (AAP), high-quality nursing care has been described as not always being delivered across the entire acute care chain. This patient group frequently seeks care across the acute care chain and the care procedures and quality may differ widely. The quality of nursing care provided to patients can be understood through the framework Fundamentals of Care. The framework is divided into three dimensions: establishing a relationship with the patient, integration of the patient’s fundamental care needs, and context of care. Stakeholders are one important part of the context of care and a prerequisite for delivery of high-quality care.  Aim: The overall aim was to explore managers’ and health professionals’ understanding of managing and conducting care of patients with AAP across the acute care chain.  Method: Individual interviews with open-ended questions were used in two studies and data were analysed with a conventional qualitative content analysis method. Participants represented ambulance services, emergency departments, and surgical departments. Managers at head nurse level (n=11) and operational level (n=6) at four hospitals were included in Study I. Registered nurses (n=11) and physicians (n=8) at five hospitals were included in Study II. Results: In Study I, managers described the adult patient group as challenging and heterogenous. The managers reflected on themselves as role models. Guidelines were used to organise care, but they often had a medical focus and the managers referred to others as being responsible for the guidelines. Managers who were registered nurses focused on the medical care of patients with AAP, while managers who were physicians underlined the value of nursing care to improve patient outcome. In Study II, health professionals described dedication to applying evidence-based practices. However, they used personal experience over guidelines in care provision. They described organisational barriers to delivering high-quality care, such as varying competence among colleagues, lack of available patient beds, and lack of collaboration across the acute care chain.  Conclusion: The stakeholders’ perspectives complemented each other, but their descriptions of managing and conducting care of patients with AAP did not always fit together, which revealed a gap in the everyday clinical practices as well as structural issues at the system level. These empirical descriptions of differing understanding may reveal some of the reasons why patients with AAP do not always experience high-quality care. To optimise patient care across the acute care chain, stakeholders need a shared understanding to meet patients’ fundamental care needs and enable provision of high-quality nursing and medical care.