Thesis (Ph.D.)--Virginia Commonwealth University, 2009. / Prepared for: Dept. of Health Administration. Title from title-page of electronic thesis. Bibliography: leaves 182-192.

Report-in-lieu-of-Thesis (M.P.H.)--University of North Texas Health Science Center at Fort Worth, 2008. / Title from title page display. Bibliography: p. 48-52.

Theoretical Basis Demographic data show that the world's population has been aging and there are more and more elderly people who need health and social care. The same situation is in our country. Every person lives his/her life in a unique way. With aging changes occur in physical, mental and social aspects. To cope with them requires help, tolerance, respect and patience shown by other people. The current forms of care for seniors are carried out in health facilities, social facilities as well as families. The changes bring about the need to find a new way of life. The most frequent changes occur in self-care which results in increased demands on the care of other people. Some seniors do not need almost any services and some are dependent on permanent comprehensive care. Definitely, the best way for seniors is living at home with the support of their families and the cooperation with home care agencies when health care is necessary. Everyday nursing care for seniors depends on the degree of their self-sufficiency and is extremely challenging. Caring for seniors is often complicated by changes in the behavior of seniors in communication, aggressiveness, disorientation caused by today's relentlessness and memory disorders. Caring for immobile seniors also places an enormous physical strain on nurses. Aims of the Study In this thesis, one goal was set, that is to survey the activities of nurses in nursing care for seniors in selected health care facilities, home care agencies and nursing homes. Methods Used in the Study In the empirical part of this thesis the qualitative research method of observation was used to conduct the research survey. The research survey was conducted through observation, in which the frequency of nursing activities was observed, and the time consumption of selected nursing activities (recording nursing documentation, intramuscular injection administration, subcutaneous injection administration, insulin administration with an insulin pen, capillary blood collection, venous blood collection, a planet urinary catheter insertion in women, blood pressure taking, blood sugar levels testing using a glucometer and colostomy care) were recorded into pre-prepared observation sheets (Appendix 2) and (Appendix 3) in the Home care Agency in České Budějovice from May 1 to July 5, 2013, in the Home for Seniors in České Budějovice from July 8 to July 12, 2013 and in České Budějovice Hospital, plc, in the Aftercare department from July 22 to July 26, 2013. The data sheet with activities when time measurements were carried out was compiled based on a preliminary research, when all the mentioned facilities were visited beforehand to find out which activities were carried out in all the facilities where the research study was conducted. A digital stopwatch was used for measurements. The time measurements are stated in units of time rounded up to the nearest minute. Each nursing activity was measured from its preparation through implementation to completion. Observations were carried out eight hours a day, 5 days a week in each facility. Overall, 160 hours for 3 weeks. Observations were conducted during regular operating hours in the facilities; every day one nurse treating fifteen seniors in each facility was observed. The frequency of nursing activities and the measured values were statistically processed - summed, averaged, and standard deviations were calculated. Results of the Thesis The analysis of the data implies differences in nursing activities carried out by nurses in particular facilities and the time measurements show time differences between particular facilities in nursing activities performance. The goals of this thesis were achieved after the research investigation and the research questions were answered.

This extended essay deals in more detail with the organizations which give only health home care for their clients. It is a special form of the health care given to a patient at his home and paid by the state within the framework of public health insurance. During the visits, the patient is treated or rehabilitated by a gualified nurse. All the treatments are put into effect according to the treating doctor´s indications who has called for this care form. Although the questions is a health services, we can see a social influence here, too when the patient and his relations to the people round him are influenced as well. Nowadays. great numbers as state in the Czech Republic. In the first theoretical part, the attention is paid to a history of home care, a definition of basic words and a detailed specification of agency activities. Basides, the clients the services was inicated for are noticed here, too. It also concerns their state of health and social relations to the people around them and the surroundings. The data obtained from my own research are stated in the practical part. This research was carried out by a quntitative method with several techniques of a run interview and a secondary analysis of data in a set of some chosen patients living in the northern part of the Pilsen Region and agencies being situated in that area. The aim of my extended essay is to evaluated a social influence of home care on a patient and to point out the most frequent diagnoses it has been indicated for.

In the Czech Republic the Romani minority is a numerous as well as often discussed minority in these days. As one of the largest minorities in the Czech Republic is involved, not only nurses in health care facilities but also nurses working for home-care agencies meet members of the Romani minority at work. For a Romani family it is almost a duty to take care for their ill and dying relatives at home in a family circle. This care still bears elements of Romani tradition, which however often contravene with treatment regime. Despite this fact nurses from home-care agencies have good experience with taking care for Romani patients, and sometimes certain Romanies accept the use of home-care agency services. These theses on Specific Features of Nursing Care for Romani Minority in the Framework of Home-care Agencies deals in its theoretical part with a history, communication, religion, traditions and manner of living of Romani minority, further it focuses on history and scope of activities of home-care agencies, on ethics of dying and death in health-care facilities and on basic information in the field of palliative care. The second part of the theses is focused on quantitative and qualitative research. The quantitative research has been carried out in a form of a questionnaire addressed to nurses working in home-care agencies. Seventy one nurses from selected home-care agencies from the whole Czech Republic took part in this research. Qualitative research was carried out through structured interviews with 15 members of Romani minorities. Tasks of the work: to ascertain extent of use of services of home-care agencies by Romani minority, and to determine specific features of nursing care for dying member of the Romani ethnicity were fulfilled. Three hypotheses were determined to such tasks ? H1: Nurses from home-care agencies have already provided services to members of Romani ethnicity. H2: The Romani minority uses services of home-care agencies. H3: Nurses from home-care agencies are aware of specific features of nursing care for Romani minority. Hypotheses H1 and H2 were accepted. H3 was not accepted, as from the statistical evaluation of quantitative research it follows that nurses are not aware of specific features of nursing care. The following research questions were determined for the qualitative research: Are the members of Romani ethnicity aware of a possibility to receive help from home-care agencies in care for a dying family member? Are the members of Romani minority interested in help offered by nurses from home-care agencies in nursing of a dying family member? Results of the research of these theses were used for creation of a manual of specific features of nursing care for a dying Romani patient. The manual was sent to selected home-care agencies. Information contained in the manual may serve to nurses in an out-patient and patient departments of health-care facilities as well, as knowledge in the field of care for a member of the Romani minority dying at home may help such nurses to understand acting, communication, manner of living as well as life values of such patients at hospitalization. The whole theses may also serve in practice as an indicator of insufficient foreknowledge of the Romani minority on services of home-care agencies and necessity to spread information on such services to the Romani ethnicity.

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