This thesis deals with nutrition in palliative care. The main aim is to introduce the issue of nutrition in palliative care, to help with a comprehensive perception of the context and the application of a palliative approach in nutritional care. The aim is to monitor and examine the current state of nutrition in facilities providing palliative care in the Czech Republic. The work is divided into theoretical and practical part. The theoretical part is focused on the issues of palliative care, nutrition and hydration. The practical part contains the objectives of the work, hypotheses and research with evaluation and analysis of the obtained data. There were two hypotheses established and evaluated. From a methodological point of view, a combination of several research methods of a quantitative nature was used. As a means of obtaining data, the use of the survey in the form of an internet survey was sent to the management of individual facilities providing palliative care in the Czech Republic. The obtained data were processed using standard statistical methods. Using descriptive statistics procedures in the form of analysis of the obtained results, especially with the use of absolute and relative frequency. The total number of 97 questionnaires were distributed. 18 questionnaires for hospices, 70...

Bakgrund: Studier visar på att användandet av omvårdnadsdiagnoser har flera fördelar för sjuksköterskans omvårdnadsarbete. De främjar patientens delaktighet i vården samt uppmärksammar sjuksköterskan på patientens omvårdnadsbehov. Andra studier visar på att standardvårdplaner upplevs effektivisera sjuksköterskans omvårdnadsdokumentation och bidra till en likvärdig och god kvalité på vården. Dock kan de anses vara oflexibla och därför behöva kompletteras med en individuell vårdplan.  Syfte: Syftet var att undersöka i vilken utsträckning omvårdnadsdiagnoser och -åtgärder dokumenterades och utfördes. Vidare undersöktes vilken typ av vårdplan som användes och om det gick att se någon skillnad mellan avdelningarna avseende omvårdnadsdokumentationen. Metod: Det utfördes en retrospektiv journalgranskningsstudie med innehållsanalys och kvantitativ analys, även en statistisk analys Mann-Whitney U test användes. Studien utfördes på två medicinska avdelningar och undersökningsgruppen var patienter med hjärtsvikt. Resultat: Totalt ingick 43 patientjournaler i studien. Det förekom omvårdnadsdiagnoser endast i ringa utsträckning. Det identifierades 259 omvårdnadsproblem som indelades i 34 olika kategorier. Det identifierades 193 omvårdnadsåtgärder, de delades in i 28 olika kategorier. På avdelning 1 var majoriteten av SVP-er kopplade till undersökningar/ingrepp, på avdelning 2 gällde majoriteten hjärtövervakning och utskrivningsplanering. Individuella vårdplaner förekom endast i ringa utsträckning. Det fanns en signifikant skillnad mellan avdelningarna gällande antalet utförda omvårdnadsåtgärder/journal och förekomsten av individuella vårdplaner. Slutsats: Omvårdnadsdokumentationen var bristfällig. Avdelningarna skulle behöva göra en översyn och utveckla arbetet med journalföringen. Flera och mer djupgående studier behöver genomföras inom området. / Background: The use ofnursing diagnoseshas severalbenefits fornursing care. Previous studies showthat they promotepatientparticipationin the nursing careand increase nurses’ awareness ofthe patient'scare needs.Other studies showthatstandardized care plansare perceived as promoting theefficiency ofnursingdocumentation andcontribute to anequitable andquality of the nursing care.However,by some nurses they are considered inflexible, andtherefore they have to be supplementedwith an individualcare plan. Aim: The aim of this study was to examine to what extent nursing diagnoses and interventions were documented and executed. Furthermore there was an examination as to what kind of standardized care plan was used and whether it was possible to see any differences between the departments regarding nursing documentation. Method: A retrospective medical record study with content analysis and quantitative analysis was conducted, even a statistical analysis, Mann-Whitney U test, was used. The studywas conducted ontwo medicalwards andthe study groupconsisted of patients with heart failure. Results: In total,43patient records were included in the study.Nursing diagnoses appearedonlyto a negligible extent. 259nursing problems were identified and divided into34different categories and 193nursing interventions were identified and partitioned into28 differentcategories.Onsection 1, the majority of the standardized care plansconcernedtreatments/interventions. The majority of standardized care plans onsection 2 concerned cardiac monitoringand dischargeplanning.Individualcare plansappeared only to a smallextent.There was asignificant difference between the departments regardingthe number of executednursing interventions per recordand the occurrence ofindividual care plans. Conclusion: The nursing documentation was inadequate. It would be advisable for the departments to conduct a reviewand developthe work ofthe nursing documentation. A greater number of studies, with additional depth, would have to be conducted.

Abstrakt: Okontrollerade symptom och upprepade sjukhusinläggningar kännetecknar den sista tiden i livet hos en del patienter med mycket svår KOL. Trots att det finns en växande insikt att tidig integration av palliativ vård förbättrar patientens symtombehandling och livskvalitet, dör majoriteten av patienter med KOL utan tillgång till palliativ vård. Sjuksköterskor i hemsjukvården har en central roll när det gäller att identifiera och hantera patienternas palliativa vårdbehov. Syfte: Syftet med denna studie är att belysa hur sjuksköterskor i hemsjukvården upplever den palliativa vården av patienter med mycket svår KOL. Metod: Kvalitativ studie där 11 semistrukturerade intervjuer bearbetats med kvalitativ innehållsanalys. Resultat: Insamlat datamaterial resulterade i tre kategorier som påvisar förutsättningar för god palliativ vård i hemmet: 1) Personella och organisatoriska resurser i hemsjuk- och primärvården där stora brister i samarbetet med primärvården samt bristande resurserna för god vård i hemmet noteras. 2) Planering och kommunikation där bristande kommunikation med patienten och mellan olika vårdinsatser samt planering kring patientens vård poängteras. 3) Kunskap där ett behov av att utöka kunskapen om KOL och palliativ vård hos alla yrkeskategorier uppmärksammas. Konklusion: Patienter med mycket svår KOL får ofta en god palliativ vård i livets absoluta slutskede. Resultatet visar dock att patientens vård under de sista månaderna i livet ofta upplevs som oklar och diffus, vilket pekar på att palliativ vård behöver integreras tidigare i vården av patienter med mycket svår KOL. I kommunikations- och planeringsprocessen med patienten har sjuksköterskor en samordnande roll som behöver specificeras och utrustas med de erforderliga personella och organisatoriska resurserna, kunskaperna och befogenheterna. / Abstract: Uncontrolled symptoms and repeated hospitalizations characterize the last period of life in some patients with very severe COPD. Although there is a growing recognition that early integration of palliative care improves the treatment of patient's symptoms and quality of life, the majority of patients with COPD dies without access to palliative care. Nurses in home care have a central role in identifying and managing patients' palliative care needs. Aim: The purpose of this study is to examine how nurses in home care and in nursing homes experience palliative care of patients with severe COPD. Method: Qualitative study in which 11 semi-structured interviews processed using qualitative content analysis. Results: Collected data resulted in three categories that indicate conditions for good palliative care in the home: 1) Human and organizational resources in home- and primary care, where serious deficits within primary care and resources for good home care is noted. 2) Planning and communication, where the lack of communication with the patient and between different health care institutions as well as care planning is emphasized. 3) Knowledge, where a need to improve knowledge of COPD and palliative care for all care professions is recognized. Conclusion: The result shows that the patient's care during the last months of life is often perceived as vague and diffuse, suggesting that palliative care needs to be integrated earlier in the care of patients with very severe COPD. In the communication process and care planning with patients, nurses have a coordinating role that needs to be specified and equipped with the requisite human and organizational resources, skills and competences.

The present thesis is concerned with the Importance of Children's Centres influencing an active involvement of the family in the remediation process, a theme so far unexplored in this respect. The objective of the thesis is to design suitable starting points of an individual care plan of families at risk which contribute to returning the child to his or her biological family in the remediation process by way of social rehabilitation. This is fulfilled with respect to partial objectives that reveal the influence of social and pathological effects, partial characteristics of remediation of the family and services rendered, and on the basis of these findings, the author identifies the ways, methods and techniques of health and social work that are applied by Children's Centres in relation to an active involvement of parents in a social rehabilitation process. In addition, the present thesis determines aspects of the multidisciplinary help that assist in participation in the support provided, or, as the case may be, aspects that prevent such participation. The thesis is divided into two parts - theoretical and methodological. The theoretical part is engaged in the family as such, its functions, risk factors, the most common types of parental disorders in relation to a family at risk, families at risk, the contemporary status of care of children at risk. The thesis delineates in detail the forms of threats to children and the key risk factors influencing parents with respect to participation in solving the problem per se. The last chapter scrutinizes the problem of family remediation, its characteristics and stages. Further, the last chapter focuses on activities of "Dětské centrum Jihočeského kraje, o.p.s." [Children's Centre of the South Bohemian Region, public service company] in Strakonice and the social rehabilitation service the Centre provides - ways, methods and techniques of health and social work with families at risk. The content of the methodological part gives an explanation of the importance of the Children's Centre influencing an active involvement of parents in the remediation process using social rehabilitation, by applying the method of a semi-conducted interview as a primary technique of data collection. The data acquired are analysed and interpreted in Chapter eight. Chapter nine presents starting points for an individual care plan that serve, in compliance with the rules enumerated, as a functional tool for achieving an active involvement of parents in the social rehabilitation process. The final chapter concludes and further clarifies the problems at issue.