Renáta Zeleníková

Comparison of three screening tools for nutritional status assessment of the elderly in their homes.

BACKGROUND The prevailing recommendation for the elderly is to live in their own homes as long as conditions allow. With this emphasis on the natural living environment, it is imperative to closely monitor both the general health and nutritional needs of the elderly in community settings. AIM The aim of the study was to compare three nutritional status screening and evaluation tools of the elderly in their homes. METHODS Testing of measuring instruments, MNA, SGA, and MUST took place in the homes of 120 seniors in selected areas of the Czech and Slovak Republics. The study included 120 seniors. For testing of the relationships and dependencies, Pearsons correlation coefficient, t and Fisher tests were used. The level of statistical significance was α = 0.05. RESULTS All tests were to a large degree correlated (p(MNA) = 0.0049; p(MUST) = -0.537; p(SGA) = -0.578) with the body mass index of the seniors. Simultaneously, it was confirmed that the tools for assessing nutritional status in the study showed significant differences regarding the classification of patients at risk of malnutrition and/or malnourished patients. CONCLUSIONS Based on the findings, we conclude that MNA appeared to be a more appropriate tool for nutritional assessment of the elderly living in their homes. SGA and MUST provided rather subjective evaluation of the nutritional status and did not furnish an in-depth categorization of malnutrition.

Predictive validity of the Braden scale, Norton scale and Waterlow scale in Slovak Republic

Cieľ: Zistiť mieru predikcnej validity skal na posudenie rizika vzniku dekubitov (Bradenovej skala, Nortonovej skala, Waterlowej skala) v slovenskom klinickom prostredi. Design: prospektivna studia. Metodika: 100 pacientov hospitalizovaných v case od aprila do augusta 2014 na oddeleni dlhodobej starostlivosti bolo posudených pomocou skaly Bradenovej, Nortonovej a Waterlowej. Vstupným kriteriom pre zaradenie do výskumneho suboru bolo: vek viac ako 18 rokov, pri prijme na oddelenie nebol u pacienta pritomný dekubit. Predikcna validita skal na posudenie rizika vzniku dekubitov bola hodnotena na zaklade hodnot senzitivity, specificity, pozitivnej a negativnej prediktivnej hodnoty a hodnoty plochy pod ROC krivkou. Výsledky: Incidencia dekubitov v tejto výskumnej studii je 14 %. Senzitivita, specificita, pozitivna prediktivna hodnota, negativna prediktivna hodnota pre skalu Bradenovej je (cut-off bod 15) 85,71 %, 53,48 %, 23,07 %, 95,83 %, pre skalu Nortonovej (cut-off bod 12) 85,71 %, 48,83 %, 21,42 %, 95,45 % a pre skalu Waterlowej (cut-off bod 13) 85,71 %, 30,23 %, 16,66 %, 92,85 %. Hodnota plochy pod ROC krivkou bola 0,696 pre skalu Bradenovej, 0,672 pre skalu Nortonovej a 0,579 pre skalu Waterlowej. Zavery: V nasej výskumnej studii dosiahla najlepsie hodnoty predikcnej validity s malými rozdielmi skala Bradenovej, na druhom mieste skala Nortonovej a na poslednom mieste skala Waterlowej.

Clinical Validation of the Nursing Diagnosis Caregiver Role Strain in the Czech Republic

PURPOSE The aim of the study was to clinically validate the defining characteristics of the nursing diagnosis caregiver role strain in the Czech Republic. METHODS This is a cross-sectional study. The patient-focused clinical diagnostic validity model was used for clinical validation. FINDINGS Only two major defining characteristics were identified for caregiver role strain in a sample of 225 caregivers. CONCLUSION The study has identified the most frequently present defining characteristics related to the nursing diagnosis caregiver role strain in a caregiver population in the Czech Republic caring for their loved ones in home settings. IMPLICATIONS FOR NURSING PRACTICE It is important that defining characteristics aid diagnosis and direct nursing interventions.

Predictive validity of the Braden Scale, Norton Scale, and Waterlow Scale in the Czech Republic

The aim of this study was to determine the predictive validity of the Braden, Norton, and Waterlow scales in 2 long-term care departments in the Czech Republic. Assessing the risk for developing pressure ulcers is the first step in their prevention. At present, many scales are used in clinical practice, but most of them have not been properly validated yet (for example, the Modified Norton Scale in the Czech Republic). In the Czech Republic, only the Braden Scale has been validated so far. This is a prospective comparative instrument testing study. A random sample of 123 patients was recruited. The predictive validity of the pressure ulcer risk assessment scales was evaluated based on sensitivity, specificity, positive and negative predictive values, and the area under the receiver operating characteristic curve. The data were collected from April to August 2014. In the present study, the best predictive validity values were observed for the Norton Scale, followed by the Braden Scale and the Waterlow Scale, in that order. We recommended that the above 3 pressure ulcer risk assessment scales continue to be evaluated in the Czech clinical setting.

Symptoms as the Main Predictors of Caregivers' Perception of the Suffering of Patients With Primary Malignant Brain Tumors.

Background: The perception of suffering causes distress. Little is known about what predicts the perception of suffering in caregivers. Objective: The aims of this study were to determine the predictors of caregivers’ perceptions of the suffering of patients with a primary malignant brain tumor and to find to what extent perceived suffering predicts the caregivers’ burden and depression. Methods: Data were obtained as part of a descriptive longitudinal study of adult family caregivers of persons with a primary malignant brain tumor. Recruitment took place in outpatient neuro-oncology and neurosurgery clinics. Caregiver perception of care recipient suffering was measured by 1 item on a scale from 1 to 6. Results: The sample of caregiver interviews 4 months after recipients were diagnosed consisted of 86 dyads. While controlling for age, years of education, tumor type, being a spousal caregiver, spiritual well-being, and anxiety, perception of overall suffering was predicted by such symptoms as difficulty understanding, difficulty remembering, difficulty concentrating, feeling of distress, weakness, and pain. Caregivers’ perception of the patient’s degree of suffering was the main predictor of caregiver burden due to schedule 4 months following diagnosis. Conclusions: Care recipient symptoms play an important role in caregivers’ perception of the care recipients’ suffering. Perception of care recipient suffering may influence caregiver burden. Implications for Practice: Identifying specific predictors of overall suffering provides meaningful information for healthcare providers in the field of neuro-oncology and neurosurgery.

PERCEPTION OF THE EFFECTIVENESS OF EVIDENCE-BASED PRACTICE COURSES BY CZECH NURSING AND MIDWIFERY STUDENTS

Cil: Cilem studie bylo zjistit, jak studenti osetřovatelstvi a porodni asistence vybrane vysoke skoly v Ceske republice vnimaji efektivitu výuky předmětu Praxe založena na důkazech. Dalsim cilem bylo ověřit psychometricke vlastnosti ceske verze nastroje Vnimani efektivity výuky praxe založene na důkazech. Design: Výzkum ma charakter deskriptivni průřezove studie. Metodika: Na sběr dat byla použita ceska verze třinacti-položkoveho dotazniku Vnimani efektivity výuky praxe založene na důkazech. Sběr dat probihal od dubna do cervence 2013. Výzkumný soubor tvořilo 119 studentů osetřovatelstvi a porodni asistence. Reliabilita skaly byla měřena pomoci Cronbachova α koeficientu. Konstruktova validita byla testovana pomoci faktorove analýzy. Výsledky: Studenti vnimali, že implementace praxe založene na důkazech může zlepsit klinickou praxi, ale necitili se dostatecně kompetentni v evidence-based practice (EBP) znalostech a dovednostech. Průměrne hodnoceni efektivity EBP výuky u celeho souboru bylo 5,25 na skale od 1 (silně nesouhlasim) do 7 (silně souhlasim), přicemž vyssi skore naznacuje vyssi efektivitu výuky. Cronbachův alfa koeficient (0,915) prokazal dobrou vnitřni konzistenci skaly. Výsledky faktorove analýzy potvrzuji tři - faktorove řeseni. Jednotlive faktory reprezentuji tyto subskaly: spokojenost a behavioralni změny; výuka; zvladani EBP. Zavěr: Nastroj Vnimani efektivity výuky praxe založene na důkazech prokazal dobre psychometricke vlastnosti a může být použivaný v ceskem prostředi pro hodnoceni výuky studenty.

PREŤAŽENIE OPATROVATEĽA - OBSAHOVÁ VALIDIZÁCIA OŠETROVATEĽSKEJ DIAGNÓZY V SLOVENSKEJ A ČESKEJ REPUBLIKE

Aim: Th e aim of this work was to validate the nursing diagnosis Caregiver Role Strain (00061) in the Czech Republic and Slovakia. Methods: We employed Th e Fehring Diagnostic Content Validity Model. A set of experts included 200 nurses, experts from Slovakia and the Czech Republic. Nurses who received at least 4 points according to modifi ed Fehring criteria were categorised as experts. In order to assess the signifi cance of the diagnostic characters, we built a measurement instrument that includes 36 items – the defi ning characteristics listed in the classifi cation system of nursing diagnoses of NANDA International. Results: Out of the 36 defi ning characteristics included in NANDA International, Slovak experts considered the following fi ve as the main characteristics: sleep disturbance, fatigue, lack of time to meet personal needs, stress and depression. Czech experts only identifi ed two characteristics as defi ning: apprehension regarding the care receiver’s concerns when the caregiver is unable to provide care and family confl ict. Conclusion: Th e conclusions drawn from the results of our study confi rm the fact that not all the features described in the NANDA International nurses are considered specifi c to the determination of the nursing diagnosis Caregiver Role Strain.

Validity and Reliability of the Czech Version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS)

PURPOSE The purpose of this study was to validate the Czech version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS) in adult patients undergoing elective surgery. DESIGN A cross-sectional study. METHODS Data were collected from July 2012 to January 2013. For reliability and validity testing, two instruments measuring preoperative anxiety were administered to the participants on the same occasion, (APAIS and the Spielberg State Anxiety Inventory (STAI-S)). The sample consisted of 344 patients undergoing elective surgery. FINDINGS Reliability of APAIS anxiety subscale measured by Cronbachs alpha was 0.91. Reliability of APAIS information subscale measured by Cronbachs alpha was 0.78. The APAIS anxiety subscale correlated significantly with the STAI-S (0.69). Women scored significantly higher on anxiety scales than men. CONCLUSIONS APAIS may be a useful tool to measure preoperative anxiety in Czech patients undergoing elective surgery.

Quality of life in patients with diabetic foot ulcer in Visegrad countries

AIMS AND OBJECTIVES To identify the quality of life of patients with diabetic foot ulcers in the Visegrad countries. BACKGROUND The diabetics with foot ulcers are principally evaluated on the basis of physical parameters, but this does not always reveal much about the patients experience of life with ulceration. DESIGN The cross-sectional study. METHODS The standardised generic questionnaire World Health Organization Quality of Life-BREF was used. The sample was made up of 525 participants and the calculations were performed using the IBM spss statistical program. RESULTS The significant negative correlations between demographic data such as age, duration of diabetes mellitus, duration of diabetic ulceration treatment and a lower level of quality of life were found across the sample. The statistically significant differences according to clinical characteristics such as Wagner classification, frequency of foot ulcers, present peripheral vascular disease and pain in terms of quality of life were also revealed. Significant differences of quality of life among Visegrad countries were revealed: Hungarys participants had a worse quality of life than others, while Slovak participants expressed lower satisfaction with their health than Czech. CONCLUSIONS Socio-demographic factors and clinical characteristics influence the quality of life of patients with diabetic foot ulcer. Significant differences between patients of Visegrad countries were found in all domains of quality of life: physical, psychological, social and environmental. RELEVANCE TO CLINICAL PRACTICE The quality of life of patients with diabetic foot ulcer reflects the conditions and healthcare system in each of the Visegrad countries. We have to respect socio-demographic factors and clinical characteristics in nursing care. This could have an impact on managing patient care not only with regard to their diabetic foot ulcer but also with regard to the patient as a personality with their own problems in relation to physical, psychosocial and environmental conditions.

NUTRITIONAL STATUS ASSESSMENT OF PATIENTS IN A GENERAL PRACTITIONER’S OFFICE

Aim: The study aimed at determining the nutritional status of senior citizens in a general practitioners office. Design: A cross-sectional study. Methods: Nutritional status was assessed with the Mini Nutritional Assessment (MNA), Malnutrition Universal Screening Tool (MUST), Mini Nutritional Assessment - Short Form (MNA-SF) and laboratory parameters (prealbumin, transferrin and CRP). The study comprised 241 participants. The significance of differences in selected nutritional markers for various groups was determined using a chi-squared test, Spearmans correlation coefficient and Fishers test at a critical statistical significance level of 0.05. Results: Malnutrition was detected in a relatively high proportion of the elderly, ranging from 13% to 90% depending on the tools used. There were significant differences between the tools when identifying patients as malnourished or being at risk of malnutrition. The MNA revealed more patients at risk of or with malnutrition (90%) than the MNA-SF (58%) or MUST (13%). No statistically significant correlations were found either between nutritional status and biochemical markers of nutrition or between nutritional status and age of the elderly. Conclusion: In the general practice setting, nutrition of the elderly must not be neglected as adequate nutrition is a prerequisite for faster convalescence and return to a normal life.