T exTbook
of N ursiNg s cieNce
T exTbook
of N ursiNg s cieNce TÁMOP-4.1.2-08/1/A-2009-0061
© Ph.D. András Oláh, 2012
Authors:
Medicina
The chief executive officer of Medicina Publishing House Co. is responsible for publication Language assistant: Andrea Béresné Tímár, Jacqueline Galdwin
Technical editor: András Nász Figures designed by Géza Olgyai Identifivation number: 3593 Extent: 96 (A/5) sheet dr. István Ágoston dr. Róbert Almási Attiláné Aradán dr. József Betlehem Prof. dr. Péter Bogner dr. Imre Boncz Eszter Borján Gyuláné Deák Anikó Dér
Prof. dr. Zoltán Döbrönte Rózsa Fehér
Noémi Fullér Katalin Fusz dr. Zsuzsanna Füzesi Nikolett Gál dr. István Gáti dr. Zoltán Gelencsér Tünde Gubó
Nikolett Hegedüs Krisztina Hoffmann dr. Tibor Jakab Attila Jankó Melinda Járomi
Annamária Karamánné dr. Pakai Zsuzsanna Kívés
dr. Attila Kovács Mónika Mesicsné Köbli dr. Kinga Lampek dr. Katalin Lányi Miklós Lukács Ágnes Müller Erika Nagy dr. Gábor Nagy Katalin Németh dr. András Oláh Andrea Orbán
Ilona Pálfiné dr. Szabó dr. Magdolna Pogány dr. Balázs Radnai Veronika Rajki
Mariann Raskovicsné Csernus dr. Tamás Rostás
dr. Andrea Saághy Henrietta Schiberna-Cser dr. Béla Schmidt
Szilvia Szekeresné Szabó dr. Magdolna Takács Ibolya Tulkán
Adrienn Újváriné Siket dr. Ágnes Váradyné Horváth dr. Katalin Zámbó
Ferencné Zborovján
Medicina Publishing House Co. ● Budapest, 2012
©
dr. o
láhA
Ndrás, 2012
© A
uThors, 2012
Edited by András Oláh
5
The revisers of the book
The revisers of the book
Ernőné Balatoni SEBINKO Szövetség tiszteletbeli elnök Dr. Katalin Barabás
Szegedi Tudományegyetem Általános Orvostudományi Kar Magatartástudományi Intézet egyetemi docens, intézetvezető Klára Barótiné Dr. Tóth
Országos Vérellátó Szolgálat minőségbiztosítási igazgató Mária Baukó
Ápolási Szakmai Kollégium korábbi elnöke Magyar Egészségügyi Szakdolgozói Kamara Etikai Bizottság
elnök
Prof. Dr. Lajos Botz Pécsi Tudományegyetem Általános Orvostudományi Kar
Gyógyszerészeti Intézet és Egyetemi Gyógyszertár egyetemi tanár, intézetvezető
Miklós Bugarszki Magyar Ápolási Egyesület elnök
Elza Burnyóczky
Fővárosi Önkormányzat Szent Imre Kórház sztómaterápiás ápoló,
ápolási egység vezető
Dr. Helga Judit Feith Helga Judit
Semmelweis Egyetem Egészségtudományi Kar Alapozó Egészségtudományi Intézet
Társadalomtudományi Tanszék főiskolai docens
Prof. Dr. Mária Figler Pécsi Tudományegyetem Egészségtudományi Kar
Fizioterápiás és Táplálkozástudományi Intézet egyetemi tanár, intézetigazgató
Ágnes Dr. Fischerné Dr. Dárdai Pécsi Tudományegyetem Egyetemi Könyvtár egyetemi tanár, főigazgató Dr. Judit Futó
Fővárosi Önkormányzat Szent Imre Kórház Sürgősségi Betegellátási Centrum
Intenzív Terápiás Egység
aneszteziológus, intezív terápiás szakorvos Dr. Erzsébet Grexa
Pécsi Tudományegyetem Egészségtudományi Kar címzetes főiskolai tanár Dr. Hanzlíková Alžbeta egyetemi docens
Vysoká škola zdravotníctva a sociálnej práce sv. Alžbety, n. o. Bratislava, Slovenska republika
Dr. Katalin Hegedűs Semmelweis Egyetem Magatartástudományi Intézet
egyetemi adjunktus, igazgatóhelyettes
A Magyar Hospice-Palliatív Egyesület vezetőségi tag Dr. Attila Horváth J.
Baranya Megyei Kórház Intenzív Osztály korábbi osztályvezető főorvos
Dr. Gábor Juhász
Eötvös Lóránd Tudományegyetem Szociális Munka és Szociálpolitika Tanszék
egyetemi docens, intézetigazgató Anikó Kónya
Ápolás Szakmai Kollégiumi Tanács elnök
Balatonfüredi Szívkórház ápolási igazgató Erzsébet Kovács Zala Megyei Kórház ápolási igazgató
Ápolási Igazgatók Egyesülete elnök
Prof. Dr. József Kovács Semmelweis Egyetem Magatartástudományi Intézet egyetemi tanár,
igazgatóhelyettes Jolán Kubányi
Magyar Egészségügyi Szakdolgozói Kamara Országos Szervezete
általános alelnök
Magyar Dietetikusok Országos Szövetsége tiszteletbeli elnök
Lászlóné Mészáros
A Magyar Gyógytornászok Társasága Geriátriai Munkacsoport Vezető Dr. Zsuzsa Nemes Nagy
Országos Vérellátó Szolgálat - Budai Regionális Vérellátó Szolgálat
intézetigazgató, vezető főorvos Tibor Pápai
Magyar Honvédség Honvéd Kórház centrumvezető ápoló Dr. László Rostás főorvos
Magyar Kardiológusok Társasága vezetőségi tag
Aritmia és Pacemaker Munkacsoport vezetőségi tag
Zsuzsanna Sallainé Mezőfi
Fővárosi Önkormányzat Szent Imre Kórház Sürgősségi Betegellátási Centrum
Intenzívterápiás Egység intézetvezető ápoló
Dr. Andor Sebestyén
Dél-dunántúli Regionális Egészségbiztosítási Pénztár igazgatóhelyettes
Prof. Dr. László Simon gasztroenterológus,
Magyar Gasztroenterológiai Társaság korábbi elnök Endoszkópos Szekció korábbi elnök
Dr. Éva Susánszky
Semmelweis Egyetem Magatartástudományi Intézet egyetemi adjunktus
Dr. Emese Szilágyi
Országos Tisztiorvosi Hivatal Járványügyi Főosztály főosztályvezető helyettes Andrea Tóth
Magyar Egészségügyi Szakdolgozói Kamara Felnőtt Ápolás Szakmai Tagozat
országos tagozatvezető SEBINKO Szövetség elnökségi tag Csaba Varga
Kaposi Mór Oktató Kórház Sürgősségi Betegellátó Centrum osztályvezető főorvos
Prof. Dr. István Wittmann Pécsi Tudományegyetem Klinikai Központ
II.sz. Belgyógyászati és Nephrológiai Klinika egyetemi tanár,
klinika igazgató
Ágoston István dr.
Pécsi Tudományegyetem Egészségtudományi Kar Egészségbiztosítási Intézet Egészség-gazdaságtani,
Egészségpolitikai és Egészségügyi Menedzsment Tanszék
tanársegéd Almási Róbert dr.
Kaposi Mór Oktató Kórház Központi Anaesthesiológiai és Intenzív Betegellátó Osztály főorvos, osztályvezető helyettes Aradán Marianna
Fővárosi Önkormányzat Szent Imre Kórház intézetvezető ápoló Betlehem József dr.
Pécsi Tudományegyetem Egészségtudományi Kar Ápolás és Betegellátás Intézet egyetemi docens, intézetigazgató Bogner Péter prof. dr.
Pécsi Tudományegyetem Egészségtudományi Kar Diagnosztikai Intézet
Diagnosztikai Képalkotó Tanszék egyetemi tanár, tanszékvezető helyettes Boncz Imre prof. dr.
Pécsi Tudományegyetem Egészségtudományi Kar Egészségbiztosítási Intézet egyetemi docens, intézetigazgató, címzetes egyetemi tanár
Borján Eszter Semmelweis Egyetem Egészségtudományi Kar
Alkalmazott Egészségtudományi Intézet Ápolástan Tanszék, tanársegéd
Deák Gyuláné Pándy Kálmán Kórház sztómaterápiás asszisztens Dér Anikó
Pécsi Tudományegyetem Egészségtudományi Kar Ápolás és Betegellátás Intézet Ápolástudományi Tanszék tudományos segédmunkatárs
Döbrönte Zoltán prof. dr.
Pécsi Tudományegyetem Egészségtudományi Kar Ápolás és Betegellátás Intézet Ápolástudományi Tanszék egyetemi tanár,
tanszéki csoportvezető Fehér Rózsa dr.
Széchenyi István Egyetem Petz Lajos Egészségügyi és Szociális Intézet
főiskolai adjunktus, intézetigazgató helyettes Fullér Noémi
Pécsi Tudományegyetem Egészségtudományi Kar Ápolás és Betegellátás Intézet Ápolástudományi Tanszék tanársegéd
Fusz Katalin
Pécsi Tudományegyetem Egészségtudományi Kar Ápolás és Betegellátás Intézet Ápolástudományi Tanszék tanársegéd
Füzesi Zsuzsanna dr.
Pécsi Tudományegyetem Általános Orvostudományi Kar Magatartástudományi Intézet egyetemi docens, igazgató helyettes Gál Nikolett
Pécsi Tudományegyetem Egészségtudományi Kar Ápolás és Betegellátás Intézet Ápolástudományi Tanszék tanársegéd
Gáti István dr.
Pécsi Tudományegyetem Egészségtudományi Kar Fizioterápiás és
Táplálkozástudományi Intézet egyetemi docens
Gelencsér Zoltán dr.
Baranya Megyei Bíróság bíró
Gubó Tünde
Fővárosi Önkormányzat Szent Imre Kórház, vezető ápoló
Hegedűs Nikolett Pécsi Tudományegyetem Klinikai Központ
Szívgyógyászati Klinika
Intervenciós Kardiológiai Osztály osztályvezető főnővér
Hoffmann Krisztina Pécsi Tudományegyetem Egészségtudományi Kar Ápolás és Betegellátás Intézet Ápolástudományi Tanszszakoktató Jakab Tibor dr.
Pécsi Tudományegyetem Általános Orvostudományi Kar Magatartástudományi Intézet adjunktus
Jankó Attila
Pécsi Tudományegyetem Egészségtudományi Kar kari informatikai csoportvezető Járomi Melinda
Pécsi Tudományegyetem Egészségtudományi Kar Fizioterápiás és
Táplálkozástudományi Intézet adjunktus
Karamánné dr. Pakai Annamária Pécsi Tudományegyetem Egészségtudományi Kar Ápolás és Betegellátás Intézet Ápolástudományi Tanszék adjunktus
Kívés Zsuzsanna Pécsi Tudományegyetem Egészségtudományi Kar Egészségbiztosítási Intézet Egészségfejlesztési és Népegészségtani Tanszék tanársegéd
Kovács Attila dr.
Vas Megyei Markusovszky Kórház belgyógyász, gasztroenterológus Lampek Kinga dr.
Pécsi Tudományegyetem Egészségtudományi Kar Egészségbiztosítási Intézet Egészségfejlesztési Tanszék főiskolai tanár, tanszékvezető
The authors of the book
Lányi Katalin dr.Szent István Egyetem Egészségtudományi és Környezetegészségügyi Intézet főiskolai docens
Lukács Miklós
Betegápoló Irgalmasrend Pécsi Háza ápolási igazgató
Mesicsné Köbli Mónika Pécsi Tudományegyetem Egészségtudományi Kar Ápolás és Betegellátás Intézet Ápolástudományi Tanszék tanársegéd
Müller Ágnes
Pécsi Tudományegyetem Egészségtudományi Kar Egészségtudományi Intézet tanársegéd
Nagy Erika
Szegedi Tudományegyetem
Egészségügyi és Szociális Képzési Kar Ápolási Tanszék
tanársegéd Nagy Gábor dr.
Pécsi Tudományegyetem Egészségtudományi Kar Ápolás és Betegellátás Intézet Sürgősségi Ellátási Tanszék tanársegéd
Németh Katalin Pécsi Tudományegyetem Egészségtudományi Kar Ápolás és Betegellátás Intézet Ápolástudományi Tanszék tanársegéd
Oláh András dr.
Pécsi Tudományegyetem Egészségtudományi Kar Ápolás és Betegellátás Intézet Ápolástudományi Tanszék egyetemi docens, tanszékvezető Orbán Andrea
Kátai Gábor Kórház sztómaterápiás nővér
Pálfiné dr. Szabó Ilona Pécsi Tudományegyetem Egészségtudományi Kar Ápolás és Betegellátás Intézet Ápolástudományi Tanszék tudományos főmunkatárs címzetes egyetemi docens Pogány Magdolna dr.
Szegedi Tudományegytem
Egészségügyi és Szociális Képzési Kar dékán
Radnai Balázs dr.
Pécsi Tudományegyetem Egészségtudományi Kar Ápolás és Betegellátás Intézet Sürgősségi Ellátási Tanszék adjunktus, tanszékvezető helyettes Rajki Veronika
Semmelweis Egyetem Egészségtudományi Kar
Alkalmazott Egészségtudományi Intézet
Ápolástan Tanszék tanársegéd
Raskovicsné Csernus Mariann Semmelweis Egyetem Egészségtudományi Kar
Alkalmazott Egészségtudományi Intézet
Ápolástudományi Tanszék tanársegéd
Rostás Tamás dr.
Pécsi Tudományegyetem Klinikai Központ
Radiológiai Klinika klinikai főorvos Saághy Andrea dr.
Pécsi Tudományegyetem Gazdasági Főigazgatóság
Humán Erőforrás Gazdálkodási Osztály osztályvezető
Schiberna-Cser Henriett Pécsi Tudományegyetem Egészségtudományi Kar könyvtáros
Schmidt Béla dr.
Pécsi Tudományegyetem Egészségtudományi Kar
Fizioterápiás és Táplálkozástudományi Intézet
Fizioterápiás Tanszék főiskolai tanár, tanszékvezető Szekeresné Szabó Szilvia Pécsi Tudományegyetem Egészségtudományi Kar Fizioterápiás és
Táplálkozástudományi Intézet Táplálkozástudományi és Dietetikai Tanszék, tanársegéd
Takács Magdolna dr.
Pécsi Tudományegyetem Egészségtudományi Kar Egészségbiztosítási Intézet Szociális Munka Tanszék főiskolai docens, szakvezető Tulkán Ibolya
Szegedi Tudományegyetem
Egészségügyi és Szociális Képzési Kar Ápolási Tanszék
főiskolai docens, tanszékvezető helyettes Újváriné Siket Adrienn dr.
Debreceni Egyetem
Orvos és Egészségtudományi Centrum Egészségügyi Kar
főiskolai adjunktus, ápoló szakirányfelelős
Váradyné Horváth Ágnes dr.-né Pécsi Tudományegyetem Egészségtudományi Kar Ápolás és Betegellátás Intézet Ápolástudományi Tanszék szakoktató
Zámbó Katalin prof. dr.
Pécsi Tudományegyetem Klinikai Központ
Nukleáris Medicina Intézet egyetemi tanár, intézetigazgató Zborovján Ferencné
Széchenyi István Egyetem Petz Lajos Egészségügyi és Szociális Intézet
mestertanár
Foreword
1. A Historical Overview of Nursing (by Ph.D. József Betlehem, Ph.D. András Oláh) ...31
The formation of the social role of nursing ...31
Main international highlights of nursing ...31
Europe ...32
France ...32
Austria ...32
Germany ...33
Switzerland ...33
The United Kingdom ...34
America (Canada, the United States) ...34
Asia ...34
Japan ...34
Hungary ...35
Beginnings of domestic organization ...35
Red Cross nursing training ...35
Nursing training in the Austro-Hungarian Monarchy ...36
Organization of secular nursing in Hungary...36
Training of nurses and health visitors ...37
Nursing after World War II. ...39
References ...39
2. Fundamentals of Health Insurance (by Ph.D. Imre Boncz) ...41
Basic types of healthcare systems ...41
Bismarck’s solidarity-based social insurance ...41
Beveridge-type state healthcare service ...42
The system built on strong self-provision (private insurance) ...42
Szemasko-type socialist healthcare system ...42
The Structure of Healthcare Systems in Developed Countries ...43
Germany ...43
Austria ...44
The Netherlands ...45
The United Kingdom ...46
The United States of America ...47
Health Maintenance Organization (HMO) ...47
Preferred Provider Organization (PPO) ...48
C) Point-of-service (POS) ...49
D) Exclusive Provider Organization (EPO) ...49
Funds Flow in Healthcare Systems ...49
Generation of funds ...50
Collection of funds ...50
Allocation of funds ...50
Financing of service providers ...51
Determination of Healthcare Expenditures ...51
Financing Techniques in Healthcare...54
Financing healthcare services ...54
Fixed input systems (base financing) ...55
Contents
Performance-based financing ...55
Risk sharing ...56
Techniques of price support for pharmaceuticals ...57
Supply side regulation ...57
Demand side regulation ...58
Use of pharmaceutical-market regulation techniques in individual countries ...61
Health-economic analyses ...61
Role and significance of health-economic analyses ...61
Main types of health economic analyses...63
Cost analysis and cost of illness ...63
Cost-minimization analysis ...63
Cost-benefit analysis ...64
Cost-effectiveness analysis ...64
Cost-utility analysis ...64
Significance of scientific evidence in health-economic analyses ...64
The Structure of the Hungarian Healthcare System ...65
Primary care ...65
Outpatient specialist care ...65
Inpatient specialist care ...66
Progressiveness ...66
Territorial obligation to provide specialist care ...67
Key terminology ...67
References ...69
3. The Hungarian and International Attributes of Legal Health Care Regulation ...71
(by Ph.D. Magdolna Takács, Ph.D. István Ágoston, Ph.D. Tibor Jakab, Ph.D. Zoltán Gelencsér, Ph.D. Andrea Saághy, Ph.D. Magdolna Pogány) ... 71
Historic Overview ... 71
The Development of Regulations Concerning Healthcare Institutions and Provisions ... 71
The Evolvement of Legal Regulation Concerning Social Security ... 71
Today’s Mandatory Health Insurance System ... 73
Bibliography... 73
International Outlook ... 73
Social Rights ... 73
Patients’ Rights ... 74
Bibliography... 75
Legal Aspects in Health Care Provision Based on Act Cliv of 1997 on Health ... 75
Legal references ... 76
Patients’ Rghts in Act Cliv of 1997 on Health ... 76
The Importance of Patients’ Rights ... 76
The Right to Health Care... 77
The Right to Human Dignity ... 77
The Right to Have Contact ... 78
The Right to Leave the Healthcare Facility ... 78
The Right to Information ... 78
Right to Self-determination ... 79
The Right to Refuse Health Care ... 82
The Right to Become Acquainted with the Medical Record... 82
The Right to Professional Secrecy ... 83
Obligations of the Patient ... 83
Enforcement of Patients’ Rights ... 83
Investigation of the Complaints of Patients ... 84
The Patient Advocacy System ... 86
The Mediation Council ... 87
Bibliography... 88
Legal references ... 88
Rights and Obligations of Healthcare Workers ... 89
The law includes the multi-stage regulation of the provisional obligations of healthcare workers ... 89
The Protection of Healthcare Workers ... 89
Legal references ... 90
Legal Questions Occurring in the Course of Nurses’ Practice ... 90
The Peculiarities of Psychiatric Nursing ... 90
Special Rules on the Rights of Psychiatric Patients ... 91
Institutional Treatment of Psychiatric Patients... 91
Voluntary Treatment ... 91
Emergency Treatment ... 92
Mandatory Treatment ... 92
Common Rules of Procedure ... 92
Bibliography... 93
Legal references ... 93
Responsibilities and Compensational Obligations of Health Care Workers ... 93
The Civil Indemnification Liability System ... 93
The System of Ethical Liability ... 94
The System of Disciplinary Liability ... 94
The Legal Liability System of Work ... 95
The Misdemeanour Liability System ... 95
Criminal Liability System ... 95
Liability for Damage Caused to the Patient ... 96
Bibliography... 96
The Regulation of Labour LawRelationsips in Health Care ... 96
”Basic Concepts” ... 96
Employment Contract ... 96
The Cessation of an Employment Relationship ... 97
Termination of the Employment Relationship ... 97
Ordinary Dismissal (with Resignation or Acquittal)... 97
Dismissal Prohibitions, Dismissal Restrictions ... 97
Extraordinary Dismissal ... 97
Termination of Fixed-term Employment ... 98
Regulations for the Performance of Work ... 98
Working Time and Rest Periods ... 98
Bibliography... 98
Legal references ... 98
Special Labour Law ... 99
Regulations in Health Care ... 99
Legal Sources of the Regulations of Labour Laws on Health Care ... 99
Special Regulations Related to the Establishment of Legal Relationships Concerning Healthcare Service Performance ... 99
General Rules for Healthcare ActivityPerformance ...100
Suitability for healthcare activities...100
Regulations Related to Working Time ...100
Legal Reference ...103
4. Changes in the Concept of Health (by Ph.D. Zsuzsanna Füzesi, Ph.D. Kinga Lampek) ...105
Introduction ...105
The concept of health – viewed by practising professionals ...106
Concept of health – the functional approach ...106
Health concept – from laymen’s point of view ...107
12 Az ápolástudomány tankönyve Tartalom 13
Theories affecting the health concept ...108
Health risks...109
Limits of the health concept ...110
References ...111
5. Organizational Sociology and Health Care (by Ph.D. Kinga Lampek and Ph.D. Zsuzsanna Füzesi) ...113
Introduction ...113
The major sociological attributes of organizations ...113
The definition of organization and its types ...113
The social embeddedness of health state ...114
Health care organizations ...115
The bureaucratic system ...115
The peculiarities of the health care system ...116
The value of health ...116
Societal need and the degree of utilization ...116
Austerity ...116
Monopolistic position ...117
System of relations in health care ...117
The client-centred organization ...117
Organizations controlling the operation of health care organizations ...118
Participants in the functioning of health care organizations ...118
Doctors ...119
Nurses ...120
Patients ...120
Summary ...121
Bibliography...121
6. Literature Research in Nursing ...123
(by Henrietta Schiberna-Cser, Annamária Karamánné Ph.D. Pakai, Anikó Dér, Ph.D. András Oláh) ...123
The importance of the critical way of thinking in nursing ...123
The mapping of previous researches (literature research) ...124
Collecting data ...125
Collecting literature ...125
The tools of literature research ...126
Library catalogues ...126
Bibliographies ...129
Offline databases ...132
Internet search ...132
Unpublished literature ...132
Reference ...133
Summarizing the literature used, making a bibliography ...134
The characteristics of the search for relevant specific literature...135
Multidisciplinary, medical, healthcare database ...137
EBSCOhost ...137
Medline ...138
PubMed ...139
EISZ (Electronic Information Service) databases. ...145
Web of Science (WoS) ...145
ScienceDirect ...149
SpringerLink ...151
Scopus database ...151
OVID ...156
MATARKA ...158
E-journals ...161
Appendix I ...166
Appendix II – EBSCO journal article databases are ...167
Appendix III – The Electronic Information Service (EISZ) includes the following databases at present: ...168
Appendix IV – The selected journal list of health science ...170
Appendix V – Other relevant databases...171
Appendix VI – Examples of domestic and international medical and health websites ...173
Basic terms ...174
Bibliography...174
7. Fundamentals of Research Methodology and Biostatical Knowledge ... 177
(by Ph.D. Kinga Lampek, Zsuzsanna Kívés) ...177
Introduction ...177
Sources of knowledge for professionals working in nursing and medical attendance ...177
Following customs and traditions ...177
Following the position which is taken by an authority, professional office, agency ...177
Following intuitions, instinctive anticipations ...177
Trial, experience: successes and errors ...178
Cognition of scientific research findings ...178
The process of scientific research ...178
Formulation of a research problem ...178
Exploration of previous research, review of literature and other sources ...179
Development of conceptual frameworks of research ...179
Identification of theories ensuring the research framework ...179
Measurement methods and data types ...180
Definition of variables ...180
Formulation of hypotheses ...181
Determination of research methods ...181
Quantitative research methods ...181
Qualitative research methods ...182
Forms and practice of sampling ...182
Concepts related to sampling ...182
Types of sampling procedures ...182
Non-probability sample ...182
Probability sample ...183
Criteria of inclusion and exclusion ...184
Aspects necessary for determination of sample size ...184
Data collection research instruments ...184
Experiment ...185
Real experimental research ...185
Intervention ...185
Control ...185
Randomization ...186
Quasi experimental research ...187
Questionnaires ...187
General rules of compiling the questionnaire ...188
Question types applicable in questionnaires ...188
Indices and scales ...189
Concept and use of the indices ...189
Compilation of questionnaires ...190
Pilot survey ...191
Observation ...191
Types of observations ...191
Forms of observation according to the observer’s role ...192
Interviews ...192
Types of interviews ...192
Unstructured interview ...192
Recommendations for the interview process ...193
Processing the interview ...193
Validity ...194
Compilation of database ...194
Database compilation using ...195
Excel programme ...195
Data analysis ...196
Univariable analyses ...196
Calculation of frequency and percentage distribution by Excel programme...196
Middle value measures ...196
Measures of dispersion ...197
Calculation of middle values and standard deviation in Excel programme...198
Hypothesis review ...198
Confidence interval (CI) ...200
Prevalenc CI and its calculation in the Excel programme ...200
Calculation of mean CI in Excel programme ...201
The t-test – with data interpreted on an interval scale ...201
The use, conditions and calculation of one-sample t-test in Excel programme ...201
The use, conditions and calculation of two-sample t-test in Excel programme ...203
Use, conditions and calculation of Chi-square test in Excel programme...203
Evaluation of relationship between continuous variables using correlational coefficient ...204
Conditions of calculation of linear correlation coefficient ...205
Calculation of correlation in Excel programme ...205
Evaluation of the relationship between continuous variables with regression coefficient ...205
Calculation of regression in Excel programme ...206
Conclusion and publication of research results ...206
Application of research findings ...208
References: ...208
8. Ethical Aspects of the Nursing Profession (Extract from ETHICS) ...211
(by Ilona Pálfiné Ph.D. Szabó – Mariann Raskovicsné Csernus) Moral issues of nursing and the ethics of nursing care: ...211
Morals, morality, ethics ...211
Parts of ethics ...212
From doctors’ paternalism to ‘the principle of informed consent’ in modern medical ethics ...214
General principles of healthcare worker behaviour ...215
Healthcare ethics, nursing ethics ...215
Becoming and being a nurse ...215
Nursing ethics ...216
Activity – a carrier of moral value ...217
The connection between morals and religion ...217
The connection between morals and the law ...217
Place and role of ethical codes of nurses in practice ...218
Preserving human dignity during medical attendance ...219
Impersonality in healthcare provision ...220
Ethical issues connected with patients’ treatment ...220
Other topics in bioethics ...221
Sanctity of life and quality of life ...221
“Living Will or Life Passport”! ...221
The issue of euthanasia: ...221
Ethical issues concerning ‘do-not-resuscitate’ decisions ...222
Ethical dilemmas in nursing ...222
Examples: ...223
Decision-making of children ...223
Ethical issues of organ and tissue transplantation: ...224
Psychological antecedents and moral effects of transplantation ...224
References ...224
9. The Complexity of Lossand Death in the Course of Human Life ... 227
(by Ilona Pálfiné Ph.D. Szabó, Miklós Lukács) Introduction ...227
About Loss, Death and Dying ...227
About Grief ...228
Approaches to Pallative Care / ...230
Hospice ...230
Background ...230
Nursing principles regarding the major symptoms ...232
Pain ...233
Special advice for care at point of end-of-life ...236
Death, caring for the dead customs of bereavement, funeral ...237
The Hospice Team ...239
Summary ...240
Bibliography (References) ...240
10. Transcultural Health Care (by Zsuzsanna Kívés) ...243
Introduction ...243
International migrating trends ...243
General characteristics of culture ...243
The passage of the patient from observing the symptoms to the hospital...244
Patient behaviour ...244
Symptoms, observing symptoms ...244
The evaluation of symptoms ...244
Becomingill ...245
Seeking recovery ...245
Autotherapy ...245
Alternative therapies ...245
Motivations of turning to a doctor ...245
The hospital ...246
The viewpoints of the doctor- nurse- patient in relation to the disease ...246
The lay theory of the reasons for diseases ...247
The individual ...247
The world of nature ...248
The social world ...248
Supernatural world ...248
The problems of doctor/nurse-patient encounter ...248
The culture of the health care worker ...249
Pain and culture...249
The cultural correlations of anatomy and physiology ...250
16 Az ápolástudomány tankönyve Tartalom 17
Cultural aspects of nourishment ...251
Communication between cultures ...252
Ceremonies and misfortune ...253
Spirituality, religious faith and practices ...254
Culture and medication ...254
Culture specific diseases ...254
The model of transcultural nursing ...254
Leininger’s “Sunrise Model” – Modell A ...255
Leininger’s shortened model (Model B) ...257
The main characteristics of cultural groups, case-histories...257
Spanish folk group ...257
Middle East folk group ...258
Asian community ...259
The Black American folk group...259
Gypsy folk group ...259
Bibliography (References) ...260
11. Nursing Theories – Nursing models (complete) ... 263
(by Katalin Németh, Ibolya Tulkán, Noémi Fullér, Veronika Rajki, Mariann Raskovicsné Csernus) Definition of ’theory’ and ’nursing theory’...263
Nursing models ...264
The evaluations and criticisms of nursing theories and nursing models ...264
Early nursing theories, their effects, the first experts in nursing theory ...265
Brief introduction of certain nursing theories, nursing models ...267
Virginia Henderson (1897–1996) ...267
Nancy Roper (1918–2004) ...267
Dorothea Orem (1914–2007) ...267
Faye Glenn Abdellah (1919–) ...269
II. Interactionist theories ...269
Ida Jean Orlando (1926–2007) ...269
Ernestine Wiedenbach (1900–1996) ...270
Hildegard Peplau (1909–1999) ...270
Imogene King (1923–2007) ...271
III. Result theories ...271
Dorothy Johnson (1919–1999) ...271
Martha Elisabeth Rogers (1914– 1994) ...272
Myra Estrin Levine (1920–1996) ...272
Callista Roy (1939–) ...272
System theories ...272
Betty Neuman (1924–) ...272
Jean Watson (1940s) ...273
Madeleine Leininger (1925–) ...273
The application of nursing theories in practice ...274
A practical example of the appearance of nursing models in the nursing process. Case report ...274
Bibliography ...276
12. Critical Thinking in Nursing – Nursing Process and Documentation ... 279
(by Ph.D. András Oláh, Mariann Raskovicsné Csernus, Ibolya Tulkán, Ilona Pálfiné Dr. Szabó, Krisztina Hoffmann, Attila Jankó, Rózsa Fehér, Ferencné Zborovján, Veronika Rajki, Katalin Németh) The nursing process ...280
Nursing documentation and its forms ...281
Healthcare and nursing documentation ...281
Parts of patient documentation/healthcare documentation ...282
Regulation of access to healthcare documentation in Hungary ...284
Nursing documentation ...284
Nursing documentation techniques ...286
The advantages of keeping nursing documentation ...288
Possible future improvements: electronic nursing documentation ...288
Bibliography...288
13. Introduction to Examination of Patients (by Ph.D. Gábor Nagy) ...293
First Encounter with the Patient ...293
Communication ...293
Anamnesis (medical history) ...294
Documentation ...295
Summary, suggestions ...295
The Bases of Physical Examinations ...295
Inspection ...296
Percussion ...297
Auscultation ...298
The examination of cardiovascular system ...298
Examination of respiratory system ...300
Examination of the abdomen ...303
Establishing anamnesis in gastrointestinal heath problems ...303
Establishing anamnesis in case of diseases in urogenital sytem ...305
Inspection ...306
Auscultation ...306
Palpation ...307
Percussion of the abdomen ...308
Organs of locomotion ...309
Bibliography...309
14. Vital Parameters (by Ph.D. András Oláh, Ph.D. Balázs Radnai, Ágnes Müller, Nikolett Gál, Noémi Fullér) ...311
Temperature ...311
Physiological background ...311
The depth levels of hypothermia...312
Higher than normal body temperature, hyperthermia ...312
The types of fever are...313
Reduction of fever ...314
Temperature Measurement...315
Pulse 317 Tachycardia ...317
Bradycardia ...318
Assessing the quality of pulse ...318
Rhythm ...318
The places for measuring the pulse are ...318
Monitor systems ...321
Breathing ...322
Anatomic and physiological bases ...322
Pathological respiratory patterns/ breathing types ...322
Abnormal respiratory sounds ...324
Bad breath – halitosis – foetor ...324
Légzôrendszeri hangjelenségek ...325
The observation of respiration ...325
Blood pressure ...326
Normal and pathological blood pressure categories...326
Vérnyomásmérés ...327
Indirect (non-invasive) blood pressure measurement ...328
Direct, invasive blood pressure measuring ...333
Bibliography...334
15. Pain and Pain Management (by Ph.D. RóbeRt Almási, KAtAlin németh, KAtAlin Fusz)...337
Introduction ...337
Nociception and pain ...340
The first encounter with the patient ...340
The anatomical bases of nociception ...340
nociception ...341
thetransMissiontractsofthespinalcord ...341
supraspinalsysteM ...341
thecerebralcortex...342
thedescendingModulationsysteM...342
thesyMpatheticnervoussysteM ...342
The pharmacology of pain ...343
The classification of pain ...344
Neurophysiological classification...344
Classification according to time ...344
Aetiological classification ...345
Anatomical classification ...345
Pain and pain-related psychological phenomena ...345
The pain-related pathophysiological and pharmacological phenomena ...346
The physiological effects of pain ...346
Acute pain ...346
Chronic pain ...347
Cancer pain ...347
Pain assessment and measurement ...348
The description of pain ...348
Signs, symptoms referring to pain ...348
Diagnostic procedures ...349
The nurse’s role in pain assessment ...350
The treatment of pain ...351
Non-pharmacological analgesia ...351
Alternative medicine ...353
Pharmacological therapy, the pharmacology of pain management ...355
theopioidreceptoragonists – narcoticanalgesics ...355
non-steroidalanti-inflaMMatories ...355
localanaesthetics ...355
adjuvantsubstances ...356
theapplicationforMsofanalgesicdrugs ...357
Analgesia during surgery ...357
Regional anaesthesia ...357
General anaesthesia ...358
The drugs of premedication and anaesthesia induction ...359
The treatment of chronic pain ...361
Interventional pain management ...362
Cancer pain management ...362
The role of pain clinics ...363
The role of nurses in relieving pain ...363
bibliography ...365
16. Protection and Safety Requirements Part 1 (by Katalin Németh, Krisztina Hoffmann, Melinda Járomi) ...373
Safety requirements, hospital room environment, bedding, lying, laying. ... 373
Safety requirements ...373
Hospital room environment ...373
Sick-bed ...373
The clean-up and tidying-up of patients’ bed: ...373
Tidying up a lying patient’s bed ...373
Lying, laying ...377
Laying ...378
Active and passive position changes ...380
Necessary and convenient means for changing positions are: ...380
Body mechanics ...383
Basic concepts of body mechanics ...384
The basic concepts of anatomy, biomechanics, osteokinematics, arthrokinematics and pathomechanics ...385
The protection of the spine, correct body posture and spinal usage during nursing patients...385
Protecting the knee joints ...385
Applied body mechanics, ergonomics ...386
Bibliography ...388
17. Basic Hygienic Rules in Healthcare (by Katalin Németh, Katalin Fusz, Noémi Fullér, Ph.D. Katalin Lányi, Ph.D. András Oláh) ....391
Nosocomial Infections...391
The Pathogenesis of Nosocomial Infections ...391
Clinical forms of nosocomial infections ...392
Nosocomial infections of the hospital staff ...392
Nosocomial surveillance ...392
Asepsis, antisepsis ...393
Antisepsis ...395
Decontamination ...395
Disinfecting processes ...396
Hygienic expectations as far as ...397
healthcare workers are concerned ...397
Hygienic hand disinfection ...397
Sterilizing ...399
Healthcare waste management ...403
Bibliography...406
18. Personal hygiene care for the sick (by Mónika Köbli, Krisztina Hoffmann, Ph.D. József Betlehem) ...409
Personal hygiene...409
Skin ...409
Skin care ...410
Bathing, washing the patient in bed ...410
Bathing in bathroom (shower and tub) ...417
Nursing of the perineal area ...419
Nail (hand) and leg care ...420
Mouth care ...422
20 Az ápolástudomány tankönyve Tartalom 21
Hair care ...423
Eye care ...426
Ear care ...426
Nose care ...426
References ...426
19. The Need for Sleep and Rest (by Krisztina Hoffmann, Adrienn Újváriné Siket, Ph.D. József Betlehem) ...429
Az alvás, pihenés alapfogalmai ...429
Stages of sleep ...430
Frequent sleep disorders ...431
Dyssomnias...431
Parasomnias ...432
Medication ...433
List of references: ...434
20. Medication – The Types and Rules of Parenteral and Non-parenteral Medication ... 435
(by Ph.D. András Oláh, Noémi Fullér, Annamária Karamánné Pakai) Introduction ...435
Pharmacology ...435
The subject and most important notions of pharmacology ...435
The main areas of pharmacology ...435
Forms of medicine ...436
Solid medicines (Pethő 2003, Fürst 1998, Vízi 1997) ...436
Semi-solid medications ...436
Liquid medicines ...437
Liquid medicines for external use ...437
Ingested liquid medicine forms ...437
Other liquid forms of medicine ...437
Signature of liquid medicine forms ...438
Solutions for parenteral use ...438
Pharmaceutical preparations made by extraction ...438
Other pharmaceutical forms ...439
Transdermal Therapeutic System (TTS) ...439
Nursing tasks in medication ...439
Co-operation of the patient: compliance and persistence ...439
The notion of compliance ...439
Patient education ...440
Nursing tasks in medication ...442
Guidelines in medication (Malcolm 2010) ...442
Abbreviations in medication ...443
Household measurements ...443
Prescription types ...443
The prevention of medication errors ...444
Medicine storage in healthcare institutions ...445
Nursing tasks according to the route of administration ...445
Oral (per os) administration of medication ...446
Otological treatment ...446
Vaginal treatment ...448
Inhalation therapy ...448
Nasal administration ...448
Ophtalmologic treatment ...449
Rectal treatment ...449
Transdermal patches ...451
Tools for administering injections ...452
Syringes ...452
Needles ...454
Protective equipment ...455
Drawing up and injection from medicine containers containing multiple doses ...455
Preparation for injection ...455
Tools for drawing up and mixing medicines ...455
Drawing up injection from glass ampoule ... 456 Drawing up injection from injection bottle ...456
Most common injection methods ...458
Intracutaneous /intradermal (IC/ID) injection: ...458
Subcutaneous injection (under the skin, sub-q, SC, SQ) ...458
Intramuscular injection (IM) ...460
Intravenous injection (IV) ...463
Bibliography ...464
21. The System and Maintenance of Water, Electrolyte and Acid-base Balance ... 467
(by Ph.D. András Oláh, Ph.D. Balázs Radnai, Ágnes Müller, Nikolett Gál, Noémi Fullér) Anatomical and physiological bases ...467
Types of intravascular cannulae (Vascular Access Devices): ...468
The peripheral catheter (short) ...468
Midline catheter ...470
Central vein access ...470
Central vein ...470
Intravenous catheter care ...471
Needles for Infusion Therapy ...472
Other factors affecting the vein access: ...473
Rubber tourniquets – strangulator ...473
Infusion therapy ...474
Infusion Tubing ...474
Infusion dosing devices ...475
The protocol of the compilation of infusion ...476
The protocol of the administration of infusion ...478
The protocol of the removal of the infusion tubing ...479
The infusion / transfusion variations ...480
The specific forms of infusion therapy ...480
Arterial cannula ...480
Bibliography...482
22. The General Aspects of Transfusion (by Ph.D. András Oláh, Nikolett Gál, Rózsa Fehér, Ferencné Zborovján, Katalin Fusz) ...485
The concept of transfusion ...485
Transfusion-related responsibilities ...485
Legal aspects of transfusion ...486
The ethical aspects of transfusion ...486
Haemovigilance ...486
The history of transfusion ...486
The serological – ...487
blood group bases of transfusion ...487
Blood Group Systems ...487
AB0(H) – blood group system ...487
Rh blood group system ...488
Alloimmunization ...488
Preparative Transfusiology ...488
Blood donation, he suitability of blood donors ...488
Investigation of blood products ...490
Production of blood products from whole blood and by the apheresis technique ...490
Information on blood preparations ...490
Forms of autologous transfusion ...490
Artificial oxygen carriers (artificial blood) ...492
Directed donation ...492
Storage of blood products in blood depot and blood products transport ...492
Compatibility test ...492
Laboratory blood-typing/blood group determination ...492
The validity of compatibility tests ...492
Things to be done prior to transfusion ...493
Survey...493
Administrative tasks ...493
The pre-transfusion checks and identifications ...493
Blood group/ application for blood selection ...494
Request for other laboratory tests ...494
Clinical blood group determination for blood group request ...494
Card (bed-side) blood-typing protocol ...494
Documentation of blood request ...495
Blood product-application form must include the following information ...495
The blood-group control of blood products...496
Clinical cross-matching ...496
Administration of Transfusion ...496
The protocol of transfusion therapy ...499
Special Forms of Transfusion...500
Transfusion reactions, complications ...505
Bibliography...507
23. Nutrition, the Need for Nutrition ... 509
(by Attiláné Aradán, Tünde Gubó, Szilvia Szekeresné Szabó, Ph.D. András Oláh, Ágnes Müller, Annamária Karamánné Pakai) Dietetics ...509
Anatomical and physiological context ...509
Nutrition ...509
Metabolism ...509
Energy ...509
Basic functions of nutritional components ...509
Dietary regulations concerning carbohydrates ...509
Dietary regulations concerning fats ...510
Dietary regulations concerning proteins ...510
Dietary regulations concerning vitamins ...510
Dietary regulations and minerals ...510
Functional foods ...510
Enriched foods ...510
Additives ...511
Nutritional needs according to age groups ...511
Balanced nutrition of healthy adults ...511
Infant nutrition ...511
Nutrition of the 1–3-year-old child...511
Nutrition of the 4–14-year old child ...512
Nutrition of the pregnant and breast-feeding mother ...512
Nourishment of the elderly ...512
Unified Dietary System ...512
Diagnostic diets ...513
Dietary therapy in the treatment of patients /dietary suggestions for certain diseases ...513
Body mass index (BMI) ...514
Osteoporosis ...515
Nourishment of patients with diabetes mellitus ...515
Medication – nutrition interaction ...515
Nutrition support, ...515
Problems influencing nutrition ...515
Appetite ...515
Eating, meals ...515
Nutritional ability support ...516
Oral nutrition of patients in need ...516
Problems influencing nutrition ...516
Relieving the stomach ...517
NG tube insertion ...517
The process of nasogastric tube insertion...517
Conducting nasogastric tube protocol ...518
Gastric lavage ...520
Preparing an antidote ...521
Process of the lavage, things to be done during the lavage ...521
Things to be done after gastric lavage ...522
Undernourishment ...523
Undernourishment, the danger of undernourishment ...523
The notion of malnutrition ...524
Consequences of malnutrition ...524
Forms of malnutrition ...524
Groups endangered by malnutrition ...524
Causes leading to the development of malnutrition ...524
Causes of iatrogenic malnutrition...525
Morbidity internationally and in Hungary ...525
Characteristics of malnutrition ...525
Defining nutritional status ...525
Detailed examination according to competences ...526
The following steps can be identified as parts of the care process ...526
Setting up a diagnosis ...527
Artificial nutrition ...527
Planning artificial nutrition ...527
The care plan ...527
The nutritional plan...527
The ways of artificial nutrition ...527
The practice of enteral nutrition ...528
Applicable enteral nutrition methods ...528
Enteral formulas ...528
Dosing enteral formulas ...528
Dilution of enteral formulas ...528
Storage regulations of enteral formulas ...528
Enteral nutrition devices ...529
General aspects of structuring enteral nutrition ...529
Hygienic principles of enteral nutrition ...529
Documentation of enteral nutrition ...529
24 Az ápolástudomány tankönyve Tartalom 25
The patient’s education in case of nutrition ...529
Checking enteral nutrition ...529
Fluid and electrolyte balance ...529
Recognizing complications ...530
Entering formula orally into the organism ...530
Delivering food into the stomach through a nutrition tube ...530
The patient’s preparation for probe insertion ...530
Preparation of the equipment ...530
Preparation of the formula ...530
Structure of nutrition ...530
Things to be observed ...530
Prevention of complications ...530
The patient’s education ...531
Gastric nutrition through a stoma device ...531
Making percutan endoscopic gastrostomia (PEG) with the deletion method ...531
Frequent causes of complications accompanying ...531
PEG usage, nutrition, and treatment ...531
The patient’s preparation for nutrition ...531
Preparation of the formula ...531
The procedure of nutrition ...531
Check ...532
Care ...532
Patient education ...532
Documentation ...532
Nutrition into the small intestine (jejunum) through a feeding tube ...532
The advantages of jejunal nutrition ...532
A The patient’s preparation for feeding probe insertion ...532
Jejunal feeding probe insertion technique with an endoscope ...533
Special nursing tasks after nasojejunal eeding probe insertion ...533
Recommendations for jejunal feeding ...533
Construction of nutrition ...533
Nursing tasks during the nutrition to support the patient’s physical activity ...533
The practice of parenteral nutrition ...533
Planning parenteral nutrition ...533
asic principles of parenteral nutrition ...534
Methods of parenteral nutrition ...534
Indications of parenteral nutrition ...534
Possibilities of dosing parenteral solutions ...535
The pace of dosing nutritional solutions ...535
Parenteral solutions ...535
Preparation of parenteral solutions ...535
Major rules of preparing products, solutions ...535
Major actions of blending parenteral solutions ...535
Attachment of parenteral nutritive solutions, cannula care ...536
Hygienic rules ...536
Washing hands and using gloves ...536
Disinfection of the equipment ...536
Disinfection of the work top, surfaces ...536
Disinfection of the skin ...536
Use of sterile devices, materials ...536
Checking points of parenteral nutrition ...536
Complications of parenteral nutrition ...537
Documentation ...537
References ...537
24. The Need to Urinate, Modified Urination ... 543
(by Ph.D. András Oláh, Krisztina Hoffmann, Ágnes Müller, Nikolett Gál, Katalin Németh) Anatomical and physiological bases ...543
The need to pass urine...546
The differences in urine volume ...547
Micturition problems ...547
Its forms are as follows ...547
The symptoms of urination disorders ...548
Lower urinary tract infections ...548
The lack of the ability to hold urine ...548
Urinary incontinence ...548
Supplementary diagnostic tests in case of urine incontinence ...549
Urodynamic tests ...549
The indications and methods of urine tests ...549
Urine test indications ...549
Indication areas of urine testing ...549
Testing the characteristics of urine ...550
Macroscopic urine tests ...550
Quantity tests ...550
Urine sampling forms ...550
Identification and storage of urine specimens ...550
Urine sampling and transportation recommendations ...551
High-quality tests to promote diagnostics ...551
Microscopic tests ...552
Devices suitable for urine storage and transportation ...552
Promoting urine capture and drainage with special devices ...554
Urine capture devices ...554
Male urine bottle with lid ...554
Female urinals...555
A vizelôedények tisztítása ...555
Incontinence pads and pants ...555
Condom catheter (urinary sheaths) ...556
Penis pouch ...556
Pubic pressure urinal ...556
Special devices for promoting urine drainage ...556
Catheterization ...556
Types of catheterization ...557
Permanent catheterization...557
Catheter valves (closure valves) ...557
Urine collection bags ...558
Bibliography ...558
25. Defaecation ... 563
(by Ph.D. András Oláh, Mariann Raskovicsné Csernus, Andrea Orbán, Eszter Borján, Gyuláné Deák, Katalin Németh, Annamária Karamánné Pakai, Ágnes Müller, Nikolett Gál, Katalin Fusz) Anatomical and physiological basics ...563
The observation of faeces ...563
The number and amount of defaecation ...564
The colour of faeces ...564
Stool odour ...564
The consistency of faeces ...564
The pathological components of faeces ...564
Tests in case of intestinal dysfunctions ...565
Stool examination, stool sampling purposes and methods ...565
Diarrhoea ...567
Constipation (obstipatio) ...567
Enema 568 Cleansing enema / evacuant enema ...571
soapsuds enema / SSP ...571
Medicated enema ...571
Constrictive / astringent enema ...571
Barium enema ...571
Oil enema / oil retention enema ...572
Carminative enema ...572
Return-flow enema (in other words Harris flush) ...572
Contraindications of enemas ...572
Enema protocol ...572
Different defaecational ...573
environments and methods ...573
The application of bed-pans ...573
Stoma care ...573
Historical outlook ...575
The classification of enterostomas ...575
Classification according to duration ...575
Classification according to forms ...575
Enterostoma care ...576
Peri-operative stoma care ...577
Emptying and cleaning the stoma pouch ...578
The exchange of the stoma pouch ...579
The patient’s education ...581
Stoma complications ...583
Self-Care ...583
Rehabilitation and stoma ...583
Controlling the rhythm of defaecation...584
The significance of self-support groups ...586
The significance of transcultural nursing in stoma care ...586
The application of nursing philosophies in ostomy care ...586
Bibliography...587
26. Oxigen Therapy ... 593
(by Ph.D. Oláh András, Fullér Noémi, Fehér Rózsa, Ferencné Zborovján, Ágnes Müller, Nikolett Gál, Ph.D. Balázs Radnai) Anatomical and physiological introduction: ...593
The aim of oxygen therapy ...594
The forms of oxygen therapy ...594
Airway adjuncts ...595
Oropharyngeal airway adjuncts ...595
Nasopharyngeal devices ...595
Supraglottic airway devices ...595
Endotracheal tube ...597
Intubation ...597
Tracheostomy tubes ...597
Removal of mucus from the ...598
respiratory tract – tracheal suction ...598
Respiratory specimen collection ...601
Ventilation ...602
Inhalation therapy ...605
Bibliography ...608
27. Wound Care – Wound Management ... 611
(by Ph.D. Ágnes Váradyné Horváth, Nikolett Hegedűs, Ágnes Müller, Erika Nagy, Ph.D. Béla Schmidt, Mariann Raskovicsné Csernus) Anatomical and physiological introduction ...611
Properties of the skin ...611
Wounds; types of wounds ...612
Wound treatment ...613
Removal of stitches and clips ...614
Drainage ...614
Chronic wounds and their care ...616
Collecting discharge sample from the wound ...618
Foot and leg ulcers ...619
Venous origin ...619
Arterial origin ...619
Neuropathy ...620
Complex treatment of leg/foot ulcers ...620
Diabetic foot ...622
Treatment of tumorous wounds ...624
Decubitus ...625
Decubitus prevention ...625
Decubitus therapy ...630
Bibliography ...633
28. The Basis of Nuclear Medicine (by Prof. Ph.D. Péter Bogner, Ph.D. Katalin Zámbó) ...635
Isotopic imaging ...635
The general characteristics of isotopic examinations: ...636
Types of examinations ...636
Radiation Protection ...636
Radiopharmaceuticals ...636
Perfusion lung scintigraphy ...637
Inactive and functional myocardial perfusion test ...637
Brain perfusion examination ...638
Dynamic perfusion examinations ...639
Examinations founded on labelling of the heart blood content ...639
ECG portal left chamber parietal and ejection fraction examination ...639
Examinations by radiopharmaceuticals concentrated in the cells of parenchyma ...640
Colloidal liver-, spleen scintigraphy ...641
Hepatobiliary scintigraphy ...642
Kidney scintigraphy ...642
Kidney perfusion and camera renography ...644
Examinations performed by radiopharmaceuticals accumulated in tumour cells ...644
Thyroid iodine storage, scintigraphy, ...644
therapy of non-malignant and malignant thyroid diseases with iodine-131 isotope ...644
Bone scintigraphy ...646
Nonspecific radiopharmaceutical concentration in diverse tumorous tissues ...647
Parathyroid scintigraphy ...647
Scintimammography ...648
Adrenergic receptor examination ...648
28 Az ápolástudomány tankönyve Tartalom 29
Adrenal cortex scintigraphy ...648
Somatostatin receptor scintigraphy ...649
Sentinel lymph node examination ...650
The FDG examination of tumours with tomography emitting positron ...651
A képalkotó módszerek alapja ...652
Introduction ...652
X-ray imaging ...652
Aspects of radiation protection – biological effect ...654
The types of X-ray-examinations ...655
A röntgenvizsgálat folyamata...656
Patient preparation ...656
Swallowing test ...657
Examination of stomach and upper passage ...657
Selective enterography...657
Irrigoscopy ...657
Intravenous urography ...657
Computer tomography (CT) ...658
Patient preparation ...660
Aspects of radiation protection ...660
Types of examination ...660
Ultrasound imaging ...661
Magnetic Resonance Imaging (MRI) ...664
Bibliography...668
29. Electocardiography (by Ph.D. Balázs Radnai, Noémi Fullér, Nikolett Gál, Ph.D. András Oláh) ...669
Physiological basics ...669
Impulse generation ...669
Conduction ...669
Electrophysiological basics ...670
Intracellular electroPHYsiology ...670
Spherical model ...670
The detection of electrical activities: unipolar and bipolar leads ...673
Electrophysiological processes of the heart ...673
Electocardiography ...678
The working principle of electrocardiography ...678
The technique of electrocardiography...678
Einthoven’s bipolar standard limb leads ...678
Goldberger’s unipolar limb leads ...678
Unipolar chest leads ...678
Protocol for 12-lead ECG ...679
Supplemental leads ...681
NORMAL ECG ...681
Formation of ECG waves ...681
P wave ...681
PQ (PR) distance ...682
QRS complex ...682
St segment ...682
T wave ...682
Qt interval ...682
U wave ...683
Parameters in physiologic ECG ...683
source of impulse generation ...683
regularity (Rhythmicality) ...683
Frequency ...683
axis deviation ...683
PATHOLOGIC ECG ...684
Common disorders of impulse generation ...684
Supraventricular disorders of impulse generation ...684
Ventricular disorders of impulse generation ...685
Common conduction disorders ...685
Atrioventricular block ...685
Intraventricular conduction disorders ...686
30. Instrumental Examinations (by Prof. Ph.D. Zoltán Döbrönte, Katalin Németh, Ph.D. Attila Kovács, Katalin Fusz) ...687
ENDOSCOPIC EXAMINATIONS ...687
The classification of endoscopic examinations ...687
The types of endoscopes ...687
Diagnostic and therapeutic forms of endoscopic examinations ...688
Diagnostic examinations ...688
Therapeutic alternatives...689
General guidelines for indication of endoscopic examinations ...690
Types of endoscopic procedures ...690
Oesophagi-gastro-duodenoscopia ...690
Jejunoscopy (proximal enteroscopy) ...691
Balloon enteroscopy ...692
Capsule endoscopy ...692
Colonoscopy ...693
Protoscopy ...694
Rectosigmoideoscopy ...694
Endoscopic retrograde cholangiopancreatography (ERCP) ...694
Bronchoscopy ...695
Cytoscopy (urethrocystoscopy)...695
Laparoscopy ...696
The methods of medication preparation of endoscopic examinations ...697
Local anaesthesia ...697
Sedative and analgesic premedication ...697
The Endoscopic Nurse’s ...698
Duties Before the Endoscopic Examination...698
Patient Preparation ...698
The endoscopic nurse’s duites during the endoscopic examination ...699
The endoscopic nurse’s after the endoscopic examination ...700
Bibliography...700
31. Puncture and biopsy ...703
(by Annamária Karamánné Pakai, Ph.D. András Oláh, Noémi Fullér, Katalin Németh, Ph.D. Tamás Rostás, Ph.D. István Gáti, Katalin Fusz) Puncture (punction), aspiration (for sample collection) and centesis (fluid withdrawal) ...703
Lumbar puncture ...703
Cisternal puncture ...705
Peritoneal (ascites)-puncture (abdominal puncture / abdominal paracentesis /„abdominal tap”) ...705
Thoracocentesis (thoracentesis, pleural tap) ...705
Chest tube ...706
Pericardial puncture ...706
Bone marrow aspiration, biopsy ...707
Liver biopsy ...708
Renal biopsy ...708
Breast biopsy ...709
Thyroid gland aspiration and biopsy ...710
Taking blood from veins and arteries (Phlebotomy; venipuncture and arterial puncture) ...710
Venipuncture ...711
Blood gas analysis ...714
Arterial phlebotomy for blood gas analysis ...714
Arterial sample collection by puncture ...714
Capillary blood sampling ...715
Bibliography ...716
32. Protection and Safety Requirements Part 2 Immobility-Syndrome ... 719
(by Ph.D. András Oláh, Ágnes Müller, Melinda Járomi, Nikolett Gál, Mariann Raskovicsné Csernus, Ph.D. Ágnes Váradyné Horváth, Noémi Fullér) Mobility and immobility, the immobilty sindrome ...719
Respiratory system ...719
Circulatory system ...720
Thrombosis Prophylaxis ...721
Mobilisation ...722
Pharmaceutical prophylaxis in thrombosis prophylaxis: the application and education of LMWHs and oral anticoagulants ...723
Locomotive system ...724
Contracture prophylaxis ...724
Muscle atrophy prophylaxis ...724
Integument; decubitus prophylaxis...725
Changes in the digestive system and metabolism ...725
The urinary system ...726
Nervous system ...727
Psychological effects ...727
Bibliography...727
33. Physiotherapy (by Melinda Járomi) ...729
Physiotherapy ...729
The methods of physiotherapy ...729
Electrotherapy ...729
Low-frequency treatments...729
Mid-frequency treatments ...730
High-frequency treatments ...730
Phototherapy, heliotherapy...731
Hydrotherapy ...731
Thermotherapy ...731
Mechanotherapy ...732
Ultrasound therapy ...732
Balneotherapy ...732
Climatic therapy...732
Speleotherapy (cave therapy) ...732
Inhalation treatments ...733
Medical gymnastics ...733
Bibliography...736
In the present chapter we have attempted to give a sum- mary of historical antecedents of nursing interpreted within up-to-date conceptual frameworks. The aim of this chap- ter is to familiarize the reader with the main highlights and significant societal factors leading to nursing becoming an independent profession, both on international and national level. In order to learn about the conceptual frameworks of modern nursing it is essential to review major organizations and movements which dealt with nursing activity, nurses and their training as well as with enforcement of their pro- fessional interests. What is covered by this is not a chrono- logically detailed list but rather social processes lobbying for the profession.
The formation
of the social role of nursing
There are several elements of discussion in relation to the journey of Nursing becoming a profession Numerous tasks performed for people in need have been rated as nursing in a broad sense. Most often these tasks included providing for sick people, keeping their environment clean and tidy, satisfy- ing the basic needs of sick people, and in the case of more qualified staff they included helping and assisting the inter- ventions done by physicians (surgeons). Originally, care for the poor and the needy belonged to the fraternity. According to the most accepted approach, on the basis of activities of nurses and carers it is useful to differentiate:
• organizations of the church, denominations (orders),
• secular (civil) organizations and
• nursing created and operated by military corps.
In terms of social roles, nursing activity was partly carried out voluntarily and in certain frameworks (state, local authorities, local governments, private individuals, associations) for pay- ment, which was a basic condition for it becoming a voca- tion as it provided a living for those practising the vocation.
In addition to all this, professional skills, conscientiousness, shaping of ethical norms had an influence on the autonomy of nursing, and its achieved prestige. (Kozon et al, 2010; Seidl, 1999).
Main international highlights of nursing
Although major stages in the development of the nursing vo- cational group (obstetrics, nursing, care) can be seen in early historical periods, the most significant happenings which influenced the fundamentals of the modern profession can be traced back to the Modern Age. Healing existed in earlier times and accompanying nursing could be observed as well, but it was never discussed separately. Thus, in our review of the vocational group, this will be regarded as the starting point.
In the Middle Ages religion and medicine were closely re- lated, that is why it can be understood that the first hospitals were organized around churches. Many times patients also prayed for healing at the holy places, they were accompanied by their relatives who frequently carried out actual nursing tasks for the sick. However, by this time there were already a lot of practical observations and medicinal knowledge avail- able for healers about diseases and injuries. Provisions for the poor and the sick were organized around hospitals in Europe, which, through this, marked a social group having special needs as well.
The persons who worked in Christian hospitals organized around churches were called deaconesses, who many times were unmarried ladies or widows. Serving the community was their main job.. In times of war, tending to casualties fell upon people living near to the battlefields, though soldiers were taught to be able to dress a wound themselves during their military training in most armies. However, care was su- perficial in many cases, and limited by lack of hygiene.. Lack of application of professional rules served as basis for the out- break of many epidemics .
Philanthropic love was the main tenet of religious orders, which was followed by monks and through their work they fulfilled a useful role in caring for the needy. Their appearence also expressed their role fulfilled in society. Both female (e.g.
Saint Elizabeth, Saint Catherine, Grey Sisters, Black Sisters) and male (e.g. Saint Anthony, Saint John) religious orders carried out caring and nursing tasks with the sick. This separation was also important because sick people could only be cared for by a carer of the same gender. In spite of this, there were hospi-
1. A Historical Overview of Nursing
by
