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Role of a Nurse in SCI Rehabilitation

Roopa Rawat SinghviM.Sc Nursing (UK)

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Some eye popping facts

Indian data• SCI cases 20,000/year• Total no. of pts. 3,00,000• Total rehabilitation centre

28• Total no. of bed 858

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1. Current process of care of individual with disabling conditions is both ineffective and inefficient.

2. There is critical need of clinician to understand the need of rehabilitation.

3. Rehabilitation is a philosophy of practice and an attitude toward caring for people with disabilities and chronic health problems (Larsen, 2011).

Introduction of Topic

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“Presently Rehabilitation is the grey area in the care of patients with disabilities. Lack of knowledge & its need from patient’s perspective is made this problem further bigger”

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World War I & II(Need is the mother of necessity)

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Aim of Rehabilitation

• Relearning of former skills.• Assist the individual with adjusting to an altered lifestyle• Maximize the quality of life of the individual• Address the individual’s specific needs• Be directed toward promoting wellness and minimizing

complications• Assist the individual in attaining the highest degree of function and

self-sufficiency possible• Assist the individual to return to home and community

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Rehabilitation

Re learn

Re live

Re adjust

Re joice

Re grow

Re invent

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Rehabilitation

Rehabilitation of people with disabilities is a process aimed at enabling them to reach and maintain their optimal physical, sensory, intellectual, psychological and social functional levels.

The process of restoring the individual to the fullest physical, mental, social, vocational, and economic capacity of which he or she is capable.

OR

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Psychological

Vocational

Social

Recreational

Spiritual

Needs of

Pts.

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Issues related to Rehabilitation• Rehabilitation focuses on continually improving the

quality of the person’s life, not merely maintaining life itself.

Quality of Life versus Quantity of Life

• Many conditions are irreversible; therefore, the focus of care is related to adaptation and acceptance of an altered life rather than to resolving an illness.

Care versus Cure

• Rehabilitation is expensive. Success is sometimes seen as a return to productive employment; may be if the individual becomes sufficiently independent that no caregiver is required.

High Cost of Interdisciplinary Care

versus Long-term Care

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Rehabilitation Nurse

A rehabilitation nurse has specialized training in rehabilitative and restorative principles, works collaboratively with the entire rehabilitation team, and takes a holistic approach to meeting a patient’s functional, emotional, medical, vocational, educational, environmental, and spiritual needs.

The nurse assists patients with SCI to adapt to an altered lifestyle, designs and implements treatment strategies based on scientific nursing theory and evidence based practice related to self care, and promotes physical, psychosocial and spiritual health.

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Rehabilitation Team

SCI consultantNursePhysiotherapistOccupational therapistOrthoticsPsychologistPeer counselorSocial workerVocational counselorPatient & family

Rehabilitation starts at the time

of admission

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Role & responsibility RN

Care giver

Counsellor

Advocate

Coordinator

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Qualities of Rehabilitation nurse

Patience, understand the pt. psychology

Good Listener & counsellor

Well oriented, good IPR & good team player

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5 stages

1. Denial & isolation2. Anger3. Bargaining4. Depression5. Acceptance

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Component of Rehabilitation

Psychological

Physiotherapy

Occupational Therapy

Sexuality & Fertility

Assistive Technology

OrthoticsVocational/Avocational

Nutrition

Social

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Rehabilitation plan includeHelping to understand injuriesEnable or modify self care (ADLs) eg. Grooming, eating etc.Prepare them to ask for help in self care.

Assist in mobility eg. Wheel chair use.

Assist in accepting a new lifestyle, especially pertaining to sexual, recreational, and housing options.

Preparing them for vocational & avocational rehabilitation.Readjust in their social life.

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1. Psychological need

Intervention:• To make him understand the injury &

disabilities. • Help him to accept the new image of body.• Motivation & role model • Monitor frustration & toleration level

Nursing Diagnosis: depression or stages of grief

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2. Physical Needs

Intervention:• Assess & assist ADLs• Foster self care ability by positive reinforcement• Focus on gross movement first than finer movement• Assist in self care dependency.• Recommend assistive devices

Nursing Diagnosis: self care deficit

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ADL’s Assistive devices

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3. Prevent complications

Intervention: • Prevent complication since beginning• Maintain skin integrity• Bladder & bowel management & training• Early Mobilisation• Health Education to pt. & family

Nursing Diagnosis: Pressure ulcers, OH, AD etc

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3. Nursing Management

Intervention: • Prevent complication such as Contractures, foot

drop, DVT.• Assess patient’s ability to move, muscle strength,

tone & movement.• Proper positioning to prevent contracture

Identification of the problem : early mobilisation

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Nursing Responsibility

• Maintain muscle strength & joint mobility• Perform active, passive & assistive ROME• Move joint 3 times a day• Prepare pt. for ambulation eg. Crutch walking• Promote independent mobility

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Vocational Need

Intervention: • Returning the SCI person to earn his livelihood

acc. to his ability as before.• Modify the job profile & work area• Flexible hours• Gradually start work

Nursing Diagnosis: Financial independency

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Occupational Therapist Who give vocational training

• Peer counsellor eg. Yoga or exercise trainer• Sitting jobs like clerical• Teaching• Any job which requires less physical

movement & more brain work.

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Avocational Need

• Intervention:• Don’t overlook the need of recreational activities as

this is the important part of healthy & happy life.• Practice the outdoor games• Change or modify the hobbies acc. to present

condition eg. Gardening, cooking

Nursing Diagnosis: restart recreational activity

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Spiritual need

Intervention: • Arrangement of prayer room with accessible

for wheelchair entry.• Privacy• Regular religious preaching sessions

Nursing Diagnosis: Identify the spiritual needs

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4. Social needs

Intervention: • Help the pt. to enter into previous life with

new capabilities & adjust.• Respect the limitations• Ask for help & conserve energy• Family & pt. counselling

Nursing Diagnosis: reintroduce into life

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• Home modification

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Follow up care/ community care

Intervention: • Trained HPs should extend their care in the

community.• Video conferencing or telemedicine• Detail Health education to pt. family & prepare

them for emergency management.• Emphasize on follow up visits.

Nursing Diagnosis: Lack of community care

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Sexual needs

Intervention: • Counselling to pt., partner & family• Sexual desire of the pt. is same as before.• Fertility is not directly affected due to injury

(mostly).

Nursing Diagnosis: Sexual needs & fertility

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Health Education

Intervention:• Prevention of complications eg. Pressure ulcer,

OH, AD, Spasticity.• Early detection of s/s• Initial management • Compliance of the treatment & follow care.

Nursing Diagnosis: Intense need of health education

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Need of acceptance

Intervention:• Patient & family have to accept & understand

the change in the role of person• Welcome the role reversal or exchange.• Partner should be cooperative to help the pt.• Avoid guilt & grief.

Nursing Diagnosis: Feeling of Isolation or burden on the family

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Personal & family counselling

• Tell them the importance of pt. in his family• Counsel partner & family about this issue &

give them importance as before.• Respect the pt. wish to socialising or not• Motivate to be social either to earlier

friends or new made in hospital

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Nutrition

Overview:• 11-38 acute pt. undernutrition• 2 over nutrition/ obese• Over wt. obesity & abdominal obesity

prevalent among SCI pts.

Nursing Diagnosis: under or over nutrition

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Nursing Intervention

• S/E of undernutrition: PU, delay healing, osteoporosis

• Over nutrition: obesity, metabolic syndromeNsg. Intervention:• Diet counselling• Maintain intake output diary• Measure intake of calorie.

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Conclusion• Injury to spinal cord doesn’t mean end of life.• Life can be still same after the injury but accept the changes• Rehabilitation play vital role to readjust in the previous life• SCI is not merely change the life of the pt. but family also.

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Thanks