dedicated to nurses caring patients with SCI

1. Role of a Nurse in SCI
Rehabilitation
Roopa Rawat Singhvi
M.Sc Nursing (UK)
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2. 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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3. 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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4. “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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5. World War I & II
(Need is the mother of necessity)
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6. 28-09-2015 6

7. 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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8. Rehabilitation
Re learn
Re live
Re adjust
Re joice
Re grow
Re invent
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9. 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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10. Physical
Psychological
Vocational
Social
Recreational
Spiritual
Needs
of
Pts.
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11. 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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12. 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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13. Rehabilitation Team
SCI consultant
Nurse
Physiotherapist
Occupational therapist
Orthotics
Psychologist
Peer counselor
Social worker
Vocational counselor
Patient & family
Rehabilitation
starts at the time
of admission
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14. Role & responsibility
RN
Care
giver
Counsellor
Advocate
Coordinator
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15. Qualities of Rehabilitation nurse
Patience, understand the pt.
psychology
Good Listener & counsellor
Well oriented, good IPR & good
team player
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16. 5 stages
1. Denial & isolation
2. Anger
3. Bargaining
4. Depression
5. Acceptance
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17. Component of Rehabilitation
Psychological
Physiotherapy
Occupational
Therapy
Sexuality &
Fertility
Assistive
Technology
Orthotics
Vocational/
Avocational
Nutrition
Social
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18. Rehabilitation plan include
Helping to understand injuries
Enable 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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19. 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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20. 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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21. ADL’s Assistive devices
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22. 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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23. 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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24. 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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25. 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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26. Occupational
TherapistWho 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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27. 28-09-2015 27

28. 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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30. 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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31. 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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32. • Home modification
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33. 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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34. 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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35. 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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36. 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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37. 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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38. 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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39. Nursing Intervention
• S/E of undernutrition: PU, delay healing,
osteoporosis
• Over nutrition: obesity, metabolic syndrome
Nsg. Intervention:
• Diet counselling
• Maintain intake output diary
• Measure intake of calorie.
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40. 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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41. Thanks
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