Knowledge Profile About the Care of Spinal Cord Injury Patients Among Their Caretakers at BPKIHS Mehta RS*1, Shrestha B*2 , Khanal GP*3, Rijal D*4 B.P. Koirala Institute of Health Sciences, Dharan, NepalAbstract: According to the National Spinal Cord Injury Association, as manyas 450,000 people in the United States are living with a spinal cord injury (SCI).Other organizations conservatively estimate this figure to be about 250,000.Every year, an estimated 11,000 SCIs occur in the United States. Most of theseare caused by trauma to the vertebral column, thereby affecting the spinalcords ability to send and receive messages from the brain to the bodys systemsthat control sensory, motor and autonomic function below the level of injury.It is chronic disease condition which requires a lot of care duringhospitalization as well as in the home. Special training to care the activities ofdaily living is vital. Keeping these issues in mind the investigator has plannedto assess the training need of the SCI caretakers so that educational packagecan be planned and implemented in ward for better patient care.It was a hospital based descriptive analytical study conducted among the SCIpatients and their caretakers admitted in orthopedic ward. Using purposivesampling technique 30 subjects were selected from 1st July 2006 to 31stDecember 2006. Using prepared semi-structured questionnaire data wascollected.It was found that the most of the subjects were between age 20-60 years, male,married, middle economic group and from villages. Majority of cases admittedin first time (83%) having cervical and thoracic spine injury. The main reasonsare fall injury. Most of the subjects have the ability to care manage theproblems of bed sore, Paralysis, Nutrition where as very less no of care takershave knowledge about management of UTI, constipation, Pneumonia, andtraction.This study concluded that the continuous in-service education programme oncare of SCI patient to their caretakers is very essential for quality patient care.Key Words: Knowledge Profile, Spinal Cord Injury, CaretakersNote: *1 Ram Sharan Mehta, Asst. Professor, Medical-Surgical Nursing Department, *2 Dr. Bikram Shrestha, Associate Professor, Department of Orthopedics, *2 Dr. Guru Prasad Knanal, Asst. Professor, Department of Orthopedics, *3 Mrs. Dewa Rijal, Nursing Officer, orthopedic WardCorresponding Author: RS Mehta, Email: email@example.com
Introduction: Mobility is the most prized human capability. It denotesindependence. Impaired mobility due to trauma not only leaves theperson dependent on others for the activities of daily living but alsohinders body’s normal physiological functions apart from draining theperson psychologically.The human spine is more frequently exposed to the traumatic influencesthan one would expect. Traumatic injuries are becoming major publichealth problems, with ever increasing prevalence, imposing a greatburden on society than other disease.1Spinal Injuries are known to occur since time immemorial. Populationgrowth and rapid industrialization leading to increased vehicular traffic,growing social tension leading to increase violence and modern daystress of daily living have greatly increased the number and rate of spinalinjuries and the associated mortality and morbidity.2Spinal injuries occur when excessive forces are exerted on the spinalcolumn. These forces are the result of acceleration deceleration eventswhich result in hyperflexon, hyperextension, deformation, axial loadingand excessive rotation of spine.3,4,5Injuries remain the leading cause of death each year, under 45 years ofage, claiming more than 1,42,000 lives and causing 62 million people toseek medical help in America. Of course, spinal cord injuries are one ofthe leading causes of young deaths.6The Incidence of spinal injuries in industrialized countries isapproximately 3 per 1 lac population. Approximately 10,000-12,000cases of SCI occur every year in U.S.A.6,7The treatment of such injury begins at the outset and ideally thesepatients should be transferred to specialized centers geared up tomanage spinal trauma. Morbidity (further injury to the spinal cord,pressure sores, pneumonia and urinary tract infections) will be reducedand so will the mortality and thus in the long term there will be moneysaved which would normally be used to treat complications related toinadequate initial care. 8The incidence of SCI is highest among persons age 16-30, in whom 53.1percent of injuries occur; more injuries occur in this age group than inall other age groups combined. Males represent 81.2 percent of allreported SCIs and 89.8 percent of all sports-related SCIs. Among bothgenders, auto accidents, falls and gunshots are the three leading causesof SCI, in that order. Among males, diving accidents ranked fourth,followed by motorcycle accidents. Among females, medical/surgical
complications ranked fourth, followed by diving accidents. Autoaccidents are the leading cause of SCI in the United States for people age65 and younger, while falls are the leading cause of SCI for people 65and older. Sports and recreation-related SCI injuries primarily affectpeople under age 29.Persons with neurologically complete tetraplegia are at high risk forsecondary medical complications. The percentages of complications forindividuals with neurologically complete tetraplegia have been reportedas follows: 60.3 percent developed pneumonia , 52.8 percent developedpressure ulcers , 16.4 percent developed deep vein thrombosis , 5.2percent developed a pulmonary embolism and 2.2 percent developed apostoperative wound infectionYoung males of age group 15-34 years form the majority of spinal injurypatients. Therefore these injuries place a great burden on society byclaiming the young lives and increasing permanent disabilities amongthe youth. 8Most common areas of spinal injury are mid to low cervical and thoracic-lumbar junction, as they are the areas of maximum mobility. Thoracic,lumbar and sacral points are other commonly involved areas of spine.Cervical injuries are the most devastating kind of spinal injuriesconstituting maximum morbidity and mortality among these injuries. 3B.P. Koirala Institute of health sciences is a center of excellence in theeastern region of Nepal for orthopedic services. Under the orthopedicdepartment spinal cord injury patients are admitted and treated. Theincidence of admitted SCI patients in orthopedic ward is very high. About10-15 patients every day out of 34 patents of orthopedic are SCI patients.SCI patients need special attention, treatment and care. As problem isvery life threatening and chronic in nature patient admitted in orthopedicwards for more than 4-6 weeks. The prognosis of SCI patients dependsupon the services and nursing care provided to them. Usually SCIpatients treated with bed rest traction, surgery, and conservativemanagement, which require a lot of knowledge and skill to take proper,care, especially caretakers, as the number of nurses are limited.Title of the study: Knowledge Profile about the Care of Spinal CordInjury Patients among their Caretakers at BPKIHSObjectives: The Objectives of this study is to find out the socio-demographic profile of the SCI patients, examine the various facts aboutSCI patients and explore the knowledge regarding care of SCI patientsamong their care takers.
Methodology: It is hospital based descriptive analytical study,conducted among the SCI patients admitted in Orthopedic unit ofBPKIHS and their main caretaker during the period of 1st July 2006to31st December 2006 i.e. 6 Months. Using purposive sampling techniqueall the diagnosed SCI clients admitted in orthopedic ward during thestudy period was included in the study. Using self-prepared pre-testedinterview scheduled the data was collected from the SCI patients andtheir caretaker, who most of the time involved in the care after three daysof admission in ward by a trained nurses working in orthopedic unit afterobtaining informed verbal consent. The collected data was entered inSPSS-10 software package and analyzed.Results:Socio-demographic Profile of the SCI patients: Majority of the SCIpatients (76.7%) were of age group 20-60 years. The mean age was 41.5yrs, SD 14.926 and range 16-68 years. Majority of the subjects wereMale (73.3%), Hindu (90%), Villagers (76.7%), married (83.3%), Non-vegetarian (73.3%), middle class family (60%), and heavy physicalworkers.The details about demographic profiles are depicted in table – I.Details about injury and admission: Majority of the patients areadmitted in first time (83.3%), most of the injury occur between 6am to12MD, i.e. 54.4%, most of the Patients (69.7%) were admitted within 12hours after injury. Fall Injury (73.3%) is the main cause of SCI amongthe admitted clients.The details about the injury are mentioned in table – II.Opinion Regarding Knowledge profile about the care of SCI amongthe caretakers:Most of the caretakers reported that they have knowledge about the basicstructure so spinal cord ( 62.1%), functions of spinal cored (57.1%),reasons for paralysis (53.6%), common complications of SCI(59.31%),and None of the caretakers mentioned proper method of turningthe spinal cord injury patients.The details are described in table- III.Opinion Regarding the Ability of caretakers to care/manage theproblems of SCI patients: It was found that the care takers are capableto manage the problems like: Bed sore (83.3%), care of paralysis parts(79.3%), Nutrition/diet (86.7%), but not at all able to manage theproblems like: urinary tract infection(43.3%), constipation(43.3%),incontinence bowel (43.3%), pneumonia(40%) and care of traction (40%).The details are mentioned in table IV.
Discussion: It was found that most of the patients are of age group 20-60 yearsi.e. of productive age group and most of the time they are involved in work. Male(73.3%) subjects have more chance of SCI as they are involved in heavy andrisky physical works. Most of the subjects are villagers (76.7%), illiterate (40%),or literate/primary education (36.7%) , from middle class (60%) family andheavy physical workers(56.7%). This picture clearly explains that the spinalcord injury is common among the heavy physical workers of middle class familymay be due to nature of work.Most of the subjects are admitted for first time (83.3%). The most of the injury(54.4%), occurs between 6am-12MD, because this is peak working hours forvillagers. Most of the subjects (67.9%), admitted in hospital within 12 hours asBPKIHS is a only center of orthopedic patients of SCI in eastern Nepal and highawareness among the public.About half of the caretakers have basic knowledge abut structure, functions,causes of paralysis and complications of SCI, which may be due to learning inhospital as the interview is collected only after 3 day. The mean duration of staywas 23.366 days, SD14.4114, and range 3 to 48 Days.Regarding the care of their patients most of the caretakers reported that theyare capable to care of bed sore, paralyzed parts, and Nutrition as relatives areinvolved in these care inward by the sisters, where inadequate knowledge onmanagement of urinary tract infection, constipation, incontinence, pneumoniaand traction, as these complications require advanced knowledge and nursesthemselves mostly provide the care during hospitalization.Conclusions: Skin Breakdown, pneumonia , Osteoporosis and Fractures,Heterotopic Ossification, Spasticity, Urinary Tract Infections, AutonomicDysreflexia, Deep Vein Thrombosis, Pulmonary Embolism, OrthostaticHypotension, Cardiovascular Disease, Syringomyelia, Neuropathic / SpinalCord Pain, Medication Problems, Hyperthermia and Hypothermia are the areasof care for SCI patients. Continuous in-service education programme fornurses involved in the care of SCI patients and all caretakers of SCI is veryessential.References. 1. Junghanns HS. The human spine in health and disease. New York: Grune and Stratton, 1971. 2. Glass CA, Krishman KR, Bingley JD. Spinal Injury Rehabilitation: Do staff and patients agree on what they are talking about. Paraplegia.1999; 29(5): 343-9. 3. Black JM, Jacobs EM. Medical surgical Nursing – Clinical Management for continuity of care. Philadelphia: Saunders, 1997. 4. Errico TJ, Bauer RD, Waugh T. spinal Trauma. Philadelphia. JB Lipppincott comp. 1991. 5. Post MW, Bloemn J, Wittee LP. Burden for Partners of Person’s with spinal cord injuries. Spinal cord. 2005; 43(5): 311-9. 6. Eyester EF, Kelker DB, Porter Rw, The national had and SCI prevention program Neurosurgry. New York: Mc. Graw Hill Pub, 1996. 7. Devivo MJ. Causes and costs of spinal cord injury in US. In Gibbbs SR. Bradly WG ed. Yearbook of Neurology and Neurosurgery. St. Louis: Mosby Inc, 1999. 8. Yashon D. spinal Injury. Norwalk: Appleton Century Crofts, 1986.
Table – I Socio-demographic Profile of the Spinal Cord Injury Patients N= 30 SN Item/Particular Percentage1 Age ( In years) < 20 10.0 20-40 33.3 40-60 43.4 >60 13.3 Mean 41.5 SD 14.9268 Range 16-682 Sex Male 73.3 Female 26.73 Religion Hindu 90 Buddhist 6.7 Kirat 3.34 Ethnic Group Brahmin/Chhetri 33.3 Mangolian 40 Newar 3.3 Tetai Origin 20 Others 3.45 Occupation Agriculture 46.7 Business 10 Service/Job 10 Others 33.36 Education Level Illiterate 40 Literate/Primary 36.7 Secondary 20 Higher secondary and above 3.37 District ( Permanent address): Basantpu 6.7 Bhojpur 6.7 Dhankuta 16.7 Janakpur 3.3 Jhapa 3.3 Kathmand 3.3 Mahendra 3.3 Morang 6.7 Sankhuwa 3.3 Sirha 10.0 Sunsari 20.0 Tanhu 3.3 Terathum 6.7 Udayapur 6.7
Table – I ( Continue) Socio-demographic Profile of the Spinal Cord Injury Patients N= 30 SN Item/Particular Percentage8 Residence Village(VDC) 76.7 Municipality ( NP) 23.39 Marital Status Married 83.3 Unmarried 16.710 Dietary Habit Vegetarian 20 Non-Vegetarian 73.3 Egg-Vegetarian 6.711 Yearly Saving Deficit Budget/Loan 10 No Saving/balanced 60 < 5000 10 5000-25000 20 > 25000 0012 Economic Status Poor 40 Medium 60 High 0013 Life style Heavy physical worker( farmer/labor) 56.7 Office worker 10 Sedentary life style 20 Others 13.314 Obesity Present 00 Not Present 100 Table – II Details about Nature Spinal Cord Injury N=30 SN Item/Particular Percentage1 Frequency of Admission st 1 time 83.3 nd 2 time 13.3 > 2 times 3.32 Duration of Diseases: till the day of admission 3 days 21.7 3-7 days 47.9 7-14 days 13 > 14 days 17.43 Time of Injury 6 AM-12 MD 54.4 12 MD-6 PM 35.6 6 PM-12 MN 6.7 12 MN-6 AM 3.3
Table – II (continue) Details about Nature Spinal Cord Injury N=30 SN Item/Particular Percentage4 Interval between injury and admission < 6 hrs 39.3 6-12 hrs 28.6 12-24 hrs 7.1 24-48 hrs 2.6 >48 hrs 21.45 Level of Injury Cranio-Vertebral Junction 0 Cervical 44 Cervico-thoracic 4 Thoracic 36 Thoraco-Lumber 4 Lumber 12 Lumbo-Sacral 0 Sacral 06 Causes of Injury Road Traffic Accident 13.3 Fall Injury 73.3 Gun Shot/Stab Injury 0 Work related Injuries 13.3 Sport Injuries 07 Mode of Immobilization applied Skeleton / Skull traction 42.9 Cervical color 9.5 Others: Skin traction, Conservative management etc. 47.6 Table – III Knowledge Profile about Care of Spinal Cord Injury among the Caretakers` N=30 SN Item/Particular Percentage 1 Have Knowledge about Structure of Spinal Cord 62.1 2 Have Knowledge about functions of Spinal Cord 57.1 3 Have Knowledge about Occurrence of Paralysis 53.6 4 Have Knowledge about Complications of SCI 59.3 5 Have Knowledge about Turning of the SCI Patients 0 Table – IV Ability to Care/Manage the Problems of Spinal Cord Injury Patients N=30 Capability/ Ability to manage Problems SN Problems Fully Some Extent Not at all 1 Bedsore 40 43.3 16.7 2 UTI 13.3 43.3 43.3 3 Paralysis 17.2 62.1 20.7 4 Nutrition 53.3 33.3 13.3 5 Pain 30 46.7 23.3 6 Constipation 26.7 30 43.3 7 Incontinent of bowel 20 36.7 43.3 8 Pneumonia 13.3 46.7 40 9 Care of traction 30 30 40