Nursing staff facilitate patient participation by championing the patient's perspective: An action research study in spinal cord injury rehabilitation

INTRODUCTION

Persons with spinal cord injury have experienced a life-changing event, and they need to engage in the rehabilitation process to adjust to their current situation and future living conditions. Due to the highly contextual and varying psychological and physical ability to participate from patient to patient during rehabilitation, this is difficult for the injured person and for health professionals to support. Therefore, the aim of the study was to develop and facilitate patient participation by engaging nursing staff and from this engagement in the process, disclose methods to support participation.

METHODS

The processes conducted were based on an action research approach, from problem identification to the development, test and evaluation of four new nursing initiatives. The initiatives were developed by eight nursing staff members who participated actively as co-researchers in a 2-year study conducted at a Spinal Cord Injury Centre in Denmark from 2016 to 2018. Data evolved from workshops, transcriptions of meetings and written evaluations and was further analysed using Ricoeur's phenomenological-hermeneutic approach.

RESULTS

Action research processes facilitated the development of four communicative initiatives and a shift in the nursing staff's support of the patient. In a collaborative process, the nursing staff acted as participants in the patient's rehabilitation. Awareness of the patient's perspective facilitated a caring, attentive and engaged approach from the nursing staff, which promoted rehabilitation tailored to the individual.

CONCLUSION

Patient participation was enhanced when nursing staff actively participated in the development of initiatives and a culture supporting a person-to-person approach involving the patient and themselves as equal participants in the collaborative rehabilitation process.

PATIENT OR PUBLIC CONTRIBUTION

Eight nursing staff members from the rehabilitation centre participated throughout the study as co-researchers. Patients participated in observations and as informants in interviews during the first phase to identify challenges to patient participation. Patients also participated in testing the nursing initiatives during the action phase (Phase 3). Furthermore, a former patient was a member of the advisory board.

Action research as a catalyst for change: Empowered nurses facilitating patient participation in rehabilitation

Based on action research as a practitioner-involving approach, this article communicates the findings of a two-year study on implementing patient participation as an empowering learning process for both patients and rehabilitation nurses. At a rehabilitation facility for patients who have sustained spinal cord injuries, eight nurses were engaged throughout the process aiming at improving patient participation. The current practice was explored to understand possibilities and obstacles to patient participation. Observations, interviews and logbooks, creative workshops and reflective meetings led to the development and testing of four new rehabilitation initiatives aimed at enhancing patient participation. This study suggests that skills of critical reflection from action research toolbox shed light on both the notion of patient participation and caring in nursing rehabilitation. By actively involving nurses in research, the knowledge development stems from practice and the solutions therefore became practice-oriented. In addition, the personal and professional development experienced by the involved nurses points to a secondary gain in the form of an analytical and reflective approach to complex issues in relation to patient participation, rehabilitation in general and the individual nurses' sense of professional pride.

Exercise intervention alleviates nerve injury by the suppression of inflammatory mediator expression via the TLR4/NF-κB signaling pathway

Spinal cord injury (SCI) may cause changes that have damaging effects on sensation and functionality. However, methods for the significant amelioration of SCI-reduced nerve injury are lacking. Previous studies have indicated that reasonable and effective exercise may promote the recovery of injured nerves. Therefore, the aim of the present study was to investigate the ability of exercise to improve recovery following SCI and the underlying mechanism. A rat model was used to evaluate the effects of two different periods of exercise intervention on recovery following SCI. The exercise intervention comprised 15 or 30 min/day passive walking for 30 days. ELISA measurements were used to analysis the plasma levels of inflammatory cytokines. Reverse transcription-quantitative polymerase chain reaction and western blot analyses were performed to examine the levels of proteins and mRNAs associated with nuclear factor (NF)-κB-related signaling. In addition, histological examination and immunostaining were used to evaluate the neural injury and associated indicators. The results indicated that severe SCI induced a peripheral inflammatory response and increased the expression of inflammatory cytokines. In addition, the SCI-induced nerve injury was associated with increased glial fibrillary acidic protein (GFAP) expression and the upregulation of Toll-like receptor 4 (TLR4)/NF-κB signaling, which may further aggravate the inflammatory responses induced by SCI. However, the exercise intervention decreased SCI-induced GFAP expression and reduced the activation of the TLR4/NF-κB signaling pathway compared with that of SCI model rats that did not exercise. Furthermore, the exercise intervention inhibited the release of inflammatory cytokines into the serum. These results indicate that exercise treatment reduces inflammation and glial activation, and may be beneficial to recovery following SCI.

Health-Related Quality of Life Among Caregivers of Individuals With Spinal Cord Injury

The consequences of spinal cord injury (SCI) not only affect patients' health-related quality of life (HRQoL) but also extend to the entire family. The health condition the injury imposes requires the participation of a family caregiver, who will be responsible for taking care of the individual in a disabling condition. This is an observational, exploratory study using a cross-sectional design that aimed to study the association between HRQoL and gender, age, presence of comorbidities, and characteristics of the care among caregivers of individuals with SCI with the purpose of identifying potential factors that are associated with HRQoL in this population. Participants were 59 caregivers of individuals with traumatic SCI. The data were collected by consulting the patient histories and applying questionnaires. To assess the caregivers' HRQoL, the Short Form-36 was used. For analysis, exploratory and inferential statistics were used. Most of the caregivers of the individuals with SCI were female, with a mean age of 44.8 years. The domains that most contributed to a worse HRQoL were physical aspects, pain, vitality, and emotional aspects. No statistically significant associations were found between HRQoL and the variables gender, hours per day spent on care, and length of activity as caregiver. The associations between HRQoL and self-reported diseases and age were statistically significant. The results support the planning of nursing interventions from the perspective of aspects of the care demands, which can affect the caregiver's HRQoL.

RELEVANCE TO CLINICAL PRACTICE

Interventions to prepare the individuals with SCI and their caregivers are a strategy aimed at improving the HRQoL of both.

The Stanmore Nursing Assessment of Psychological Status: Understanding the emotions of patients with spinal cord injury

CONTEXT

Research has shown that individuals who have sustained a spinal cord injury can experience strong and abrupt variations in their emotional state; however no instrument for nurses has been developed to assess these patients' psychological status.

OBJECTIVE

To develop a brief, reliable instrument to enable nurses to accurately assess, record and respond to spinal cord injury patients' psychological status.

METHODS

In Phase 1, semi-structured interviews were conducted with spinal cord injury patients (n = 10) and nurses (n = 10) which were audio recorded, transcribed and thematically analysed to develop the instrument. The instrument's content validity was then ensured via independent expert review. In Phase 2, the instrument was trialled on 80 spinal cord injury patients to determine inter-rater reliability, internal consistency and test-retest reliability.

RESULTS

In Phase 1, four core themes (emotional impact, coping, relationships and assessment) were identified together with a number of related sub-themes. In Phase 2, the instrument was shown to have excellent inter-rater reliability, acceptable internal consistency and satisfactory test re-test reliability. Subsequently a rating sheet, user manual and prompt card were produced.

CONCLUSION

The new instrument, the Stanmore Nursing Assessment of Psychological Status, was shown to be valid and reliable. It is anticipated that training nurses to use this instrument may help to enhance good emotional care of patients.

Living with a spinal cord injury: a grounded theory approach

AIMS

This paper reports a study which examined patients' experiences of suffering a spinal cord injury.

BACKGROUND

Spinal cord injury has major bio-psycho-social and spiritual implications for patients. However, very limited research exists regarding the experience of patients with spinal cord injury in Taiwan or other countries worldwide.

METHOD

Grounded theory was used to explore the psychosocial implications for patients of spinal cord injury.

DATA COLLECTION AND ANALYSIS

Data were collected from October 2002 - March 2003 through tape-recorded, semi-structured interviews and complete observation of a group discussion focusing on patients with tetraplegia, in a rehabilitation hospital in Taiwan. The number of patients with spinal cord injury interviewed for this study was 15, involving 18 interviews. Data collection and analysis occurred concurrently.

RESULTS

The findings resulted in the core category 'living with a spinal cord injury' and identify the experiences of suffering a spinal cord injury. Three stages were identified as the individual experience, including four categories: stage 1 A catastrophic life event, stage 2 Confront challenges and stage 3 Moving forward or Withdraw from society.

CONCLUSIONS

This study shows that patients suffering a spinal cord injury have to find their own way and learn to live with their disability. Patients who did better in living with spinal cord injury point could move forward, otherwise, they may withdraw from society.

RELEVANCE TO CLINICAL PRACTICE

Health professionals need to recognize patients' experiences, perceptions and needs, to provide better nursing care.

Establishing a super-link system: spinal cord injury rehabilitation nursing

AIM

This paper reports a study to identify the needs of clients with spinal cord injury and their family/carers during rehabilitation, and the strategies used by rehabilitation nurses to meet those needs.

BACKGROUND

In Taiwan, spinal cord injury is a major problem with financial implications for the state and major bio-psycho-social and spiritual implications for the individual. Rehabilitation nurses do not have an appropriate nursing theory to guide their care.

METHODS

Using a grounded theory approach, data were collected from October 2002 to March 2003 in a rehabilitation hospital in Taiwan by means of interviews, participant observations and documentary resources; analysis was an interrelated process. A total of 39 interviews was carried out with 31 individuals, including eight rehabilitation nurses, one nurse supervisor, seven clients with tetraplegia, eight with paraplegia and seven family/carers. There were 18 participant observations. Data were analysed using a multi-step analytic procedure, based on the works of Glaser, Charmaz, and Strauss and Corbin.

FINDINGS

The core category, 'establishing a super-link system', explained the complex structure of interactions observed during the investigation and the importance of developing a middle-range theory entitled the 'Super-Link System Theory'. This theory includes the following four links: 'linking to client', 'linking to family/carer', 'linking to interdisciplinary rehabilitation team' and 'linking to community'.

CONCLUSION

This Super-Link System Theory will help rehabilitation nurses to organize their thinking about spinal cord injury rehabilitation nursing, to transfer their thinking into practice by making links effective, and to promote their professional position in the interdisciplinary rehabilitation team.