Lesiones por presión en la lesión medular: actualización del conocimiento / Pressure injuries in spinal cord injury: knowledge update

El presente artículo tiene como objetivo ofrecer una actualización clínica y bibliográfica del conocimiento enfermero sobre las lesiones por presión en el ámbito de la lesión medular destacando los aspectos específicos y concretos inherentes a la lesión medular. Se desarrolla para ello un exhaustivo análisis del riesgo exponiendo los principales factores sociodemográficos, clínicos asociados a la patología medular, conductuales y sociosanitarios, así como el efecto del daño neurológico sobre la piel y tejidos, escalas, y características de las lesiones por presión en esta población: localización, severidad y recurrencia. Asimismo, se describen las principales estrategias de prevención a lo largo de todo el proceso de cuidado, en el paciente encamado y el paciente en sedestación en silla de ruedas. Se muestran las principales líneas de tratamiento recomendadas desde la evidencia y diferenciadoras de otras poblaciones susceptibles de riesgo. Finalmente se describen intervenciones de educación para la salud desde una perspectiva interdisciplinar y global, así como los retos futuros a los que hacer frente en las unidades especializadas en la lesión medular. (AU)

The objective of this article is to offer a clinical and bibliographic update of nursing knowledge about pressure injuries in the field of spinal cord injury, highlighting the specific and concrete aspects inherent to spinal cord injury. An exhaustive risk analysis is developed for this, exposing the main sociodemographic, clinical factors associated with spinal injury, behavioral and socio-sanitary factors, as well as the effect of neurological damage on the skin and tissues, scales, and characteristics of pressure injuries in this population: location, severity and recurrence. Likewise, the main prevention strategies are described throughout the entire care process, in the bedridden patient and the patient sitting in a wheelchair. The main lines of treatment recommended from the evidence and differentiating it from other populations susceptible to risk are shown. Finally, health education interventions are described from an interdisciplinary and global perspective, as well as the future challenges to be faced in units specialized in spinal cord injury. (AU)

Impact of simulation-based learning on family caregivers during the rehabilitation period of individuals with spinal cord injury.

STUDY DESIGN: Mixed-methods study. OBJECTIVE: Evaluate the knowledge that family caregivers of individuals with spinal cord injuries acquired through the use of a high-fidelity simulation-based learning (SBL) program. SETTING: The study was comprised of three phases: a previous qualitative research study detecting training needs, one in which clinical simulation scenarios were designed, and a final quasi-experimental phase in which ten caregivers of individuals with spinal cord injuries were trained in their care using simulations at the Toledo National Hospital for Paraplegics (Spain). METHODS: The competences acquired by the family were evaluated before and after the simulation training. A researcher-validated tool for each scenario was utilized for this evaluation. RESULTS: Four learning scenarios were designed based on the needs identified through the caregiver interviews. Following the training of the caregivers with SBL, an increase in their knowledge and skills was identified. For all the scenarios, the caregivers obtained a higher average score on the post test than on the pre test, and these differences were significant (p < 0.001). CONCLUSIONS: Simulation training is a useful and efficient learning tool for caregivers of individuals with a spinal cord injury.

Relatives of people with spinal cord injury: a qualitative study of caregivers' metamorphosis.

STUDY DESIGN: Qualitative study. OBJECTIVE: To detect the major challenges and needs reported by family member caregivers of people with spinal cord injury (SCI). SETTING: Family member caregivers of people with SCI and expert professionals were evaluated. This study was conducted in Spain, and most of the participants attended the National Paraplegics Hospital of Toledo. METHODS: We performed 25 semi-structured interviews. The data were analyzed from a phenomenological perspective using the Colaizzi method. RESULTS: The metamorphosis of the caregiver is a complex personal and family-related process. Analysis of the adjustment phase of the caregiving role allowed us to describe three stages, patterns, and trends. Five basic needs were identified. CONCLUSIONS: People with SCI and their primary caregivers experienced changes in every sphere of their lives. Their most important needs were psychological support, social support, economic resources, information, training throughout the process of suffering, and the creation of informal groups of mutual aid.