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1.
BMC Neurol ; 19(1): 117, 2019 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-31176359

RESUMO

BACKGROUND: Following spinal cord injury (SCI), family members are often called upon to undertake the caregiving role. This change in the nature of the relationship between the individuals with SCI and their families can lead to emotional, psychological, and relationship challenges. There is limited research on how individuals with SCI and their family caregivers adapt to their new lives post-injury, or on which dyadic coping strategies are used to maintain relationships. Thus, the objectives of this study were to obtain an in-depth understanding of 1) the experiences and challenges within a caregiving relationship post-SCI among spouses, as well as parents and adult children; and 2) the coping strategies used by caregivers and care recipients to maintain/rebuild their relationships. METHODS: A qualitative descriptive approach with an exploratory design was used. Semi-structured face-to-face and telephone interviews were conducted. Thematic analysis was used to identify key themes arising from individuals with SCI's (n = 19) and their family caregivers' (n = 15) experiences. RESULTS: Individuals with SCI and family caregivers spoke in-depth and openly about their experiences and challenges post-injury, with two emerging themes (including subsequent sub-themes). The first theme of deterioration of relationship, which reflects the challenges experienced/factors that contributed to disintegration in a relationship post-injury, included: protective behaviours, asymmetrical dependency, loss of sex and intimacy, and difficulty adapting. The second theme of re-building/maintaining the relationship, which reflects the strategies used by dyads to adjust to the changes within the relationship brought upon by the injury, included: interdependence, shifting commonalities, adding creativity into routine, and creating a new normal. CONCLUSIONS: These findings should alert healthcare professionals and peer support groups as to the need for possible education and training (e.g., coping strategies, communication skills training) as well as counseling prior to discharge to assist individuals with SCI and family caregivers with adaptation to a new life post-injury.


Assuntos
Adaptação Psicológica , Cuidadores/psicologia , Relações Familiares/psicologia , Traumatismos da Medula Espinal/enfermagem , Traumatismos da Medula Espinal/reabilitação , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Adulto Jovem
2.
Br J Nurs ; 28(6): 377-381, 2019 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-30925253

RESUMO

BACKGROUND:: approximately 40 000 people in the UK live with spinal cord injury. AIM:: to explore the views of patients and healthcare staff relating to the specialist education and information provided following a spinal cord injury. METHODS:: a service evaluation consisting of questionnaire surveys distributed to patients and staff at the London Spinal Cord Injury Centre. RESULTS:: of the healthcare staff who responded, 98% found giving education an enjoyable part of their role with most agreeing (45/48) that it is the responsibility of all healthcare staff. The formal education programme was valued by patients. Sessions were graded to inform the development of future programmes. Face to face was the preferred delivery method for 80% of inpatients and 40% of outpatients, with the second most preferred method being an app/e-learning for both patient groups. CONCLUSION:: findings support the continued need for both formal and informal sessions, provided by all members of the healthcare team, with particular emphasis on issues such as bladder and bowel management and sexual function following discharge.


Assuntos
Atitude do Pessoal de Saúde , Pacientes Internados , Educação de Pacientes como Assunto , Satisfação do Paciente , Traumatismos da Medula Espinal/enfermagem , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medicina Estatal , Inquéritos e Questionários , Reino Unido
3.
Rev. Esc. Enferm. USP ; 53: e03445, 2019. tab
Artigo em Inglês | LILACS, BDENF - Enfermagem | ID: biblio-1003103

RESUMO

ABSTRACT Objective: To develop a bank of terms of specialized nursing language based on the International Classification for Nursing Practice (ICNP®) for the care of the person with spinal cord injury. Method: Descriptive, quantitative study guided by the guidelines of terminological studies. Terms were extracted from an official document of the Ministry of Health through use of a computer tool, and were standardized and mapped with the ICNP® Version 2015. Results: We identified 446 relevant terms, of which 265 were equal, 68 were similar, 23 were more comprehensive, 66 were more restricted, and 24 were not in concordance with terms of the ICNP®. Terms classified as equal and similar were considered as constant. Thus, the bank of terms consisted of 333 constant terms and 113 not contained in the classification. Terms included in the Focus, Action, Means and Location axes predominated. Conclusion: The bank of terms will contribute to the construction of the ICNP® terminology subset for the care of people with spinal cord injury.


RESUMEN Objetivo: Elaborar un banco de datos de términos del lenguaje, con base en la Clasificación Internacional para la Práctica de Enfermería (CIPE®), para el cuidado a la persona con lesión medular. Método: Investigación descriptiva, de abordaje cuantitativo, orientada por las directrices de estudios terminológicos. Los términos fueron extraídos de documento oficial del Ministerio de la Salud, mediante uso de herramienta computacional, normalizados y mapeados con la CIPE® Versión 2015. Resultados: Se identificaron 446 términos relevantes, siendo 265 iguales, 68 similares, 23 más amplios, 66 más restrictos y 24 sin concordancia con los términos de aquella clasificación. Los términos clasificados como iguales y similares se consideraron constantes. De ese modo, el banco de términos estuvo constituido de 333 términos constantes y 113 no constantes en la clasificación. Predominaron términos clasificados en los ejes Foco, Acción, Medios y Ubicación. Conclusión: El banco de términos contribuirá a la construcción de un subconjunto terminológico CIPE® para el cuidado a personas con lesión medular.


RESUMO Objetivo: Elaborar um banco de termos da linguagem especializada de enfermagem, com base na Classificação Internacional para a Prática de Enfermagem (CIPE®), para o cuidado à pessoa com lesão medular. Método: Pesquisa descritiva, de abordagem quantitativa, orientada pelas diretrizes de estudos terminológicos. Os termos foram extraídos de documento oficial do Ministério da Saúde, mediante uso de ferramenta computacional, normalizados e mapeados com a CIPE® Versão 2015. Resultados: Identificaram-se 446 termos relevantes, sendo 265 iguais, 68 similares, 23 mais abrangentes, 66 mais restritos e 24 sem concordância com os termos daquela classificação. Os termos classificados como iguais e similares foram considerados constantes. Assim, o banco de termos foi constituído por 333 termos constantes e 113 não constantes na classificação. Predominaram termos classificados nos eixos Foco, Ação, Meios e Localização. Conclusão: O banco de termos contribuirá para a construção de um subconjunto terminológico CIPE® para o cuidado de pessoas com lesão medular.


Assuntos
Traumatismos da Medula Espinal/enfermagem , Enfermagem em Reabilitação/classificação , Terminologia Padronizada em Enfermagem
4.
Am J Nurs ; 118(11): 64-69, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30358604

RESUMO

With the support of colleagues and hospital management, the author, an RN with board certification in therapeutic massage and bodywork, developed and implemented the role of the integrative therapy nurse on the spinal cord injury and disorders unit at the Minneapolis Veterans Affairs Medical Center. The goal of this initiative was to provide patients with additional nonpharmacologic options for addressing their symptoms through the creation of an integrative therapy nurse role within the existing interdisciplinary team of physicians, NPs, psychologists, registered dieticians, physical therapists, occupational therapists, speech pathologists, and staff nurses. This article outlines the process of creating this role, discusses implications for practice, and reports the outcomes of three years of its implementation. The outcomes of decreased pain and increased relaxation among the veterans who participated in this initiative warrant its further expansion to additional clinical settings.


Assuntos
Medicina Integrativa/métodos , Massagem/métodos , Papel do Profissional de Enfermagem , Cuidados de Enfermagem/métodos , Equipe de Enfermagem/métodos , Traumatismos da Medula Espinal/enfermagem , Adulto , Feminino , Hospitais de Veteranos , Humanos , Masculino , Pessoa de Meia-Idade , Minnesota
5.
Int J Orthop Trauma Nurs ; 30: 31-38, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29934253

RESUMO

BACKGROUND: Nurses are involved in delivering care for patients following acute traumatic spinal cord injury throughout the entire care journey. An injury of this type is significant for the individual and their family and can be challenging for nurses delivering care for patients with life changing injuries, especially for nurses new to this setting. There is a lack of research that examines the experience of nurses caring for these patients in the acute setting. METHOD: A hermeneutic phenomenological approach was used to understand the experience of nurses caring for patients in the acute setting who had sustained a traumatic spinal injury with associated neurological deficit. Using the phenomenological approach guided by the insight of Gadamer and Max Van Manen, participants with a broad range of experience were recruited and interviewed. The responses were transcribed into a text and subjected to hermeneutic analysis. Burnard's (1991) 14-step process and the hermeneutic approach were used to interpret and understand the phenomenon of interest. CONCLUSION: The study highlights the experience and challenges of providing care to these individuals. Although patients had significant physical disabilities and were often dependent physically, the nurses' concerns were directed more towards fulfilling their psychological needs. Nurses identified grieving patients and felt their role was to provide realistic hope to motivate them. They felt an internal tension regarding desensitisation towards their patients, but this was often an internal protective mechanism to deal with the significance of the events surrounding these patients. Nurses new to this setting took time to learn the routines and manage the unique challenges effectively. Caring for these patients gave the nurses the opportunity to understand their patients and their families, and appreciate that both groups will fluctuate in their behavior throughout the acute process, as they adjust to grief and loss.


Assuntos
Atitude do Pessoal de Saúde , Recursos Humanos de Enfermagem no Hospital , Padrões de Prática em Enfermagem , Traumatismos da Medula Espinal/enfermagem , Humanos , Entrevistas como Assunto
6.
J Wound Ostomy Continence Nurs ; 45(2): 163-167, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29521927

RESUMO

PURPOSE: The purpose of this study was to explore the experience and perceptions of nurses providing bowel care to patients after spinal cord injury. DESIGN: Qualitative study using thematic analysis of semistructured interviews. SUBJECTS AND SETTING: Eleven RNs who provided bowel care to patients following spinal cord injury and were deemed competent to do so by their employer were invited to participate. The study setting was a large, London NHS Trust providing acute hospital care to a population of around 1 million people. METHODS: Semistructured interviews were digitally audio-recorded and transcribed verbatim. Analysis of data was undertaken using Braun and Clark's 6 stages of thematic analysis. RESULTS: Four main themes emerged: (1) unpleasantness of task; (2) perceived patient experience; (3) motivation and avoidance; and (4) barriers to care. There was stoic acceptance of the unpleasant nature of bowel care for the nurse, but unpleasantness for patients was not as readily acknowledged. Perceived patient experience ranged from descriptions of positive aspects of comfort and continence to negative aspects of embarrassment and discomfort. Nurses were motivated by the medical need for bowel care but often saw it as low priority due to the unpleasant nature and displayed avoidance tactics. The barriers concerned inadequate training, the taboo nature of bowel care, and potential sexual interpretations of care. CONCLUSION: Nurses described bowel care as unpleasant but accepted its physiologic need and importance. The standardization of bowel care training and increasing the numbers of nurses trained in bowel care may decrease stigma surrounding provision of care. Study findings suggest that male nurses' experience may differ from female nurses' experience, but this result requires further investigation.


Assuntos
Intestino Neurogênico/complicações , Enfermeiras e Enfermeiros/psicologia , Percepção , Adulto , Atitude do Pessoal de Saúde , Feminino , Humanos , Londres , Masculino , Intestino Neurogênico/enfermagem , Pesquisa Qualitativa , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/enfermagem , Medicina Estatal/organização & administração
7.
Rio de Janeiro; s.n; fev. 2018. 314 f p. tab.
Tese em Português | LILACS, BDENF - Enfermagem | ID: biblio-908725

RESUMO

O objeto centra-se na construção compartilhada junto à pessoa com lesão medular e seus cuidadores de um aplicativo como material educativo cuidadores sobre prevenção e tratamento das lesões por pressão e sua validação. O objetivo geral compreende em desenvolver uma tecnologia de informação junto a pessoa com lesão medular e seus cuidadores por meio de um aplicativo como material educativo voltado a prevenção e tratamento das lesões por pressão. Os objetivos específicos consistem em construir e validar um aplicativo como material educativo com orientações para pessoas com lesão medular e seus cuidadores sobre as medidas preventivas e tratamento das lesões por pressão. Aplicaram-se os conceitos de Freire e Orem sobre a valorização e conhecimento da realidade do indivíduo e a horizontalidade do diálogo para identificação da demanda terapêutica de cada um, além da aplicabilidade dos requisitos de autocuidado no desvio à saúde. Pesquisa qualitativa de abordagem convergenteassistencial na elaboração do aplicativo. Depois de sua construção, foi utilizada a Técnica Delphi para validação e após, foi realizada a avaliação junto aos participantes do estudo. Foram entrevistadas 19 pessoas com lesão medular, sendo 02 tetraplégicas e 11 paraplégicas, bem como 06 cuidadores, captadas pela Técnica Bola de Neve. O cenário escolhido para a realização desta pesquisa foram os domicílios de pessoas cadastradas nas Estratégias de Saúde da Família da cidade de Macaé, Rio de Janeiro. As fases de desenvolvimento da pesquisa consistiram em entrevistas individuais com problematização dos cuidados concernentes à prevenção e tratamento das lesões por pressão bem como elaboração de um processo de cuidado voltado às suas reais necessidades. De acordo com as informações, foi elaborado o aplicativo. Após, seguiuse para o processo de validação e avaliação. Ao corpus de dados aplicou-se a análise temática de conteúdo. Identificou-se questões que interferem diretamente no cuidado como a necessidade da Rede de Cuidados à pessoa com Deficiência, essencial em todo este processo para a promoção da autonomia e qualidade de vida da pessoa com lesão medular. Desta forma, foi realizado o cuidado educativo, utilizando a educação em saúde como estratégia de cuidado. Assim, identificou-se também que os participantes acumulavam saberes, que eram constantemente compartilhados com outras pessoas nas mesmas condições que devem ser valorizados e, através do diálogo o profissional pode acrescentar o saber científico. Os participantes foram levados a refletir, sendo mobilizados a conhecer o que não sabiam. A tecnologia da informação criada nesta tese é uma ferramenta de fácil uso, auxiliando no cuidado e tem a acessibilidade disponível, uma vez que o uso de celulares é muito frequente nos dias atuais, com a informação chegando cada vez mais rápido. Ainda, foram abarcadas questões além das lesões por pressão. Participaram da validação do material, 21 enfermeiros. O grau de concordância do aplicativo foi de 91,7%. O aplicativo foi avaliado como um recurso positivo e importante pelos participantes do estudo a ser disseminado para outras pessoas.(AU)


The object focuses on the shared construction next to the person with spinal cord injury and their caregivers of an application as educational material caregivers on prevention and treatment of pressure injuries and their validation. The general objective is to develop an information technology for the person with spinal cord injury and their caregivers of an application as an educational material for the prevention and treatment of pressure injuries. The specific objectives are to build and validate an application as educational material with guidelines for people with spinal cord injury and their caregivers on preventive measures and treatment of pressure injuries. The concepts of Freire and Orem were applied on the valuation and knowledge of the reality of the individual and the horizontality of the dialogue to identify the therapeutic demand of each one, besides the applicability of the requirements of self-care in the deviation to health. Qualitative research of convergent-assistance approach in the elaboration of the application. After its construction, the Delphi Technique was used for validation with the expertises and after, the evaluation was carried out with the study participants. We interviewed 19 people with spinal cord injury, being two quadriplegic and 11 paraplegic, as well as 06 caregivers, captured by the Snowball Technique. The scenario chosen for this research was the households of people enrolled in the Family Health Strategies of the city of Macaé, Rio de Janeiro. The development phases of the research consisted of individual interviews with problematization of care concerning the prevention and treatment of pressure injuries as well as elaboration of a care process focused on their real needs. According to the information, the application was prepared. Afterwards, we proceeded to the validation and evaluation process. The content analysis was applied to the data corpus. We identified issues that directly interfere with care as the need for the Disabled Care Network, essential in this whole process to promote the autonomy and quality of life of the person with spinal cord injury. In this way, educational care was carried out, using health education as a care strategy. Thus, it was also identified that participants accumulated knowledge, which were constantly shared with other people under the same conditions that should be valued and through dialogue the professional can add scientific knowledge. The participants were led to reflect, being mobilized to know what they did not know. The information technology created in this thesis is an easy-to-use tool, aiding in the care and accessibility available, since the use of cell phones is very frequent in the present day, with the information arriving faster and faster. In addition, questions were raised in addition to pressure injuries. Twentyone nurses participated in the validation of the material. The degree of agreement of the application was 91.7%. The application was rated as a positive and important resource by study participants to be disseminated to others.(AU)


Assuntos
Humanos , Cuidadores , Estratégia Saúde da Família , Informática em Enfermagem , Lesão por Pressão/enfermagem , Lesão por Pressão/prevenção & controle , Traumatismos da Medula Espinal/enfermagem , Traumatismos da Medula Espinal/prevenção & controle
8.
J Clin Nurs ; 27(5-6): e1146-e1151, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29193471

RESUMO

AIMS AND OBJECTIVES: To study the effect of quantitative assessment-based nursing intervention on the bowel function and life quality of patients with neurogenic bowel dysfunction after spinal cord injury. BACKGROUND: Neurogenic bowel dysfunction after spinal cord injury was clinically manifested by abdominal distension, intractable constipation, prolonged defecation and faecal incontinence, which seriously affected the normal life of patients. Traditional ways of nursing for these patients focused on basic care, but lacked sufficient recognition of disease severity and individual needs. DESIGN: One hundred and eighty-four patients with neurogenic bowel dysfunction after spinal cord injury were randomly allocated into observation group (n = 92) and control group (n = 92). METHODS: The patients in the control group were given regular nursing, and the patients in the observation group were given quantitative assessment-based nursing intervention. Recovery of bowel function, quality of life and satisfaction were compared between the two groups. RESULTS: Scores for bowel function including bloating, constipation, prolonged defecation, defecation drug dependence and faecal incontinence in the observation group were significantly lower than those in the control group (p < .05). The scores for the quality of life including physical function, general health, social functioning, role-motional, mental health in the observation group were significantly higher than those in the control group (p < .001). Finally, the satisfaction rate in the observation group was 95.56%, which was significantly higher than that in the control group (83.7%) (p < .01). CONCLUSION: We concluded that quantitative assessment-based nursing intervention contributed to recovery of bowel function and improvement of life quality and satisfaction. RELEVANCE TO CLINICAL PRACTICE: Our finding can increase the rational allocation of nurse-patient ratio and provide personalised nursing for severe patients to reduce complications and promote the rehabilitation of the disease. Our findings can also serve as a reference for other countries to develop the nurse practitioner role.


Assuntos
Incontinência Fecal/enfermagem , Intestino Neurogênico/enfermagem , Traumatismos da Medula Espinal/enfermagem , Adulto , Constipação Intestinal/etiologia , Defecação , Incontinência Fecal/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intestino Neurogênico/etiologia , Satisfação do Paciente , Qualidade de Vida , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/reabilitação , Resultado do Tratamento
9.
Disabil Rehabil ; 40(3): 338-345, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27967253

RESUMO

OBJECTIVE: To examine the psychometric properties of the International Classification of Functioning, Disability and Health (ICF) set for spinal cord injury nursing (ICF-SCIN) using Rasch analysis. METHODS: A total of 140 spinal cord injury patients were recruited between December 2013 and March 2014 through convenience sampling. Nurses used the components body functions (BF), body structures (BS), and activities and participation (AP) of the ICF-SCIN to rate the patients' functioning. Rasch analysis was performed using RUMM 2030 software. RESULTS: In each component, categories were rescored from 01234 to 01112 because of reversed thresholds. Nine testlets were created to overcome local dependency. Four categories which fit to the Rasch model poorly were deleted. After modification, the components BF, BS, and AP showed good fit to the Rasch model with a Bonferroni-adjusted significant level (χ2 = 86.29, p = 0.006; χ2 = 22.44, p = 0.130; χ2 = 39.92, p = 0.159). The person separation indices (PSIs) for the three components were 0.80, 0.54, and 0.97, respectively. No differential item functioning (DIF) was detected across age, gender, or educational level. CONCLUSIONS: The fit properties of the ICF set were satisfactory after modifications. The ICF-SCIN has the potential as a nursing assessment instrument for measuring the functioning of patients with spinal cord injury. Implications for rehabilitation The International Classification of Functioning, Disability and Health (ICF) set for spinal cord injury nursing contains a group of categories which can reflect the functioning of spinal cord injury patients from the perspective of nurses. The components body functions (BF), body structures (BS), and activities and participation (AP) of the ICF set for spinal cord injury achieved the fit to the Rasch model through rescoring, generating testlets, and deleting categories with poor fit. The ICF set for spinal cord injury nursing (ICF-SCIN) has the potential to be used as a clinical nursing assessment tool in measuring the functioning of patients with spinal cord injury.


Assuntos
Classificação Internacional de Funcionalidade, Incapacidade e Saúde , Avaliação em Enfermagem , Traumatismos da Medula Espinal/enfermagem , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria , Amostragem , Adulto Jovem
10.
J Adv Nurs ; 74(1): 23-33, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28726274

RESUMO

AIM: To synthesize the qualitative research evidence that explored how survivors of adult spinal cord injury experience and make sense of resilience. BACKGROUND: Spinal cord injury is often a sudden and unexpected life-changing event requiring complex and long-term rehabilitation. The development of resilience is essential in determining how spinal cord injury survivors negotiate this injury and rehabilitation. DESIGN: A qualitative systematic review and thematic synthesis of the research evidence. DATA SOURCES: CINAHL, PubMed, Embase, Scopus and PsycINFO were searched, no restriction dates were used. REVIEW METHODS: Methodological quality was assessed using the Critical Appraisal Skills Programme checklist. Thematic synthesis focused on how survivors of adult spinal cord injury experience and make sense of resilience. RESULTS: Six qualitative research articles reported the experiences of 84 spinal cord injury survivors. Themes identified were: uncertainty and regaining independence; prior experiences of resilience; adopting resilient thinking; and strengthening resilience through supports. CONCLUSION: Recovery and rehabilitation following spinal cord survivors is influenced by the individual's capacity for resilience. Resilience may be influenced by previous life experiences and enhanced by supportive nursing staff encouraging self-efficacy. Survivors identified the need for active involvement in decision-making about their care to enable a sense of regaining control of their lives. This has the potential to have a significant impact on their self-efficacy and in turn health outcomes.


Assuntos
Resiliência Psicológica , Traumatismos da Medula Espinal/psicologia , Traumatismos da Medula Espinal/reabilitação , Sobreviventes , Adulto , Humanos , Papel do Profissional de Enfermagem , Sistemas de Apoio Psicossocial , Pesquisa Qualitativa , Autoeficácia , Traumatismos da Medula Espinal/enfermagem
11.
Spinal Cord ; 56(1): 28-34, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28895575

RESUMO

STUDY DESIGN: Secondary analysis of data from a prospective cohort study. OBJECTIVES: The objective of this study was to identify the medical and demographic factors associated with the development of pressure ulcers during acute-care hospitalization and inpatient rehabilitation following acute spinal cord injury. SETTING: The study was carried out at acute hospitalization, inpatient rehabilitation and outpatient rehabilitation sites at a university medical center in the United States. METHODS: Adults with acute traumatic spinal cord injury (n=104) were recruited within 24-72 h of admission to the hospital. Pressure ulcer incidence was recorded. RESULTS: Thirty-nine participants out of 104 (37.5%) developed at least one pressure ulcer during acute-care hospitalization and inpatient rehabilitation. Univariate logistic regression analyses revealed significant association of pressure ulcer incidence for those with pneumonia and mechanical ventilation (P=0.01) and higher injury severity (ASIA A) (P=0.01). Multiple logistic regression showed that the odds of formation of a first pressure ulcer in participants with ASIA A was 4.5 times greater than that for participants with ASIA B, CI (1-20.65), P=0.05, and 4.6 times greater than that for participants with ASIA C, CI (1.3-16.63), P=0.01. CONCLUSION: Among individuals with acute traumatic SCI, those with high-injury severity were at an increased risk to develop pressure ulcers. Pneumonia was noted to be associated with the formation of pressure ulcers.


Assuntos
Lesão por Pressão , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Estudos de Coortes , Feminino , Humanos , Incidência , Pacientes Internados , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Lesão por Pressão/diagnóstico , Lesão por Pressão/epidemiologia , Lesão por Pressão/etiologia , Curva ROC , Índice de Gravidade de Doença , Traumatismos da Medula Espinal/enfermagem , Traumatismos da Medula Espinal/reabilitação , Fatores de Tempo , Adulto Jovem
12.
Spinal Cord ; 56(1): 63-70, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28853447

RESUMO

STUDY DESIGN: Cross-sectional, observational. OBJECTIVES: To investigate the association of conflicts between work and family life with indicators of health and to examine the antecedents of those conflicts in employees with spinal cord injury (SCI) and their caregiving partners. SETTING: Community, Switzerland. METHODS: Data from employed persons with SCI (n=79) and caregiving partners (n=93) who participated in the pro-WELL study were used. Logistic and tobit regressions were performed to assess the association of work-family and family-work conflicts with health indicators, namely mental health (36-item Short Form Health Survey (SF-36)), vitality (SF-36), well-being (WHOQoL BREF) and positive and negative affect (Positive and Negative Affect Scale short form (PANAS-S)). Own and partners' engagement in productive activities and socioeconomic circumstances were evaluated as potential antecedents of work-family and family-work conflicts using logistic regression. RESULTS: Work-family conflicts were related to reduced mental health (caregiving partners only), vitality and well-being. Family-work conflicts were linked to reduced mental health, vitality, well-being and positive affect in SCI and to reduced vitality in caregiving partners. Persons with lower income (SCI only) and lower subjective social position reported more conflicts than persons with higher income and higher subjective position. Higher workload increased work-family conflicts in caregiving partners and decreased family-work conflicts in SCI. Education, amount of caregiving, care-receiving and partners' employment status were not associated with the occurrence of conflicts. CONCLUSION: The optimal balance between work and family life is important to promote mental health, vitality and well-being in employees with SCI and their caregiving partners. This is especially true in employees perceiving their social position as low and in caregivers with a high workload.


Assuntos
Cuidadores/psicologia , Emprego , Conflito Familiar/psicologia , Traumatismos da Medula Espinal/psicologia , Adulto , Feminino , Nível de Saúde , Inquéritos Epidemiológicos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Características de Residência , Traumatismos da Medula Espinal/epidemiologia , Traumatismos da Medula Espinal/enfermagem , Estatísticas não Paramétricas , Suíça/epidemiologia
13.
BMJ Open ; 7(12): e017369, 2017 12 22.
Artigo em Inglês | MEDLINE | ID: mdl-29275339

RESUMO

OBJECTIVE: To investigate associations of objective caregiver burden, subjective caregiver burden and positive aspects of caregiving with self-reported health indicators in caregiving partners of persons with a severe physical disability (spinal cord injury). DESIGN: Cross-sectional, observational. SETTING: Community, Switzerland. PARTICIPANTS: Caregiving partners of persons with spinal cord injury (n=118, response rate 19.7%). OUTCOME MEASURES: General health, role limitations due to physical health, role limitations due to mental health, pain intensity, mental health and vitality were assessed using items from the 36-Item Short Form Health Survey (SF-36). Three items were used to assess the frequency of different types of sleep problems. RESULTS: Subjective caregiver burden was associated to all self-reported health indicators. A high subjective burden was linked to poorer general health (OR 6.5, 95% CI 2.0 to 21.5), more role limitations due to physical health (OR 4.2, 95% CI 1.4 to 12.8), more role limitations due to mental health (OR 3.6, 95 % CI 1.1 to 11.7), higher pain intensity (OR 4.0, 95% CI 1.4 to 11.5), poorer mental health (coefficient -17.9, 95% CI -24.5 to -11.2), lower vitality (coefficient -20.3, 95% CI -28.4 to -12.1), and more frequent sleep problems (OR 5.3, 95% CI 1.6 to 18.4). Partners who indicated positive aspects of caregiving further reported better mental health (coefficient 6.5, 95% CI 0.2 to 12.8). Objective burden was not related to any health indicator. CONCLUSIONS: Subjective burden and lack of positive aspects of caregiving were associated with poorer physical and mental health. Caregiver health may be promoted through the strengthening of psychological and psychosocial resources.


Assuntos
Cuidadores/psicologia , Efeitos Psicossociais da Doença , Pessoas com Deficiência , Qualidade de Vida , Traumatismos da Medula Espinal/enfermagem , Adaptação Psicológica , Adulto , Compreensão , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Autorrelato , Suíça
14.
J Nurs Res ; 25(4): 276-282, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28683015

RESUMO

BACKGROUND: Clients with a spinal cord injury (SCI) must learn to manage their disabilities and may never be able to resume their previous lifestyle. Therefore, receiving relevant information and support from care practitioners and institutions is essential for clients with long-term SCI. PURPOSE: This study investigated the long-term homecare needs of clients with SCIs. METHODS: A qualitative approach was used in this study. Data were collected from March to May 2013. Four SCI associations were selected using purposive sampling, and four focus group interviews were conducted in Northern, Central, Southern, and Eastern Taiwan. Each focus group was composed of 7-12 participants. In-depth interviews (1.5-2.5 hours) were conducted. A content analysis method was adopted for data analysis. RESULTS: Thirty-eight participants took part in the study. The long-term care needs of clients with SCI require the following dynamic processes for rebuilding their lives: physical care and complication prevention, life planning, social support, discovery of the value of existence, and sexual satisfaction. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The results reveal the long-term care needs of clients with SCI. Nurses are expected to provide client-centered care, emphasize prevention rather than treatment of complications, initiate life planning at the early stages of a client's rehabilitation, enhance a client's social support, encourage a client's search for companionship and search for the value of existence and a life purpose, and be attentive to the sexual concerns of people with physical disabilities.


Assuntos
Necessidades e Demandas de Serviços de Saúde , Serviços de Assistência Domiciliar , Traumatismos da Medula Espinal/enfermagem , Feminino , Grupos Focais , Humanos , Assistência de Longa Duração , Masculino , Pessoa de Meia-Idade , Taiwan
15.
Clin Rehabil ; 31(7): 948-956, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28637391

RESUMO

OBJECTIVE: To understand and describe in a sample of caregivers of persons with spinal cord injury, their burden of care, resilience and life satisfaction and to explore the relationship between these variables. DESIGN: Cross-sectional design. SETTING: One Spinal Cord Injury Acute Inpatient Unit from a general hospital. SUBJECTS: Seventy-five relatives of persons with spinal cord injuries (84% women) with a mean age of 48.55 ( SD = 12.55) years. INTERVENTIONS: None. MEASURES: Demographics (neurological loss and severity according to the American Spinal Injury Association criteria), the Zarit Burden Interview, the Resilience Scale and the Life Satisfaction Checklist. RESULTS: All caregivers experienced feelings of different intensities of burden (52% mild-to-moderate, 43% moderate-to-severe and 5% severe), and none of them expressed little or no burden at the assessment moment. Caregivers' main worries were "dependence" and "the future of the injured." Resilience was medium-to-high (mean = 141.93, SD = 23.44) for the whole sample with just a minority of them revealing low (15%) or very low resilience (7%). The highest scores were obtained in relation to "caregivers' independence" and "meaning of their lives." Life satisfaction scores were medium-to-high (mean = 36.6, SD = 6). These scores were not related to demographics or the severity of the injury. Zarit Burden Interview scores were negatively correlated to Resilience Scale ( r = -.370, P = .001) and Life Satisfaction Checklist scores ( r = -.412, P < .001). CONCLUSION: More resilient and satisfied caregivers experienced lower burden. Burden is moderate-to-high and mainly related to uncertainty about the future, caregivers' insecurity with caregiving and dependence of the injured.


Assuntos
Cuidadores/psicologia , Relações Familiares/psicologia , Resiliência Psicológica , Traumatismos da Medula Espinal/enfermagem , Estresse Psicológico/epidemiologia , Inquéritos e Questionários , Adaptação Psicológica , Adulto , Fatores Etários , Ansiedade/epidemiologia , Ansiedade/psicologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação Pessoal , Medição de Risco , Fatores Sexuais , Traumatismos da Medula Espinal/diagnóstico , Traumatismos da Medula Espinal/reabilitação
16.
J Eval Clin Pract ; 23(1): 149-155, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27766734

RESUMO

RATIONALE: Program evaluation is essential to help determine the success of an evidence-based practice program and assist with translating these processes across settings. AIMS: The purpose of this study was to evaluate the usefulness of 2 competency programs that sought to improve neurocritical care nurses' knowledge of and adherence to evidence-based stroke and spinal cord injury guidelines. These programs consisted of 3 specific implementation strategies, including local opinion leaders, printed educational materials, and educational outreach. METHODS: A qualitative study using one-on-one interviews with 10 neurocritical care nurses was used. Semi-structured interview questions examined the nurses' perceptions of the competency programs and the implementation strategies used; themes were identified through first-level coding. The transcripts were deductively analyzed and categorized using a predetermined implementation outcomes framework, including the concepts of acceptability, appropriateness, adoption, and sustainability. RESULTS: Nurses reported that the 3 implementation strategies used for the competency programs were acceptable and appropriate. Further, the nurses perceived that the evidence-based practices reviewed during the programs were being adopted into practice and provided suggestions for sustaining improvements in nursing knowledge of and adherence to these evidence-based practices. CONCLUSIONS: Findings from this study support the success of the Stroke and Spinal Cord Injury Competency Programs, as well as the usefulness of the 3 implementation strategies used. This study provides insight for improvements for subsequent studies focused on implementing evidence-based practices.


Assuntos
Competência Clínica/normas , Enfermeiras e Enfermeiros/psicologia , Enfermeiras e Enfermeiros/normas , Traumatismos da Medula Espinal/enfermagem , Desenvolvimento de Pessoal/organização & administração , Acidente Vascular Cerebral/enfermagem , Enfermagem de Cuidados Críticos/normas , Prática Clínica Baseada em Evidências , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Entrevistas como Assunto , Guias de Prática Clínica como Assunto , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa
17.
Nurs Times ; 112(26): 12-5, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27544957

RESUMO

Patient with spinal cord injuries have individualised care routines to help prevent complications. Disruption to these routines following admission to non-specialist settings can have long-term consequences. This article focuses on the key long-term problems of pressure ulcers, bladder and bowel dysfunction, and autonomic dysreflexia. Nurses working on general wards need to consider how to manage these problems when caring for patients with spinal cord injury.


Assuntos
Disreflexia Autonômica/enfermagem , Incontinência Fecal/prevenção & controle , Lesão por Pressão/prevenção & controle , Traumatismos da Medula Espinal/enfermagem , Bexiga Urinaria Neurogênica/enfermagem , Disreflexia Autonômica/etiologia , Defecação , Incontinência Fecal/etiologia , Incontinência Fecal/enfermagem , Hospitalização , Humanos , Educação de Pacientes como Assunto , Lesão por Pressão/enfermagem , Encaminhamento e Consulta , Higiene da Pele/enfermagem , Especialização , Traumatismos da Medula Espinal/complicações , Bexiga Urinaria Neurogênica/etiologia
19.
Int J Orthop Trauma Nurs ; 23: 3-13, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27256768

RESUMO

AIMS AND OBJECTIVES: To investigate the effect of preoperative bowel preparation for patients undergoing spinal fusion surgery. BACKGROUND: Bowel preparation before major surgery is performed routinely to reduce the risk of postoperative complications related to gastrointestinal function. METHODS: A randomised clinical trial was performed that included forty-five elective spinal fusion patients allocated to one control group and two treatment groups. The patients received preoperative bowel preparation with enema, suppository or no bowel preparation. The outcome measures were defecation within 72 hours postoperatively, defecation on the fifth postoperative day, postoperative constipation, nausea, pain, well-being and ambulation. RESULTS: There were significant differences in favour of no bowel preparation compared with suppository group for the primary outcome; days to first defecation. There was a tendency for the patients who received no bowel preparation to recover from constipation more quickly than patients in the bowel preparation groups. The majority of patients did not defecate until the fourth postoperative day. CONCLUSIONS: This randomised study found no benefit from bowel preparation before major spine surgery on gastrointestinal function. The use of bowel preparation is not evidence-based and not performing it should be considered before major spine surgery until the effect is known.


Assuntos
Constipação Intestinal/prevenção & controle , Cuidados Pré-Operatórios , Traumatismos da Medula Espinal/cirurgia , Irrigação Terapêutica , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Traumatismos da Medula Espinal/enfermagem , Fusão Vertebral , Resultado do Tratamento , Adulto Jovem
20.
Int J Rehabil Res ; 39(3): 240-8, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27171607

RESUMO

The International Classification of Functioning, Disability and Health (ICF) has potential to be used as a clinical assessment instrument directly. However, difficulty in operationalizing the ICF qualifiers has led to unsatisfactory inter-rater reliability of ICF instruments in previous studies. The ICF set for spinal cord injury (SCI) nursing contains a group of categories that can reflect the functioning of SCI patients from the perspective of nurses. The aim of this study was to explore the inter-rater reliability of the ICF set for SCI nursing. Detailed measuring guidelines were prepared for each category of the ICF set. Two trained nurses then used the ICF set to independently rate 40 SCI patients within the first 3 days after their admission. The results showed that the percentage of the observed agreement between the nurses ranged from 42.5 to 100% (median 75%, interquartile range 62.5-87.5%). The weighted κ ranged from -0.03 to 1.00 (median 0.68, interquartile range 0.45-0.84). A total of 50 categories (79.4%) showed weighted κ greater than 0.4 and 39 categories (61.9%) had weighted κ greater than 0.6. The medians of the weighted κ for the body functions, body structures, activity and participation and environmental factors components were 0.6, 0.64, 0.84, and 0.11, respectively. This study indicated that the inter-rater reliability of the ICF set for SCI nursing was acceptable. Establishment of detailed measuring guidelines could help reduce the differences between raters. Simpler and clearer measuring guidelines are recommended and the definitions of some categories need to be clarified in future studies.


Assuntos
Classificação Internacional de Funcionalidade, Incapacidade e Saúde , Traumatismos da Medula Espinal/enfermagem , Adulto , Idoso , Estudos Transversais , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Adulto Jovem
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