Introduction to Spinal Cord Injury Nursing Presented by: Kelly
D. Skinner, RN, MSN, CRRN, WCC, APRN, BC, GNP-BC & Michele
Lacroix, RN, ADN April 5, 2011 Slide 2 Objectives Review statistics
related to Spinal Cord Injury. Provide an overview of the Spinal
Cord Injury Program at the VA Boston Healthcare System. Analyze the
myth that there are limited educational experiences in SCI Nursing.
Describe the learning opportunities for SCI nurses related to
clinical, education and research. Slide 3 Incidence of Spinal Cord
Injury (SCI) General Public Approximately 12,000 new cases of
spinal cord injury (SCI) occur each year in the United States.
There are 265,00 SCI persons alive in the United States.. (Facts
& Figures at a Glance, February 2011) Veterans Newly-injured
SCI veterans receive treatment at one (or more) of the VAs 23 SCI
specialty centers across the country 462 SCI persons are on the SCI
Registry at Boston (VABHS SCI Registry, March 2011) Slide 4 Causes
General Public 40.4% vehicular 27.9% falls 15% violence 8% sports
8.5% other (Facts & Figures at a Glance, February 2011)
Veterans 27% motor vehicle accidents 27% falls 7% sports 39% other
(non-traumatic) (VABHS SCI Registry, March 2011) Slide 5
Demographics General Public The average age at injury is 40.7 years
80.7% males and 19.3% females 66.5% Caucasian, 26.8% African
American, 2% Asian, and 4.7% Other (Facts & Figures at a
Glance, February, 2011) Veterans Average age for veterans: 59 years
old 87% male and 13% female for veterans 82% Caucasian, 12%
African-American, and 6% Other (VABHS SCI Registry, March 2011)
Slide 6 Neurological Level of Injury General Public 62% Tetraplegia
38% Paraplegia (Facts & Figures at a Glance, February 2011)
Veterans 20% Tetraplegia 80% Paraplegia (VABHS SCI Registry, March
2011) Slide 7 Disposition at Discharge General Public 89.8% are
sent to a private, non-institutional residences (home). 6.2% are
discharged to nursing homes. The remaining are discharged to
hospitals, group living situations or other destinations. (Facts
& Figures at a Glance, February 2011) Veterans 80% Discharges
to Community (home/boarding house) 20% Nursing Homes (67% Non-VA
and 33%VA) (VABHS SCI Registry, March 2011) Slide 8 Togus SCI/D
Support Clinic VABHS JP SCI/D Primary Care Clinic VABHS SCI/D
Support Clinic Providence SCI/D Primary Care Clinic Manchester
SCI/D Primary Care Clinic White River Junction SCI/D Support Clinic
Northhampton SCI/D Primary Care Clinic Bedford SCI/D Primary Care
Clinic Slide 9 Acute SCI Unit Long-Term Care SCI Unit SCI
Outpatient Clinic SCI Home Care (ALL provide venues for nursing
education across the continuum of care!) Slide 10 Spinal Cord
Injury Interdisciplinary Team West Roxbury Campus Slide 11 The
Brockton SCI staff was featured in an article entitled: Recipe for
Staff Satisfaction Advance for Nurses, (2004), 21(4), 10, 38. Slide
12 West Roxbury SCI Staff NEPVA Banquet New England Paralyzed
Veterans of America (NEPVA) Brockton SCI Staff NEPVA Banquet Slide
13 Wheelchair Sports Handcycling 5K Air Guns Swimming Basketball
Kayaking Skiing Slide 14 Who says there are limited educational
opportunities in Spinal Cord Injury Nursing? Misconception or
reality? Slide 15 SCI Clinical Specialist SCI Orientation: Didactic
Phase/Clinical Component/Competency Demonstration Medication
Administration Supervision for Licensed Nurses Suctioning
Competency Demonstration Bar Code Medication Administration (BCMA)
Slide 16 SCI Orientation Topics Introduction to Rehabilitation
Sexual FunctionOrthotic Devices Autonomic DysreflexiaAdjustment to
InjuryNutritional Considerations Bowel ManagementSpastic
HypertoniaRange of Motion Bladder ManagementPainTurning &
Positioning Skin Care Issues & Prevention of Pressure Ulcers
Impaired Temperature Regulation Cardiovascular Management Slide 17
SCI Games SCI Sexuality Trivia Game Promoting Healthy SCI
Lifestyles Game Slide 18 SCI Nail Care Program Routine nail care is
essential for spinal cord injured persons. Spinal cord injured
persons with hyperkeratotic and elongated toenails are at risk for
complications since they have limited or no sensation in their
lower extremities. Podiatry services were limited. Therefore, it
became apparent that the SCI Nail Care Program was needed in order
to meet the foot and nail care needs of the spinal cord injured
veterans. Slide 19 SCI Educational Programs SCI Patient Education
Series (Thursdays at 1:00pm, VABHS) SCI Workshops (8/26/08 12/5/08)
SCI Interdisciplinary Conference (3/30/09: 8 th SCI
Interdisciplinary Conference, VABHS) Spinal Cord Injury Medicine:
Educational Symposium (10/30/09: Spinal Cord Injury Medicine: 17 th
Educational Symposium, VABHS) SCI Workshop SCI Symposium Slide 20
VALOR (VA Learning Opportunity Residency Program) VALOR Students In
2008 three VA Learning Opportunity Residency (VALOR) Students
joined the SCI Team at the VA Boston Healthcare System. The VALOR
Program is an initiative to recruit nursing students who are
entering their senior year in a baccalaureate degree nursing
program. The VALOR students shown here (Left to Right: Alessandra
Adamo, Lauren Aiello and Kelly Sullivan) are seniors in the
UMASS-Boston Nursing Program. Slide 21 Orthotic Devices Slide 22
Respiratory Management Slide 23 Prevention of Pressure Ulcers Slide
24 Bowel & Bladder Management Slide 25 Spinal Cord Injury at
the VABHS is going live in March 2009 Telemetry Slide 26 Research
Opportunities in SCI Poster Presentations Respite Care: A Necessary
Break for SCI Caregivers Developing an SCI Nail Care Program: How
to Make It Happen The Ramifications of Sensory Deprivation in
Spinal Cord Injury Decreasing the Incidence of Clostridium
Difficile in SCI: An Interdisciplinary Approach Blistering Skin
Diseases in SCI The Impact of Smoking Cessation on Chronic Pressure
Wounds in Spinal Cord Injury Bringing Non-SCI Nurses Up-to-Speed on
SCI Care Utilizing Digital Wound Imaging in Long-term Care: Is a
Picture Really Worth a Thousand Words? Cellulitis in Spinal Cord
Injury Surgical Flaps: Preoperative to Postoperative Care Central
Parenteral Nutrition: What SCI Nurses Need to Know Slide 27 Respite
Care: A Necessary Break for SCI Caregivers The amount of support
that a caregiver has is crucial to maintaining the spinal cord
injured person in the community. In fact, the health and well-being
of spinal cord injured persons is directly affected by caregiver
stress. The Caregiver Stress Test was administered to SCI
Caregivers who utilize the respite services offered at the VABHS
long-term care unit. SCI Caregivers Gender Female: 91% Male: 9% SCI
Caregiver Wife: 60% Mother: 10% Daughter/Son: 20% S/O: 10% Duration
of Caregiving 0-10 years: 36% 10-20 years: 46% 60+ years: 18% SCI
Person Age 40-50: 10% 50-60: 18% 70-80: 36% 80+: 36% Gender Female:
0% Male: 100% Level of Injury Quadriplegia: 73% Paraplegia: 27%
Profile of SCI Persons Utilizing Respite Care Services Profile of
SCI Caregivers Slide 28 SCI Staff Nurse/Coordinator of the New
Graduate Program: John Huether Fortunately, I was influenced by a
family member to initiate my nursing career immediately after
graduation on an SCI unit rather than the traditional med/surg
environment. I strongly urge nursing students to work on an SCI
unit if they wish to jump start their nursing careers. Slide 29 SCI
Staff Nurse: Karen Flaherty Learning opportunities abound in SCI
nursing! I have had the opportunity to provide direct hands on care
as well as provide emotional, psycho-social support. This aspect of
providing care for me is an added enrichment. Slide 30 SCI Staff
Nurse: Mary Nelson SCI is a diagnosis not a label. Persons with a
spinal cord injury have the same health problems as persons without
a spinal cord injury. It is the effects of the damage to the spinal
cord on the body systems that provides continuous learning
opportunities. Slide 31 SCI Staff Nurse: Susanne Clark I have
worked in nursing for 35 years in everything from Triage Nursing in
Vietnam to Spinal Cord Injury Nursing. I can say without a doubt
that there are unbelievable learning opportunities in SCI nursing
if you are open to the idea. Slide 32 Spinal Cord Injury &
Disorders Outcomes (SCIDO) Coordinator: Bonnie Rowe I work in an
environment which promotes quality patient care through
evidence-based practice (EBP). I am a member of the Nursing Policy
& Procedure Committee. Nurses are encouraged to ask for the
research or evidence before a procedure or policy is implemented.
Slide 33 SCI Staff Nurse/New Graduate: Heidi Abrahamsen "Since my
level of educational training in nursing school included very
little about Spinal Cord Injury, I would never have known the high
level learning capacity of working with spinal cord injured
patients if I did not rotate to this unit. I have seen more acute
care in SCI and learned more about our powerful body systems than
anywhere else I have trained." Slide 34 SCI Nurse Manager: Nancy
Connors The work environment influences the retention of nurses. By
coaching and mentoring one another, we will produce a stronger
nursing workforce; one which ultimately improves staff performance
and the care delivered to the spinal cord injured veteran
population. Slide 35 The VA Boston Healthcare System does offer
numerous clinical, educational and research opportunities in Spinal
Cord Injury Nursing. Slide 36 The End!!! Slide 37 References DeVivo
MJ. Epidemiology of traumatic spinal cord injury. In: Kirshblum S,
Campagnolo DI, DeLisa JA. Spinal cord medicine. Philadelphia:
Lippincott, Williams & Wilkins; 2002. 69- 81. Facts and Figures
at a Glance. January 2008. National Spinal Cord Injury Statistical
Center. Glick T. Spinal cord injury surveillance: is there a
decrease in incidence? J Spinal Cord Med 2000; 23:61. Halfer, D.
& Graf, E. (2006). Graduate nurse perceptions of the work
experience. Nursing Economics, 24, 3, 150-155. Jackson AB, Dijkers
M, DeVivo MJ, Poczatek RB. A demographic profile of new traumatic
spinal cord injuries: change and stability over 30 years. Arch Phys
Med Rehabil 2004; 85:1740- 1748. Ledger, T, Pulfrey, A. (2008).
Developing clinical research nurses. Nursing Management, 15, 2.
Lfmark A et al (2008) Nursing students views on learning
opportunities in primary health care. Nursing Standard. 23, 13,
35-43. Pine, R. & Tart, K. (2007). Return on investment:
Benefits and challenges of a baccalaureate nurse residency program.
Nursing Economics, 25, 1, 13-18, 19. Pinkerton, S.(2007). Mentoring
new graduates. Nursing Economics, 21, 4, 202-203. Skinner, K.
(2000). Creating a game for sexuality and aging: The Sexual
Dysfunction Game. Journal of Continuing Education in Nursing, 31,
4, 185-189. Tolson, T. & Skinner, K. (2004). Recipe for staff
satisfaction. Advance for Nurses, 10, 38. VABHS Quarterly Outcome
Report FY 2008 http://vaww1.va.gov/SpinalCordBoston www.pva.org
www.spinalcord.uab.edu www.wheelchairgames.com
