The nursing role in SCI rehabilitation

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REHABILITATION OF SCI PERSONS

Price, Makintubee, Herndon and Istre (1994:37), Stiens, Bergman and Formal (1997:S65) and others maintain that few injuries result in more profound and long-term disability than the traumatic SCI. Sjolund (2002:252) states that many general physicians might think that the first shock striking the SCI victims is due to trauma, but the greatest shock comes from the lost bodily identity when they suddenly realize that they have lost their ambulatory capacity along with many other important bodily functions. The patients perceive these changes, and experience and react at the personal level. Their impressions, beliefs, predictions and response to this predicament drive the adjustment process as catalysed by rehabilitation (Stiens et al 1997:S65). T

Post-acute SCI rehabilitation

In the early rehabilitation, the focus is on vital functions, providing adequate respiratory care, thrombosis and pressure sore prophylaxis as well as an adequate bowel and urinary bladder management, and maintaining adequate nutrition as the SCI patient may develop a severe catabolic state and as a result a negative nitrogen balance predisposes the patient to sepsis and other complications (Mitcho & Yanko 1999:67). Simultaneously, specially trained staff provide crisis psychotherapy, much needed by the injured person to be able to gradually reflect on his or her situation. Also crucial is an early contact with an independent SCI person. Ideally, this should be achieved within the first week, as the newly injured person usually considers this extremely valuable (Sjolund 2002:251).

Rehabilitation interventions

The collective secondary effects of spinal cord trauma produce a unique state of disablement for the person with SCI. According to Stiens et al (1997:S65), the World Health Organization (WHO) has provided terminology for disablement as related to three domains: organ (impairment), person (disability), and social (handicap). Thus, the interdisciplinary team and the patient must integrate data from patient experience and clinical parameters to derive a unique plan in each case and to target specific needs for rehabilitation. Rehabilitation interventions to promote adaptation should restore selfdirected behaviour; engaging the patient in independent thought and problem solving restores a sense of power. The learning process achieves adaptation of the unique SCI individual. Through experimentation, personal solutions are derived for negotiating barriers in individuals’ own environment.

Rehabilitation approaches and models

The predominant approach, also referred to as the restorative, rehabilitative, or medical model of intervention, that underpins health care for people with SCI is rehabilitation, which aims at helping individuals to return to optimal effectiveness in daily living (Richardson 1997:1270). According to the medical model, disability is caused by disease or trauma. In this study, a fractured spine disables the person. Disability, here, is perceived as a falling away from normality. The role of the disabled individuals is to gratefully and passively accept the care imposed on them by the experts (health professionals). Their role is to shift the patients’ functioning towards what is normal (Goodall 1995:324).

ADJUSTMENT TO SCI

According to Rolland (1999:247), adjustment entails the long haul of day-to-day living with a SCI, and coming to terms with losses and limitations. Adjustment includes a multitude of spontaneous and applied processes that enable a person to achieve optimal health, personal role performance and environmental integration in spite of disablement (Stiens et al 1997:S65). Adjustment is often viewed as an outcome of coping (Loy, Dattilo & Kleiber 2003:233). Loy et al (2003:233) refer to Shontz’s (1975) view that adjustment is a function of the congruence between the subjective perceptions of the individual with a disability and the external environment. Livneh and Antonak (1997:22) state that in adjustment, the “individual reaches a state of cognitive reorganization and reorientation toward self and the external environment typified by the integration of the functional limitations associated with the condition into his/her self-concept”.

THEORIES ON ADJUSTMENT

It was initially assumed that a SCI itself produced not only major physical consequences but also grave psychological consequences, which made these people inherently ‘different’ from non-disabled individuals. Thus earlier research examined the psychological characteristics of those with SCI in order to document these differences (Triechmann 1992:58). However towards the end of the twentieth century, it became clear that people with physical disabilities are no different from non-disabled people except for the presence of a physical impairment Theories on adjustment to SCI fall into three categories, namely psychological, personality and sociological.

Table of contents :

• Chapter 1 Orientation
  • 1.1 INTRODUCTION
  • 1.2 BACKGROUND TO THE STUDY AND STATEMENT OF THE PROBLEM
    • 1.2.1 What is a spinal cord injury (SCI)?
    • 1.2.2 Causes of spinal cord injuries
    • 1.2.3 Incidence, age and gender in spinal cord injuries
    • 1.2.4 Emergency care of SCI
    • 1.2.5 Physiological effects of spinal cord injuries
    • 1.2.6 Life expectancy after a spinal cord injury
    • 1.2.7 Research on SCI
    • 1.2.8 Setting
    • 1.2.9 Statement of the problem
    • 1.2.10 Research questions
  • 1.3 RATIONALE FOR THE STUDY
  • 1.4 PURPOSE OF THE STUDY
  • 1.5 OBJECTIVES OF THE STUDY
  • 1.6 PARADIGMATIC PERSPECTIVE
    • 1.6.1 Origin of research paradigms
    • 1.6.2 Paradigm and its application in the context of this study
    • 1.6.3 Assumptions
    • 1.6.4 Meta-theoretical assumptions
      • 1.6.4.1 Ontological assumptions
      • 1.6.4.2 Theoretical-conceptual assumptions/epistemological commitments
      • 1.6.4.3 Methodological assumptions
• 1.7 RESEARCH DESIGN AND METHODOLOGY
  • 1.7.1 Research design
  • 1.7.2 Population and sample
  • 1.7.3 Data-collection methods
  • 1.7.4 Data analysis
• Chapter 2 Literature review
  • 2.1 INTRODUCTION
  • 2.2 REHABILITATION OF SCI PERSONS
    • 2.2.1 Post-acute SCI rehabilitation
    • 2.2.2 Rehabilitation phases
    • 2.2.3 Rehabilitation interventions
    • 2.2.4 The nursing role in SCI rehabilitation
    • 2.2.5 Rehabilitation approaches and models
    • 2.2.6 Rehabilitation outcomes
  • 2.3 ADJUSTMENT TO SCI
  • 2.4 THEORIES ON ADJUSTMENT
    • 2.4.1 Psychological theories
      • 2.4.1.1 Crisis and denial
      • 2.4.1.2 Stage models of psychosocial adjustment
    • 2.4.2 Personality theories on adjustment
      • 2.4.2.1 Locus of control
      • 2.4.2.2 Crisis theory
    • 2.4.3 Sociological theory
  • 2.5 CRITICISM OF STAGE MODELS
  • 2.6 AN INTEGRATED MODEL OF PSYCHOSOCIAL ADJUSTMENT
  • 2.7 DEMOGRAPHIC VARIABLES AND SCI ADJUSTMENT
• Chapter 3 Methodological framework
  • 3.1 INTRODUCTION
  • 3.2 QUALITATIVE RESEARCH
    • 3.2.1 Ethnography
    • 3.2.2 Grounded theory
    • 3.2.3 Phenomenology
  • 3.3 PHENOMENOLOGY: THE PHILOSOPHICAL STANCE OF THE STUDY
    • 3.3.1 Origin of the term “phenomenology”
    • 3.3.2 Philosophical roots of phenomenology
    • 3.3.3 The phenomenological movement
  • 3.4 HUSSERLIAN PHENOMENOLOGY
    • 3.4.1 Concepts associated with Husserlian philosophy
  • 3.5 BRACKETING IN QUALITATIVE RESEARCH
  • 3.6 REACTION OF HUSSERL’S PHILOSOPHY
  • 3.7 HEIDEGGER’S ONTOLOGICAL PHENOMENOLOGY
• Chapter 4 Research design and methods
  • 4.1 INTRODUCTION
  • 4.2 RESEARCH DESIGN
    • 4.2.1 Qualitative aspect
    • 4.2.2 Phenomenological aspect
  • 4.3 RESEARCH PROCESS
    • 4.3.1 Methods
    • 4.3.2 Gaining entry and access
    • 4.3.3 Population and sample
    • 4.3.4 Sampling technique
• Chapter 5 Research findings
• Chapter 6 Framework and guidelines
• Chapter 7 Conclusions, limitations and recommendations

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THE PERSONAL AND EMBODIED EXPERIENCES OF PEOPLE LIVING WITH A SPINAL CORD INJURY IN THE OR TAMBO DISTRICT MUNICIPALITY IN THE EASTERN CAPE