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Clinical nurse specialist Cindy Gatens, MN, RN, grew
up wanting to be a nurse. Her plans were interrupted
six months into a three-year nursing program when she
suffered a spinal cord injury. Despite being in a wheelchair
since that time, Gatens' injuries did not deter her
from completing her goal of being a nurse-after completing
rehab, she enrolled in a four-year nursing program.
Gatens now works at Ohio State University Medical Center
Rehabilitation Center. She has worked with spinal cord
injury patients for more than 30 years.
Throughout her years as a nurse, Gatens has seen many
changes in how spinal cord injury patients are managed.
Higher-level spinal cord injured patients now are surviving
and being discharged. Even with the more severely injured
patients, the length of hospitalization has shortened.
In the past, newly injured patients were hospitalized
for three months or more. Now, patients are being discharged
from the hospital to rehabilitation one to two weeks
after an injury.
"We know people are ready for rehab as soon as
they are stable. We admit them right from the intensive
care unit," said Sandra DeLeon, RN, spinal cord
injury coordinator at the Kessler Institute for Rehabilitation
in New Jersey. Nurses in all settings need to be knowledgeable
about the proper handling of patients immediately post-trauma
and about caring for the patient in the acute setting.
"The more time a patient is recovering from a pressure
ulcer, the less time they have to focus on recovery,"
said Marilyn Pires, MS, RN, FAAN, rehabilitation clinical
specialist at Rancho Los Amigos in Downey, Calif.
Along with the new standard of shorter hospital stays,
insurance companies also frequently limit the amount
of time they will pay for rehabilitation. This requires
nurses to speed up the education process. "In the
past, we had the luxury of letting the patient adapt
to the disability before we started bombarding the family
with education," Pires said. She believes there
is a fine line in deciding when to inject reality into
a patient with a spinal cord injury. "You never
remove hope. What they are hoping for may not come for
a long time so they need to take really good care of
themselves in the meantime," Pires said.
Pires, like the other rehab nurses, spends time with
patients to help them reassess their life goals and
decide how to work toward them and what adaptations
will be required. Pires has worked with many spinal
cord injury patients who were in gangs. "They expected
to be dead, and now they have a different future,"
Pires said. For these patients, they work together to
establish goals based on a future they never considered.
Because she is a paraplegic, Gatens finds herself in
a unique position when educating patients with spinal
cord injuries. "I try not to put myself in front
of patients and say, 'See what I can do.' But it is
nice for them to see someone successful when the future
is so unknown. It gives them hope," Gatens said.
Despite advances, the goal of caring for the recovering
spinal cord injury patient hasn't changed and continues
to concentrate on the prevention of secondary complications,
such as urinary tract infection, pressure ulcers and
deep vein thrombosis. Although more sophisticated medications
and equipment are available, nurses and patients must
remember that the new equipment does not replace frequent
turning. DeLeon compares the new pressure cushions available
to air bags. "Cushions are beneficial, but turning
prevents skin breakdown. It is just like an air bag.
It is only effective when you wear your seat belt."
Another obstacle for spinal cord injury patients is
access to the world. "Transportation is a huge
issue," DeLeon said. Technology such as improved
wheelchairs and voice-activated computers have made
parts of life easier to access.
All three rehabilitation nurses interviewed by NURSEWEEK
would like to see a decrease in the number of spinal
cord injuries due to education about injury prevention.
Pires said she is hopeful that future research into
the prevention of secondary cell death at the time of
injury will reduce the amount of neurological deficits
of spinal cord injury patients.
"The cell death is caused by anoxia. The cells
that die release a toxin that kills other cells in the
area. I think we are close to stopping this secondary
death," Pires said.
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