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Introduction to Spinal Cord Injury Nursing

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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 – PowerPoint PPT presentation

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Title: Introduction to Spinal Cord Injury Nursing


1
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

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.

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)

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)

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)

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)

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 33VA)

  • (VABHS SCI Registry, March 2011)

8
Togus SCI/D Support Clinic
Bedford SCI/D Primary Care Clinic
VABHS JP SCI/D Primary Care Clinic
Northhampton SCI/D Primary Care Clinic
VABHS SCI/D Support Clinic
White River Junction SCI/D Support Clinic
Providence SCI/D Primary Care Clinic
Manchester SCI/D Primary Care Clinic
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!)

10
  • Spinal Cord Injury Interdisciplinary Team
  • West Roxbury Campus

11
The Brockton SCI staff was featured in an
article entitled Recipe for Staff
Satisfaction Advance for Nurses, (2004), 21(4),
10, 38.
12
New England Paralyzed Veterans of America (NEPVA)
  • West Roxbury SCI Staff
  • NEPVA Banquet

Brockton SCI Staff NEPVA Banquet
13
Wheelchair Sports
Basketball
Handcycling 5K
Swimming
Air Guns
Skiing
Kayaking
14
  • Who says there are limited educational
    opportunities in Spinal Cord Injury Nursing? 

Misconception or reality?
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)
16
SCI Orientation Topics

Introduction to Rehabilitation Sexual Function Orthotic Devices
Autonomic Dysreflexia Adjustment to Injury Nutritional Considerations
Bowel Management Spastic Hypertonia Range of Motion
Bladder Management Pain Turning Positioning
Skin Care Issues Prevention of Pressure Ulcers Impaired Temperature Regulation Cardiovascular Management
17
SCI Games
SCI Sexuality Trivia Game
Promoting Healthy SCI Lifestyles Game
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.

19
SCI Educational Programs
  • SCI Patient Education Series
  • (Thursdays at 100pm, VABHS)
  • SCI Workshops
  • (8/26/08 12/5/08)
  • SCI Interdisciplinary Conference
  • (3/30/09 8th SCI Interdisciplinary
    Conference, VABHS)
  • Spinal Cord Injury Medicine Educational
    Symposium
  • (10/30/09 Spinal Cord Injury Medicine 17th
    Educational Symposium, VABHS)

SCI Workshop
SCI Symposium
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.
21
Orthotic Devices
22
Respiratory Management
23
Prevention of Pressure Ulcers
24
Bowel Bladder Management
25
Telemetry
Spinal Cord Injury at the VABHS is going live in
March 2009
26
Research Opportunities in SCI
Evidence-Based Practice
  • 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

27
Respite Care A Necessary Break for SCI
Caregivers
Profile of 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.

Profile of SCI Persons Utilizing Respite Care
Services
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.
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.
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.
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.
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.
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."         
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.
35
The VA Boston Healthcare System does offer
numerous clinical, educational and research
opportunities in Spinal Cord Injury Nursing.
36
The End!!!
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 2361.
  • 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 851740-1748.
  • Ledger, T, Pulfrey, A. (2008). Developing
    clinical research nurses. Nursing Management, 15,
    2.
  • Löfmark 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
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