A strategy to facilitate renewed resilience to re-establish meaning for persons with spinal cord injuries
- Authors: Willemse, Hermanus Barend
- Date: 2013
- Subjects: Spinal cord -- Wounds and injuries , Spinal cord -- Wounds and injuries -- Rehabilitation
- Language: English
- Type: Thesis , Doctoral , DPhil
- Identifier: vital:10021 , http://hdl.handle.net/10948/d1008119 , Spinal cord -- Wounds and injuries , Spinal cord -- Wounds and injuries -- Rehabilitation
- Description: Census estimates in 2010 indicated that 6,3 percent South Africans aged 5 years and older are currently classified as disabled in five of the nine provinces in the country. The national figure for 2005 was 5 percent, with the figure for females (6,5 percent) slightly higher than that for males (6,1percent). Spinal cord injured persons and their significant others experience a range of emotions which affect their relationships with themselves, others and their environment. To deal with the life-changing consequences of the injury and regain control, these persons not only require a variety of coping strategies but rediscovery of resilience is inevitable if the experience of personal purpose and meaningful existence is ever to be regained. In the Nelson Mandela Bay Municipal area, Port Elizabeth, South Africa – the geographical area in which this research study was undertaken - persons with spinal cord injuries have many challenges to face due to the shortcomings the existing resource for health care delivery in the post-discharge phase. The research objectives identified for the study were, firstly, to explore and describe the lived experiences of persons with spinal cord injuries; secondly, to explore and describe the lived experiences of the significant others of persons with spinal cord injuries; and thirdly, to develop a strategy to guide the professional nurse and the health care team in facilitating the health care of persons with spinal cord injuries. The study was a qualitative, exploratory, descriptive, and contextual method of inquiry. The data obtained was used to formulate the strategy with its three sub-strategies to guide professional nurses and the health care team to facilitate renewed resilience and the re-establishment of meaning for persons with spinal cord injuries. Although the experiences of the significant others were explored in order to thicken the description of the experiences of persons with spinal cord injuries, the strategy developed was limited to the persons with spinal cord injuries. Although it is well documented that there are significant physical needs, the themes that emerged from the current research mostly related to psychological and social aspects. In acknowledging the human being as unitary multi-dimensional being, the researcher in his discussions and quest to address the issue of renewed resilience in spinal cord injured persons towards finding purpose and re-establishing meaning in their lives, focused on their psychological, spiritual and social health. The outcome of the study is a strategy constructed to facilitate renewed resilience, and three sub-strategies ‘addressing experienced emotions’, ‘facilitating meaningful relationships’ and ‘facilitating effective coping’. The strategy has as purpose the empowering of spinal injured persons in their efforts to re-establish meaning by serving as a tool to guide professional nurses and members of the health care team in their facilitating of renewed resilience in persons with spinal cord injury. It is envisaged that the co-ordination of the strategy will take place from the health care delivery facility nearest to the spinal cord injured individual concerned. In order for persons with spinal cord injuries to become accountable members of society, all levels and aspects of care aimed at physical, psychological, spiritual and social well-being need to be holistically addressed. The front-line role of the professional nurse is vital as the professional nurse acts as the co-ordinator for the health care team in ensuring that persons with spinal cord injuries receive quality and holistic care in order to deal meaningfully with the life-altering consequences of a spinal cord injury. Through this study, valuable insight was gained with regard to experiences of both persons with spinal cord injuries and that of their significant others. Recommendations were made for nursing practice, nursing education and nursing research.
- Full Text:
- Date Issued: 2013
- Authors: Willemse, Hermanus Barend
- Date: 2013
- Subjects: Spinal cord -- Wounds and injuries , Spinal cord -- Wounds and injuries -- Rehabilitation
- Language: English
- Type: Thesis , Doctoral , DPhil
- Identifier: vital:10021 , http://hdl.handle.net/10948/d1008119 , Spinal cord -- Wounds and injuries , Spinal cord -- Wounds and injuries -- Rehabilitation
- Description: Census estimates in 2010 indicated that 6,3 percent South Africans aged 5 years and older are currently classified as disabled in five of the nine provinces in the country. The national figure for 2005 was 5 percent, with the figure for females (6,5 percent) slightly higher than that for males (6,1percent). Spinal cord injured persons and their significant others experience a range of emotions which affect their relationships with themselves, others and their environment. To deal with the life-changing consequences of the injury and regain control, these persons not only require a variety of coping strategies but rediscovery of resilience is inevitable if the experience of personal purpose and meaningful existence is ever to be regained. In the Nelson Mandela Bay Municipal area, Port Elizabeth, South Africa – the geographical area in which this research study was undertaken - persons with spinal cord injuries have many challenges to face due to the shortcomings the existing resource for health care delivery in the post-discharge phase. The research objectives identified for the study were, firstly, to explore and describe the lived experiences of persons with spinal cord injuries; secondly, to explore and describe the lived experiences of the significant others of persons with spinal cord injuries; and thirdly, to develop a strategy to guide the professional nurse and the health care team in facilitating the health care of persons with spinal cord injuries. The study was a qualitative, exploratory, descriptive, and contextual method of inquiry. The data obtained was used to formulate the strategy with its three sub-strategies to guide professional nurses and the health care team to facilitate renewed resilience and the re-establishment of meaning for persons with spinal cord injuries. Although the experiences of the significant others were explored in order to thicken the description of the experiences of persons with spinal cord injuries, the strategy developed was limited to the persons with spinal cord injuries. Although it is well documented that there are significant physical needs, the themes that emerged from the current research mostly related to psychological and social aspects. In acknowledging the human being as unitary multi-dimensional being, the researcher in his discussions and quest to address the issue of renewed resilience in spinal cord injured persons towards finding purpose and re-establishing meaning in their lives, focused on their psychological, spiritual and social health. The outcome of the study is a strategy constructed to facilitate renewed resilience, and three sub-strategies ‘addressing experienced emotions’, ‘facilitating meaningful relationships’ and ‘facilitating effective coping’. The strategy has as purpose the empowering of spinal injured persons in their efforts to re-establish meaning by serving as a tool to guide professional nurses and members of the health care team in their facilitating of renewed resilience in persons with spinal cord injury. It is envisaged that the co-ordination of the strategy will take place from the health care delivery facility nearest to the spinal cord injured individual concerned. In order for persons with spinal cord injuries to become accountable members of society, all levels and aspects of care aimed at physical, psychological, spiritual and social well-being need to be holistically addressed. The front-line role of the professional nurse is vital as the professional nurse acts as the co-ordinator for the health care team in ensuring that persons with spinal cord injuries receive quality and holistic care in order to deal meaningfully with the life-altering consequences of a spinal cord injury. Through this study, valuable insight was gained with regard to experiences of both persons with spinal cord injuries and that of their significant others. Recommendations were made for nursing practice, nursing education and nursing research.
- Full Text:
- Date Issued: 2013
Respiratory management of the mechanically ventilated spinal cord injured patient in a critical care unit
- Authors: Love, Janine Ann
- Date: 2013
- Subjects: Respirators (Medical equipment) , Critical care medicine , Intensive care units , Spinal cord -- Wounds and injuries
- Language: English
- Type: Thesis , Masters , MCur
- Identifier: vital:10031 , http://hdl.handle.net/10948/d1008451 , Respirators (Medical equipment) , Critical care medicine , Intensive care units , Spinal cord -- Wounds and injuries
- Description: Background: Spinal Cord Injuries (SCIs) are traumatic, life-changing injuries that can affect every aspect of an individual's life and can lead to death if not treated timeously and appropriately. Respiratory complications occur frequently after the SCI and are the leading cause of mortality and morbidity. Respiratory complications are predictable based on the neurological level of impairment of the spinal cord lesion; the higher the neurological injury, the more severe the respiratory complication. Changes in pulmonary function, poor cough, hypersecretion, immobility and bronchospasm all contribute to the development of respiratory complications. If the patient is unable to protect his/her airway or if respiratory failure occurs, mechanical ventilation is often required. Many patients require prolonged ventilation and subsequently need to go for tracheostomies. The critical care nurse plays an important role in the early identification of complications and can, therefore, act to limit and prevent these complications, which may be a direct result from the injury or treatment modality such as mechanical ventilation. Respiratory management has been promoted in preventing and treating respiratory complications and is associated with better prognosis in the SCI patient. Design and method: The research study aims to explore and describe existing literature and to make recommendations for the respiratory management of a mechanically ventilated spinal cord injured patient in a critical care unit (CCU). A systematic review was undertaken with clear inclusion and exclusion criteria. Ethical principles were maintained throughout the study. The quality of the study was ensured by critically appraising data that was utilized in the systematic review. It is envisaged that the results from this systematic review will improve the respiratory management of the SCI patient and prevent any variations in practice. Results: Were presented under the following themes: priorities of care for the SCI patient in the acute phase, during the critical care phase and preventative care. Conclusion: The SCI patient regardless of the neurological level or completeness of injury should be admitted to the CCU for intensive ventilatory, cardiopulmonary support and hemodynamic monitoring in order to detect and prevent respiratory complications. The use of larger tidal volumes is associated with improved comfort and less dyspnea however if a patient has acute lung injury or ARDS the use of low tidal volumes 6ml/kg is recommended. Prevention and early identification of respiratory complications is associated with improved outcomes for the SCI patient.
- Full Text:
- Date Issued: 2013
- Authors: Love, Janine Ann
- Date: 2013
- Subjects: Respirators (Medical equipment) , Critical care medicine , Intensive care units , Spinal cord -- Wounds and injuries
- Language: English
- Type: Thesis , Masters , MCur
- Identifier: vital:10031 , http://hdl.handle.net/10948/d1008451 , Respirators (Medical equipment) , Critical care medicine , Intensive care units , Spinal cord -- Wounds and injuries
- Description: Background: Spinal Cord Injuries (SCIs) are traumatic, life-changing injuries that can affect every aspect of an individual's life and can lead to death if not treated timeously and appropriately. Respiratory complications occur frequently after the SCI and are the leading cause of mortality and morbidity. Respiratory complications are predictable based on the neurological level of impairment of the spinal cord lesion; the higher the neurological injury, the more severe the respiratory complication. Changes in pulmonary function, poor cough, hypersecretion, immobility and bronchospasm all contribute to the development of respiratory complications. If the patient is unable to protect his/her airway or if respiratory failure occurs, mechanical ventilation is often required. Many patients require prolonged ventilation and subsequently need to go for tracheostomies. The critical care nurse plays an important role in the early identification of complications and can, therefore, act to limit and prevent these complications, which may be a direct result from the injury or treatment modality such as mechanical ventilation. Respiratory management has been promoted in preventing and treating respiratory complications and is associated with better prognosis in the SCI patient. Design and method: The research study aims to explore and describe existing literature and to make recommendations for the respiratory management of a mechanically ventilated spinal cord injured patient in a critical care unit (CCU). A systematic review was undertaken with clear inclusion and exclusion criteria. Ethical principles were maintained throughout the study. The quality of the study was ensured by critically appraising data that was utilized in the systematic review. It is envisaged that the results from this systematic review will improve the respiratory management of the SCI patient and prevent any variations in practice. Results: Were presented under the following themes: priorities of care for the SCI patient in the acute phase, during the critical care phase and preventative care. Conclusion: The SCI patient regardless of the neurological level or completeness of injury should be admitted to the CCU for intensive ventilatory, cardiopulmonary support and hemodynamic monitoring in order to detect and prevent respiratory complications. The use of larger tidal volumes is associated with improved comfort and less dyspnea however if a patient has acute lung injury or ARDS the use of low tidal volumes 6ml/kg is recommended. Prevention and early identification of respiratory complications is associated with improved outcomes for the SCI patient.
- Full Text:
- Date Issued: 2013
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