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 VA’s 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 33%VA) (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 Swimming Handcycling 5K 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

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 • cordinjured veterans.

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: 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; 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. • 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