The Concept of Nursing used in the treatment of a Paraplegic Patient

The Concept of Nursing used in the treatment of a Paraplegic Patient

The Concept of Nursing used in the treatment of a Paraplegic Patient

Introduction

At present, each year, between 750 and 1000 Paraplegic people experience a new spinal cord injury (SCI) in the UK (Grundy and Swain, 1996 and Grundy and Swain, 2002), while the observed average annual number of new cases is 1000 in Taiwan (Yang and Wang, 2001). Unfortunately, the exact number is unknown, because SCI is not a notifiable condition. The leading causes of SCI were traffic accidents, especially motorcycle, in both UK and Taiwan (Chen et al., 1997; Grundy and Swain, 2002).

SCI is one of the most disastrous injuries a person may experience. It has been identified as a high cost disability requiring tremendous change in a patient's lifestyle, accompanied by numerous physical and psychological stresses (Lou et al., 1997). SCI affects every aspect of the person's life. Adjustment to dramatic changes in functioning, lifestyle, roles, vocation, family, and social relationships is an individualized process that continues throughout the lifetime. Following such injury, all aspects of self-concept are threatened. The Roy and Andrews Adaptation Model (1991) is the only nursing model which defines self-concept—physical self and personal self. Payne and Walker (1997) propose that self-concept is composed of self-image and self-esteem. If patients have a negative self-concept, they will never return to their previous lifestyle and personal relationships will deteriorate. It is during rehabilitation in hospital that the role of the rehabilitation nurse moves from an emphasis on care to a position in which she assists the patients to motivate themselves to regain a measure of independent living and the ability to reintegrate themselves (Lindsey, 1995; Wirtz et al., 1996). In so doing, they can learn to live with dignity.

Paraplegia

Paraplegia is an impairment in motor and/or sensory function of the lower extremities. It is usually the result of spinal cord injury or a congenital condition such as spina bifida which affects the neural elements of the spinal canal. The area of the spinal canal which is affected in paraplegia is either the thoracic, lumbar, or sacral regions. If the arms are also affected by paralysis, tetraplegia is the proper terminology.

Causes

The causes range from trauma (acute spinal cord injury: transsection or compression of the cord, usually by bone fragments from vertebral fractures) to tumors (chronic compression of the cord), myelitis transversa and multiple sclerosis.

Any disease process affecting the corticospinal or pyrimidal tracts of the spinal cord from the thoracic spine downward may lead to paraplegia. These tracts are responsible for movement or the "instructions" for movement from the brain to the anterior horncells respectively. The most common cause of paraplegis (and all spinal cord injuries) is motor vehicle accidents. Other causes include violence, sports, cancer (tumors) involving the epidural or dural space, vertebral fractures and myelitis transversa. Gunshot wounds to the spine, although decreasing, are one of the major causes of paraplegic spinal cord injuries (for instance, Ron Kovic, ...