Learning needs of spinal cord-injured patients

Perceptions of patient education in spinal cord injury rehabilitation

PURPOSE

Patient education is a key part of spinal cord injury (SCI) rehabilitation with the goal of preparing persons with SCI to meet life's daily challenges. The purpose of this study was to evaluate experiences of the patient education program from the patients' perspective.

METHODS

The qualitative design of this study involved a semi-structured interview format to gather descriptive information relevant to the aspects of the patient education program identified to facilitate or impede learning. Twenty-two patients participated in the individual interviews.

RESULTS

The framework that emerged from the analysis of the interview transcripts included a total of six main categories, two subcategories and two main themes. There were two central categories of Need to know and Information access and delivery that were influenced by categories of: Learning readiness, Learning affects, Problem exploration and Family involvement. The category of Information access and delivery included two subcategories labeled Resources and Learning strategies. From these categories the main themes of Learning partnership and Individuality were identified.

CONCLUSIONS

This research provides valuable information from the patients' perspective that may be used to enhance patient education programs. The importance of incorporating principles of adult learning is highlighted.

Evaluation of patient education in spinal cord injury rehabilitation: knowledge, problem-solving and perceived importance

PURPOSE

Through inpatient education programmes the person with spinal cord injury (SCI) learns to understand and monitor his or her own physical, emotional and social well-being. The purpose of this study was to determine the patients' knowledge and problem-solving skills regarding SCI at admission, discharge and follow-up at 6 months after discharge; and to determine the perceived importance of each content topic included in the education programme.

METHODS

A one-group repeated measures design was used to evaluate the outcomes. Knowledge was evaluated with a Multiple Choice Questionnaire (MCQ). Problem-solving ability based on participants' responses to Life Situation Scenarios relevant to each topic area was rated on a standardized four-point criterion reference scale. Perceived importance for each topic area was rated on a five-point Likert scale.

RESULTS

Twenty-three participants completed all assessments. There was significant improvement in MCQ scores from admission to discharge (P = 0.04) and admission to follow-up (P = 0.02). For problem-solving ability, there was a trend toward improvement in all content topics with significant improvement from admission to follow-up for the topic of bowel care (P = 0.004). However, many participants continued to demonstrate poor problem-solving ability. Bowel, Bladder and Skin Care were consistently perceived as the most important education topics.

CONCLUSIONS

Improvements in knowledge do not necessarily translate to improvements in problem-solving ability even for the topics perceived as important. This may indicate the need to incorporate more active learning strategies or contextually based strategies within patient education programmes to facilitate the transfer of knowledge within life situations.

Developing the nurse's role in patient education: rehabilitation as a case example

Over the past decade considerable emphasis has been placed on the nurse's role in patient education. Despite this numerous studies have suggested that this aspect of nursing practice is under-developed. Using rehabilitation as a case example this paper explores the nursing contribution to patient education in five conditions: multiple sclerosis; arthritis; myocardial infarction; spinal injury and stroke. Although the literature identifies considerable potential for nurses to take a lead role in patient education this is rarely achieved in practice. Analyses of printed curricula from a range of courses indicate that nurses are not adequately prepared for patient education and that a reorientation of nurse education is required.

Rehabilitation following spinal injury: the nursing response

Spinal cord injury is one of the most unexpected and devastating of events that typically affects young people, often males. Thus it stands in stark contrast to both multiple sclerosis and arthritis, the conditions considered in the previous two articles of this series. The differences do not end here as spinal injury is relatively stable once the initial phase has passed, whereas both multiple sclerosis and arthritis are progressive. However, despite this variation the literature suggests that rehabilitation in all three conditions raises similar concerns. This article focuses on these concerns and how nurses can respond to them.

Educational interests of individuals with spinal cord injury living in the community: medical, sexuality, and wellness topics

As a component of Baylor College of Medicine study of the life status of people with spinal cord injury (SCI), this study determined the educational topics of interest to a cohort of 590 adults with SCI living in the community. Thirty-five items in nine topic areas were included in the inventory. Three topic areas--medical, sexuality, and wellness--are discussed in this article. Across the three topic areas, the five topics of greatest interest were exercise programs, testing of nerve and muscle function, bladder or kidney problems, pain, and sexuality issues. Information about smoking cessation and alcohol or drug abuse was of interest to very few participants. Ten grouping variables were analyzed and individual differences, such as educational level and whether an individual had paraplegia or quadriplegia, were found to account for differences in the topics of interest. The results of this study can be used in setting priorities for the development of educational activities and learning experiences for individuals with SCI living in the community.

Rehabilitation learning needs: patient and family perceptions

Understanding consumer needs for information provides the foundation for empowering patients and families to assume more responsibility for their own care both in hospital and after discharge. Self administered questionnaires identified adult rehabilitation learning needs from the perspectives of patients and their families both during and following hospitalization. The greatest needs for both groups in both time periods were for information about medical, psychosocial and community integration topics. During the in-patient phase, families identified high needs for information which suggests that they should be targeted for educational activities along with patients. Surveys repeated 6 weeks following discharge indicated that information needs were lower but continued to exist.