Relationship of nursing education and care management inpatient rehabilitation interventions and patient characteristics to outcomes following spinal cord injury: the SCIRehab project.

OBJECTIVE: To investigate associations of nursing bedside education and care management activities during inpatient rehabilitation with functional, participation, and quality-of-life outcomes for patients with traumatic spinal cord injury (SCI). METHODS: In a prospective observational study, data were obtained by means of systematic recording of nursing activities by registered nurses (RNs), chart review and patient interview. RESULTS: Greater patient participation in nursing activities is associated with better outcomes. More time spent by RNs in coordination with other members of the care team, consultants and specialists, along with participation in physician rounds (team process) is associated with patient report of higher life satisfaction and higher CHART mobility at the one-year injury anniversary; more time providing psychosocial support is associated with higher CHART mobility and occupation scores and with greater likelihood of working or being in school at the anniversary. More time spent providing education about specific care needs is associated with several outcomes but not as consistently as might be expected. CONCLUSION(S): Higher levels of patient participation in nursing care activities is associated with multiple better outcomes, and hence, nurses should promote active patient participation during all aspects of care and interactions between themselves and patients with SCI. Time spent providing psychosocial support of patients and their families should be evaluated to ensure that other necessary education or care management interventions are not minimized. Note: This is the seventh of nine articles in the SCIRehab series.

The SCIRehab project: treatment time spent in SCI rehabilitation. Nursing bedside education and care management time during inpatient spinal cord injury rehabilitation.

BACKGROUND: Nurses are an integral part of the spinal cord injury (SCI) rehabilitation team and provide significant education to the patient and family about the intricacies of living with SCI, as well as help manage the care process. OBJECTIVE: This is the second in a series of reports by clinical nursing leaders involved in the SCIRehab research project, a multi-center, 5-year study to record and analyze details of SCI inpatient rehabilitation, with focus on descriptions of time spent by nurses on bedside education and care management. METHODS: Six hundred patients with traumatic SCI were enrolled at six rehabilitation centers. Nurses providing usual care to patients with SCI documented the content and amount of time spent on each bedside interaction using portable electronic devices with customized software or a newly developed customized page in electronic documentation systems; this included details of education or care management. Patient and injury characteristics, including level and nature of injury, were taken from the medical record. RESULTS: Nursing data for this report were derived from 42 048 shifts of nursing care. The mean total of nursing education and care management per patient was 30.6 hours (range 1.2-126.1, standard deviation (SD) 20.7, median 25.5). The mean number of minutes per week was 264.3 (range 33.2-1253, SD 140.9, median 241.9). The time that nurses spent on each activity was significantly different in each neurological injury group. Fifty percent of care management time was devoted to psychosocial support, while medication, skin care, bladder, bowel, and pain management were the main education topics. CONCLUSIONS: Nurses in SCI rehabilitation spend a significant amount of time providing education and psychosocial support to patients and their families. Typically, this is not included in traditional documentation systems. Quantification of these interventions will allow researchers to discern whether there are pertinent associations between the time spent on bedside activities and patient outcomes. The data will also be relevant for patient care planning and acuity staffing.