Respiratory Management Following Spinal Cord Injury - 26

RESPIRATORY MANAGEMENT FOLLOWING SPINAL CORD INJURY

Education Program Development
The respiratory management of people with SCI who are ventilator dependent requires complex physical, social, and psychological interventions. These interventions present an enormous challenge to the multidisciplinary health-care team, which must provide the educational support and self-care skills essential to long-term survival following SCI (Gardner et al., 1985; Gardner et al., 1986). People whose families and caregivers receive effective training and support during acute care and rehabilitation have fewer preventable secondary medical complications, fewer rehospitalizations, and more successful discharge outcomes (Prince et al., 1995; DiPasquale, 1986). 37. Plan, design, implement, and evaluate an educational program to help individuals with SCI and their families and caregivers gain the knowledge and skills that will enable the individual to maintain respiratory health, prevent pulmonary complications, return home, and resume life in the community as fully as possible.
(Scientific evidence–V; Grade of recommendation–C; Strength of panel opinion–Strong)

resulted in improved patient care and fewer complications (Vitaz et al., 2001). Provide support, reduce anxiety, clear up any misconceptions, and foster a sense of control among family members during the acute phase (Zedjlik, 1992). Establish the readiness of the patient, family members, and caregiver to learn, and engage the hands-on cooperation of family and peers in the training as soon as possible (Anderson, 1994). Individualize the approach to meet the specific social, emotional, educational, and cultural needs of the patient, family, and caregiver. Pay particular attention to learning styles, educational level, literacy, and fluency with English. Provide information in a supportive and sensitive manner, recognizing that the stress of SCI and ventilator dependency may disrupt the usual learning process. An information-only approach will not reduce anxiety among ventilator-dependent pediatric patients unless additional active relaxation components are implemented (Warzak et al., 1991). Prepare the patient for respiratory interventions before they occur to minimize feelings of anxiety and loss of control (La Favor, 2000). Warzak et al. (1991) suggest a relaxation package, including muscle relaxation and imagery techniques, to reduce anxiety during daily ventilator and tracheostomy care. Encourage the patient, family, and caregiver to actively participate in activities that foster learning about and commitment to respiratory care in real-world settings. Possibilities include trips and outings away from the health-care facility (DiPasquale, 1986; Prince et al., 1995). Make use of a wide variety of teaching methods, including written materials, interactive educational devices, games, SCI multimedia tools, videos, Web-based resources, individual and group sessions, and patient and family workshops (Heenan, 1999). Specify outcomes that are demonstrable, measurable, and observable. Evaluation and documentation of the outcomes should cover three areas: knowledge, performance of requisite skills, and feelings of confidence. Evaluation should occur throughout the process to measure the extent to which learning has occurred.

Patients, family members, and caregivers of individuals with SCI experiencing respiratory care issues need a comprehensive educational program to help them achieve the best possible outcome. To be effective, the program plan should follow these guidelines: Rely on established functional outcomes of the individual’s respiratory function, which includes the ability to breathe with or without mechanical assistance and to adequately clear secretions (Consortium for Spinal Cord Medicine, Clinical Practice Guideline: Outcomes Following Traumatic Spinal Cord Injury, 1999). The program should take into consideration contextual factors such as the patient’s physiological and psychosocial status, level of injury, medical stability, treatment protocols and therapies, method and place of care delivery, readiness to learn, and available resources (DiPasquale, 1986; Splaingard et al., 1983). Integrate patient, family, and caregiver education and support during all phases of care, from acute rehabilitation to community reintegration. The use of a clinical care pathway for spinal cord injuries, of which patient education is a critical component, has

Respiratory Management Following Spinal Cord Injury

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