Knowledge and attitudes of nurses regarding patients with spinal cord injuries

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ACHAIKI IATRIKI | 2024; 43(3):111–117

Original Research Article

Nikos Kalaitzis1, Panagiotis Plotas2, Nikos Stefanopoulos3, Maria Lagadinou4,5

1General Hospital Athens “KAT”, Athens, Greece
2Laboratory Primary Health Care School of Health Rehabilitation, University of Patras, Patras, Greece
3Nursing Department, University of Patras, Patras, Greece
4Department of Internal Medicine University Hospital of Patras, Patras, Greece
5Medical School University of Patras, Patras, Greece

Received: 20 Mar 2024; Accepted: 11 Jul 2024

Corresponding author: Maria Lagadinou, Assistant Professor of Internal Medicine, e-mail: mlagad@upatras.gr

Key words: Spinal cord, injury, psychological disorders, caregivers, attitudes

 

Abstract

Background and Aim: Traumatic spinal cord injury (SCI) affects 27–59 individuals per million globally, with a bimodal distribution, predominantly impacting young adults through motor vehicle accidents and older individuals through accidental falls. Significant efforts have been made to evaluate SCI severity and recovery potential, but there is a gap in knowledge about SCI and its related complications. This study aimed to assess nurses’ knowledge and practice in caring for patients with spinal cord injury.

Methods: We provided a cross-sectional study which included 86 nurses of both genders. Our survey utilized a questionnaire developed by our research team, based on prior studies for collecting data on their experiences and challenges in caring for SCI patients.

Results: A significant number of participants reported that the greatest difficulties encountered involve the family environment of SCI patients. A statistically significant correlation was found between the work department and the quality of care provided to SCI patients. Nurses working in rehabilitation centers provided the best care (p<0.05) compared to those in Intensive Care Units (ICUs) and Emergency Departments. Additionally, there was a significant correlation (p = 0.03) between the nurses’ educational level and their perception of providing optimal care to SCI patients.

Conclusion: While the age of professionals, frequency of caring for SCI patients, and nursing experience may influence attitudes towards SCI patients, the most reliable factors appear to be the nurses’ educational level and the work department.

INTRODUCTION

Spinal cord injury (SCI) refers to damage to any part of the spinal cord or nerves, often resulting in permanent changes in strength, sensation, and other body functions below the site of the injury [1]). SCI is classified into two types: complete and incomplete. Traumatic SCI occurs in 27–59 individuals per million population globally and exhibits a bimodal distribution, with peaks among young adults and older individuals, primarily due to motor vehicle accidents and accidental falls, respectively [2,3].

Patients with SCI face increased risks of secondary health conditions, such as pressure ulcers, deep venous thrombosis, and urological complications. Efforts have been concentrated on evaluating SCI severity and predicting recovery potential. Healthcare providers play a crucial role in explaining and discussing these risks with SCI patients and their caregivers. Besides providing psychosocial support, discharge planning, and consulting with other caregivers as part of a team process, nursing staff are pivotal in educating patients and family members about the physiological changes resulting from traumatic SCI, including secondary complications. Despite these responsibilities, there is a notable gap in knowledge about SCI and its related complications [4].

Nurses are integral to the care of patients with acute traumatic spinal cord injuries throughout the entire care journey. While research on the experiences of nurses caring for these patients in acute settings is limited, numerous studies worldwide are exploring treatments and rehabilitation methods to help individuals with SCI remain productive and live independently [5,6].

Recognizing the challenges faced by nurses in providing care for patients with life-changing injuries, this study aims to assess the knowledge and practices of nurses regarding the care of patients with spinal cord injury.

MATERIAL AND METHODS

We conducted a cross-sectional study in KAT Attica General Hospital from January to May 2023. The study involved nurses from the Emergency Department, Intensive Care Unit (ICU), and Rehabilitation Center. Participants were randomly selected without any exclusion criteria. Detailed information regarding the study aims and data confidentiality was provided to all potential participants. Nurses who consented to participate were required to complete an anonymous questionnaire.

Our survey utilized a questionnaire developed by our research team, based on prior studies. The questionnaire was designed following a systematic review of all online medical search engines and was piloted with a small number of nurses before the study commenced to allow for necessary adjustments. Written in Greek, the questionnaire comprised two parts: Part A included four questions on demographic characteristics, work experience duration, and educational level and Part B consisted of twenty-one questions addressing knowledge and attitudes towards the care of patients with spinal cord injury and their caregivers. The answers were limited to “yes” or “no” (Table 1).

This study received approval from the Institutional Ethics Committee (University of Patras: 98828/19.12.2022, Referral Hospital: 1186/11.11.2022) and was conducted in accordance with the Guidelines of the Declaration of Helsinki. Participant anonymity was ensured throughout the study.

DATA ANALYSIS

Data were analyzed using the Statistical Package for Social Sciences (IBM SPSS software) version 27.
A significance level of 0.05 was set for all analyses.

RESULTS

The study included 86 nurses from both genders. Table 2 represents the demographic characteristics of the participants, highlighting that the majority were women (75.6%).

Figures 1a and 1b illustrate the self-reported knowledge and attitudes of nurses towards patients with spinal cord injuries. It is remarkable that of all the negative answers, the higher percentages gathered those related to the family environment of patients with spinal cord injuries. The question ”In your opinion, is it easy to train the family environment for the care of a patient with spinal cord injuries?” received the highest percentage of negative responses (57%). While a slightly lower percentage was gathered by the question “Do you believe that a family environment of a patient could meet the   demands of his care after spinal cord and spinal column injuries?” (50%).

Figure 1a and 1b. Knowledge and attitudes of nurses on problems patients with spinal cord injuries confront.

x2 correlations between educational level and responses to each question

A statistically significant correlation (p = 0.03) was found between educational level and responses to Q7: “Do spine and spinal cord injury patients consider themselves to be getting the best care they need from you?”. Multiple correlations showed that more nurses with two years of training (76.5%) responded positively to this question compared to nurses with a master’s degree (32%), while nurses with a university degree responded positively in 61.4% of cases. No other statistically significant correlations were reported. All measurements are shown in Table 3.

x2 correlations between work department and responses to each question

A statistically significant correlation (p = 0.02) was found between the work department and responses to Q1: “Do you give the same care to patients with acute organic psychosyndrome as to patients without?”. More nurses in the Intensive Care Unit (84.2%) gave a positive answer compared to those working in the Emergency Department (54.5%). Another statistically significant correlation (p < 0.05) was found between the work department and responses to Q7. All nurses (100%) working in the Rehabilitation Center answered positively to that question, whereas those in the Intensive Care Unit responded positively in 49.1% of cases. No other statistically significant results were reported. All measurements are shown in Table 4.

DISCUSSION

To our knowledge, this is the first study in a Greek hospital that has formally assessed the awareness and knowledge of nurses regarding SCI patients. The sample size involved and response rate in the present study (n=86) were comparable to other foreign published studies.

Most of the participants demonstrated that spine and spinal cord patients get the best care they need. Similarly, there is a large body of literature related to rehabilitation nursing care for patients with SCI; however, little research focuses on how this care may influence outcomes, such as length of stay (LOS), complications, and quality of life [4]. It is well known that the delay in accessing rehabilitation is associated with reduced quality of life and opportunity for independence [7]. McRae et al., reported that psychosocial and emotional adjustments are influenced by support received, especially from family members although increased caregiver burden has been identified in those caring for people with spinal injuries during and after rehabilitation [7].

Most of the participants answered that it is not easy to train the family environment of the spine or spinal cord injury patient in their care. Nevertheless, it is essential to maximally understand the capacity of family members in order to provide quality care to patients with SCI [8]. On the other hand, they answered that the family cannot cope with the demands of caring. Family caregivers are in touch with SCI patients and feel committed to them more than any other person [8]. Psychosocial support for patients and their families emerged as the most common component of care management for spinal cord injury groups. The provision of psychosocial support is important and may contribute to improved patient outcomes. In addition to supporting their patients physically and psychologically, family caregivers help patients accomplish their daily activities, reducing the care burden imposed on health systems, the need to use professional home care, and the rate of admission to nursing homes [8]. Decision makers who plan staffing for SCI rehabilitation centers should consider the time consumed for psychosocial support addressing both the patients and the family environment [4].

Most of the nurses with basic (two years) education (76.5%) and 61.9% of nurses with university education answered that spinal cord injury patients get the best care they need from them. This can be interpreted as the higher level of education and clinical experience might be associated with more time spent in interdisciplinary conferences on this category of patients [7]. Moreover, strengthening nursing in rehabilitation (through clinical experience and training) is a vital factor in delivering high-quality care and to ensure that rehabilitation can meet the needs of persons experiencing disability and achieve optimum health outcomes [8].

In our study, 100% of rehabilitation nurses answered that they give the best to patients with spinal cord injuries. It is important to create opportunities for nurses to specialize in rehabilitation nursing. Rehabilitation service providers should ensure that positions of specialized rehabilitation nurses are included in the rehabilitation team. This approach will enable people experiencing disability to achieve optimal functioning, independent living and quality of life [7].

Spinal cord injuries have a large negative impact on patients’ physical and mental health (organic psychosyndrome). Effective nursing measures are effective in the critical period of treatment and can prevent the recurrence of illness by paying close attention to the psychological and neuropsychiatric changes of SCI patients. Therefore, in the process of improved nursing measures humanized care and patient-centered care concepts should be adopted [10].

Our study has some limitations. Initially, it is geographically limited to only one General Hospital and not to other hospitals in the country. Still, the number of nurses enrolled is small. Finally, the questionnaires were completed on a voluntary basis and, therefore, some did not want to participate in the research.

Our questionnaire-based survey, which appears to be representative of the population of interest, identified significant differences in the attitudes toward patients with spinal cord injuries between nurses who work in the rehabilitation center, intensive care unit and emergency department. Although the professionals’ age, the frequency of caring for patients with SCI and the time of nursing experience may influence the nurses’ attitudes towards SCI patients, the most reliable factors associated with the attitudes seem to be the nurses’ level of education and work department.

Conflicts of interest: The authors declare that there are not any conflicts of interest.

Declaration of funding sources: No grants or funding were received.

Author contributions: All authors of this manuscript have directly participated in the planning, execution, or analysis of this study; all authors of this paper have read and approved the final version submitted.

Ethics approval: This study received approval from the Institutional Ethics Committee (University of Patras: 98828/19.12.2022, Referral Hospital: 1186/11.11.2022) and was conducted in accordance with the Guidelines of the Declaration of Helsinki. Participant anonymity was ensured throughout the study.

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