Deborah L. Downey MN, CNRN, ANP-BC Heidi Maloni, PhD, ANP-BC Cassandra Miller-Hardwick, MSN, RN, CRRN

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1 Deborah L. Downey MN, CNRN, ANP-BC Heidi Maloni, PhD, ANP-BC Cassandra Miller-Hardwick, MSN, RN, CRRN

2 Disclosures Deborah Downey Has no financial interest or relationships to disclose Heidi Maloni Has no financial interest or relationships to disclose Cassandra Miller-Hardwick Has no financial interest or relationships to disclose

3 Learning Objectives At the conclusion the participant will be able to: Recognize and understand the unique care needs of SCI, MS, and ALS veterans across all settings. Identify and discuss competencies expected to meet the needs of this patient population. Identify ways to enhance collaboration and networking among nurses providing care for SCI, MS, and ALS patients.

4 Abstract Spinal cord injury (SCI) nurses practice with expertise and competencies in managing key issues in spinal cord disease. SCI nurses practice typically in the inpatient and rehabilitation setting. Multiple sclerosis (MS) nurses practice with expertise in the care of the veteran living with MS most commonly in outpatient settings and home based care. Patients with amyotrophic lateral sclerosis (ALS) receive care from nurses in a variety of settings to include: Spinal cord injury, Pulmonary, Medicine, Neurology and Homebased primary care.

5 Abstract The advent of Spinal Cord Injury and Disease integration has expanded practice guidelines, blended roles, and traversed settings of care for nurses who care for SCI, ALS and MS patients. This session aims at meeting the SCI, ALS and MS patient needs through understanding best practices in both SCI, ALS and MS nursing care across settings and across diseases. The session will adopt a case study approach with the aim of integrating best practices and optimizing care for SCI, ALS and MS patients.

6 Abstract SCI case studies will emphasize care needs related to bowel, bladder, skin, and autonomic dysreflexia, prevention and management; MS case studies will emphasize care needs related to cognition, immunization, complementary and alternative medicine, and disease modifying therapies; and, ALS case studies will emphasize care needs related to diet, respiratory, communication, and assisted technologies

7 Continuing and facilitating the care of spinal cord patients that require care on an acute med/surg unit requires a strong collaborative relationship between inpatient SCI/D nurses and acute care nurses It is vitally important that we provide ongoing support and education for med/surg colleagues to ensure the continuation of basic SCI/D cares and services until the patient is stable enough to transfer to the SCI/D center.

8 Off-service Care SCI/D patients are admitted to the Medicine Service for a variety of reasons, including but not limited to Urosepsis, Pneumonia, DVT, Cardiac events, and other diagnosis requiring Internal Medicine specialty care. Regardless of the reason for an admission to an acute unit, the following nursing care needs are of significant importance: Bowel and Bladder management Pressure Ulcer prevent and management Mobility issues Equipment needs Preservation of Independence Autonomic Dysreflexia prevention and management

9 Bowel and Bladder Management Continuation of established Bowel and Bladder management programs is vitally important and requires a collaborative approach that includes the patient and the SCI/D team. One of the challenges that patients face is the inability to maintain established routines. Incorrect orders or inadvertent changes in bowel and bladder program Staff competency/comfort/willingness to perform steps of the established bowel program Changes in bladder drainage method upon admission by admitting provider

10 Pressure Ulcer Prevention and Mgmt Establishing appropriate pressure ulcer related activity orders is important to promote healing and patient independence The correct bed frame and mattress is also very important! One size does not fit all Bed rest is not always required for patients with pressure ulcers. Innovative approaches to PU management can allow the patient time up in their chair throughout the day Strict sitting and turning and repositioning schedules can be challenging on non-rehab units

11 Equipment Needs Bedside equipment Alternative Call lights systems Soft touch Sip & Puff Tent Other types Bed control options/assistive technology Appropriate Commode/shower chair options

12 Mobility and Independence Storage and maintenance of wheelchairs in a standard hospital room. Is there room for the chair? Power wheel chairs with elaborate accessories Lateral supports Head array Various control options Limb support Proper installation/positioning of cushions

13 Autonomic Dysreflexia Prevention and management All of the areas discussed can have a potential impact on the development of Autonomic Dysreflexia (AD) in patients at risk It is vitally important that our acute care/med- Surg colleagues are aware of the signs and symptoms of AD and the importance of Listening to the patient when it comes to this life threating emergency

14 As you can seem our patients face many challenges when they are admitted to a non- SCI/D unit in addition to the medical reasons for the admission. There are also unique issues related to Outpatient Care for SCI/D patients Initial and Ongoing education/training for all nursing staff in the following areas is very important to facilitate continuation of established care routines:

15 Bowel and Bladder management How to preform a proper bowel program Specific competency for use of specialty catheters Instructions on how to obtain specialty catheters Pressure Ulcer prevent and management Ongoing training and education on pressure ulcer management with special focus on the needs of SCI patients Early involvement of the WOCN for guidance and consultation related to PU treatment, bed/mattress selection

16 Equipment needs Availability of alternative call lights Annual SPH competency for staff Increase availability of commode/shower chairs Mobility issues Involve PT and OT colleagues when needed for Just in time training related to wheel chairs and cushions Autonomic Dysreflexia prevention and management Initial and ongoing education and training for all staff Autonomic Dysreflexia prevention and management

17 Continuing and facilitating the care of spinal cord patients that require care on an acute med/surg unit requires a strong collaborative relationship between inpatient SCI/D nurses and acute care nurses It is vitally important that we provide ongoing support and education for med/surg colleagues to ensure the continuation of basic SCI/D cares and services until the patient is stable enough to transfer to the SCI/D center.

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