Nursing bedside education and care management time during inpatient spinal cord injury rehabilitation

Abstract

BackgroundNurses 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.ObjectiveThis 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.MethodsSix 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.ResultsNursing 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.ConclusionsNurses 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.