A body of nursing knowledge in rehabilitation cannot be attained until the specific problems nurses encounter in their work are identified. The purpose of this study was the identification of some of the specific nursing problems in relation to the paraplegic. This study included interviews with seventeen nurses caring for paraplegics during the three stages of their rehabilitation, during the acute stage, during the time of intensive rehabilitation, and after returning to the community. A basically unstructured interview method was used, permitting the nurses a wide scope in identifying nursing problems they had encountered. The specific nursing problems were summarized within components of a typology developed during the study. A total of sixty-eight different specific nursing problems were identified a total of 247 times. The greatest number of different specific nursing problems, fourteen, were within the component of the typology of psychological-emotional problems. The psychological-emotional problem identified most frequently, twelve times, was that of trying to help the paraplegic face the future as a disabled person. The largest per cent of the total number of nursing problems identified, 35.22 per cent, were within the component of the typology of physical problems. The three most frequently identified nursing problems were within this component. These were, maintaining the bowel and bladder function, thirty-one times, maintaining the integrity of the skin, twenty times, and being alert for complications, sixteen times. The largest number of different nursing problems, thirty, and the greatest per cent of the total number of nursing problems, 63.56 per cent, concerned the paraplegic himself. Seventeen different nursing problems, 19.84 per cent of the total number of nursing problems identified, concerned the paraplegic's relationship to those outside of the health care system. There were sixteen different nursing problems, 12.96 per cent of the total number of nursing problems, concerned with the paraplegic's relationship to the health care system. The remaining 3.64 per cent of the total number of nursing problems, five different ones, concerned the paraplegic's inanimate surroundings. Research should be done to discover the best way of solving the specific nursing problems identified in this study. Many of them are currently being dealt with by intuition or trial and error, others are being ignored. It also would be well to discover what paraplegics identify as their needs or problems as they move through the various stages of the rehabilitation program. Nursing which is aimed at helping the paraplegic accomplish his goals should be alert to what he regards as his problems and help him arrive at a satisfactory solution to them. / Applied Science, Faculty of / Nursing, School of / Graduate

Thesis (MSc (Interdisciplinary Health Sciences. Speech-Language and Hearing Therapy))--University of Stellenbosch, 2009. / ENGLISH ABSTRACT: Spinal cord injury is a devastating sudden cause of disability which renders a person paralyzed and dependent on care immediately after the incident. A person who has suffered a spinal cord injury requires an intensive rehabilitation program to achieve physical independence as well as reintegration into the community. The aim of this study was to evaluate the rehabilitation program for patients with complete paraplegia at the Netcare Rehabilitation Hospital, a 120 bed private rehabilitation facility in Johannesburg, where rehabilitation for patients with physical disabilities is offered by an interdisciplinary team. The rehabilitation program was evaluated in terms of effectiveness including the degree of physical independence the patients achieved and how well the program prepared patients for successful integration into the community. The Functional Independence Measure (FIM), a standardized outcome measure that measures certain physical and cognitive functions and the Needs Assessment Checklist (NAC), an instrument designed to assess if the rehabilitation program is geared towards the patients’ individual needs were used as outcome measure. FIM scores were determined on admission and discharge and NAC scores were determined at discharge. A convenient, consecutive sample of sixteen patients with complete paraplegia (ASIA A), with a neurological level between T1 and T12, formed the study population. Consistently high FIM and NAC scores in the area of physical functioning suggested that the rehabilitation program at Netcare Rehabilitation Hospital was effective in terms of providing patients with physical independence. However, NAC results showed that the patients were not completely ready to reintegrate back to their communities. Areas that were identified as particularly problematic were knowledge on follow up health care services in the community, readiness for work and accessibility of the home and work environments. Therefore it is recommended that the rehabilitation team re-evaluate the program and incorporate strategies with the aim to improve it’s effectiveness in terms of preparing patients for community reintegration. It is also recommended that further research is conducted to assess the current success rate with regards to community reintegration and determine challenges to re-integration in order to assist with program panning. / AFRIKAANSE OPSOMMING: ‘n Spinaalkoordbesering is ‘n skielike oorsaak van gestremdheid wat die persoon verlam en afhanklik van sorg laat direk na die voorval. ‘n Persoon wat ‘n spinalkoordbesering opdoen benodig ‘n intensiewe rehabilitasie program om weer fisies onafhanklik te wees en ook om hom/haar voor te berei om weer by die gemeenskap in te skakel. Die doel van hierdie studie was om die rehabilitasie program by die Netcare Rehabilitasie Hospitaal, ‘n 120 bed private rehabilitasie fasiliteit in Johannesburg, waar rehabilitasie vir fisies gestremde persone deur ‘n interdissiplinere span aangebied word, te evalueer. Die program is geevalueer in terme van twee uitkomste naamlik, die graad van fisiese onafhanklikheid wat die pasiënte behaal en tot watter mate die program pasiente voorberei vir herintegrasie in die gemeenskap Die “Functional Independence Measure” (FIM), ‘n gestandaardiseerde uitkoms skaal wat sekere fisiese en kognitiewe funksies meet en die “Needs Assessment Checklist” (NAC), `n instrument wat ontwikkel is om te evalueer of rehabilitasie programme pasiente se spesifieke behoeftes aanspreek. Is gebruik om the rehabilitasie program te evalueer. Die FIM is met toelating en ontslag voltooi en die NAC is met ontslag voltooi. ‘n Steekproef van sestien pasiente met volledige spinaalkoordletsels (ASIA A) tussen T1 en T12 het die studie populasie gevorm. Deurgans hoë FIM en NAC tellings vir fisiese funksionering het daarop gedui dat die rehabilitasie program by die Netcare Rehabilitation Hospital effektief is in terme van fisiese onafhanklikheid van pasiente. Aan die ander kant het die NAC tellings daarop gedui dat die program minder suksesvol is wat betref die voorbereiding van pasiente vir gemeeskapsintegrasie. Spesifieke probleem areas sluit in kennis van waar om opvolg gesondheidssorg in die gemeenskap te bekom, gereedheid vir werk en toeganklikheid van die huis en werksomgewing. Daar word aanbeveel dat die rehabilitasie span by Netcare Rehabilitasie Hospitaal die program herevalueer om die effektiwiteit van die program in terme van die voorbereiding vir gemeenskaps herintegrasie te verbeter. Dit word ook aanbeveel dat ‘n opvolg studie gedoen word om die huidige sukses ten opsigte van gemeenskaps herintegrasie te evalueer en sruikelblokke te identifiseer ten einde die span the help met program beplanning.