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Spinal cord injury: early impact on the patient’s significant others Hart, Geraldine Angela

Abstract

This exploratory study was designed to gather information about the needs and concerns of significant others of patients with recent spinal cord injuries. The respondents were asked about the impact of the patients' injuries on their own lives and about their feelings in relation to the treatment they and their patients were receiving from health care personnel. The study was conducted with a convenience sample of seven respondents, five women and two men, designated as significant others by seven patients with recent spinal cord injuries. Using a semi-structured interview guide each significant other was interviewed in depth from one to three times over a period of three to six weeks following their patient's injury. The interview guide covered eight selected themes relating to the significant other's': - need to feel that he or she is getting adequate information - need to feel that he or she is being helpful to the patient - need to feel able to cope with home and family responsibilities - need to have someone from whom he or she can obtain emotional support - need to express feelings, both positive and negative - need to feel that his or her patient is getting good care - past experiences and methods of coping with crisis situations - needs and concerns that may arise because of the likely major effects the patient's injury will have on the significant other's life in the future. All respondents reported needing initial access to physicians who would give a true report of their patients' medical conditions and progresses. Thereafter five respondents reported receiving adequate information from their patients or the nurses. The six respondents who were given a negative prognosis for their patients' recovery of function expressed less apparent emotional conflict than the one who was told there was some possibility of recovery. After the first interview three respondents stressed the need for practical information about how to help with their patients' physical care, although during the first interview all respondents expressed fear that any physical assistance they attempted might harm their patients. All respondents felt their greatest value to their patients was as a source of emotional support. Two respondents reported being able to defer all home and family responsibilities; the other five stated their home and family responsibilities were not directly increased by their patients' injuries. However these five reported stress caused by the necessity of coping with the patients' needs as well as home and family responsibilities. All seven significant others reported using some sources of external support, the most common being family members and close friends. All respondents voiced positive feelings about their patients and the health care they were receiving. Only three respondents expressed strong negative feelings which were directed at the cause of their patients' injuries or what they perceived as incorrect or inappropriate information given to them by health care personnel. All respondents stressed their need to know their patients were receiving good care. All significant others reported their patients' injuries were the severest crises they or their patients had ever undergone, but all also stated they believed they would be able to cope with the crisis. The respondents reported their patients' gravest concerns for the future related to finances, work and sexual functioning. The respondents themselves voiced less concern about finances and sexual functioning. Other concerns for the future expressed by the respondents related to housing, transportation, family activities, social relationships and coping with the inevitable "ups and downs" of the patients. There were some differences in concerns expressed by male and female respondents. The findings of the study demonstrated the presence of selected needs and concerns in a small convenience sample of significant others of spinal cord injured patients. Further research would be necessary to determine whether the findings are representative and whether there is a relationship between expressed needs and concerns and the sex of patients and/or significant others. The study offers suggestions to practicing nurses who wish to improve their care of spinal cord injured patients and their significant others.

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