Review of Factors Influencing Successful Patient Education in a Rehab Unit for Spinal Cord Injuries.

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Table of Contents


4.2.1.        Study-1:        29

4.2.2.        Study-2        29

4.2.3.        Study-3        

4.2.4.        Study-4        

4.2.5.        Study-5        

4.2.6.        Study-6        

4.2.7.        Study-7        34

4.2.8.        Study-8        35

4.2.9.        Study-9        36

4.2.10.        Study-10        37

4.2.11.        Study-11        38

4.2.12.        Study-12        39

4.2.13.        Study-13        40

4.3.        Summary        


CHAPTER-6: CONCLUSION...................................................................................................................46

Recommendation and action plan..............................................................................................................47

Action plan (figure 2).................................................................................................................................50

Researcher reflection.................................................................................................................................52


Figure (1)....................................................................................................................................................54



  1. Study Scope

Spinal Cord injuries are the most devastating traumatic injuries causing numerous complications in individuals (May et al., 2006). These injuries initiate with a blow fracture and progressively dislocate the vertebrae (bone disks which make up the spine). Injuries of this type does not sever the spinal cord, but instead cause damage when vertebrae pieces tear into cord tissue and press down on the signal carrying nerve parts. Spinal cord injuries are the medical emergency conditions costing immense financial leverage on the community. Immediate treatment through effective patient education measures can help in minimising the long term complications. In many of the cases, treatment to spinal cord injuries initiate with the restraining of spine and regulating inflammation to minimise further damage (May et al., 2007). The usual treatment to spinal cord injuries differs completely depending on the exact location and the level of injury. Most of them need substantial physical therapy and rehabilitation, more particularly if the injury of the patient involves day to day activities (Bennett et al., 2004).

Patients with spinal cord injuries possess a life time threat for clinical complications and other health related conditions secondary to their injury, involving pain, spasticity, shoulder ache, infections in the urinary tract, breathing complications, pressure ulcers, cognitive impairments and other depressive episodes. Secondary complications amongst these patients contribute to considerable morbidity, medical costs, and increased rates of re-hospitalisation in the initial year following the injury. Presence of these secondary conditions has been linked with deleterious quality of life and well-being (May et al., 2007).

Patients with severe spinal cord injuries need to be educated to a significant level for managing the consequences of the neurological disability and impairment. The complexities associated to post spinal cord injuries usually influence the individual’s life in a negative manner. They impact on the physical, psychological and social well-being of the person. Many of the secondary complications can be minimised or optimised through appropriate levels of self-care and self-management (Aveyard et al., 2011). However, the present scenario of shorter rehabilitation stays, owing to limitations in the insurance and complexity of accessing the specialists on spinal cord injuries needs patients and family members to absorb information on self-care while staying in the hospital. They even necessitate being proactive in exploring health information as soon as they get discharged. To allow individuals in managing their own care and long term implications, it is important to provide with more than simply information on their clinical situation. Nonetheless, most of the complications can be minimised through the delivery of effective (but challenging) patient education measures. These measures are crucial to promotion of independence, efficacy, self regulation and measurement (Bennett et al., 2004).

Patient education is the crucial segment of rehabilitation and it encompasses the ultimate target of preparing patients to meet the day to day challenges. Various patient education programmes developed in the recent years enable the spinal cord injured patient in understanding and monitoring their own physical, emotional, cognitive and psychological well-being. However, improvements in knowledge may not completely translate the problem solving competencies even for the crucial issues. Many of the studies have then suggested the need to include the more active learning or contextually based interventions within the patient education programmes. Incorporation of these measures will necessarily increase the transfer of knowledge in the situations associated to life (May et al., 2007).

The value of patient education in the spinal cord injured patient includes the following (May et al., 2006):

  • Enhanced understanding of clinical situation, disease and disability.
  • Enhanced knowledge on the various methods and forms to control different aspects of clinical situation.
  • Increased self-advocacy in choosing to function independently from the health care practitioners and in interdependence with them.
  • Improved acceptability, flexibility and compliance (This can be due to the fact that effective communication and patient education amongst spinal cord injured patients enhances their motivation to comply).
  • Informed consent (due to the fact that patients perceive the practitioners in best information providers).
  • Usage-Increased use of safe and effective medical services with minimal phone calls and visit.
  • Referrals and Satisfaction-the probability of patients staying in the practice of general practitioner and referring to other patients is immense.
  • Management of risks or threats (if any)-due to minimal likelihood of malpractices when working with patients possessing realistic expectations.

Effective delivery of patient education necessitates presence of certain competencies amongst the health care providers. The below-mentioned attributes amongst the health care professionals influence the success of patient education in rehabilitation of spinal cord injured patients (May et al., 2006).

  • Encompass the perspectives related to personal ethics in the context to social responsibilities and services over others.
  • Offer accurate, competent and evidence-based care.
  • Gain sufficient experience in the field of preventative health care.
  • Developing focus on the relationship centred care by combining with individuals and their respective families.
  • Include different multiple determinants associated to health when offering care and support for spinal cord injured patient.
  • Ability to be culturally sensitive and open to the issues surrounding the clinical situations and diverse society.
  • Utilise technology in most appropriate and effective manner.
  • Developing knowledge on the current treatment methods in the fields of practice and
  • Ability to continue to improve measures and strategies in patient education.

There is considerable level of research evidence signifying the fact that information overload from minimal rehabilitation stays involves with the patient’s and family’s ability to completely master the skills and information to prevent secondary complications after leaving the hospital. Numerous research studies (like for instance May et al in 2006, Cortez and Levi, 2000, Rimmer, 2000, Grant and Booth, 2009 and others) that outlined the role of patient education have ascertained its role in improving quality of living, well-being. According to these studies, patient education is one of the valuable information tools that can help individuals with spinal cord injuries in minimising hospitalisations and practitioner consultations. More than ever, patients with severe spinal cord injuries require timely and high quality information on the issues related to health and medicine following their discharge and all throughout the lifetime to prevent the symptoms, stay healthy and promote quality of life (Cortez and Levi, 2000).

Although, a significant proportion of patients are educated at the time of their stay in the rehabilitation unit, many of them still experience complexities in identifying its importance. To overcome such issues, it is highly important to bear in mind the below mentioned fundamental aims of patient education programme. The prime targets of patient education programme identified through ground breaking research by Rimmer (1999) comprise of:

  • Enhancing safe and effective healthy and sustaining environment for well-being.
  • Minimising and preventing the underlying secondary complications (such as pressure ulcers, obesity, and bladder and bowel complications) of spinal cord injuries.
  • Preparing patients who are suffering with spinal cord injuries to regulate and manage their own physical and health complications.
  • Controlling and keeping in place the functional independence and
  • Increasing freedom and independence to enjoy and increase the quality of life.

Achieving the above mentioned targets necessitates individuals to consider the best ways of implementing the best ways of patient education measures. The readiness, agreement and characteristic nature of patient form the crucial parts of patient education. Many of the studies have even indicated that the absence of compliance and readiness of the patient in gaining information are the usual reasons for failure.

  1. Study Background

The underpinning necessity for choosing the current topic –“A critical review of the factors that influence the success of effective patient education in a rehabilitation unit for individuals with spinal cord injuries”, emerged after the continuous meetings with the professionals associated with this clinical condition. The meeting emerged in response to numerous complaints made by the patients, who failed to receive sufficient levels of information during their stay. Very recently, the numbers related to re-hospitalisation owing to secondary complications following the spinal cord injury have increased to a significant level. In addition, the department and individuals concerning the outpatients have been overwhelmed through telephone conversations and sudden visits from the already encountered patients (May et al., 2006).

Although there is a patient education programme in my unit, the desired results of its effectiveness are not met. This may be because of the low profile of the subject in the department despite spending significant amount of time and resources to educate patients, families and carers. Nevertheless the process of patient education is not documented systematically to verify its effectiveness. The numbers of re-admissions of former patients are increasing and the post injury complications are growing. On the other hand many patients and care agencies benefit from the existing patient education programme. The question of why some patients are benefiting and others returning with complications is crucial (Cortez and Levi, 2000).

  1. Study Purpose

This project explores the topic – “A critical review of the factors that influence the success of effective patient education in a rehabilitation unit for individuals with spinal cord injuries” and aims to integrate the research findings to obtain knowledge with regard to the context. The wide range of developments, innovations and technological advancements in the patient education measures for spinal cord injuries together with their individual effectiveness in offering best results have inspired me to gain an interest on this topic

However, the prime aims for this study include:

  • To critically explore the underpinning literature governing the research topic.
  • To develop an evidence base for supporting the best available strategies for effective patient education.
  • To investigate the barriers and facilitators for implementing effective patient education.

Besides, the presence of a relative gap in the literature concerning treatment procedures of spinal cord injuries and the significance of such measures in the field of scientific research are some of the other reasons. This study uses the critical review and literature search methodology for information collection. These methodologies evaluate the article or an essay combining a summary and critical commentary presentation. By moving much beyond the usual explanation of resources, this methodology enables individuals to include a wide variety of degrees of analysis and conceptual innovation methods (Grant and Booth, 2009). It also aims at collecting needed information for the development and implementation of prospective education programmes at the spinal cord injury unit in Sheffield Teaching Hospitals.

  1. Aims and Objectives

Within this study, the information needs of patients with spinal cord injuries and how their necessities correlate to the well-being and promotion of life quality were explored. By considering information on the best available approaches for delivering spinal cord injury, this study addresses different research-related questions. This study aims at critically exploring and identifying the literature related to:

  • Available interventions for the effective implementation of patient education in rehabilitation centre for spinal cord injured patients.
  • Investigating the influence of personal leadership in disseminating the findings through patient education strategies in the care associated to spinal cord injuries.
  • Utilising available research evidence from the literature to propose a revised patient education programme and strategies for implementation.

To achieve the above mentioned research aims, the study aims to fulfil the below mentioned objectives:

  • Examining the obstacles and facilitators for implementing effective patient education.
  • Framing prospective recommendations, suggestions and implications for practice using gap analysis.
  • Suggest recommendations to inform a future strategy for patient education in spinal injuries care.
  1. Key definitions

Since the topic under study does not encompass any complex terms, the definitions of simple terms-“Patient education”, “Rehabilitation” and “Spinal cord injuries” were considered and the following definitions are offered:

Patient education is a process through which professionals in health care and other related fields impart information to the patients. This process aims at altering the health behaviours of patients, besides improving their status. With the crucial elements of skill building and responsibility, patient education aims at improved understanding of clinical situation, diagnosis and disability (May et al., 2006).

Rehabilitation or treatment is a specialised field of medicine that aims in enhancing and restoring the functional ability, quality of life and well-being of patients with disabilities and physical impairments. More specifically, it involves management of disorders that change the function and performance of the patient. In rehabilitation, increased emphasis is usually placed on the functional optimisation through the integrated utilisation of medications, physical modalities, and training with clinical exercise, modifications in movement and activities, assistive devices and experiential training methodologies (Cortez and Levi, 2000).

Spinal cord injuries are the highly devastating and traumatic injuries usually caused through accidents of motor vehicles, falls and other activities related to violence. More commonly, sports related spinal cord injuries persist in children and teenagers, whilst the work related types (such as construction work) predominate amongst adults (May et al., 2007).

  1. Summary

This chapter has outlined certain introductory points in relevance to spinal cord injuries, patient education and associated issues surrounding rehabilitation. It even outlined the research aims and objectives, key definitions and reasons for choosing the topic. Further chapters will explore the methodology used for data collection, together with the data analysis, inclusion and exclusion criteria, data presentation and development of information. It also accounts the analytical viewpoints associated with the present research project.


This chapter outlines the, search strategies, key words, inclusion and exclusion criteria, data presentation, gap analysis and critical appraisal tools along with the synthesis of relevant conclusions. The current research project forms a part of critical literature search methodology of considering the effectiveness of patient education in attaining success in spinal cord injury. The outcomes associated to the study were potentially limited to make sure of clinical applicability and acceptability. Drawing on my tacit knowledge as a nurse, I will be working in an empathetic patient centred way to undertake this study. However as my main focus is to critically review the literature this will require me to take an 'objective' epistemological standpoint when undertaking a review of the referred articles and the grey literature. I will resolve this tension between aiming to be 'patient centred' and taking an 'objectivism' standpoint by ensuring that I critically reflect on the process of inquiry and ensure I strike a balance between representing literature from a patient's knowledge perspective and an observational professional perspective.

Based on work by Grant and Booth (2009) this will be performed by critically reviewing the literature and by evaluating its quality, encompassing:

  • Reading and understand the main points in an article.
  • Analysing findings of an article.
  • Choosing suitable criteria which to evaluate the article.
  • Providing a critical evaluation of the article based on the criteria selected.

  1. Strategies for literature search

  1. Electronic modes of search

MEDLINE, The Cochrane Library, EMBASE, CINAHL Plus, EBSCO Nursing Source, Pub Med, Web of Science, Science Direct, British Medical Journals Online, Wiley Interscience Journals, Cochrane Library, Google Scholar, The King’s Fund and the International Pharmaceutical Abstracts were explored to identify the needed articles relating to the topic. The keywords for the disease (spinal cord injuries) were combined and the complexities associated with such condition were even indicated. At certain instances, medical side-headings (MeSH) were even used as search strategies wherever needed and relevant. As this dissertation is completely linked with the development of leadership for the implementation of revised patient education programme, the grey literature was searched in addition to the databases.  This eventually enabled in recognising other relevant examples throughout the country where in various hospitals have developed innovative models and approaches with their patient education programmes on spinal cord injury units. Boolean operators (and, or, not) were even applied during the search mechanism (Hart, 2010).

The critical literature reviews falling within the years of 2000 to 2012 were explored and referred to compare and contrast the studies in relevance to scope of the current topic (Hart, 2010). Various research studies, conference abstracts and reviews that are completely applicable to the present study were included, despite of their journal of publication. Use of this process enabled in effectively averting the complexities of search and assisted in attaining highly organised data for analysis. Exploration of different websites with regard to the health technology assessments and clinical trial registries has allowed in the assessment of non-published information. At the time of exploring the research study, the key words correlating in an effective manner to the study were used. This assisted in the recognition of studies that are completely related to the research question. It also aided in underscoring of much useful and needed information. Assessment of research aim, objectives, study strategies and outcomes (which are the crucial segments of effective exploration reviews) helped in attaining the needed information for the topic (Greenhalgh, 2010).

  1. Citation Tracking

The reference and bibliographic lists associated to various related research papers and journals assisted in gathering needed research evidence for the present topic (Parahoo, 2006). To recognise the highly relevant and suitable research study, the bibliographic information published in each and every study was accounted. Once suitable inclusion and exclusion criteria had been established, those studies that appeared to be completely appropriate for inclusion within the study were added and analysed accordingly. Before including the research article, thorough check was made to make sure that the information published was related to the review. Making of these checks even enabled in ensuring that the data did not seemed to be ineffective as a result of not being witnessed in the relevant databases. Many of the available research studies and review articles identified through suitable search phrases were being utilised to include the relevant study. The use of electronic search methodology for the present project appeared to be best; however, it consumed considerable levels of time (Hart, 2010).

  1. Methods

For exploring different ways of implementing successful patient education for the spinal cord injured patients, the methodology of critical literature search enabled in obtaining useful information. This methodology encompassed a comprehensive investigation of different available literature, reading books, research articles, journals and other related materials. Grey literature together with the discussions made with senior colleagues and other staff were included in the study. Different forms of advice, recommendations and practical implications were accounted for together with the individual, personal and field experiences. Contact with other spinal cord injury centres in and around the country (the United Kingdom) enabled in collecting possible and concrete evidence suiting the practicality of the study (Parahoo, 2006).

The tactics and knowledge gained from being a professional nurse were used to work in a patient centred way to carry out the study. The tension existing between the concepts associated to “patient centred” and undertaking an “objective” standpoint was resolved by making sure of critical reflection on the process of inquiry. In addition, ensuring of balance between representing literature from a patient's knowledge perspective and an observational professional perspective also helped in minimising research related complexities. The suggestions provided by Grant and Booth in 2009, on critical review of literature – reading and assessing the crucial points of an article, examining the findings of the research study, considering the appropriate criterion for analysing the article and offering critical assessment of the research review depending on the selected criteria, helped in effectively assessing the research study quality.

  1. Inclusion and Exclusion Criteria

Research studies published in English and from the period of 2000 to 2012 were included in the literature review. Various double blind randomised controlled trials, systematic review studies, critical literature reviews were accounted for the inclusion. Research studies that utilised experimental, survey and observational methodologies and confining to the research question were included for synthesising effective information. The pre-established exclusion criteria for the present study-irrelevant study design, longer study periods, different research aims, interventions and outcomes were used to filter the study collection.

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The research studies related to traumatic spinal cord injuries (to obtain information needing long term rehabilitation), patient education (for comparison of patient education strategies amongst individuals with spinal cord injuries), teaching and learning in the settings related to health care were accounted for inclusion. Research studies focusing on the rehabilitation of spinal cord injuries (only base for comparing the patients with spinal cord injuries), patients gaining education during spinal cord injury, from year 2000 to till date (to compare and contrast the information related to the subject and make an up-date on the patient education) and multidisciplinary methodologies to patient ...

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