Cassandra Miller-Hardwick, MSN, RN, CRRN

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

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

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.

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.

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.

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

• 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.

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

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

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

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

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

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

• 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:

• 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

• 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

• 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.