Spine Patient Care Guidelines

Nurses are in the best position to impact patient outcomes. Nurses are able to practice independently and interdependently with the entire health care team while keeping the focus on the patient. No other discipline can 'see the whole picture' like a nurse can.

No other health professional can help the patient navigate their health care by diagnosing their responses, selecting appropriate resources and interventions, recognizing and utilizing the particular strengths of each individual (in their social unit), minimizing potentially deleterious influences, and organizing the experience into an integrated whole that has meaning for the patient and improves health. Nurses are the glue that holds it all together.

Table 3:
Guidelines for the Care of the Acute Adult Spine Patient

Recommendations for patient interventions were developed based on the research and clinical literature review. Research-based nursing and medical data are used in the orthopaedic spine arena. However, in some areas, the literature lacks sufficient empirical-based data. Interventions listed below are extrapolated from research in the nursing and medical domain, for orthopaedics and other subspecialties.

Patient Education Recommendations
Most pre-operative teaching recommendations for spinal surgery patients include: information on the surgical procedure, how the procedure will relieve symptoms, approximate length of hospital stay, pre-operative preparation (NPO status, discontinuation of NSAIDs, hospital arrival time), intra-operative events (length of procedure, potential for blood transfusion, positioning), post-operative care (progression of activity, monitoring, IV lines, catheter, dressings, drains, equipment, pain control, DVT and respiratory prophylaxis). (127,183) Assessment of the patient's understanding of the risks of surgery should also be determined.

Numerous studies have focused on the effects of pre-operative teaching on many patient variables. One small descriptive study explicated the perceived informational needs and information-seeking behaviors of patients undergoing spinal surgery. (184) In this study, patients identified a need to know about activity, physical limitations, return to work, need for home health services, when to shower, when to drive, and if the bandage needed to be changed. In a post-discharge interview, pain and sleepiness from analgesic medication were identified as barriers to recall and understanding of the actual discharge teaching given.

Most patients identified their surgeon as the sole source of information if they had questions post-operatively. Moreover, 15% of the patients reported significant pain during the discharge teaching session. There were inconsistencies identified in the discharge information presented post-operatively. The authors recommended that nurses take an active, visible role in the teaching of patients and in the development of consistent written pre- and post-operative information.

Recently, the concept of self-efficacy has been the focus of research in the behavioral and nursing literature. Self-efficacy is a belief that the individual can perform behaviors that result in desired outcomes. Self-efficacy has been utilized as a framework for pre-operative teaching, with mixed outcomes. In one study, pre-operative teaching for orthopaedic patients based on an empowerment model (enabling others to take control of their own lives through gains in knowledge, skills development, and identification of resources) resulted in higher scores on a self-efficacy instrument, more feelings of empowerment in the patients, and greater confidence in ability to perform pre- and postoperative care. (185). Length of stay, complications, pain level, and respiratory and functional status were not affected compared to the control group, who received traditional pre-operative teaching from busy clinic staff.

In another study involving patients undergoing laparascopic cholecystectomy, self-efficacy-enhanced pre-operative instruction did not improve scores on the Pre-operative Self-Efficacy Scale (PSES) compared to the scores for patients receiving the usual cognitive pre-operative instruction from hospital staff. (186)