Nurses face challenges that do not arise in many other professions. Nurses render 24-hour care to a variety of highly vulnerable patients. Patients with spinal cord injury epitomize this intense vulnerability. Spinal cord injury does not occur in a vacuum, so the central focus of nursing is dealing with the human responses to injury. This case of a patient with an acute spinal cord injury highlights the challenges of providing quality care under difficult circumstances. The authors' primary analysis focuses on the challenges of providing care to patients who make the provision of that care difficult and unpleasant. Five major issues are explored: working with patients who will have long-term, injury-related deficits; the implications of labeling patients as “dumps”; working with an uncooperative and abusive patient; transforming the paradigm of care from “doing to” to “working with”; and providing consistent and comprehensive nursing care.
Questions or comments about this article may be directed to: Therese S. Richmond, PhD CS CRNP FAAN, University of Pennsylvania, School of Nursing, 420 Guardian Drive, Philadelphia, PA 19104. She is an associate professor of trauma and critical care nursing at the University of Pennsylvania.
Hilaire J. Thompson, MS CNRN CS CRNP, is a predoctoral fellow at the School of Nursing and Penn Head Injury Research Center, University of Pennsylvania.
© 2002 American Association of Neuroscience Nurses