Nursing Care for Patients with Complex Spinal Cord Injury in the Intermediate Care: 2 Cases Studies

Abstract

Spinal cord injury affects movement, sensation, and autonomic nervous system function, leading to physical, psychological, social, and quality-of-life impacts. The intermediate rehabilitation phase is crucial for functional recovery and the prevention of complications.

Objective: To compare complications, rehabilitation outcomes, and nursing care results among patients with spinal cord injury in the intermediate phase at different injury levels through two case studies.

Methods: Two patients with spinal cord injury in the intermediate phase were purposively selected. Both were admitted to the Rehabilitation Ward, Mahasarakham Hospital, between January and July 2025. A qualitative comparative case study design was employed. Research instruments included

a patient medical record review form and data collection on patient history, disease progression, and nursing care. Data were obtained from medical records and analyzed using Gordon’s Functional Health Patterns and Orem’s Self-Care Nursing Theory within the nursing process framework.

Results: The patient with a high-level injury (C4–C6) experienced multiple complications, including dysphagia, spasticity, autonomic dysreflexia, pressure ulcers, urinary tract infection, constipation, and depression. The Barthel Index score improved from 0 to 5, indicating a high level of dependence. The patient with a lower-level injury (T11–T12) had fewer complications, with the Barthel Index improving from 20 to 30, reflecting partial self-care ability and better rehabilitation outcomes. Both patients had an equal length of stay of 11 days.

Conclusion: The level of spinal cord injury directly influences the severity of complications and rehabilitation potential. Holistic assessment and individualized nursing care planning are essential to reduce complications and promote recovery. It is recommended to develop nursing care guidelines consistent with the level of injury and to enhance the self-care capacity of patients and families to improve long-term quality of life.