Knowledge acquisition and decision-making: spinal cord injured individuals perceptions of caring during rehabilitation.

Nurses and other healthcare providers have little research to guide them on specific interventions and attitudes which expedite the attainment of rehabilitation outcomes by spinal cord injured (SCI) individuals and their successful return to the community (Fuhrer, 1994; Whiteneck, 1994). Acquisition of knowledge is required during rehabilitation to learn self-care and decision-making which is essential to long term survival following SCI. However, skills that patients and families are able to accomplish in rehabilitation are often not able to be translated into the home environment (White & Holloway, 1990). The process of learning self-care and decision-making needs to be more clearly elucidated, so more effective interventions can be designed which can improve problem-solving and lead to enhanced well-being and quality of life. The purpose of this qualitative study was to describe the meaning, process and consequences of caring during rehabilitation from the perspective of the SCI individual. This paper will report on the findings from one research question: How is the process of a developing caring relationship perceived by SCI individuals during rehabilitation? The theoretical foundation of caring for this study was synthesized from philosophical, ethical, feminist, and nursing literature. A purposive sample of adults with traumatic SCI were interviewed at least once during their initial rehabilitation stay. Twenty interviews were conducted with fifteen participants at various times during their rehabilitation stay over a six month period. The core category of "getting back together" or reintegration of self, which was the major work of rehabilitation, was accomplished with nurses and therapists who were perceived as caring. The process of a developing caring relationship was conceptualized, from participants' descriptions in three phases: learning the other, learning what I need to know, and letting me find out. During each phase reciprocal behaviors occurred between the patient and the caregiver resulting in intermediate outcomes, which facilitated movement to the next phase. Consequences of these caring relationships were: well-being, self-care, autonomy, independence, and hope. Caring by rehabilitation professionals was perceived by SCI individuals as central to recovery and to a positive attitude toward disability.