When Marlene Rose, RN, MA, CNABE, CRRN, started working as a nurse in 1973, she heard a wide range of patient complaints about spinal pain that were routinely classified in general terms under back pain caused by spinal deterioration.
We didn't have all of the technology and scans there are today, like an MRI, said Rose, nurse manager for the Spinal Cord and Traumatic Brain Injury Unit at The Burke Rehabilitation Hospital in White Plains, N.Y.
"When I joined our 30-patient spinal cord unit here in 2000, I was impressed by the process that happens to not only make a proper diagnosis of the condition but also the team plan put in place to get patients back home and feeling better," she said.
A common condition that once was referred to as "spinal deterioration" is now termed spinal stenosis, the narrowing and weakening of the spinal column.
"We do see many older patients with spinal stenosis, a result of anything from arthritis-related issues to osteoporosis," Rose said. "But we also see younger men and women who come here for rehab following acute care after spinal surgery following an injury to the spinal column, which has resulted in spinal stenosis."
All hands on deck
Rose said the staff uses a team conference approach once a week with nursing staff, case management, social workers, physical therapists, occupational therapists, and doctors to examine the goals, progress, and plan for each patient.
So many of the roles of hospital staff have changed over the years, and everyone works together much more closely for the best results, she said.
Even as a nurse, it's a much different approach working in the rehab unit than what it was like 30 years ago.
"As a nurse when I was starting out, being in a rehab unit was often much more like serving as a helper, and assisting patients with everyday things as basic as getting dressed," she said. "Today, we work with the rest of the staff as we teach the patients how to care for these needs on their own and as soon as possible as part of the rehab process."
What hasn't changed, according to Rose, is the nurse's responsibility to guide and monitor pain management during rehabilitation. Spinal stenosis and any spine-related injury results in some of the most intense pain during rehab and therapy, Rose said.
"As the process for rehab begins, we always begin to administer any pain meds prior to therapy, which is often one of the only ways a patient can tolerate to participate in any therapy just following surgery," she said.
Rose also emphasized the importance of rest after therapy sessions as patients slowly regain their strength and abilities.
Elizabeth Dominick, PT, DPT, MS, NCS, has worked as a physical therapist with Rose for the past eight years on the Spinal Cord and Traumatic Brain Injury Unit at The Burke Rehabilitation Hospital.
"We focus on both the injury and means for improvement," Dominick said. "It's key that all of the physical therapists work closely with our nursing staff to resolve patient issues with a range of concerns from pain management to sensory impairment. Prior to a surgery and rehab stay, our goal is to return the patient to his or her prior level of function and follow the transition for the return home."
Home sweet home
Both Rose and Dominick say education and awareness are important for not only the patient but also for family members and others in roles of support.
"We have a great follow-up process which continues even after a patient has left our unit and returned home," Rose said. "And as the nurse responsible for my patients, I'm the one who does our follow-up calls. So in September, I'm calling all of our patients who returned home in June to find out how they are progressing, note any issues, and discuss any ongoing pain management or medication."
As for how soon patients with spinal stenosis leave the Spinal Cord and Traumatic Brain Injury Unit at The Burke Rehabilitation Hospital, Rose said she works closely with case management, and often with social worker Stella Marino, who has worked with her for almost three years.
"Our function as case management is to work with the nursing and therapy staff and assess each patient's needs, goals, and progress," Marino said. "It's only by working together that we set goals, provide choices, and ultimately work toward a discharge plan."
Pain relief
Spinal stenosis also ranks as one of the most common conditions patients seek medical help with on the Spinal Cord Injury Unit at Kessler Institute of Rehabilitation, which has three campuses in New Jersey.
Robin Bischoff, BSN, CRRN, started as a nurse in 1978 and has been in the Spinal Cord Injury Units at Kessler for 15 years, including serving as the clinical coordinator for the 48-patient unit for the past two years.
Spinal stenosis involves a wide range of various levels, depending on the injury, with a broad spectrum of resulting conditions from mild pain and stiffness of the spine to complete paralysis, Bischoff said.
She also said there is a close connection to spinal stenosis with arthritis.
"Our goal is to work as a team to help patients regain independence and have relief from pain and discomfort," Bischoff said.
Jeanette Centeno, RN, who has worked with Bischoff on the Spinal Cord Injury Unit at Kessler Institute of Rehabilitation for three years, said spinal stenosis narrowing often starts in the cervical lumbar and branches out to the nerves, which results in the patient's pain.
"Spinal stenosis can be a condition of patients of any age, from someone with a history of a herniated disk to the weakening of the spine because someone does lots of lifting or any repetitive motion," Centeno said. "When someone first arrives to our unit, our first step is a very thorough assessment, including looking at the patient's medical history and any medications used for pain relief."
Life after spinal stenosis
Centeno said one of the most important responsibilities is working with patients to understand how they can manage their conditions.
"As a nurse, I work closely with our case management and the patient as we look into the available support from family and friends as well as available outside resources we can recommend and arrange," she said.
Centeno reminds that any spinal condition or spinal surgery is a delicate situation and results in a life-changing physical challenge.
"There's certainly a comfort for patients to know that a dedicated team of nurses, doctors, therapists, and case managers are working together for positive results," Centeno said. "It's this help, hope, and understanding that encourages patients to work hard and find a strength within to work toward recovery."
