Experience of patients with spinal cord injury regarding the quality of care during acute hospital stay in Nepal

• Author / Creator

  Gautam, Srijana

• Spinal Cord Injury (SCI) results in physical impairments, psychosocial issues, increased mortality and morbidity that challenge individuals and demand lifelong support, which starts from acute care. Understanding the experience after SCI in acute care is essential as it may impact the Person(s) with Spinal Cord Injury (PWSCI’s) subsequent journey to the rehabilitation centre and community. While similar studies were conducted in Western countries, this experience has yet to be studied in low-resource countries like Nepal, where there are distinct socioeconomic and cultural differences.
  This thesis focused on how PWSCI (1) perceive overall positive and negative experiences regarding their care, (2) are involved in decision-making for their care, and (3) are educated about secondary complications during their acute care hospital stay in Nepal.
  We interviewed participants (n=24) admitted at the Spinal Injury Rehabilitation Centre who were treated for their acute SCI in nine different acute hospitals in Nepal. We used a semi-structured interview guide co-developed with SCI experts and PWSCI of Nepal. We identified five main themes: (1) Limited communication; (2) Limited education and knowledge; (3) Limited participation in decision-making for care; (4) Limited access to resources; (5) The importance of providers’ demeanour and conveyance of hope. These themes were mapped under the World Health Organization (WHO) 's three core domains of quality of care: patient-centredness, effectiveness, and safety. We observed positive experiences among PWSCI in some aspects, while ample room for improvement remains in others. These include delayed surgery in government hospitals, insufficient involvement of PWSCI in effective communication and decision-making processes before surgery, and transitioning to rehabilitation hospitals. Additionally, inadequate education sessions for preventing secondary complications were identified as areas for improvement. Despite limitations in communication, education, participation, and resource access, the words of kindness from the care team significantly impacted patients.
  Opportunities exist to improve the acute care experience for PWSCI in Nepal, especially within government hospitals. PWSCI desired to be well-informed about their condition and prognosis and to be actively engaged in decision-making processes. They expect positive behaviour, a compassionate demeanour, and respectful treatment from the care team.

• Subjects / Keywords

  • acute care
  • spinal cord injury
  • Nepal
  • experience
  • quality of care

• Graduation date

  Fall 2024

• Type of Item

  Thesis

• Degree

  Master of Science

• DOI

  https://doi.org/10.7939/r3-x9er-ah41

• License

  This thesis is made available by the University of Alberta Library with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.