Virginia Henderson defined nursing as “primarily assisting the individual (sick or well) in performance of those activities contributing to health or its recovery (or to a peaceful death), that he would perform unaided if he had the unnecessary strength or will, or knowledge. It is likewise the unique contribution of nursing to help people be independent in such assistance as soon as possible “(as cited in Parker and Smith, 2010, pg 59) In the Spinal Cord injury and Disorder unit (SCID), the one major component that nurses strive to assist patient in managing is elimination of wastes, one of Virginia Henderson’s component in basic nursing care. The reason why elimination of wastes is one of the main components nursing care for spinal cord nurses is because bowel and bladder elimination may cause severe illnesses among the spinal injury population if proper management does not exist. One of the few major complications that many Spinal Injury patients face is the possibility of going into Autonomic Dysreflexia. Autonomic dysreflexia (AD) “is a potentially life threatening condition that can be considered a medical emergency. It mainly affects people with injuries at T6 or higher.AD requires quick and correct action. Serious AD can lead to a stroke. AD can be cause from variety of noxious stimulus such as but not limited to: Irritation of bladder wall, urinary tract infection, blocked catheter, overfilled collection bag, over-distended or irritated bowel, constipation/impaction, etc” (Autonomic Dysreflexia, n.d.). For this reason, most basic nursing care for spinal injured patients revolves around the management of wastes elimination. The nursing care around bladder and bowel management in SCI is done in many ways. Nursing collaborate with interdisciplinary team as well as the patients and care givers to develop the best plan to care in assisting the patients with proper bowel and bladder management. Depending on the level of injury in the patients, dexterity and vision are often being evaluated to see if the patients are able to manage their bladder management using straight intermittent catherization. If the patient is able to cath himself or herself independently nursing will assist the patients in performing this task independent through education, follow up with return demonstration and continual assessment during the hospital stay. In addition, nursing care for these patients is also education in signs and symptoms of AD and UTI. If the patients are unable to use their hands to perform the cath independently the interdisciplinary team will evaluate the patients for a Foley or suprapubic catheter (SP). Nursing care around Foley catheter and SP is education of signs and symptoms of UTI and AD. In addition, patients with an indwelling catheter and SP will receive education on what to do during and AD episode such as: making sure the catheter is not kink, making sure the tube is free from other obstruction, etc. Foley and SP catheter is the last resort for SCI patient as the increase of nosocomial infection.
SCI patients are often has problem with eliminating wastes in the bowel. Basic nursing care in bowel management is encouraging patients to eat a high fiber diet to decrease constipation which may lead the patients into AD. Patients that are able to do their own bowel program will be taught about different enemas, enemeezes, and suppositories to aide with the bowel program. The collaboration with the interdisciplinary team, the patients, and care givers will help to determine how often the bowel program should be done to prevent accidents that may interfere with patients’ lives.
For the SCI patients that are not able to perform their bowel program independently, basic nursing care revolved around educating the patients in how to direct their bowel program to help caregivers when they are at home. Nursing will continue to educate and evaluate caregivers in management of the patients’ bowel program.
Basic nursing care around wastes elimination for SCI patients is crucial in every aspect of the patient’s health. Nursing care continues to promote independent in performing these tasks as independently as possible; however, for those that may not be able to perform these tasks independently education in elimination bodily wastes will allowed the patients to direct his or her care in order to maximize independent as much as possible.

Autonomic Dysreflexia. (n.d.). In Christopher and Dana Reeve Foundation. Retrieved 01/27/2013, from http://www.christopherreeve.org/site/c.mtKZKgMWKwG/b.4453413/k.5E2A/Autonomic_Dysreflexia.htm Parker, M., and Smith, M. (2010). Nursing Theories and Nursing Paractic (3rd ed.). Philadelphia, PA: F.A.
Davis Company.