Management and Knowledge 1

MANAGEMENT AND KNOWLEDGE AMONG HEALTH PRACTITIONERS OF

AUTONOMIC DYSREFLEXIA SECONDARY TO SPINAL CORD INJURY PATIENTS

By (Name)

The name of the class (course)

Professor

Institution

The city

Date

As healthcare provider shortages loom, hospital and

health system training and development programs

become increasingly important. Such programs can

help retain current employees, improve their skills and

positively impact the overall quality of a health system

 Management and Knowledge 2

— something that is increasingly important in a value-

based world.

Yet, training and development initiatives aren't often a

top concern for health system leaders. This, of

course, is not surprising given that leaders are faced

with more pressing issues, such as reimbursement,

compliance, clinical quality and beyond. However,

training and development is an important area that

leaders should assess often.

Donnetta Horseman, corporate responsibility officer

for CaroMont Health in Gastonia, N.C., oversees the

health system's compliance training and development

 Management and Knowledge 3

initiatives, along with Cynthia Machuga, the system's

educational services coordinator. Together, the two

oversee the delivery of system-wide training

programs.  

The health system offers thousands of training

courses each year — both mandatory (such as those

for compliance, privacy, clinical skill development,

etc.) and optional, by role. Examples of optional

trainings include continuing medical education and

leadership development opportunities. Overseeing

thousands of trainings each year can be a daunting

task; however, Ms. Horseman and Ms. Machuga say

there are a few best practices that can help ensure

 Management and Knowledge 4

any given training program meets its goals without

overextending a health system's resources.

1. Create training programs for different learning

styles. Training programs should include material that

appeals to various learning styles: verbal, visual,

hands-on, etc.

"You have to be willing to use a variety of different

teaching methods," says Ms. Machuga.

Training programs also need to reflect the multilingual

employee population in so many hospitals today. "We

often make the generalization that if this is in English

 Management and Knowledge 5

and it is simple enough then everyone's going to get

it, and that may not be the case," notes Ms.

Horseman. "You need to ensure all of your different

employees in their different roles — from the

housekeeper to facility worker all the way through the

CEO — can comprehend the information."

2. Make programs interactive. Group work, quizzes

and other activities can help make training programs

less lecture-based and more interactive — something

that not only helps employees retain information but

also makes the training more enjoyable for them.

"You have to make it as interactive as possible; the

more involved [employees] are, the more they retain,"

 Management and Knowledge 6

explains Ms. Horseman.

3. Embrace computer-based training

modules. While certain types of trainings may be

better suited for face-to-face training, many others

can be completed online. Computer-based training

modules are often more convenient for employees as

they can be completed from various locations, at

different paces and at times that work within an

employee's schedule, says Ms. Machuga.

Ms. Horseman adds that computer-based trainings

also help CaroMont deliver consistent training and

allow administration to track that each employee has

 Management and Knowledge 7

completed a training module — something that is

especially important for mandatory trainings around

compliance and privacy issues. Additionally, using

computer-based modules developed by third parties

are less resource intensive than developing them in-

house. While CaroMont actually prefers to develop its

own modules because doing so is less costly, when

trainings need to be developed and rolled out quickly,

using a third-party product can be advantageous,

says Ms. Horseman.

When using computer-based trainings, it is important

to prepare for some technical difficulties. "If you can,

have the IT department involved early on in the

 Management and Knowledge 8

process, even in planning, to make sure what you're

looking at purchasing will work with your hardware

and system," advises Ms. Machuga.

4. Personalize information so it is specific to your

hospital or health system. Another reason

CaroMont often develops its own training programs is

because, in addition to being cost efficient,

information within the training can be specific to

CaroMont's facilities and procedures.

If using a third-party module, Ms. Horseman

recommends selecting one that allows for some

personalization. "Pre-packaged [modules] are a little

 Management and Knowledge 9

more generic," she explains. However, when

CaroMont selected a third-party module for

compliance training, it chose one that allowed the

system to add its own documents, policies and

procedures. “It made us feel like we were still able to

have training very specific to our organization without

having to spend as much time developing content,”

she adds.

5. Ensure training reflects changing skills. Hospital

training programs have always covered issues such

as compliance and clinical competency, but

increasingly hospitals are developing programs

around newly sought-after skills, such as customer

 Management and Knowledge 10

service and patient-centered care.

"What we've seen more than anything else because

of value-based healthcare is that we're putting more

focus on the patient experience and balancing it with

quality and cost," says Ms. Machuga. "We've always

covered customer service in orientation, but it's

certainly more in depth than before. As the patient

experience plays more into our reimbursement, we

have to get across to staff what this means and how

the employee can impact it."

6. Consider employee demands beyond

training. Employees at hospitals have multiple

 Management and Knowledge 11

responsibilities, and training should be designed so

that it can be completed without taking away from

those responsibilities.

"One of the things that makes healthcare unique is a

large part of our employees are nurses or physicians

who are caring for patients," says Ms. Horseman. "We

really need to make sure we're putting together

training that is effective for them. Not everyone is at a

desk, so training they can do between daily activity is

ideal."

7. Evaluate the effectiveness of training

programs. Finally, hospitals should always assess

 Management and Knowledge 12

the effectiveness of their training programs through

surveys and testing of skills. After all, a training

program that doesn't effectively improve some skill or

competency is a waste of health system resources

and employees' time.

"Did you achieve what you were trying to achieve, and

if not, what do you need to do from that point on?"

asks Ms. Machuga.

More Articles on Hospital Employee Training and Development:

One Philosophy to Achieve the Ultimate Patient

Experience

10 Questions Every Hospital Should Ask its

Employees
 Management and Knowledge 13

3 Personas in Every Organization: Builders, Cutters

and Maintainers

Latest articles on leadership & management:

What Black C-suite representation looks like at 100

US hospitals, 7 more diversity survey findings

Leadership Rounding: Shifting to a Tracer Approach

for Regulatory Compliance

Governor taps former Landmark Medical CEO to

oversee embattled Rhode Island hospital

Your input is needed! Becker's

Healthcare is hosting a survey
focused Employee Benefits/ Health
Plans. Click here to fill out the 5
minute survey to receive a
complementary badge to a Becker's
conference.
 Management and Knowledge 14

© Copyright ASC COMMUNICATIONS 2021. Interested in LINKING

to or REPRINTING this content? View our policies by clicking here.

Subscribe to the Becker's Hospital

Review newsletter for the latest in

healthcare news!

General comment: Dear Writer,

1. Action plan is supposed to be 2000 words, not 1696. Add (yes, the customer said it can be (at least)
1650 words but they paid for more. Either you provide what you are paid or we refund and reduce your
payment). The customer is worried about the word count as well (Hi, word count came to 6693, not
including abstract and reference. )
2. Analysis should have 4 key themes. The customer provided 3 (Key theme:3) the most common
stimulus for autonomic dysreflexia is bladder and bowel issues. These are also in attached refences.
Bladder can be discussed with an argument but focus more on bowel (this is a suggestion due to word
limit).- missing), and asked to add another one. 'Botulinum Toxin Injection' and 'Nifedipine' can be sub-
themes (format accordingly) but not proper themes.
4. Once again, discussion cannot have new sources (Herrity et al. (2020) etc), it can only discuss the
findings from the analysis and compare them to the sources before the methodology. Prest the finding,
then state if it is in line with a source etc. Discussion should clearly answer the research questions.
5. Analysis is not critical at all. Compare and contrast findings, state contradicting views if any; at the end
of the paragraph, make your own conclusion as based on the comparison. In order to achieve criticality,
one paragraph cannot be based on one reference only.
6. Conclusion should start with the aim, proceed with methodology and explain the key findings,
answering the research questions.
Note: abstract is not included into the word count.
Please make the changes asap.
Regards

If you have any questions concerning the order rating, do not hesitate to contact our QA representatives.
 Management and Knowledge 15

Dear Olympia,

Our QA Department has checked your order

Instructions: 5.0/10

Grammar: 6.0/10

Plagiarism: 9.0/10
General comment: Dear Writer,
1. Action plan is supposed to be 2000 words, not 1696. Add (yes, the customer said it can be (at least)
1650 words but they paid for more. Either you provide what you are paid or we refund and reduce your
payment). The customer is worried about the word count as well (Hi, word count came to 6693, not
including abstract and reference. )
2. Analysis should have 4 key themes. The customer provided 3 (Key theme:3) the most common
stimulus for autonomic dysreflexia is bladder and bowel issues. These are also in attached refences.
Bladder can be discussed with an argument but focus more on bowel (this is a suggestion due to word
limit).- missing), and asked to add another one. 'Botulinum Toxin Injection' and 'Nifedipine' can be sub-
themes (format accordingly) but not proper themes.
3. 'Firstly, there were too many sentences starting with 'The' or 'This'.' - still a problem.
4. Once again, discussion cannot have new sources (Herrity et al. (2020) etc), it can only discuss the
findings from the analysis and compare them to the sources before the methodology. Prest the finding,
then state if it is in line with a source etc. Discussion should clearly answer the research questions.
5. Analysis is not critical at all. Compare and contrast findings, state contradicting views if any; at the end
of the paragraph, make your own conclusion as based on the comparison. In order to achieve criticality,
one paragraph cannot be based on one reference only.
6. Conclusion should start with the aim, proceed with methodology and explain the key findings,
answering the research questions.

Abstract

Autonomic dysreflexia (AD) is a dangerous infection related to spinal cord

complications. In simple terms, Autonomic dysreflexia is a health-related crisis happening after

spinal line injury brought about by disturbance of the typical autonomic reactions to an upgrade

beneath the degree of spinal cord lesion. Such situations often lead to complications in
 Management and Knowledge 16

autonomic responses, and that can cause adverse health effects to those who experience the

defects. Even though it can prompt stroke, spasms, heart failure, and demise, health experts are

to a great extent oblivious of the condition, and it is habitually misdiagnosed (Inskip et al., 2018,

325). Therefore, the most genuine inconvenience of spinal cord injury (SCI) is autonomic

dysreflexia (AD), in which a harmful boost underneath the degree of damage, like an obstructed

catheter or gut distension, triggers a scene of outrageous hypertension that can prompt stroke,

discharge, seizures, and demise. The problem is characterized by paroxysmal hypertension as a

reaction to the extent of injury (Bloom, Herman, & Spungen, 2020, 23). Early knowledge about

AD, especially among people with spinal cord injury, is significant to both the patients and their

relatives since it promotes early control and management.

Severity of Autonomic dysreflexia increases the degree of SCI. During acute episodes,

hypertension is among the key symptoms resulting from radiology and other diagnostic methods.

The interventions lead to the destruction of the gastrointestinal tract, and the use of anesthetics

affects the health of the patients (Wheeler, 169-176). Nonetheless, the condition is under-

perceived and frequently not comprehended outside of expert SCI focuses, which can prompt

postponed or inappropriate treatment. In one review, crisis health practitioners scored a normal

of two out of 29 focuses on a survey to test their insight into AD. Various current studies focus

on AD (Caruso, Gater, & Harnish, 2015, 96). During the London 2012 Paralympic Games, The

condition acquired consideration when the hazardous act of boosting in which competitors self-

trigger AD to improve execution because of the expanded circulatory strain was depicted.

International Paralympic Committee has now prohibited this, and all competitors are tried for the

presence of AD before contending. Moreover, the research aims to critically analyze knowledge

and management among health practitioners of AD Secondary to SCI patients. One of the key
 Management and Knowledge 17

themes in this study include bowel care and stimulus for autonomic dysreflexia (Walter, 2015,

12). This article seeks to report on the significance of knowledge application in managing

patients with AD secondary to SCI in the United Kingdom.

Introduction

Role and Practice Context

I am a learning disability nurse who works for a neuro-disabilities nursing home

supporting adult patients with various conditions such as Multiple Sclerosis, Cerebral Palsy,

hypoxic brain injury, stroke, and spinal cord injury (SCI) (Eldahan, & Rabchevsky, 2018, 59-

70). Exploring practice into AD secondary to SCI developed through experienced practitioners

lacking knowledge and management of AD conditions while mentoring nurses to support SCI

patients who experience AD. Discussing informally with the home manager, nurses, and external

health practitioners did not have the knowledge and/ management skills of AD secondary SCI

Service users (Nash et al. 2018, 56-70).

Rationale

According to Stoffel et al. (2018), analyzing the work setting and considering the health

complexity of patients experiencing AD required specialist nursing care to extend specific

training to manage patients AND condition to improve individual’s outcome and quality of life.

Additionally, Knowledge and management of AD are crucial to investigate to enhance

practitioners’ clinical skills. AD is a potentially life-threatening condition that affects patients

with SCI triggered by stimulus below the level of injury and involves episodes of uncontrollable

blood pressure. If Hypertension occurs in AD and does not understand how it should be

managed, patients can be asymptomatic or complain of headache and flushing (Tarhan, et al.

2018, 96). AD is commonly triggered by stimulus below the level of T6 SCI involves bladder
 Management and Knowledge 18

distention, rectal distention from stool, or rectal stimulation (RS) during bowel care.

Additionally, if AD is not initially understood and managed, it can lead to seizures, pulmonary

edema, cerebral hemorrhage, and death.

Therefore, further feedback from management highlighted knowledge gaps among health

professionals and the organization to facilitate training to staff in preventing health implications

for SCI patients. Previously, I trained in management AD in SCI in a specialist hospital (Elliott

et al. 2019, 45). After that, nurses received internal training on general continence management

and not AD-related continence management. Consequently, there was a conflict with knowledge

being exchanged regarding what evidence-based practice suggests in managing AD concerning

continence care. Study session 1, Activity three, Block 1 (Open University 2020a). (Morgan,

2019). Conversely, (Strcic and Markic, 2018,63) tested health professionals before the AD

seminar, most related their knowledge of AD poor to none. Post-seminar, health professionals

felt their knowledge of AD improved.

In comparison, concerning bladder and bowel care are often neglected or poorly

understood. For one thing, bowel and bladder care is a familiar stimulus to AD in SCI patients,

triggering hypertension in SCI patients. (Inskip and Lucci, 2017,56). Nonetheless, the chosen

topic for the critical literature review is to focus on Autonomic Dysreflexia (AD) secondary to

SCI along with discussing the effect of continence management in bowel care exacerbating AD

and what evidence-based practice suggests how AD can be managed (Caruso, Gater & Harnish,

2015, 78). Above all, I observed, questioned, and discussed knowledge and management gaps in

AD with the home manager, scoped my work practice and conducted a preliminary literature

search, and concluded the overarching question: ‘Knowledge and Management of AD among

health practitioners AD secondary to SCI patients’

 Management and Knowledge 19

Consequently, the staggering occurrence of gross wounds to the spinal cord during the

First and Second World Wars implied AD started to be perceived as a clinical arrangement of

side effects. Lucci et al. (2019) uncovered that recently harmed patients with SCI were showing

signs of comparable indications; in one common patient, they noticed that: Sweat ran together

into tremendous dabs which moved off his face and neck, and dampness could be wrung out of a

wipe, disregarded his skin, as though it had been plunged into the water (Lucci, 2019, 430-440).

A sensation of Completion and distress joined the respective inordinate perspiring in the head,

and the beat would, in general, turn out to be slower, more persuasive, and sporadic. Researchers

Murray et al. (2019) noticed a trademark appropriation of the noticed perspiring, flushing, and

sweating over the degree of SCI and pale, cool skin and piloerection beneath the SCI. Systolic

circulatory strain was seen to 190-250mmHg and the diastolic to ascend to 130-150mmHg - this

was especially disturbing as the typical resting pulse in individuals with spinal rope sores is

around 20mmHg lower than in physically fit individuals.

However, the most well-known contributing variables for AD are bladder and entrail

distension; understudies are generally educated to recollect the 6 Bs as a simple outline of

potential triggers (Xing et al., 2021). These are bladder, guts, bubbles, bones, babies, and back

entry; they freely include the conditions summed as conditions related to AD. Following an SCI,

there is a time of spinal stun in which all spinal reflexes are lost totally underneath the degree of

sore. Over merely weeks or months, these reflexes gradually return somewhat; indications of AD

regularly arise in the equal affirmation that AD is brought about by some variation in a spinal

reflex curve. According to Petriello, Groah, and Matiana (2021), the current literature states that

the condition is due to physiologic processes that lead to the condition because of a trigger

associated with the outbreak of SCI that is caused by blockages of neuronal pathways because of
 Management and Knowledge 20

the total crosscut of the spinal line; this outcome is destructive in a manner that it causes

excessive vasoconstriction.

In this case, it would clarify the noticed hypertensive emergency, ECG changes, and pale,

cool skin underneath the SCI in patients with AD. A study by Nash et al. (2018) states that

fringe baroreceptors in the aortic curve and carotid vein recognize the expansion in circulatory

strain and convey messages to the brainstem actuating the parasympathetic sensory system; huge

bradycardia happens through the vagus nerve, and vasodilatation is set off - albeit just over the

degree of spinal string injury which brings about the trademark flushing and perspiring seen in

the head, neck, and chest area. The thoughtful reaction underneath the degree of sore far

surpasses the parasympathetic response; thus, hypertension is kept up, prompting extreme

cerebral pain. With injuries underneath the degree of T6, notwithstanding, AD is once in a while

seen. According to Liu et al. (2021), understanding the component of AD gives knowledge into

the plan of the autonomic sensory system: regularly, the two branches are reliant and precisely

tuned, yet in SCI, the input circles between them are interfered, showing paroxysmally and

significantly in scenes of AD. More examination is being attempted to comprehend the

fundamental cell components.

Research Aims and Question

Autonomic Dysreflexia, secondary to SCI is a dangerous and common infection that

prompted the research goals and aims to analyze the current evidence on the Management and

Knowledge among Health Practitioners of Autonomic Dysreflexia Secondary to Spinal Cord

Injury Patients. The research questions are as follows

 What is the significance of providing knowledge to health practitioners on the

management of AD, secondary to SCI?

 Management and Knowledge 21

 What are some of the medical interventions that are best for the treatment of Autonomic

Dysreflexia?

Background

Method of Appraisal

In this study, the method of appraisal that was used is the Management of Objectives

(MBO). In this technique, the managers, workers and other stakeholders are responsible for

planning, organizing and giving feedback on the management of AD secondary to SCI. Apart

from being a dangerous condition, Autonomic Dysreflexia is a life-threatening disease.

Subsequently, this medical condition usually develops among patients that are exposed to Spinal

Cord Injury in the contemporary era. The medical challenges usually cause 'uncontrollable

hypertension' in its extreme manifestation. According to Sawatzky et al. (2021), nurses,

Healthcare workers, caregivers, doctors, and therapists that manage persons with spinal cord

injuries factor the positivity or presence of the condition among the SCI patients (Caruso et al.,

2015). Besides, the relevant professionals should strive to identify and acknowledge the situation

within the SCI patients at their disposal and conduct investigation that facilitates their

comprehension of the causes of the dangerous situation and pursues the appropriate skills

relevant to treating patients autonomously dysreflexia. Experts and scholars in the medical

profession contend that autonomic dysreflexia usually develops in patients whose 'spinal cord

injuries' have attained the neurologic level (Inskip et al., 2018). More appropriate levels that

Indicate the precise point on the vulnerable patients could be exactly or slightly higher than the

thoracic vertebral threshold (T6).

Subsequently, this medical condition causes imbalanced reflexes among the patients,

including sympathetic discharges in its extreme condition (Lucci et al., 2019). The severe signs
 Management and Knowledge 22

and symptoms of AD subsequently expose the patients' hypertension potentially life-threatening

to SCI patients. Patients with spinal injuries, including the families with patients undergoing

neurological disorders of the nervous system, should identify the existence of autonomic

dysreflexia. Besides, they should initiate interventions to ensure that the condition is effectively

managed at earlier stages to prevent extreme situations that could lead to death or stroke on the

patients. Scholars have observed that autonomic dyslexia as a substantial cardiovascular

dysfunction usually exhibits clinical manifestation among patients with T6 and above spinal

complications. Milligan et al. (2020) state that the completeness of the inherent spinal injury is

another contributory factor for increasing the patients' exposure to AD.

Similarly, Rapidi (2014) indicates that evidence from the medical professionals indicates

that AD could manifest among the spinal injury patients within the first days of their injuries or

Few weeks after the individuals have encountered the injuries that subsequently permeate to the

spinal cord. Autonomic Dysreflexia is mainly caused by bladder and bowel issues which mostly

occur when there is rectal stimulation. Cases of autonomic dysreflexia can also be triggered by

various noxious stimuli, including non-noxious stimulants. Additionally, AD cases activate

through the irritation of the colon or the urinary bladder(Rapidi, 2014, 227). Based on the

physiological aspect of the causes of AD, the medical condition can be initiated by excess

sympathetic discharges generated by the non -noxious stimuli or the noxious stimuli that

originate from the lower levels of the spinal injury complications (Eldahan et al., 2018).

Most scholars and experts have engaged in comprehensive research to establish the

relevant knowledge and skills that can facilitate the health practitioners, including the patients

and family of spinal patients, in AD management in case it manifests (Morgan, 2020). The

investigators have published massive literature providing numerous and critical information
 Management and Knowledge 23

concerning the medical condition. Signs and symptoms that manifest among the patients during

infections with AD are usually short-lived. Patients who experience Spinal cord injury will often

experience continuous headaches, blockages of the urinary catheter, hypertension, and persistent

intracranial bleeding (Sawatzky et al., 2021, 63). Therefore, the phenomenon is attributed to the

detection and treatment of the disease by medical practitioners or the self-limiting nature of the

condition.

Following the discussion, questions were raised; therefore, a preliminary literature search

was conducted through the Open University (OU) online library and Google Scholar of the

keyword’s knowledge and management of AD secondary to SCI (Solomons, & Woodward,

2013, 23). Following this, substantial researched evidence-based literature relevant to AD

secondary to SCI produced thousands of pieces of works of literature. Additionally, I used Mind

Mapping (Key skills, 2014) to document in a journal to determine if mapping a spider graph will

give answers or questions relating to AD condition (Study session 1, Activity 2, Block 1, 2020a)

Exclusion and Inclusion Criteria

Inclusion Exclusion
Peer-reviewed articles that range from Journals present information about AD

2012-2021 treatment algorithms but it is outdated

They must be written in English Journals are written in languages other than

English
Must-have information on the triggers, Journals have information about

potential medical interventions such as hypertension only

pathophysiological and pharmacological

Journals have information on how to Articles lack background information about

prevent the triggers, provide proper selfcare on how medical practitioners can well

and ensure that proper nursing practice is manage and control the extent of AD and
 Management and Knowledge 24

applied by following the various continence SCI

policies and guidelines.

Findings

Knowledge of Health Practitioners on Autonomic Dysreflexia

Strčić and Markić (2018) and, Tarhan et al. (2018) evaluated knowledge of AD among

health students and health practitioners and, both studies explain AD is a potentially life-

threatening condition that affects patients with SCI at T6 and above, leading to uncontrolled

elevation of blood pressure (BP). Among the few causes for increased BP can be constipation

and digital rectal stimulation to empty patients’ bowel due to paraplegia. However, the methods

used To evaluate qualified practitioner participants ‘and student health practitioner participants’

knowledge were questionnaires. Tarhan et al. (2018) had 95 qualified health professionals’

answering seven questions and, Strčić and Markić (2018) had 91 student health practitioner

participants answer 11 questions. Comparing, both questionnaires covered relevant areas in what

clinical intervention should take place when it is suspected a patient may experience AD

symptoms, detailing causes and how to prevent AD occurrence in the first instant by removing

the cause of stimulus. In this case, strength of evidence in Strčić and Markić (2018) and, Tarhan

et al. (2018) studies showed there was a low level of knowledge among qualified health

professionals And health students where necessary guidelines and education of AD in SCI

patients should be given to qualified practitioners and health students’ on how the condition

should be managed. Therefore, health students require more education, and qualified

practitioners may need compulsory training and guidelines/protocols on identifying and

managing AD conditions.

Tarhan et al.’s (2018) study consist of anesthesia practitioners’, emergency health

practitioners, neurosurgeons,’ urologists’ and the rehabilitation team within a department. At the
 Management and Knowledge 25

same time, Strčić and Markić’s (2018) study consisted of student nurses and student

physiotherapists. Tarhan et al. (2018) state that none of the questions could be answered by 38

(40%) of 95 qualified health professionals and, Strčić and Markić (2018) knowledge test among

health students of AD was poor or none in 73.6% of students. Health student participants were

towards the end of their first year or second-year cohort. One of the limitations of Strčić and

Markić (2018) study suggests student health professionals at this stage in their cohort year would

not necessarily have the complete understanding to manage AD in SCI patients due to the

complexity of the condition, especially in a life-threatening situation, although they had work

experience of AD. Strčić and Markić (2018) commented that their results are evidence that

health Students and qualified healthcare practitioners need more education to apply adequate

treatment to patients with AD episodes. Strčić and Markić's (2018) comprehensive study focused

on health students and no qualified health professionals who participated in the research.

Nonetheless, health students are valuable members who contribute to the treatment of AD.

However, health students’ knowledge of qualified health practitioners should not be compared;

Tarhan et al.’s (2018) study poses that qualified health professionals are more likely to have

more knowledge and understanding in AD in SCI patients than health students.

Conversely, Strčić and Markić (2018) recommended that more education is needed for

student health professionals to understand AD conditions and apply adequate treatment to

patients experiencing AD due to their researched evidential findings of insufficient AD

knowledge. Agreeable in terms of health students having evidence of insufficient knowledge as,

pre-registered health practitioner’s understanding of AD may differ to qualified health

practitioners’ Above all, 60% of student participants had contact with up to 10 patients with SCI

per month, which suggested these two groups represented their knowledge of SCI. A part of the
 Management and Knowledge 26

questionnaire score determined their exposure to the AD condition during work experience.

Although students were initially exposed to SCI patients, Strčić and Markić (2018) suggest that

education about AD secondary to SCI is insufficient while health students are educated.

Additionally, Strčić and Markić (2018) discussed there were no significant differences in

knowledge of AD among student nurses and student physiotherapists though, student nurses had

a longer duration of work experience, and student physiotherapists were more exposed to SCI

patients considering, student nurses scored slightly higher. Therefore, studies concerning

insufficient knowledge of AD among student health professionals should commence more AD

training, and qualified professionals should have further training and access to guidelines. And

protocols to better understand the condition. Tarhan et al. (2018) study demonstrated

participants’ who are qualified practicians’ ranging from different disciplines that 40% (of 95

qualified health professionals’ participants’) could not answer the questionnaire. In caparison

Strčić and Markić’s (2018) study with 73.6% (of 91 student participants’) judged as inferior to

no knowledge of AD in SCI patients is inevitable to scholars Tarhan et al. (2018) discussion of

health student participants’ understanding of AD.

Clinical Management of Autonomic Dysreflexia

Consequently, Tarhan et al.’s (2018) research could have been more valid if the study

compared knowledge across individual disciplines rather than generalizing health disciplines

knowledge; this would identify what fields lack the ability for training and development to be

established to support patients with AD secondary to SCI. Knowledge and management among

health practitioners of AD in patients with SCI are essential for qualified health professionals and

student health professionals’ to educate patients to reduce the risk of further AD episodes.

Caruso et al. (2015) discussed the primary treatment is to remove the causes, which is not always
 Management and Knowledge 27

possible as in the case of chronic wounds or urinary tract infection causing stimulus, triggering

uncontrolled high BP. In these cases, prescribed medication for severe AD can be administered.

Curuso (2015) and Morgan (2020) report that Nifedipine is the most common treatment for

episodes of raised BP at 20 mmHg or higher if the cause of stimulation has not been identified

and/ BP cannot decrease after removal of stimulus or regular monitoring. Morgan (2020)

describes transdermal glyceryl trinitrate patches, sublingual medicines, and botulinum toxin

injection to prevent bladder spasms from preventing further increase of erratic BP. Morgan

(2020) studied AD management and was discussed in physical terms of removing stimulus;

however, more study surrounding pharmacological intervention for Reoccurring high BP may

have given more strength to how the condition could be further managed.

Furthermore, Inskip et al. (2015) discussed the relationship between bowel care, AD, and

quality of life, in individuals with SCI; participants of 163 of 245 had completed a questionnaire,

and those at risk of AD were 123 of 163 (74%) who reported at least one symptom of AD during

DRS; the most common symptoms were goosebumps, spasticity, flushing, and headaches.

Hence, 163 of 245 participants’ with T7 and above (62%) had AD symptoms during frequent

bowel digital rectal stimulation (DRS); participants used laxatives, suppositories, enema, and

stool softeners were used. However, the use of DRS intervention was weighed up with the

quality of life, with 166 of 214 respondents answering bowel care as a problem for them with 46

of 214 respondents who felt it was a significant impact, interfering with personal life, social

relationship, and preventing staying and working away from homes. Additionally, Inskip et al.

(2015) study included abdominal massage and food/fluid intake to enhance bowel care

management, reduce the onset of elevated BP, and reduce AD complications.

 Management and Knowledge 28

In contrast, Nice’s (2012) guidelines stipulate that suppository insertion, rectal

stimulation, and rectal enemas have all been reported to trigger AD. In this instance of bowel

care, acute signs of AD can arise, and necessary clinical assessment and intervention should be

undertaken, with educating the patient and caregiver about the AD condition. For example, the

use of local anesthetic gel during the digital intervention may reduce or prevent AD, is not

suitable for prolonged use of 30 minutes or more; Nice (2012) guidelines and Morgan (2020)

study discusses the risk of increased blood pressure is higher if DRS continues for a more

extended period than recommended.

Botulinum Toxin Injection

According to Eldahan and Rabchevsky (2018), Botulinum toxin is also used to prevent

Autonomic Dysreflexia, especially in bladder distention conditions. Effects of Detrusor-

Sphincter also cause AD, and botulinum injection is considered to treat the situation. In this case,

the injection helps increase the bladder’s capacity by aiding in reducing urine amounts. The

effect is felt by the subjects for up to 9 months. When the afferent is stimulated, it stops the

impending danger of an individual having the AD infection, thanks to botulinum toxin. The

injection serves as an alternative to urologic follow-up and other bladder management methods

used to reduce the effects of SCI on an individual due to renal failure. Milligan et al. (2020)

Allude that botulinum toxin is used in all level 4 assessments, and in all the cases, it proves its

effectiveness.

Actually, in all the cases where the injection was applied in AD treatment to facilitate the

reduction of urine in the bladder, traces of AD seemed to disappear entirely in individuals with

tetraplegia, and the condition was never seen even after botulinum is wholly lost. Therefore, as

per Rapidi (2014), there is robust evidence that the application of botulinum in the detrusor
 Management and Knowledge 29

occurs to be the best therapy among individuals suffering from spinal cord injuries. The

effectiveness of this injection is based on the fact that it aids in safe and effective intermittent

catheterization and becomes an option if they are resistant to other interventions like

anticholinergic medication. Botulinum is also used in sphincter surgery, and its use in

augmentation enterocytoplasty has yielded much success since it also reduces erectile

dysfunction.

Nifedipine

According to Gao, Danforth, and Ginsberg (2017), Nifedipine is another pharmacological

agent proposed as an alternative medication in managing AD and SCI-related patients.

Nifedipine is also referred to as a calcium blocker in simple words. The agent limits calcium

increase at the cardiac muscle walls without making any blood calcium levels. Decreases in both

systolic and diastolic, reduced blood pressure have been attributed to the agent’s application.

That occurs when the peripheral vascular pressure falls drastically.

The drug is more effective for acute episodes of AD, where the patients are offered to

swallow following dosage of 10mg. Gupta et al. (2021) have proved a significant reduction in

the levels of AD with continuous use of Nifedipine. The agent was once applied to one non-

Randomized Control Trial with symptoms of SCI during electroejaculation. In this case, the

levels of systolic, diastolic, and blood pressure were reduced. Moreover, Petriello, Groah, and

Matiana (2021) conducted a study on several clinicians managing patients with AD and the

Secondary infection, SCI. They realized that the intervention in AD treatment was different as

they moved from one health practitioner to the other. Most commonly, antihypertensive drugs

were most preferred. Nifedipine recorded about 47% of use in minor cases, while 59% was

reserved for application in acute and more severe episodes involving AD.
 Management and Knowledge 30

Discussion

Eldahan, & Rabchevsky's (2018) study looks at AD’s various mechanisms and

pathophysiology. In several cases, the most life-threatening conditions related to AD become

unethical when there is no team to conduct the treatment procedures while the Consortium of

Spinal Cord Medicine Association has a well-established protocol on management of the

disorder as per the available principles on clinical practice. Various effective measures are

primary in preventing AD related to spinal cord injuries, such as proper education, bladder, and

bowel management, and maintenance of pressure ulcers (Elliott et al., 2019, 68-84). Even though

the measures are legible to saving AD patients, recognizing possible triggers, improved health

practitioner awareness, and avoiding any possible noxious stimuli are key aspects subject to AD

prevention.

Therefore, Herrity et al. (2020) state that all medical providers and those who care for the

patients should know that an influx in afferent stimulation resulting from surgery and labor

increases the chances of suffering from AD long as the person has SCI related causes.

Preliminary evaluation and control of AD with sole dependence on the bladder program is not

enough because it requires pharmacological treatment in more acute cases. However, in the

controlled trials, there were only two pharmacological treatments available. The intravesical

Resiniferatoxin and surgery were the ones involved. This evidence is strongly undermined by

preliminary controlled trials, especially those related to treatment (Nash et al., 2018, 379). On a

positive note, the studies have some long-term benefits, such as the various effects of botulin and

augmentation on detrusor hyperreflexia over some time.

During an intense scene, clinical and nursing staff must consider an AD dependent on the

side effects found in patients with SCI and act similarly. Medication treatment is once in a while
 Management and Knowledge 31

required - mediation, for example, bladder and gut, the executives are typically viable.

Antihypertensives with brief span and fast beginning of activity can be thought of as possible

methods that could be used to treat AD-related to SCI. The agents mostly used include

nifedipine, nitrates, and sildenafil, even though consideration should be taken to prompt

profound hypotension (Petriello, Groah, & Matiana, 2021, 89). The named drugs are significant

since the patients can engage in the self-health intervention. Preparing and backing can be

obtained from expert spinal injury communities. When the AD condition is solved, it is

significant for the multidisciplinary group to ponder potential causes and act to limit repeat if the

scene was set off through obstruction or fecal impaction. The patient's inside administration

program should be investigated as far as recurrence and whether medications, such as diuretics,

could help DRF. Weight conditioning, suspending of smoking, and exercise programs, just as

counsel on liquid admission and diet, would all improve general wellbeing and inside

propensities, reducing the danger of AD (Miller, & Kennelly, 2021).

I emphasize that AD lacks formal recognition outside the rehabilitation centers for spinal

cord injuries. The majority of the people at risk of contracting AD, such as those who suffer from

both cervical and thoracic SCI, are exposed to acute rehabilitation periods even after proper

pathophysiology and medical intervention of the infection. Surprisingly, such situations are

prevalent because patient physicians and health practitioners in emergency units lack the

required awareness of AD and especially patients suffering from SCI. The justification for this is

supported by Walter et al. (2015), who believe that it is the reason why there is a need for

education and empowerment of SCI patients and their respective relatives for them to have a

choice of the particular intervention required to solve the problem.

 Management and Knowledge 32

Moreover, all the individuals involved must have a medical emergency card for AD

always with them. Therefore, the card contains the causes, description, and management of AD

(Tederko et al. 2019, 169-176). The main objective in providing knowledge and control of AD in

patients with SCI is to reduce the risk of further development and to ensure that the right

interventions are applied on time. Pharmacological agents are appropriate for use when non-

pharmacological methods are limited and the pressure of systolic blood is high. As per Xing et

al. (2021), acute AD scenarios are generally reduced using nifedipine and nitrates as the main

pharmacological agents. In some cases, individuals with SCI are supposed to use

antihypertensive agents before seeking full medical attention from the clinicians. However,

persistence in their symptoms and destabilization in blood pressure levels means that they should

visit the nearest emergency units for further check-up.

According to Neuro-disability nursing home (2018), the whole process of ensuring that

health professionals have the requisite knowledge on the management of Autonomic dysreflexia,

secondary to SCI, requires that there must be based policies on the promotion of continence and

procedures (Tarhan, et al. 2018, 96). For example, the staff members will be allowed to access

the required sources with a policy framework that outlines the expected codes of practice that

promote evidence-based health care. Various promoters will be initiated so that the continence

program is a success. First is by the provision of adequate continence aids. Along with that, they

also require Proper care in terms of storage with high levels of privacy (Solomons, &

Woodward, 2013, 23). Secondly, the continence aids are supposed to be used correctly as per

the manufacturer’s guidelines.

Besides, not all continence aids are automatically appropriate to all the patients.

Therefore, the correct aids should be directed to clients based on their needs. Tarhan et al.’s
 Management and Knowledge 33

(2018) study state that the last measure is to ensure that the continence aids are disposed of

according to the set legislation and infection management laws. For the residents, there will be

an updated continence assessment that will be vital for keeping their overall independence and

preventing any future potential complications. In the same policy framework, the residents will

have the independence to refer to the best nursing professionals who will offer them the guidance

and health practice services required (Inskip and Lucci, 2017,56). A well-elaborated plan will

then be incorporated so that the staff should evaluate and effectively harness their skills to

promote ethical practice in their work.

The Neuro-disability nursing home (2018) states that the policy framework will also

ensure that the staff recruited into the system have the required knowledge, skills, and high-

competence levels that acknowledge the significance of independence and have a positive effect

on the status of the residents. The patients are supposed to be fully involved in the care

management process in situations that are possible, that will promote their confidence and

independence, which are the key principles in continence planning. However, circumstances in

which the resident’s involvement is somehow difficult, especially when making decisions related

to their health care. In such scenarios, every step and the final decision must be within their

interests, which would attract a possible reference to the Mental Capacity Act 2005 (Modgill,

Bryant, & Moosajee, 2017, 923). However, there is also an action plan that will be incorporated

into the study. The main aim of this plan is to ensure that health professionals are equipped with

the required knowledge while at their workplaces. However, the significance of this scenario is

to maintain effective clinical practice while ensuring the safety of their patients and the personnel

present in the environment.

Conclusion
 Management and Knowledge 34

Management and knowledge among health practitioners of Automatic Dysreflexia

Secondary to Spinal Cord Injury patients are very significant. AD is a frequent issue among

individuals and often leads to serious and acute conditions. Education and awareness of AD and

the associated spinal cord injury are very significant to clinicians engaged in providing medical

care to the patients. Clean and safe clinical practice is supported by appropriate management,

proper planning procedures, and empowerment on the knowledge of the pharmacological

interventions required in treating the disorder. Health experts supervising the process must

identify the risk conditions and procedures before handling the supervision and provision of

anesthesiologic support. When all radiologists, nurses, and the patients’ caregivers know about

the prevention and limitation of the triggers, it successfully manages the disease.

However, there lacks of controlled trials in the control of AD secondary to spinal cord

injury patients. Medical interventions like surgical and pharmacological do not show any

evidence of a controlled group except for the intersphincteric anal block. The primary treatment

of AD features the identification and subsequent limitation of the potential triggers that lead to

acute episodes. If pharmacological interventions are not successful, certain drugs are preferred,

such as nifedipine, nitrates, and captopril. Among the named agents, nifedipine is the most

effective and recommended by clinicians because it has level 4 controlled trials. Therefore, it is

vital to conduct Randomized Controlled Trials (RCTs) to determine the best group of drugs and

therapeutic mechanisms that are more effective during treatment. Apart from educating health

professionals on the care and management of AD, the patient’s area is also Supposed to be given

Intensive training and empowerment on the health practices related to AD, secondary to Spinal

Cord Injuries. Awareness among the subjects can be achieved by issuing them with wallets or
 Management and Knowledge 35

cards that have information on the symptoms, preventive measures, and management of

Autonomic Dysreflexia.

References

Bloom, O., Herman, P.E. and Spungen, A.M., 2020. Systemic inflammation in traumatic spinal

cord injury. Experimental neurology, 325, p.113143.

Caruso, D., Gater, D. and Harnish, C. (2015). Prevention of recurrent autonomic dysreflexia: a

survey of current practice. Clinical Autonomic Research, 25(5), pp.293–300.

Eldahan, K.C. and Rabchevsky, A.G. (2018). Autonomic dysreflexia after spinal cord injury:

Systemic pathophysiology and methods of management. Autonomic Neuroscience, 209,

pp.59–70.
 Management and Knowledge 36

Elliott, S., Jeyathevan, G., Hocaloski, S., O’Connell, C., Gulasingam, S., Mills, S., Farahani, F.,

Kaiser, A., Mohammad Alavinia, S., Omidvar, M. and Craven, B.C., 2019. Conception

and development of Sexual Health indicators to advance the quality of spinal cord injury

rehabilitation: SCI-High Project. The journal of spinal cord medicine, 42(sup1), pp.68-

84.

Fritel, X., 2015. Should we systematically ask about postnatal incontinence?. BJOG: An

International Journal of Obstetrics & Gynaecology, 122(7), pp.963-963.

Gao, Y., Danforth, T. and Ginsberg, D.A., 2017. Urologic management and complications in

spinal cord injury patients: a 40-to 50-year follow-up study. Urology, 104, pp.52-58.

Gupta, S., McColl, M.A., Smith, K., and McColl, A., 2021. Prescribing patterns for treating

common complications of spinal cord injury. The Journal of Spinal Cord Medicine, pp.1-

9.

Herrity, A.N., Aslan, S.C., Ugiliweneza, B., Mohamed, A., Hubscher, C.H. and Harkema, S.J.,

2020. Improvements in bladder function following activity-based recovery training with

epidural stimulation after chronic spinal cord injury. Frontiers in Systems Neuroscience,

14, p.99.

Inskip, J.A., Lucci, V.-E.M., McGrath, M.S., Willms, R. and Claydon, V.E. (2018). A

Community Perspective on Bowel Management and Quality of Life after Spinal Cord

Injury: The Influence of Autonomic Dysreflexia. Journal of Neurotrauma, 35(9),

pp.1091–1105.

Liu, T., Xie, S., Wang, Y., Tang, J., He, X., Yan, T. and Li, K., 2021. Effects of App-Based

Transitional Care on the Self-Efficacy and Quality of Life of Patients With Spinal Cord
 Management and Knowledge 37

Injury in China: Randomized Controlled Trial. JMIR mHealth and uHealth, 9(4),

p.e22960.

Lucci, V.-E.M., McGrath, M.S., Inskip, J.A., Sarveswaran, S., Willms, R. and Claydon, V.E.

(2019). Clinical recommendations for use of lidocaine lubricant during bowel care after

spinal cord injury prolong care routines and worsen autonomic dysreflexia: results from a

randomized clinical trial. Spinal Cord, 58(4), pp.430–440.

Miller, C.A. and Kennelly, M.J., 2021. Pulse article: a survey of neurogenic bladder management

in spinal cord injury patients around the world. Spinal Cord Series and Cases, 7(1), pp.1-

7.

Milligan, J., Burns, S., Groah, S., and Howcroft, J., 2020. A Primary Care Provider’s Guide to

Preventive Health After Spinal Cord Injury. Topics in Spinal Cord Injury Rehabilitation,

26(3), pp.209-219.

Milligan, J., Lee, J., Hillier, L.M., Slonim, K., and Craven, C., 2020. Improving primary care for

persons with spinal cord injury: Development of a toolkit to guide care. The journal of

spinal cord medicine, 43(3), pp.364-373.

Modgill, O., Bryant, C. and Moosajee, S., 2017. The Mental Capacity Act 2005: Considerations

for obtaining consent for dental treatment. British dental journal, 222(12), p.923.

Morgan, S. (2020). Recognition and management of autonomic dysreflexia in patients with a

spinal cord injury. Emergency Nurse, 28(1), pp.22–27.

Morgan, S., 2021. Recognition and management of autonomic dysreflexia in patients with a

spinal cord injury. Emergency Nurse, 29(3).

 Management and Knowledge 38

Murray, T.E., Krassioukov, A.V., Pang, E.H., Zwirewich, C.V. and Chang, S.D., 2019.

Autonomic dysreflexia in patients with spinal cord injury: What the radiologist needs to

know. American Journal of Roentgenology, 212(6), pp.1182-1186.

Nash, M.S., Groah, S.L., Gater Jr, D.R., Dyson-Hudson, T.A., Lieberman, J.A., Myers, J.,

Sabharwal, S. and Taylor, A.J., 2018. Identification and management of cardiometabolic

risk after spinal cord injury: clinical practice guideline for health care providers. Topics

in spinal cord injury rehabilitation, 24(4), p.379.

National Institute for Clinical Excellence (NICE). Spinal Injury Association: statement on

autonomic dysreflexia (2017). (online) Available at https://www.mascip.co.uk/ wp-

content/uploads/2019/01/Statement -on-Autonomic-Dysreflexia-2017.pdf

Neuro-disability nursing home (NDN), (2018) Promoting Independence with Incontinences

Policy and Procedure. Anonymous, internal information

NHS Institute for Innovation and Improvement, 2015. Improvement Leaders' Guide. Managing

the human dimensions of change: Personal and Organizational development.

NMC (2018). The Code. [online] Nmc.org.uk. Available at:

https://www.nmc.org.uk/standards/code/.

Petriello, M.A., Groah, S. and Matiana, S.D., 2021. Treatment of bilateral sacral insufficiency

fractures with septoplasty in a patient with motor complete tetraplegia. Spinal Cord

Series and Cases, 7(1), pp.1-3.

Rapidi, C.A. (2014). Workshop: Autonomic dysreflexia in spinal cord injury, “A Need for

Educational Programs and Autonomic Dysreflexia Wallet Card.” Annals of Physical and

Rehabilitation Medicine, 57, p.e227.

 Management and Knowledge 39

Rizan, C., Bhutta, M.F., Reed, M., and Lillywhite, R., 2021. The carbon footprint of waste

streams in a UK hospital. Journal of Cleaner Production, 286, p.125446.

Runcie, H., 2018. Sort your waste! An audit on the use of clinical waste bins and its

implications. Future healthcare journal, 5(3), p.203.

Rantell, A., 2017. The role of the continence nurse. In Textbook of Female Urology and

Urogynecology-Two-Volume Set (pp. 458-467). CRC Press.

Sawatzky, B., Edwards, C.M., Walters-Shumka, A.T., Standfield, S., Shenkier, T. and Harris,

S.R., 2021. A perspective on adverse health outcomes after breast cancer treatment in

women with spinal cord injury. Spinal Cord, pp.1-5.

Sekido, N., Igawa, Y., Kakizaki, H., Kitta, T., Sengoku, A., Takahashi, S., Takahashi, R.,

Tanaka, K., Namima, T., Honda, M. and Mitsui, T., 2020. Clinical guidelines for the

diagnosis and treatment of lower urinary tract dysfunction in patients with spinal cord

injury. International Journal of Urology, 27(4), pp.276-288.

Solomons, J. and Woodward, S. (2013). Digital removal of feces in the bowel management of

patients with spinal cord injury: a review. British Journal of Neuroscience Nursing, 9(5),

pp.216–222.

Stoffel, J.T., Van der Aa, F., Wittmann, D., Yande, S. and Elliott, S., 2018. Fertility and

sexuality in the spinal cord injury patient. World journal of urology, 36(10), pp.1577-

1585.

Strčić, N. and Markić, D. (2018). The knowledge about autonomic dysreflexia among nursing

and physiotherapy students. The Journal of Spinal Cord Medicine, 42(6), pp.791–796.

Strčić, N. and Markić, D., 2019. The knowledge about autonomic dysreflexia among nursing and

physiotherapy students. The journal of spinal cord medicine, 42(6), pp.791-796.

 Management and Knowledge 40

Tarhan, F., Coşkun, A., Eryıldırım, B. and Sarıca, K. (2018). Evaluating Knowledge of

Autonomic Dysreflexia Among Physicians in a Tertiary Hospital. Journal of Urological

Surgery, 5(2), pp.88–92. The Open University, (2020a), KYN 316 Exploring Practice,

Block 1, Study Session 1, Activity 2. [online]. Available at

https://learn2.open.ac.uk/mod/oucontent/view.php?id=1649575 [Online] (Accessed 12th

October).

Tederko, P., Ugniewski, K., Bobecka-Wesołowska, K. and Tarnacka, B., 2019. What do

physiotherapists and physiotherapy students know about autonomic dysreflexia?. The

journal of spinal cord medicine, pp.1-7.

The Open University, (2020a), KYN 316 Exploring Practice, Block 1, Study Session 1, Activity

3. [Online]. Available at https://learn2.open.ac.uk/mod/oucontent/view.php?id=1649575

(Accessed 12th October 2020).

Walter, M., Knüpfer, S.C., Leitner, L., Mehnert, U., Schubert, M., Curt, A. and Kessler, T.M.

(2015). Autonomic dysreflexia and repeatability of cardiovascular changes during the

same session repeat urodynamic investigation in women with spinal cord injury. World

Journal of Urology, 34(3), pp.391–397.

Wheeler, T.L., de Groat, W., Eisner, K., Emmanuel, A., French, J., Grill, W., Kennelly, M.J.,

Krassioukov, A., Santacruz, B.G., Biering-Sørensen, F. and Kleitman, N., 2018.

Translating promising strategies for bowel and bladder management in spinal cord injury.

Experimental neurology, 306, pp.169-176.

Xing, H., Liu, N., Krassioukov, A.V. and Biering-Sørensen, F., 2021. How to learn the

International Standards to document remaining Autonomic Function after Spinal Cord

 Management and Knowledge 41

Injury (ISAFSCI) content: Self-study through booklet is not enough. The Journal of

Spinal Cord Medicine, pp.1-8.

Action Plan

Appendix A

What By Whom When Expected Outcome

Completed project summary to Me, as project 01/06/2021 Home policy to be more

share with home manager: proposer and detailed in the

evidence-based summary for home manager management of AD.

staff to support patients with

AD secondary to SCI (Rantell,

2017, 458-460).

The staff must have a

continence plan policy and

assessment necessary to ensure

that their practice is overall

safe and effective for positive

outcomes.

Discuss training on Me, as project 06/06/2021 Staff informed by email:

management of AD in proposer and three-day workshop for

workshop 1: Home Manager, staff

The staff should be issued with director of care

 Management and Knowledge 42

documents like pamphlets with

information about Autonomic

Dysreflexia before the meeting

for personal study and

evaluation (Morgan, 2021, 56).

The data contained in the

documents should have

information on the triggers,

management, and significance

of knowing AD, secondary to

patients with SCI

The Process Change (NHS, Me, as project 10/06/2021 Staff to discuss as a group

2007b): a checklist for proposer and and ask questions. To

managing a new beginning Home Manager, arrange the next workshop

write a 2-page evidence base Senior Carers,

summary regards to Nurses

knowledge and management of

AD in SCI patients

Workshop 2: Provide AD
 Management and Knowledge 43

home policies to discuss

changes in protocol/ guidelines

Workshop 3: Lead nurses who Me, as project To make changes to AD

will mentor and/ train staff 4 proposer, nurses guidelines and get further

units after a training session? and senior cares, feedback from the

Senior Carers, manager. The manager

Nurses. should give feedback

concerning the continence

policies and regulations

(Solomons, & Woodward,

2013, 89) He or she is

required to give feedback

that has a provision for

both the continence aids

and care tailored to meet

the needs of the patients.

 Management and Knowledge 44

Find suitable training program Me, as project A one-day training course

for management of AD in SCI proposer, nurses that enables nurses and

patients: teacher or e-learning and senior cares, senior carers to identify,

Senior Carers, diagnosed, and treat AD.

Nurses In this unit, the health care

specialists and other

caregivers are supposed to

learn about the

functioning of the Urinary

Tract Unit so that they can

easily identify any

complications among the

patients associated with

either the kidneys,

bladder, or urethra

(Solomons, & Woodward,

2013, 23-60)
Discuss the various triggers of Me, as project 15/06/2021 Proper education and

AD: proposer, nurses awareness of the AD issue

The causes of AD include the and senior cares among nursing

following: professionals who provide

-Irritation of the bladder medical care to SCI

 Management and Knowledge 45

-Blocked catheters patients is important since

-Constipation it enables proper planning,

-Anal infections monitoring, and

application of the best

pharmacological and

pathophysiological

interventions that promote

effective health care

(Elliott, 2019, 68-84).

When the medical staff

has prior knowledge about

AD, the likelihood of

initiating proper

prevention, recognition,

and overall control of

Autonomic Dysreflexia

among patients with

Spinal Cord Injury is high.

Propose the various medical Me, as project 19/06/2021 The nurses and senior

interventions suitable for proposer and Cares should be able to

managing AD and specifical home manager apply the various

patients with SCI pharmacological and

pathophysiological
 Management and Knowledge 46

medical interventions in

the prevention and

treatment of the effects

related to AD and SCI

(Gao, Danforth, &

Ginsberg, 2017, 52-58).

That is through proper

radiological practices and

the application of other

agents like the botulin

injection
Planning on Conflict Me, as project 29/06/2021 The Improvement

Management: Conflict and proposer and Personnel Manager dealt

misunderstanding implies home manager with the circumstance in a

diverse things to various variety of ways. First, the

individuals. This might be manager summed up

because of their expectations where there appeared to

of their styles or even their be understood and

expertise incorporating instances of

There was consent to choose standards set by different

several ways in referral criteria clinics both to invigorate

models for patients with conversation and to

suspected cases related to the encourage a climate of

symptoms of AD, secondary to more extensive

 Management and Knowledge 47

Spinal Cord Injuries. Every coordinated effort. The

one of the experts included group of advisors, in the

presently applied distinctive long run, concurred on a

clinical practice and various bunch of standards and

limits for choosing if the went on to show their

patients were at high risk or proprietorship and

not (Fritel, 2015, 963). arrangement by all in all

The conversations went on for guarding their choices at

half a month. Furthermore, workshops and

were portrayed by one expert conferences, even with

citing research discoveries extraordinary addressing

according to their opinions but from their companions

would end up being challenged concerning the various

by the other parties. That management mechanisms

created a misunderstanding of Autonomic Dysreflexia

and conflict of ideas. secondary to Spinal Cord

Injuries. At the point

when queries were raised

regarding the interaction,

the experts remarked that

they had never had a

particularly top to bottom

contention about clinical

 Management and Knowledge 48

practice and they had

thought that it was

stimulating. They said that

it had established the vibe

for straightforward

conversations in different

gatherings and the

'contention' had kept them

focused on their tasks.

Communication processes: 30/6/2021 There are numerous

Communication can best be reasons why

summed up as the transmission communication may fall

of a message from a sender to flat. In numerous

a recipient in a justifiable way. interchanges and

The significance of viable exchanges between

correspondence is people, the message may

unfathomable in the realm of not be gotten precisely

health and clinical sectors and how the sender proposed

in close to home life. From a (Eldahan, & Rabchevsky's

medical point of view, viable 2018, 63) It becomes

correspondence is a flat out significant that the

must, on the grounds that it communicator looks for

ordinarily represents the criticism to watch that

distinction among progress and their message is perceived

 Management and Knowledge 49

disappointment or benefit and when training and

misfortune. It has become developing the staff or

certain that powerful hospital's clinicians during the

correspondence is basic to the planning on the

fruitful activity of current management of AD,

undertaking. Each medical secondary to SCI patients.

specialist needs to comprehend

the essentials of viable

correspondence.

During the workshops, various

communication issues might

be attributed to

misunderstanding and

language barriers

Discuss clinical waste Me, as project 01/01/2021 To make necessary

management practices to the proposer and changes in the ecological

health professionals home manager setup. Effective

The wastes from clinical management and

practice include the following: prevention of Autonomic

Infectious wastes include Dysreflexia which is

blood and other patient fluids secondary among patients

samples that are deposited with SCI have some

from laboratories and are harmful effects on the

 Management and Knowledge 50

dangerous to people in case environment. According

they come into contact to Rizan, C., Bhutta, M.F.,

(Runcie, 2018, 203). Reed, M., and Lillywhite,

Pathological and R., 2021.

pharmaceutical wastes are

human tissues, fluids, expires

and contaminated drugs that

are thrown away into the

environment by the clinicians

Implementation: Barriers to Me, as project 02/07/2021

effective organization: proposer and

The following are the issues home manager

that would affect the

organization of all the staff and

stakeholders during the

worships (Fritel, 2015, 963)

-Cultural differences

-Lack of focus on the set

objectives

-Physical barriers

-Information complexity and

overload leading to

misunderstanding of key

concepts that are discussed

 Management and Knowledge 51

during the meetings

Maximizing Staff Me, as project 04/07/2021 -Set aside some effort and

Involvement: proposer, nurses time to assess the

Undeniable degrees of staff and senior cares, situations while avoiding

inclusion, commitment and Senior Carers, unnecessary assumptions.

impact are the keys to turning Nurses -Adjusting personal

out to be and staying qualities and convictions

competitive in the health to those of the association

sector.Members of staff that is

are involved might be the It could be important to

contrast between a decent challenge some individual

organization, and an to convictions that are not

uncommon one. Motivated shared by other staff or by

workers are profoundly eager the association (Fritel,

about their positions, are 2015, 963)

exceptionally dedicated and -Work at the correct speed

useful. They are also content for the group. It is vital

with their work and experience not to ask excessively too

for better prosperity at in the early

health facilities (Fritel, 2015, - Attempt to look after

963) force, particularly at the

Studies show that hospitals and beginning phases (even

health organizations utilizing though

 Management and Knowledge 52

profoundly drew in offsetting this need with

representative's are highly that of keeping a

beneficial from expanded reasonable speed). Early,

advancement and efficiency. In basic, obvious upgrades

this case, they assist ('fast successes') may

organizations with beating assist with setting up

their rivals as the facilities are energy

able to go through enduring -Comprehend How might

and flourish in terms of service this benefit clinical

delivery to their customers. practice, adjusting and

addressing the necessities

Boosting representative of people, the group, and

contribution, commitment and the association.

impact expects associations to -Picking our beginning

perceive what persuades their stage - present plans to the

employees and to change the group and let the choice

conduct of their workers on where to start be a

utilizing methodologies that collective choice. Aiding

stick. the staff to

The process of ensuring that propose/control what to be

all the health staff are changed will engage

knowledgeable and can plan

and manage the best strategies

 Management and Knowledge 53

that are best for them to

combat the various effects of

acute Autonomic Dysreflexia.

Evaluation: Determining if the Me, as project 07/07/2021 Autonomic Dysreflexia

goals of the study have been proposer and with secondary relation to

achieved and noting down the home manager patients with SCI is

positive factors that promoted managed. That means all

the success. the Caregivers, nursing

specialists and the family

members of the patients

have the required

knowledge on the health

practices of AD.

The research goals and

objectives will be

evaluated among all the

professionals involved in

the study in several ways.

First, they should have the

ability to evaluate, and

manage all the patients

who experience signs and

symptoms of Autonomic

Dysreflexia
Management and Knowledge 54

The clinicians will also be

able to demonstrate how

they can apply the

different pharmacological

and physiological

interventions such as

Botulinum Toxin

Injection and Nifedipine