Experiences of district nurses working with people with spinal cord injury in the community: A descriptive account

Abstract
Spinal cord injury is a health condition which significantly affects the health and wellbeing of a person. People with spinal cord injury access a range of health services, including community-based nursing services. There is limited international and New Zealand literature about the perspectives and roles of nurses who work with people with spinal cord injury in the community. This study used a qualitative descriptive approach to analyse the data from semi-structured interviews with three district nurses about their experiences of working with people with spinal cord injury. The findings revealed three themes related to the nature of and factors affecting the district nurse role. The task-based role refers to superficial aspects that were initially described. District nurses went on to describe the complex role, revealing the highly complex work and challenging situations they faced. Lastly, they described the barriers and enablers affecting their ability to perform their role, including the relationship between the nurse and the individual with a spinal cord injury. The nurses provided a rich description about the complexity of health problems people experience and of the short-comings of the health services available to spinal cord injury community. Their perspectives are consistent with the limitations to care reported in the international and New Zealand literature. District nurses have a vital role in supporting the health and wellbeing of people with spinal cord injury but are constrained by a service contract that severely limits their ability to provide all but basic care. Recommendations are for the district nurse context and contract to be re-examined, and for further research about the district nurse role and spinal cord injury-related health services.

Ngā ariā matua
Ko tēnei mea te wharanga aho tuaiwi tētahi mate e tino pā ana ki te hauora me te toiora o te tangata.  Ka uru te hunga kua whara te aho tuaiwi ki te tini o ngā ratonga hauora, tae atu ki ngā ratonga tapuhi ā-hapori. He iti noa ngā tuhinga pukapuka i te ao, i Aotearoa hoki mō ngā tirohanga me ngā tūranga o ngā tapuhi e mahi tahi ana ki te wharanga aho tuaiwi i te hapori. I whakamahia he tikanga whakaahua kounga i roto i te rangahau, i kawea ai ētahi uiuinga āhua ōkawa ki ētahi tapuhi ā-takiwā tokotoru mō ō rātou wheako o te mahi tahi ki te hunga kua whara te aho tuaiwi. I roto i ngā hua i puta ētahi ariā e toru e pā ana ki te āhua, me ngā āhuatanga ka pā ki te tūranga o te tapuhi ā-takiwā.  E pā ana te tūranga kawe mahi ki ngā āhuatanga o waho, i whakamāramatia e rātou i te tuatahi. I muri, i whakamārama ngā tapuhi mō te tūranga matatini nei, me te whakaahua i ngā mahi mutunga mai o te matatini, o te uaua hoki, i ngā āhuatanga o ā rātou mahi. Hei whakamutu atu, i whakamāramatia e rātou ngā maioro me ngā tikanga āwhina i pā ki tō rātou āhei ki te kawe i ā rātou mahi, tae atu ki te whanaungatanga i waenga i te tapuhi me te tangata takitahi kua whara nei te aho tuaiwi. I horaina e ngā tapuhi tētahi whakamārama whakamīharo mō te matatini o ngā raruraru hauora ka pā ki te tangata, me ngā ngoikoretanga o ngā ratonga hauora e wātea ana ki te hapori whara aho tuaiwi. He ōrite ā rātou tirohanga ki ngā pēhitanga i te taurimatanga i pūrongotia ana i ngā tuhinga o te ao, o Aotearoa hoki. He tūranga tono waiwai tō te tūranga tapuhi ā-takiwā hei tautoko i te hauora me te toiora o ngā tāngata kua pāngia e ngā wharanga aho tuaiwi, engari e herea ana e tētahi kirimana ratonga e pēhi ana i tō rātou āhei ki te hora i te taurimatanga i tua atu i te mea taketake anake. Ko ngā tohutohu, me tirotiro anō ngā tohu mō te horopaki o ngā tapuhi ā-takiwā, me ngā kirimana, me haere tonu ētahi atu rangahau mō te tūranga tapuhi ā-tkaiwā, me ngā ratonga wharanga aho tuaiwi.

Keywords / Ngā kupu matua
Spinal cord injury / wharanga aho tuaiwi; district nurse / tapuhi ā-takiwā; community health nurse / taupuhi hauora hapori; complexity / matatini; Aotearoa / New Zealand