Management and Knowledge of Autonomic Dysreflexia 1

MANAGEMENT AND KNOWLEDGE AMONG HEALTH PRACTITIONERS OF

AUTONOMIC DYSREFLEXIA SECONDARY TO SPINAL CORD INJURY PATIENTS

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 Management and Knowledge of Autonomic Dysreflexia 2

Abstract 
Autonomic Dysreflexia is a lethal clinical infection that mostly affects people with Spinal

Cord Injuries. In this case, the caregivers, medical professionals, and families of those

individuals need to know the causes, symptoms, and management of Autonomic Dysreflexia

secondary to SCI (Morgan, 2021, 29). In my experience as a learning disability nurse, studies

have shown that health practitioners did not have the required knowledge and management

skillsets of AD secondary to Spinal Cord Injuries (Walter, 2015, 12). In this case, the research

aims to report the significance of knowledge application in managing patients with AD

secondary to SCI in the United Kingdom. One of the key themes in this study includes bowel

care and stimulus for autonomic dysreflexia.

Management of Objectives (MBO) was used as the main technique of appraisal with all

the medical stakeholders, patients, and their families crafted in the organizing, planning, and

decision-making process on the prevention of the triggers and management of Autonomic

Dysreflexia secondary to Spinal Cord Injury patients (Caruso et al., 2015). Majority of this

research was conducted through the pen University (OU) online library and Google Scholar.

Additionally, I used Mind Mapping (Key skills, 2014) to document a journal to determine if

mapping a spider graph will give answers or questions relating to AD conditions. Data collection

method used in the evaluation of qualified professionals and student participants involved

questionnaires that covered areas related to the clinical intervention of AD-related to SCI.

Prevention of the infection depends on the proper bladder and bowel care.

Prevention of the infection is primarily depent catheterization and urological follow-up,

which ensures that fecal movement is managed while preventing any cases of constipation

(Solomons & Woodward, 2013, 23). Other methods used include Nifedipine and the Botulinum

Toxin injection, which are the clinical management practices mainly meant to reduce
 Management and Knowledge of Autonomic Dysreflexia 3

hypertension and promote bladder management. Extreme and acute conditions of the infection

AD related to SCI require that health professionals know the prevention strategies and

management of the disease. Apart from seeking medical attention, patients can also use personal

administration of diuretics, engage in exercises, and ensure that their body weight is fully

conditioned to live healthy lives. Through the Action plan attached to the study, the clinicians

will be ably equipped with the required to be evaluated on their knowledge of managing AD

while at their workplaces (Modgill, Bryant, & Moosajee, 2017, 923). Another significance of this

scenario is maintaining effective clinical practice and maintaining the safety of staff and patients

in health care environments.

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.
 Management and Knowledge of Autonomic Dysreflexia 4

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

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
 Management and Knowledge of Autonomic Dysreflexia 5

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’

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,
 Management and Knowledge of Autonomic Dysreflexia 6

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

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. A 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

 Management and Knowledge of Autonomic Dysreflexia 7

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?

 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. Extreme 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
 Management and Knowledge of Autonomic Dysreflexia 8

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

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
 Management and Knowledge of Autonomic Dysreflexia 9

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, 69).

Researchers and investigators have published massive literature providing numerous and critical

information 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

Must be written in English Journals are written in languages other than
 Management and Knowledge of Autonomic Dysreflexia 10

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 self-care how medical practitioners can well manage

and ensure that proper nursing practice is and control the extent of AD and SCI

applied by following the various continence

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, the 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
 Management and Knowledge of Autonomic Dysreflexia 11

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

should be managed. Therefore, looking at the two literatures, 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

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. Nash et al. (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 pose that qualified health professionals are more likely to have more

knowledge and understanding in AD in SCI patients than health students which is key in the

achievement of the overall goals and objectives of the research.

 Management and Knowledge of Autonomic Dysreflexia 12

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

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

Although students were initially exposed to SCI patients. Nash et al. (2018) suggests 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. However, 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. The scholars are thereby require to attend to
 Management and Knowledge of Autonomic Dysreflexia 13

workshops, conferences, workshops and learning institutions where they can polish their skills

and knowledge in handling cases related to Autonomic Dysreflexia.

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

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.

Prevention of Autonomic Dysreflexia Secondary to Spinal Cord Injuries

Bowel Care and Bladder Management

 Management and Knowledge of Autonomic Dysreflexia 14

Moreover, 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.

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-

 Management and Knowledge of Autonomic Dysreflexia 15

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.

Subsequenbtly, 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

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

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. Nifedipine agent limits

calcium increase at the cardiac muscle walls without making any blood calcium levels.
 Management and Knowledge of Autonomic Dysreflexia 16

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. Nifedipine 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. In this case, Nefidipine serves as the best agent in

bowel and bladder management.

Discussion

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

that health professionals have the required knowledge in the management of Autonomic

Dysreflexia secondary to SCI. 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).
 Management and Knowledge of Autonomic Dysreflexia 17

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, Tarhan et al.’s (2018) 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. Therefore,

intravesical Resiniferatoxin and surgery were the ones involved. Additionally, the 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

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. Active agents mostly used include

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

profound hypotension (Morgan, 2020, 169). 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
 Management and Knowledge of Autonomic Dysreflexia 18

through obstruction or fecal impaction. All 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. Furthermore, 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.

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

with its main objective being to provide 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 (Tederko et al. 2019, 169-176). 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,
 Management and Knowledge of Autonomic Dysreflexia 19

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

(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 guidance

and health practice services required (Strčić and Markić 2018, 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.

 Management and Knowledge of Autonomic Dysreflexia 20

According to the Neuro-disability nursing home (2018), 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. 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. Therefore, 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

Conclusively, the main aim of this paper was to critically analyze knowledge and management

among health practitioners of AD Secondary to SCI patients with one of the key themes in this

study being bowel care and stimulus for autonomic dysreflexia. 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

 Management and Knowledge of Autonomic Dysreflexia 21

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. The main method of data collection was the use of

questionnaries whuich were delivered to the caregivers, nurses and family members of the

patients with AD for the provision of feedback. In relation to that, the best method of appraisal

used was Mannegement of Objective (MBO) which enabled all the stakeholders to be involved

in the decision making process concerning the prevention and management of AD related to

patients with Spinal Cord Injuries.

However, there are several key findings that were presented in the study. For example,

the lack of controlled trials in the management of AD secondary to spinal cord injury patients

was one of the factors observed. Medical interventions like surgical and pharmacological do not

show any evidence of a controlled group except for the intersphincteric anal block. 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
 Management and Knowledge of Autonomic Dysreflexia 22

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

of Autonomic Dysreflexia.

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).

All 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 of Autonomic Dysreflexia 23

documents like pamphlets with

information about Autonomic

Dysreflexia before the meeting

for personal study and

evaluation (Morgan, 2021, 56).

Basic information and data

contained in the documents

should have information on the

triggers, management, and

significance of knowing AD,

secondary to patients with SCI

Process Change (NHS, 2007b): Me, as project 10/06/2021 Staff to discuss as a group

a checklist for managing a new proposer and and ask questions. To

beginning write a 2-page Home Manager, arrange the next workshop

evidence base summary Senior Carers,

regards to knowledge and Nurses

management of AD in SCI

patients

Workshop 2: Provide AD
 Management and Knowledge of Autonomic Dysreflexia 24

home policies to discuss

changes in protocol/ guidelines Me, as project To make changes to AD

Workshop 3: Lead nurses who proposer, nurses guidelines and get further

will mentor and/ train staff 4 and senior cares, feedback from the

units after a training session? Senior Carers, manager. Managers

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.

Me, as project A one-day training course

Find suitable training program proposer, nurses that enables nurses and

for management of AD in SCI and senior cares, senior carers to identify,

patients: teacher or e-learning. Senior Carers, diagnosed, and treat AD.

As medical care provider Nurses In this unit, the health care

 Management and Knowledge of Autonomic Dysreflexia 25

deficiencies increase, clinic specialists and other

and health facilities are caregivers are supposed to

suppoed to develop learn about the

frameworks for preparing and functioning of the Urinary

improving programs to Tract Unit so that they can

become progressively easily identify any

significant. Such projects can complications among the

help hold current health patients associated with

professionals, improve their either the kidneys,

abilities and emphatically bladder, or urethra

sway the general nature of a (Solomons, & Woodward,

wellbeing framework — 2013, 23-60).

something that is progressively After sevarl conferences

significant in a worth based and workshps the medical

world meant to offer quality sector offers a large

services to customers. Acute number of regular

Autonomic Dyreflexia is a instructional classes every

critical condition that requires year — compulsory like

hopitals and medical providers security, clinical ability

to be readily available and advancement, and

ready to aid their clients. discretionary obligations

However, preparing and that are meant to ensure

advancement drives aren't that patients with Spinal

 Management and Knowledge of Autonomic Dysreflexia 26

frequently a top priotiy for the Cord Injuries receive the

health care required health care.

sector.Obviously,this is not Instances of discretionary

unexpected given that medical trainings incorporate

are confronted with additional proceeding with clinical

major problems, like schooling and initiative

repayment, taxation and improvement openings.

regulation, clinical quality Managing a large number

among others. In any case, of trainings every year can

choosing the best method and be an overwhelming

criteria of employee training undertakings (Walter, et al

and development is a 2015, 391). However,

significant area that all the there are are a couple of

medical staff and stakeholders best practices that can

ought to evaluate regularly. help guarantee any given

training framework meets

its objectives without

wastage of resources.
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

-Blocked catheters patients is important since

 Management and Knowledge of Autonomic Dysreflexia 27

-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 All 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

medical interventions in
 Management and Knowledge of Autonomic Dysreflexia 28

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 Improvement Personnel

Management: Conflict and proposer and Manager dealt with the

misunderstanding implies home manager circumstance in a variety

diverse things to various of ways. First, the

individuals. That 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

Spinal Cord Injuries. Every coordinated effort. A

 Management and Knowledge of Autonomic Dysreflexia 29

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

Conversations went on for half guarding their choices at

a month. Furthermore, were workshops and

portrayed by one expert citing conferences, even with

research discoveries according extraordinary addressing

to their opinions but would end from their companions

up being challenged by the concerning the various

other parties. That created a management mechanisms

misunderstanding and conflict of Autonomic Dysreflexia

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

practice and they had

 Management and Knowledge of Autonomic Dysreflexia 30

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 Communication may fall

Communication can best be flat because of a variety of

summed up as the transmission reasons. In numerous

of a message from a sender to interchanges and

a recipient in a justifiable way. exchanges between

In this case, the significance of people, the message may

viable correspondence is not be gotten precisely

unfathomable in the realm of how the sender proposed

health and clinical sectors and (Eldahan, & Rabchevsky's

close-to-home life. From a 2018, 63) It becomes

medical point of view, viable significant that the

correspondence is a flat-out communicator looks for

must, because it ordinarily criticism to watch that

represents the distinction their message is perceived

between progress and when training and

disappointment or benefit and developing the staff or

 Management and Knowledge of Autonomic Dysreflexia 31

misfortune. It has become clinicians during the

certain that powerful hospital planning on the

correspondence is basic to the management of AD,

fruitful activity of the current secondary to SCI patients.

undertaking. Each medical

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. Wastes home manager setup. Effective

from clinical practice include management and

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

dangerous to people in case environment. According

 Management and Knowledge of Autonomic Dysreflexia 32

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

the effective organization: proposer and

Some of the issues that would home manager

affect the organization of all

the staff and stakeholders

during the worships are

highlighted below (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 of Autonomic Dysreflexia 33

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 is

involved might be the contrast It could be important to

between a decent organization, challenge some individual

and an uncommon one. to convictions that are not

Motivated workers are shared by other staff or by

profoundly eager about their the association (Fritel,

positions, are exceptionally 2015, 963)

dedicated and useful. They are -Work at the correct speed

also content with their work for the group. It is vital

and experience for better not to ask excessively too

prosperity in the health early

facilities (Fritel, 2015, 963) - Attempt to look after

Studies show that hospitals and force, particularly at the

health organizations utilizing beginning phases (even

profoundly drew in though

 Management and Knowledge of Autonomic Dysreflexia 34

representatives are highly offsetting this need with

beneficial from expanded that of keeping a

advancement and efficiency. In reasonable speed). Early,

this case, they assist basic, obvious upgrades

organizations with beating ('fast successes') may

their rivals as the facilities can assist with setting up

go through enduring and energy

flourish in terms of service -Comprehend How might

delivery to their customers. this benefit clinical

Boosting representative practice, adjusting and

contribution, commitment and addressing the necessities

impact expect associations to of people, the group, and

perceive what persuades their the association.

employees and to change the -Picking our beginning

conduct of their workers stage - present plans to the

utilizing methodologies that group and let the choice

stick. Consequently, the on where to start be a

process of ensuring that all the collective choice. Aiding

health staff are knowledgeable the staff to

and can plan and manage the propose/control what to be

best strategies that are best for changed will engage

them to combat the various

effects of acute Autonomic

 Management and Knowledge of Autonomic Dysreflexia 35

Dysreflexia.
Possible Health Restrictions:

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

themes in this study include

bowel care and stimulus for

autonomic dysreflexia (Walter,

 Management and Knowledge of Autonomic Dysreflexia 36

2015, 12). Therefore, this

article seeks to report on the

significance of knowledge

application in managing

patients with AD secondary to

SCI in the United Kingdom as

a case study to help the health

practiotioners as a reference

while in attending training

programs and worksops.

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

 Management and Knowledge of Autonomic Dysreflexia 37

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.

Clinicians will also be

able to demonstrate how

they can apply the

different pharmacological

and physiological

interventions such as

Botulinum Toxin

Injection and Nifedipine

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