Nelson A L
SCI Nurs. 1990 Aug;7(3):44-63.
The purpose of this study is to provide an ethnographic description of the subculture of a spinal cord injury (SCI) unit. The research method was qualitative, combining ethnographic interviews, participant observation, and document review. A 30 bed SCI facility on the west coast was selected as the setting for this ethnographic description. The developmental research sequence model (Spradley, 1980) and grounded theory (Glaser & Strauss, 1967) were used for data analysis. Findings indicate optimal rehabilitation is a creative and individualized process of reintegration. Reintegration prepares the individual for coping with physical limitations, architectural barriers, and societal prejudices while simultaneously making the person feel intact and valued. Successful reintegration promotes a "fit" between the newly injured spinal cord patient and the home environment. The patient learns to compensate for the physical limitations of the spinal cord injury in a manner that promotes safety, comfort, and personal worth. Successful reintegration assures the newly injured SCI patient returns to a viable occupation, feels physically attractive, participates in a rich, full social life, and maintains family ties. Four phases of reintegration emerged: buffering, transcending, toughening, and launching. Buffering is the nurturing and protective process of lessening, absorbing, or protecting the newly injured SCI patient against the shock of multiple ramifications of the injury and the indignities of being a patient; Transcending is the process of helping SCI patients recognize and rise above culturally imposed limitations and negative beliefs about people with disabilities. The "toughening up" process focuses on compensating for physical limitations, gaining independence, and maintaining social interactions without "using the disability." Launching is the process of (1) exposing rehabilitation patients to the real world, (2) exploring the range of options for living in the community, (3) promoting patient autonomy and decision making, and (4) facilitating the ejection of the patient from the rehabilitation program. The study is significant because it offers a new perspective for viewing a spinal cord injury unit. The proposed theoretical model explains patients' attitudes, beliefs, and behavior on SCI units. This model provides a framework for designing a prototype therapeutic milieu in SCI.
本研究的目的是对脊髓损伤（SCI）科室的亚文化进行人种志描述。研究方法为质性研究，结合了人种志访谈、参与观察和文献回顾。西海岸一家拥有30张床位的SCI机构被选为进行此人种志描述的场所。数据分析采用了发展研究序列模型（斯普拉德利，1980年）和扎根理论（格拉泽和施特劳斯，1967年）。研究结果表明，最佳康复是一个创造性的、个性化的重新融入过程。重新融入使个体为应对身体限制、建筑障碍和社会偏见做好准备，同时让个体感到完整且有价值。成功的重新融入促进新受伤的脊髓损伤患者与家庭环境之间的“契合”。患者学会以促进安全、舒适和个人价值的方式弥补脊髓损伤带来的身体限制。成功的重新融入确保新受伤的SCI患者能够回归可行的职业，感觉自己身体有吸引力，参与丰富充实的社交生活，并维持家庭关系。重新融入出现了四个阶段：缓冲、超越、强化和启动。缓冲是减轻、吸收或保护新受伤的SCI患者免受损伤的多重影响和作为患者的屈辱所带来的冲击的培育和保护过程；超越是帮助SCI患者认识并超越文化强加的限制以及对残疾人的负面信念的过程。“强化”过程侧重于弥补身体限制、获得独立以及在不“利用残疾”的情况下维持社会互动。启动是以下过程：（1）让康复患者接触现实世界，（2）探索在社区生活的各种选择，（3）促进患者的自主性和决策制定，（4）促使患者从康复项目中毕业。该研究具有重要意义，因为它为看待脊髓损伤科室提供了一个新视角。所提出的理论模型解释了患者在SCI科室中的态度、信念和行为。该模型为设计SCI的原型治疗环境提供了一个框架。
