The Role of Nursing Care in Rehabilitation

Nurses are very important members of your care team, interacting with you regularly during visits to your doctor’s office or clinic, providing answers to treatment questions, and giving the support and motivation you need to meet the challenges of living with multiple sclerosis (MS). Nurses play an especially important role in rehabilitation care because they are instrumental in helping you learn how to handle a range of symptoms and personal care issues from bladder and bowel dysfunction to skin care and general wellness, such as diet, exercise, and preventive care.^1,2

Nurses provide services in the clinic, in the hospital, at a rehabilitation facility, or as visiting nurses in your home. Nurses are often educators for information on your disease as well as general health habits and often provide referrals or resources for other services. Some common functions in care and/or rehabilitation include:^1,2

• Treatments or strategies for dealing with bladder problems, including devices and drug products
• Strategies to encourage regular bowel function and strategies for impaired bowel function, including the use of devices and drug products
• Strategies to address the increased risk of skin issues for people with MS who are not mobile or use wheelchairs
• Tips for managing medicine side effects, the importance of sticking to medication schedules, and education on self-injections
• Education about healthy eating, stress management, and exercise

Bladder function

Nursing care can play an important role in helping you learn about bladder problems that are common in MS and the variety of treatment options available to control and compensate for these problems. It is estimated that approximately 80 to 90 percent of people with MS experience bladder problems, ranging from mild to severe, at some point during their lives. Bladder problems resulting from demyelination or secondary to other health conditions include bladder storage problems, such as:^1,2

• Urgency
• Frequency
• Hesitancy and incontinence
• Difficulty emptying the bladder
• Urinary tract infections

Working with your primary doctor or urologist, your nurse can instruct you on useful self-care activities and lifestyle modifications that may be helpful in managing bladder problems. There are also a variety of medications and devices available for controlling bladder symptoms. With each of these interventions, your nurse will be a primary source of information, education, and support in making the intervention successful.^1,2

Bowel function

As with bladder problems, nurses can play a valuable role in helping you manage bowel problems. In MS, nerve damage, muscle weakness (in abdominal area), and loss of mobility can cause food to move more slowly through the digestive tract, with stool that stays too long in the intestines becoming hard, dry, and difficult to pass.^1,2

Additionally, certain medicines used by people with MS can affect bowel function. Your nurse will work with you to alleviate and manage bowel problems, including instruction about the roles of diet (high in fiber and with adequate fluid intake) and regular exercise in promoting bowel health, and suggestions about how to establish a regular schedule for bowel movements.^1,2

Skin care

Proper skin care is very important for a person with MS, especially in cases where the disease has progressed to the point where the individual has lost mobility or is confined to a wheelchair or bed. Additionally, increased muscle tone that occurs with spasticity can make a person more susceptible to skin breakdown.^1,2

Your nurse can play a crucial role in teaching principles of skin care and ways to prevent pressure sores from developing and proper care for sores if they do develop. Education will focus on use of cushions to distribute weight properly if you are confined to a wheelchair or sit for long periods of time, techniques for shifting weight (by yourself or using someone else’s help) to alleviate constant pressure to susceptible locations on your body, use of a special mattress or bedding to prevent skin breakdown, and proper nutrition to help promote skin health.^1,2

Promoting general health

Because you have MS and are at increased risk for a range of health problems, it is especially important to make sure that you are doing your best to take care of your general health. This includes getting enough exercise, eating the right foods, and getting regular check-ups to screen for chronic health problems, such as high blood pressure, diabetes, and high cholesterol, and other conditions, such as different types of cancer. Your nurse can educate you about basic nutrition and exercise and make sure that you attend to your general health and get the regular check-ups you need.^1,2