Bladder elimination transition processes following Spinal Cord Injury: a qualitative study

Authors

  • Eunice Salomé Alves Sobral Sousa Instituto de Ciências Biomédicas Abel Salazar. Unidade Local de Saúde Santo António, Porto, Portugal https://orcid.org/0000-0002-1316-1394
  • Maria João Andrade Instituto de Ciências Biomédicas Abel Salazar. Unidade Local de Saúde Santo António, Porto, Portugal
  • Carla Sílvia Fernandes Instituto Politécnico de Viana do Castelo-Escola Superior de Saúde. RISE-Health, Viana do Castelo, Portugal https://orcid.org/0000-0001-7251-5829
  • Vanessa Taveira Teixeira Unidade Local de Saúde Santo António, Porto, Portugal https://orcid.org/0000-0001-9704-8083
  • Sara Rodrigues Barbeiro Unidade Local de Saúde Santo António, Porto, Portugal
  • Maria Manuela Martins Instituto de Ciências Biomédicas Abel Salazar. RISE-Health, Porto, Portugal https://orcid.org/0000-0003-1527-9940

DOI:

https://doi.org/10.33194/rper.2026.47700

Keywords:

Spinal cord injuries, Urinary tract disorders, Nursing, Rehabilitation, Hospitals

Abstract

Introduction: Changes in bladder function following spinal cord injury (SCI) are often experienced as critical transition experiences. The aim of this study was to understand the experiences associated with the transition in bladder management among individuals with SCI in the acute phase.

Methodology: A qualitative study with thirteen individuals with SCI. Data were collected through semi-structured interviews. Categories were defined considering Meleis’s Transitions Theory. Data were analyzed using Bardin’s methodology, with the aid of ATLAS.ti software. The study followed the COREQ guidelines.

Results: The following categories were identified: Nature of Transitions, Properties of Transition Experiences, Transition Conditions, Process and Outcome Indicators, and Nursing Therapeutics. The health/illness transition was influenced by meaning, volition, beliefs, knowledge, family, and community resources. Indicators of coping, feeling connected, mastery, and fluid integrative identities were identified. Nursing therapeutics contributed to positive patterns of response throughout the transition process.

Discussion: The rehabilitation nurse’s intervention contributed to empowering individuals with SCI in bladder management through education, training, and motivation.

Conclusion: Meleis’s Transitions Theory proved to be a useful framework for understanding the transition associated with bladder management among individuals with SCI.

Downloads

Download data is not yet available.

Author Biographies

Eunice Salomé Alves Sobral Sousa, Instituto de Ciências Biomédicas Abel Salazar. Unidade Local de Saúde Santo António, Porto, Portugal

Salomé Sobral Sousa is a Nurse Manager in Neurosurgery and a Rehabilitation Nurse Specialist. Her clinical and research activities focus on neurological rehabilitation, spinal cord injury, health transition processes, and the promotion of autonomy among individuals with dependency-related needs. She is currently in the final stage of her PhD in Nursing Sciences, conducting research in Rehabilitation Nursing with a particular focus on individuals with spinal cord injury. She is the author and co-author of national and international scientific publications and has participated in research projects and initiatives aimed at advancing nursing knowledge, improving the quality of care, and promoting evidence-based practice.

Maria João Andrade, Instituto de Ciências Biomédicas Abel Salazar. Unidade Local de Saúde Santo António, Porto, Portugal

Professor Maria João Andrade, MD, PhD, is a specialist in Physical and Rehabilitation Medicine with extensive clinical, academic, and research experience in neurological rehabilitation, particularly in the care of individuals with spinal cord injury. She works at the Physical and Rehabilitation Medicine Department of Unidade Local de Saúde de Santo António and serves as Invited Full Professor at the Abel Salazar Institute of Biomedical Sciences, University of Porto (ICBAS-UP). She has developed significant research activity and interdisciplinary collaboration, including with Rehabilitation Nursing, contributing to the advancement of knowledge and the improvement of care provided to individuals with spinal cord injury.

Carla Sílvia Fernandes, Instituto Politécnico de Viana do Castelo-Escola Superior de Saúde. RISE-Health, Viana do Castelo, Portugal

Professor Carla Sílvia Fernandes is a Rehabilitation Nurse Specialist, holding a PhD in Nursing Sciences from the Abel Salazar Institute of Biomedical Sciences, University of Porto, and a postdoctoral degree in Family Studies from the School of Nursing, University of São Paulo. She serves as Assistant Professor at the School of Health of the Polytechnic Institute of Viana do Castelo and is President of the Association for the Development of Technological Innovation and Games in Health (ADITGameS). Her research focuses on Rehabilitation Nursing, Family Nursing, innovation, and health technologies. She has an extensive national and international scientific output and significant experience in research project coordination, academic supervision, and the development of innovative health solutions.

Vanessa Taveira Teixeira, Unidade Local de Saúde Santo António, Porto, Portugal

Vanessa Taveira Teixeira is a Rehabilitation Nurse Specialist with clinical and research experience in neurological rehabilitation and the care of individuals with spinal cord injury. She has collaborated in research projects and scientific publications focused on health–illness transition processes and rehabilitation nursing care for individuals with spinal cord injury.

 

Sara Rodrigues Barbeiro, Unidade Local de Saúde Santo António, Porto, Portugal

Sara Rodrigues Barbeiro is a Rehabilitation Nurse Specialist with clinical and research experience in neurological rehabilitation and the care of individuals with spinal cord injury. She has collaborated in research projects and scientific publications focused on health–illness transition processes, the promotion of autonomy, and rehabilitation nursing care. She is co-author of several national and international scientific publications in the fields of rehabilitation and nursing care.

Maria Manuela Martins, Instituto de Ciências Biomédicas Abel Salazar. RISE-Health, Porto, Portugal

Professor Maria Manuela Martins is a Rehabilitation Nurse Specialist, holds a PhD in Nursing Sciences from the University of Porto, and is an integrated researcher at RISE-Health – Research and Development Unit. She serves as Invited Coordinating Professor at the University of Porto and has a distinguished academic and research career focused on health transitions, rehabilitation nursing, family nursing, healthcare management, and quality of care. Throughout her career, she has made significant contributions to the advancement of Nursing through research leadership, supervision of master's and doctoral students, and participation in national and international scientific networks. She is the author of an extensive body of scientific work, widely recognized for its contribution to nursing knowledge and the improvement of healthcare quality.

References

1. Bickenbach J, Officer A, Shakespeare T, von Groote P. International perspectives on spinal cord injury. Geneva: World Health Organization; 2013. Available from: https://www.who.int/publications/i/item/international-perspectives-on-spinal-cord-injury,

2. Hou S, Rabchevsky AG. Autonomic consequences of spinal cord injury. Compr Physiol. 2014;4(4):1419-53. https://doi.org/10.1002/cphy.c130045

3. Panicker JN, Fowler CJ, Kessler TM. Lower urinary tract dysfunction in the neurological patient: clinical assessment and management. Lancet Neurol. 2015;14(7):720-32. https://doi.org/10.1016/s1474-4422(15)00070-8

4. Ko HY. Managing neurogenic lower urinary tract dysfunction in spinal cord injuries. In: A practical guide to care of spinal cord injuries: clinical questions and answers. Singapore: Springer Singapore; 2023. p. 519-558.: https://doi.org/10.1007/978-981-99-4542-9_27.

5. Aude CA, Dishong DM, Menta A, Jo J, Khalifeh J, Hughes L, et al. Catheterization Method and Functional Recovery of Neurogenic Bladder in Spinal Cord Injury. JAMA Network Open. 2025;8(7):e2522030-e. https://doi.org/10.1001/jamanetworkopen.2025.22030

6. Bochkezanian V, Henricksen KJ, Lineburg BJ, Myers-Macdonnell LA, Bourbeau D, Anderson KD. Priorities, needs and willingness of use of nerve stimulation devices for bladder and bowel function in people with spinal cord injury (SCI): an Australian survey. Spinal Cord Ser Cases. 2024;10(1):15. https://doi.org/10.1038/s41394-024-00628-3

7. Ribeiro O. Enfermagem de reabilitação: conceções e práticas. Porto: Lidel; 2021.

8. Wu S-Y, Jhang J-F, Liu H-H, Chen J-T, Li J-R, Chiu B, et al. Long-Term Surveillance and Management of Urological Complications in Chronic Spinal Cord-Injured Patients. Journal of Clinical Medicine. 2022;11(24):7307 https://doi.org/10.3390/jcm11247307.

9. European Association of Urology Nurses. EAUN guideline: Urethral intermittent catheterisation in adults (Including urethral intermittent dilatation). 2024 [Available from: https://nurses.uroweb.org/guideline/urethral-intermittent-catheterisation/.

10. Taweel WA, Seyam R. Neurogenic bladder in spinal cord injury patients. Res Rep Urol. 2015;7(85-99. https://doi.org/10.2147/rru.S29644

11. Adriaansen JJ, van Asbeck FW, Tepper M, Faber WX, Visser-Meily JM, de Kort LM, et al. Bladder-emptying methods, neurogenic lower urinary tract dysfunction and impact on quality of life in people with long-term spinal cord injury. J Spinal Cord Med. 2017;40(1):43-53. https://doi.org/10.1179/2045772315y.0000000056

12. Kavanagh A, Baverstock R, Campeau L, Carlson K, Cox A, Hickling D, et al. Canadian Urological Association guideline: Diagnosis, management, and surveillance of neurogenic lower urinary tract dysfunction - Full text. Canadian Urological Association Journal. 2019;13(6):https://doi.org/10.5489/cuaj.5912

13. Romo PGB, Smith CP, Cox A, Averbeck MA, Dowling C, Beckford C, et al. Non-surgical urologic management of neurogenic bladder after spinal cord injury. World Journal of Urology. 2018;36(10):1555-68. https://doi.org/10.1007/s00345-018-2419-z

14. Sousa L, Martins MM, Novo A. A Enfermagem de Reabilitação no empoderamento e capacitação da pessoa em processos de transição saúde-doença. Revista Portuguesa de Enfermagem de Reabilitação. 2020;3(1):64 - 9. https://doi.org/10.33194/rper.2020.v3.n1.8.5763

15. Ong HL, Chiang I-N, Hsu L-N, Chin C-W, Shao I-H, Jang M-Y, et al. Conservative Bladder Management and Medical Treatment in Chronic Spinal Cord Injury Patients. Journal of Clinical Medicine. 2023;12(5):2021. https://doi.org/doi:10.3390/jcm12052021

16. Sousa SS, Andrade MJ, Fernandes CS, Barbeiro SR, Teixeira VT, Pereira RS, et al. Healthcare Experience of People with Acute Spinal Cord Injury: A Phenomenological Study. Nursing Reports. 2023;13(4):1671-83. https://doi.org/doi:10.3390/nursrep13040138

17. Mandeville P. Prevention and Management of Urinary Tract Infections Among Persons With a Spinal Cord Injury: Implications for Nurses. Rehabil Nurs. 2026;51(1):18-24. https://doi.org/10.1097/rnj.0000000000000511

18. Brito MA. A reconstrução da autonomia após um evento gerador de dependência no autocuidado - Uma teoria explicativa Universidade Católica Portuguesa; 2012. Avaiable from: http://hdl.handle.net/10400.14/12617

19. Meleis A. Transitions theory: middle-range and situation-specific theories in nursing research and practice. New York:2010.

20. Sobral Sousa S, Martins MM, Andrade MJ, Rodrigues Barbeiro S, Taveira Teixeira V. Cuidados de Enfermagem em Contexto Agudo à Pessoa com Lesão Medular: Scoping review. Revista Portuguesa de Enfermagem de Reabilitação. 2022;5(2):https://doi.org/10.33194/rper.2022.204

21. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349-57. https://doi.org/10.1093/intqhc/mzm042

22. Tate JA, Happ MB. Qualitative Secondary Analysis: A Case Exemplar. J Pediatr Health Care. 2018;32(3):308-12. https://doi.org/10.1016/j.pedhc.2017.09.007

23. Lacerda MR, Costenaro RGS. Metodologias da Pesquisa para a Enfermagem e Saúde - Da Teoria à Prática. Porto Alegre, Brazil: Editora Moriá; 2018.

24. Bardin L. Análise de conteúdo. Lisboa: Edições 70; 2016.

25. Martins H, Caldeira S. Disclosing and discussing the role of spirituality in the transition theory of Afaf Meleis. Nursing Philosophy. 2021;22(2):e12348. https://doi.org/https://doi.org/10.1111/nup.12348

26. Halvorsen A, Steinsbekk A, Leiulfsrud AS, Post MWM, Biering-Sørensen F, Pape K. Labour market participation after spinal cord injury. A register-based cohort study. Spinal Cord. 2023;61(4):244-52. https://doi.org/10.1038/s41393-023-00876-4

27. Hayashi T, Kobayashi H, Irie M, Sakai H, Takegawa M, Takanami R, et al. Factors affecting return to work after spinal cord injury in Japan: a cross-sectional study. Spinal Cord. 2025;63(6):279-84. https://doi.org/10.1038/s41393-025-01083-z

28. Fernandes C, Cheila P, Paula N. Exploring the needs of the family caregiver of persons with spinal cord injury: An integrative review. Nursing Practice Today. 2022;9(4):https://doi.org/10.18502/npt.v9i4.11200

29. Mohammed RS, Boateng EA, Amponsah AK, Kyei-Dompim J, Laari TT. Experiences of family caregivers of people with spinal cord injury at the neurosurgical units of the Komfo Anokye Teaching Hospital, Ghana. PLoS One. 2023;18(4):e0284436. https://doi.org/10.1371/journal.pone.0284436

30. Moreira CM, Andrade MJ. Lesões Medulares: Caracterização Epidemiológica da Última Década num Hospital de Agudos. Revista da Sociedade Portuguesa de Medicina Física e de Reabilitação. 2023;35(2):36-42. https://doi.org/10.25759/spmfr.299

31. Wheeler TL, de Groat W, Eisner K, Emmanuel A, French J, Grill W, et al. Translating promising strategies for bowel and bladder management in spinal cord injury. Exp Neurol. 2018;306(169-76. https://doi.org/10.1016/j.expneurol.2018.05.006

32. Christiaans CHH, van Veen FEE, Scheepe JR, Blok BFM. Patient satisfaction, quality of life, and catheter-related complications in long-term urinary catheter users: a nationwide survey. World Journal of Urology. 2025;43(1):470. https://doi.org/10.1007/s00345-025-05850-8

33. Sekido N, Matsuyama F, Murata T, Takahashi R, Matsuoka M, Sengoku A, et al. Impact of urinary catheters including reusable catheters on quality of life and work productivity in persons with spinal cord lesion. Scientific Reports. 2024;14(1):24383. https://doi.org/10.1038/s41598-024-74578-z

34. Silva R, Carvalho A, Rebelo L, Pinho N, Barbosa L, Araújo T, et al. Contributos do referencial teórico de Afaf Meleis para enfermagem de reabilitação. Revista Investigação em Enfermagem. 2019;(26) 35-44. Available from: http://www.sinaisvitais.pt/images/stories/Rie/RIE26_s2.pdf

35. Kamran R, Ho C, Kovacs Burns K, Pelaez Ballestas I, Olayinka O, Bakal J, et al. Experiences of persons with spinal cord injury, their family members, and health care providers during transitions in care in Alberta: a qualitative reflexive thematic analysis. Disabil Rehabil. 2025;47(25):6557-69. https://doi.org/10.1080/09638288.2025.2509791

36. LaVela SL, Wu J, Nevedal AL, Harris AHS, Frayne SM, Arnow KD, et al. The impact of the COVID-19 pandemic on individuals living with spinal cord injury: A qualitative study. Rehabil Psychol. 2023;68(1):12-24. https://doi.org/10.1037/rep0000469

37. Sobral Sousa ES, Andrade MJ, Fernandes CS, Barbeiro SR, Teixeira VT, Martins MM. Cuidados de enfermagem de reabilitação à pessoa com lesão medular metastática: relato de caso. Enferm Bras. 2023;22(1):79-94(https://doi.org/10.33233/eb.v22i1.5371

38. van Diemen T, van Nes IJW, van Laake-Geelen CCM, Spijkerman D, Geertzen JHB, Post MWM, et al. Learning self-care skills after spinal cord injury: a qualitative study. BMC Psychology. 2021;9(1):155. https://doi.org/10.1186/s40359-021-00659-7

39. Schwartz CE, Stucky B, Rivers CS, Noonan VK, Finkelstein JA. Quality of Life and Adaptation in People With Spinal Cord Injury: Response Shift Effects From 1 to 5 Years Postinjury. Archives of Physical Medicine and Rehabilitation. 2018;99(8):1599-608.e1. https://doi.org/https://doi.org/10.1016/j.apmr.2018.01.028

40. Harel-Katz H, Carmeli E. The association between volition and participation in adults with acquired disabilities: A scoping review. Hong Kong Journal of Occupational Therapy. 2019;32(2):84-96. https://doi.org/10.1177/1569186119870022

41. Regulamento dos Padrões de Qualidade dos Cuidados Especializados em Enfermagem de Reabilitação, Regulamento n.º 350/2015 (2015). Available from: https://diariodarepublica.pt/dr/detalhe/regulamento/350-2015-67552234

42. Dorsett P, Geraghty T, Sinnott A, Acland R. Hope, coping and psychosocial adjustment after spinal cord injury. Spinal Cord Ser Cases. 2017;3(17046. https://doi.org/10.1038/scsandc.2017.46

43. Roth K, Mueller G, Wyss A. Experiences of peer counselling during inpatient rehabilitation of patients with spinal cord injuries. Spinal Cord Ser Cases. 2019;5(1. https://doi.org/10.1038/s41394-018-0144-x

44. Gassaway J, Jones ML, Sweatman WM, Young T. Peer-led, transformative learning approaches increase classroom engagement in care self-management classes during inpatient rehabilitation of individuals with spinal cord injury. J Spinal Cord Med. 2019;42(3):338-46. https://doi.org/10.1080/10790268.2017.1385992

45. Lovrić E, Edwards N, King J. Exploring therapeutic alliance in spinal cord injury rehabilitation: Control, identity, and liminality. Physiother Theory Pract. 2025;41(8):1630-46. https://doi.org/10.1080/09593985.2024.2443028

46. Bernet M, Sommerhalder K, Mischke C, Hahn S, Wyss A. "Theory Does Not Get You From Bed to Wheelchair": A Qualitative Study on Patients' Views of an Education Program in Spinal Cord Injury Rehabilitation. Rehabil Nurs. 2019;44(5):247-53. https://doi.org/10.1097/rnj.0000000000000175

47. Weber L, Voldsgaard NH, Holm NJ, Schou LH, Biering-Sørensen F, Møller T. Exploring the contextual transition from spinal cord injury rehabilitation to the home environment: a qualitative study. Spinal Cord. 2021;59(3):336-46. https://doi.org/10.1038/s41393-020-00608-y

Downloads

Published

2026-09-17

How to Cite

1.
Alves Sobral Sousa ES, Andrade MJ, Fernandes CS, Taveira Teixeira V, Rodrigues Barbeiro S, Martins MM. Bladder elimination transition processes following Spinal Cord Injury: a qualitative study. Rev Port Enf Reab [Internet]. 2026 Sep. 17 [cited 2026 Nov. 8];9(1):e47700. Available from: https://rper.pt/article/view/47700

Issue

Vol. 9 No. 1 (2026): Portuguese Rehabilitation Nursing Journal (PT - ENG)

Section

Original article reporting clinical or basic research

License

Copyright (c) 2026 Portuguese Rehabilitation Nursing Journal

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Crossref
Scopus
Google Scholar
Europe PMC

Most read articles by the same author(s)

Similar Articles

1 2 3 4 5 6 7 8 > >> 

You may also start an advanced similarity search for this article.