Essay Example on Caring for Traumatic Brain Injuries: Understanding Severity and Characteristics

Abstract

Background: Traumatic Brain Injuries often present nurses with different challenges depending on the severity of the case. The various types of TBI can be grouped as mild, moderate, and severe. The mild TBI often affects a patient’s physical functioning, emotional distress, and some levels of cognitive impairment. The characteristics of patients who are affected by traumatic brain injuries often vary with the severity of the particular injuries. Some of of the most important consequences of the mild TBI include mental and physical fatigue, impairment in concentration and attention, emotional distress as well as some somatic symptoms such as the sensitivity to sound, lights as well as headaches that may take some few weeks to resolve.

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Objectives: To determine the impact of the provision of education modules on patient satisfaction and the ability of family members to educate the traumatic brain injury patients on various therapy types.

Methods: Evidence-based Practice can be essential in changing and improving care in various healthcare settings. The home care patients and their families will be assessed pre and post the intervention on their satisfaction following the intervention. The assessment will also be done to post the intervention to assess the ability of the family members to educate their patients with traumatic brain injury. This will be done using the Self-Efficacy Questionnaire (SE). The data obtained from such scores would be entered into the SPSS tool for analysis.

Keywords: Traumatic Brain Injury, cognitive impairment, home-based care

Introduction

Traumatic Brain Injuries often present nurses with different challenges depending on the severity of the case. The various types of TBI can be grouped as mild, moderate, and severe. The mild TBI often affects a patient’s physical functioning, emotional distress, and some levels of cognitive impairment. A person suffering from moderate to severe TBI is likely to have psychomotor, verbal communication skills, cognitive function, attention, and problem-solving impairment (Oyesanya et al., 2018).

These impairment levels tend to limit a patient’s capacity to acquire new knowledge and skills, as well as the processing of information. According to Oyesanya et al. (2018), moderate to severe TBI can present immediate, chronic, and lasting impacts that significantly limits a patient’s ability to learn and socialize. On the other hand, the people who suffer from moderate to severe TBI are likely to live with the symptoms for the rest of their lives (Johnson et al., 2013). Even though there are lack ways of describing the human costs of the Traumatic brain injuries, some valid and complete estimates of costs associated with utilization cost are important in informing the allocation of the limited financial resources which are aimed at the prevention, identification of some best practices as well as addressing some of the future care needs (Oyesanya, 2019). However, there are several reasons why the estimation of the costs associated with a traumatic brain injury has always proven challenging (Peeters et al., 2015).

PICO Question

Nurses who care for TBI Patients, will an education module on the types of therapies patient receive to improve their ability to educate family members and improve patient and family satisfaction with nursing care.

Literature Review

A literature review was created to investigate if educating nurses on therapies for TBI patients would improve their ability to educate family members and improve family satisfaction with nursing care. Databases used include CINHAL, Academic Search Premier, and Medline. Keywords used to search for articles were family interventions, nursing interventions, traumatic brain injuries. In this literature review, the definition of TBI will defined, the nursing care required for traumatic brain patients will be discussed, treatments available for TBI, and satisfaction with nursing care for traumatic brain injury patients will be addressed.

What is TBI

Traumatic brain injury is the cause of external damage resulting from mechanical forces (Broadbent et al., 2016). 54-60 million people experience a new TBI each year (Broadbent et al., 2016). TBIs can be extremely dangerous because the physiological effects vary depending on the severity. A person might have a contusion, swelling, or bleeding. Death can occur from an injury. In people who people paralyzed or incapacitated, it is difficult to say how long it will take them to recuperate. It can take a TBI patient months to year to fully gain movement of their limbs. Traumatic brain patients need the support and care of their family in order to fully recuperate and gain their place back in society.

A qualitative study assesses computer brain interface as a form of TBI treatment using a computer. The sample size was only made up of ten participants and the study took place in a rehabilitation facility (Armstrong et al., 2018). The study showed great results and allowed TBI patients to participate in simple tasks like card memory games or finding a category task. This type of treatment method is convenient and would allow TBI patients to continue their therapy from home, and allow their family more time to do what they need as well. In a quantitative study by Hedgier et al (2019), a randomized control trial is held to study the effects of animal assisted therapy on social competence in patients with an acquired brain injury during therapy sessions. The therapy took place at the therapy-animal facility at the University of Basel in Switzerland. Each session lasted thirty minutes and after the sessions, the patient and therapists (animal, physical, occupation or speech) answered questionnaires (Hediger, 2019). Social competence was measured by the mood, treatment motivation, and satisfaction of patients in 222 animal-assisted therapy sessions and 219 regular therapy sessions [the control group] (Hediger, 2019). The study showed that social behavior, verbal communication, and non-verbal communication was significantly higher in animal-assisted therapy versus regular therapy sessions with a sample size of 19 patients made up of TBI injuries and non-TBI injuries. (Hediger, 2019). Social connection is essential for traumatic brain injury patients to participate in therapy. This can be difficult since some patients may lack cognititive function, may not be able to verybally commicate, or may feel stressed and unmotivated to parcipate in therapy sessions. Animals communicate non-verbally and can arouse patients to participate in therapy by making clients feel excited and enthusiastic to complete tasks that have to do with the animal, such as helping to feed him or her, walking the pet, brushing its fur, etc (Hediger, 2019). Excitement and enthusiasm are emotional affect and has been shown to help with learning and memory (Hediger, 2019). Going through a TBI injury is a life altering event and can cause depression, loneliness, and detachment in patients. Animals have a way of communicating with patients and making them feel secure and nonjudged and they are motivated to participate in therapy. When patients are comfortable and destressed they are able to connect with other people, (the therapists) through therapy sessions and can begin the road to recovery.

A systematic review by Luke-Wold et al (2018) provides detailed information about multiples types of therapies to treat secondary injury effects of a TBI. The study provides information on nutrition, vitamin, acupuncture, acupressure, and music therapy as viable treatment options. Secondary injury effects of TBI are cellular stress, immunotoxicity, oxidative stress, and inflammation (Luke-Would et al., 2018). After a brain injury, there is a loss of potassium ions and influx of calcium ions. Large amount of glucose is required to replace the potassium and calcium lost. There is also a decrease in blood flow of the brain. Blood flow is vital to transport the much-needed glucose to the injured cells. This causes an energy crisis where the body needs more glucose but reduced cerebral blood flow prevents its delivery (Luke-Would et al., 2018). The failure in the ATP-dependent ion pump causes neuronal depolarization in which glutamate levels are released. The increase of glutamate levels causes immunotoxicity and cell death. High levels of glutamate increase reactive oxygen species, which can cause more damaged to cells. Antioxidants such as glutathione and endaravone can decrease reactive oxygen species and counteract some of the effects of second injury in a TBI patient. (Luke-Would et al., 2018). Vitamin D and Progesterone, and nicotoinamide proved to be beneficial in TBI inflammation and provided neuronal protection when given together (Luke-Would et al., 2018). The systematic review article informs readers, that acupuncture that involves stimulation of specific points in the body helps improve motor and speech function, acupressure uses the hand and fingers to stimulate meridian points to improve working memory, and music therapy helps decrease agitation (Luke-Would et al., 2018). The variety of treatments available for TBI patients allows patients and their family members to pick the ideal treatment based on the severity of their case. When patients are trying to decide what type of treatment to choose for themselves, this would be a good moment for nurses to discuss the treatment options with the patient and explain the advantages of disadvantages of each. Some patients and family members might choose to combine treatment therapies and use music therapy along with the recommended vitamin and nutritional plan suggested by a physician. It is important for nurses to inform both parties where to find resources on information over the treatment options and pass on any questions they have for the physician or the therapists on to them. A patient who feels that a nurse is involved in their care and actively seeks to help him or her recuperate will become motivated to become active in their health plan and family members will also feel supported.

A quantitative study by Chieu et al (2013) had an objective to find out how often sleep disturbance occurs in mild, moderate, and severe acute TBI patients and to determine and compare the effects of sleep disturbance on brain injury severity and recovery of cognitive function. The sample size of the study was 52 TBI patients between the ages of 18-65 years and were admitted to a neurosurgical ward in Taiwan. There were 35 patients who had mild case of TBI, 7 patients with moderate cases of TBI, and 10 patients with severe cases of TBI, all of the patients were assessed using the Glasgow coma scale. Sleep is extremely is important to neural activity because it affects...