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Acquired brain injury (ABI) can be a sudden, dramatic, and, sometimes, fatal event that instantly disrupts the lives of the patients and their families. Healthcare professionals and families are being confronted with the long-term effects of ABI. This article presents a descriptive phenomenological study that aimed to explore the families' meaning of living with the cognitive, emotional, and behavioral sequelae of ABI survivors. In-depth, face-to-face, semistructured interviews were conducted with a purposive sample of five family members of ABI survivors who displayed challenging behavior. Data collected were analyzed using A. Giorgi's (1985) descriptive phenomenological method of data analysis. Analysis and descriptions from the five participants revealed seven interrelated themes; one theme described the challenging behaviors of the people with ABI, and six themes described the experiences of the family members (emotional turmoil that these behaviors engendered, a profound sense of loss, concerns for their future and for the future of the person with ABI, a sense of loneliness, the effect on family functioning, and the family members' coping and adapting to the behaviors). This study contributes to healthcare providers' understanding and knowledge of families' experiences of living with a person with ABI and their cognitive, emotional, and behavioral sequelae and supports the need for continued research in this area.

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OBJECTIVE:To assess burden and life satisfaction in family members of patients with severe traumatic brain injury (sTBI) at 1 and 2 years post-injury, examine if change in burden can be predicted by family member and patient demographics, patient's functional status, family members social network or level of burden at 1 year. METHODS:Prospective national multicenter study. Self-report from family members, patient data collected from a national cohort study on patients with sTBI. 80 family members participated. MAIN OUTCOME MEASURE:The Caregiver Burden Scale (CBS), life satisfaction. RESULTS:Total burden increased between years 1 and 2 post-injury (P=0.04). Thirty percent of the family members reported an increased burden, 55% were stable, and 15% had a decrease in burden between the two follow-up times. Logistic regression analyses revealed that experiencing loneliness was an independent predictor of increased burden from 1 to 2 years post-injury (OR=4.35, P<0.05). Life Satisfaction was lower at the 2 year follow-up than at 1 year (p=0.03). CONCLUSIONS:The results demonstrate a need for long-term follow-up of patients and family members that focuses on professional support to relieve burden and risk of loneliness or social isolation. This group may benefit from additional follow-up interventions tailored to their needs.

The evidence illustrates inconsistency and confusion in the use of the Glasgow Coma Scale in practice; this has the potential to compromise care and clarity around the issues is therefore necessary.

BackgroundFamily member’s experience and satisfaction of health care in the acute care and in-patient rehabilitation are important indicators of the quality of health care services provided to patients with severe traumatic brain injury (TBI). The objective was to assess family members’ experience of the health care provided in-hospital to patients with severe TBI, to relate experiences to family member and patient demographics, patients’ function and rehabilitation pathways.MethodsProspective national multicentre study of 122 family members of patients with severe TBI. The family experience of care questionnaire in severe traumatic brain injury (FECQ-TBI) was applied. Independent sample t-tests or analysis of variance (ANOVA) were used to compare the means between 2 or more groups. Paired samples t-tests were used to investigate differences between experience in the acute and rehabilitation phases.ResultsBest family members` experience were found regarding information during the acute phase, poorest scores were related to discharge. A significantly better care experience was reported in the acute phase compared with the rehabilitation phase (p < 0.05). Worst family members` experience was related to information about consequences of the injury. Patient’s dependency level (p < 0.05) and transferral to non-specialized rehabilitation were related to a worse family members` experience (p < 0.01).ConclusionsThis study underscores the need of better information to family members of patients with severe TBI in the rehabilitation as well as the discharge phase. The results may be important to improve the services provided to family members and individuals with severe TBI.

Although clinical governance is prominent in modern health care, it is often perceived as an abstract concept. This article explains the key components of clinical governance and relates these to nursing practice. The author emphasises that clinical governance should be viewed as an opportunity to improve care delivery.

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