Mild Traumatic Brain Injury

Abstract

Early case recognition and intervention by nurses for patients with mild traumatic brain injury (mTBI) can significantly improve outcomes for civilian and military patients. The "Concussion/mTBI Learning Needs Assessment for Registered Nurses Survey" was developed to evaluate bedside nurses' knowledge related to the assessment and care of patients with mTBI as well as their preferences for learning in order to develop a targeted curriculum. An anonymous, self-administered, Web-based survey was available from February to August 2009. A series of invitational e-mails were sent to nurses at a convenience sample of civilian, federal, and military institutions. A total of 1,224 nurses meeting the inclusion criteria of being bedside care providers and nonadvanced practice responded and were included in the analysis (civilian, n = 731; military, n = 494). Most respondents (91.3%) considered knowledge of mTBI to be important or very important to their practice, and 44.5% saw mTBI patients at least monthly. Despite this perception of importance and exposure to the patients, nurses' self-reported knowledge levels were very low. Overall, 39.8% expressed a high knowledge level (score of 4 [a lot] or 5 [expert] on a 1-5 scale) of the causes of mTBI. Fewer than 25% expressed high knowledge level in the skills needed for the identification and assessment of mTBI patients, and less than 15% had high knowledge in the treatment and prognosis of these patients. The nurses' preferred learning method was shadowing another provider (37%), but the most often used method was Internet searches (80.3%). There was minimal difference between military and civilian nurses. Although nurses recognize the importance of familiarity with mTBI for their practice and most clearly self-identify knowledge deficits in all aspects of care of the mTBI patients, a broad but succinct curriculum for the nonadvanced practice bedside nurse could provide a cost-effective, quickly accessible way to provide the needed education.

Caring for Patients with traumatic brain injury: a survey of nurses' perceptions

“…A study focusing on nurses’ perceived knowledge to care for patients with mild TBI, which also included nurses who did and did not provide care to patients with TBI on a regular basis (Watts et al, 2011), had similar findings compared to our study. According to Watts et al (2011), nurses in their sample cared for patients with mild TBI at a similar frequency as nurses in our study who cared for patients with moderate-to-severe TBI; most nurses from both the Watts et al (2011) sample and our sample saw at least 1-2 patients with TBI per month. Although Watts et al (2011) did not use a statistical analysis technique to divide nurses into homogenous subgroups based on perceived knowledge like we did, their findings show many nurses had low perceived knowledge to care for patients with mild TBI.…”

“…According to Watts et al (2011), nurses in their sample cared for patients with mild TBI at a similar frequency as nurses in our study who cared for patients with moderate-to-severe TBI; most nurses from both the Watts et al (2011) sample and our sample saw at least 1-2 patients with TBI per month. Although Watts et al (2011) did not use a statistical analysis technique to divide nurses into homogenous subgroups based on perceived knowledge like we did, their findings show many nurses had low perceived knowledge to care for patients with mild TBI. Few nurses in their sample (ranging from 15-39.8%) reported a high level of perceived knowledge on various nursing care roles and responsibilities (Watts et al, 2011).…”

“…Authors developed the Perceptions of Brain Injury Survey (PBIS) by adapting two surveys: 1) a survey about school speech-language pathologists’ perceived knowledge of and perceived confidence to provide services to students with TBI (Hux, Walker, & Sanger, 1996), and 2) a survey on nurses’ perceived knowledge and learning preferences regarding care of patients with mild TBI (Watts et al, 2011). Findings in this article focus on perceived knowledge, perceived confidence, and TBI-related training.…”

“…Yet, research has revealed gaps in nurses’ knowledge and inconsistencies in clinical practice in caring for patients with TBI (Watts, Gibbons, & Kurzweil, 2011). Current literature focuses on management of mild TBI or acute management of patients after moderate-to-severe TBI with limited to no literature focusing on non-acute management of patients with moderate-to-severe TBI.…”

“…To the authors’ knowledge, no literature could be located on nurses’ perceptions of training and education to care for patients with cognitive impairments caused by a new moderate-to-severe TBI or a history of moderate-to-severe TBI. However, literature on nurses’ perceived knowledge to care for patients with TBI exists, but only focuses on: a) nursing management of patients with TBI and their families during the acute phase (Coco, Tossavainen, Jääskeläinen, & Turunen, 2011); b) care of pediatric (Cook et al, 2013); or adult patients with mild TBI (Watts et al, 2011); and c) nursing students’ misconceptions or misattributions about patients with TBI (Linden & McClure, 2012). This presents a gap in knowledge on nurses’ perceived knowledge and perceived confidence to care for patients with moderate-to-severe TBI.…”