Pediatric nurses' perceived knowledge and beliefs of evidence-based practice in the care of children and adolescents with moderate-to-severe traumatic brain injury

Paediatric traumatic brain injuries: A descriptive analysis of incidence, visits, cause, and admission rates in Iceland from 2010 to 2021

BACKGROUND

Traumatic brain injuries (TBI) are common in emergency departments (ED) and may cause long-term negative outcomes but knowledge on how the first assessment of children with TBI may predict outcomes is lacking. This study aimed to expand the knowledge by describing the incidence, visits, causes, and outcomes of TBI in children in Iceland.

METHODS

A retrospective descriptive data analysis was conducted on electronic medical records of children aged 0-17 that visited Landspitali EDs due to a traumatic head injury in 2010-2021. Cases were based on registered ICD-10 diagnosis and data was collected on demographics, causes, triage, length of stay (LOS), admissions and mortality rates. Descriptive statistics were calculated, and associations of variables tested for significance.

RESULTS

The study sample included 30,014 emergency visits. The majority involved boys (61.21 %) and children under 6 years old (57.99 %, M = 5.98 years). Girls had a significantly lower mean age (5.75 years vs 6.13 years, p < 0.001). The highest incidence was in one-year olds (729 per 100,000) and was on average 310 per 100,000 children of all ages. Total yearly visits decreased throughout the study period (M = 2,501). Emergency Severity Index (ESI) of 4 (50.77 %) was the most common, with 59.6 % of ESI = 1 cases admitted (p < 0.001). The average LOS was 2.2 h and 1.05 % were admitted. Falls (43.62 %) and soft tissue injuries (73.68 %) were the most common, with intracranial injuries (42.57 %) being the most common in ED observations and admissions. Throughout the study period, 30 (0.10 %) died, thereof three within a week post-injury. In total, 26.64 % of children had at least one revisit to the ED with a traumatic head injury.

CONCLUSIONS

Children commonly visit EDs due to TBI, mostly with mild injuries but one fourth revisited with a new head injury. There may be groups of children that require specialised follow-up care and assessment to detect and prevent further complications of TBI. Paediatric emergency nurses may be in a key position in identifying children in need of follow-up care. Further research is needed to enhance knowledge of outcomes of TBI in children and to reflect the important role of nurses in paediatric TBI care.

Efficacy of BETTER transitional care intervention for diverse patients with traumatic brain injury and their families: Study protocol of a randomized controlled trial

OBJECTIVE

The purpose of this study is to examine the efficacy of BETTER (Brain Injury, Education, Training, and Therapy to Enhance Recovery) vs. usual transitional care management among diverse adults with traumatic brain injury (TBI) discharged home from acute hospital care and families.

METHODS

This will be a single-site, two-arm, randomized controlled trial (N = 436 people, 218 patient/family dyads, 109 dyads per arm) of BETTER, a culturally- and linguistically-tailored, patient- and family-centered, TBI transitional care intervention for adult patients with TBI and families. Skilled clinical interventionists will follow a manualized protocol to address patient/family needs. The interventionists will co-establish goals with participants; coordinate post-hospital care, services, and resources; and provide patient/family education and training on self- and family-management and coping skills for 16 weeks following hospital discharge. English- and Spanish-speaking adult patients with mild-to-severe TBI who are discharged directly home from the hospital without inpatient rehabilitation or transfer to other settings (community discharge) and associated family caregivers are eligible and will be randomized to treatment or usual transitional care management. We will use intention-to-treat analysis to determine if patients receiving BETTER have a higher quality of life (primary outcome, SF-36) at 16-weeks post-hospital discharge than those receiving usual transitional care management. We will conduct a descriptive, qualitative study with 45 dyads randomized to BETTER, using semi-structured interviews, to capture perspectives on barriers and facilitators to participation. Data will be analyzed using conventional content analysis. Finally, we will conduct a cost/budget impact analysis, evaluating differences in intervention costs and healthcare costs by arm.

DISCUSSION

Findings will guide our team in designing a future, multi-site trial to disseminate and implement BETTER into clinical practice to enhance the standard of care for adults with TBI and families. The new knowledge generated will drive advancements in health equity among diverse adults with TBI and families.

TRIAL REGISTRATION

NCT05929833.

The BETTER Traumatic Brain Injury Transitional Care Intervention: A Feasibility Study

This study aimed to investigate the feasibility, acceptability, and clinical outcome measures of BETTER (Brain Injury Education, Training, and Therapy to Enhance Recovery), a culturally tailored traumatic brain injury (TBI) transitional care intervention, among diverse younger adult patients with TBI (age 18-64) and their caregivers. Trained clinical interventionists addressed patient/family needs; established goals; coordinated post-hospital care and resources; and provided patient/family training on self- and family-management coping skills. Fifteen dyads enrolled (N = 31, 15 patients, 16 caregivers). All completed baseline data; 74.2% (n = 23; 10 patients, 13 caregivers) completed 8-week data; 83.8% (n = 26; 13 each) completed 16-week data. Approximately 38% (n = 12, 3 patients, 9 caregivers) completed acceptability data, showing positive experiences (mean = 9.25, range 0-10; SD = 2.01). Overall and mental quality of life (QOL) scores did not differ over time but physical QOL scores did improve over time (baseline: 30.3, 8 weeks: 46.5, 16 weeks: 61.6; p = 0.0056), which was considered to be a suitable outcome measure for a future trial. BETTER is a promising intervention with implications to improve TBI care standards. Research is needed to determine efficacy in a randomized trial.

"If you respect me, you are respecting my culture": methods and recommendations for personalizing a TBI transitional care intervention

OBJECTIVE

Despite research, national legislation, and clinical guidelines supporting transitional care, there is minimal benefit from existing transitional care interventions for racial/ethnic minorities with traumatic brain injury (TBI) discharged home from acute hospital care. Existing TBI transitional care interventions are not tailored to address the needs/preferences of patients from various racial/ethnic minority groups. The purpose of this study was to describe use of personalization to tailor a TBI transitional care intervention for various racial/ethnic groups.

DESIGN

Following preliminary intervention manual development, a qualitative descriptive study was conducted using eight focus groups with 40 English-and Spanish-speaking participants (12 patients, 12 caregivers, and 16 providers).

RESULTS

Three personalization-related themes emerged: 1) what is important to me, 2) finding someone to deliver the intervention who can adapt to my needs, and 3) respect over culture. Findings informed personalization strategies within our final manual.

CONCLUSIONS

We recommend researchers who wish to use personalization to tailor interventions to consider: 1) allowing stakeholders to dictate what is most important and 2) implementing an iterative intervention development process with input from diverse stakeholders. Findings have implications for informing the development of transitional care interventions to increase the likelihood that interventions are inclusive of needs and preferences of various races/ethnicities.

The Relationship Between Lifelong Learning Perceptions of Pediatric Nurses and Self-Confidence and Anxiety in Clinical Decision-Making Processes

This study was conducted to evaluate the relationship between lifelong learning perceptions of pediatric nurses and self-confidence and anxiety in clinical decision-making processes. One of the most important ways to adapt to change in the developing and changing health care environment worldwide and in evidence based nursing care is lifelong learning. The most essential characteristics of a lifelong learner are reflection, questioning, enjoying learning, understanding the dynamic nature of knowledge and engaging in learning by actively seeking learning opportunities so that evidence-based nursing care can be achieved. Pediatric nurses were included in this descriptive, correlational and cross-sectional study. The study was based on pediatric nursing in the pediatric clinics of a hospital in the capital of  Turkiye between April and July 2021. It was determined that the mean scores of lifelong learning differed according to gender, education level, length of service in the profession and the unit in which each individual worked, and these differences were statistically significant. Pediatric nurses' lifelong learning level explained the three subdimensions of self-confidence in clinical decision-making. The results of the regression analysis indicate that lifelong learning levels of the pediatric nurses did not significantly predict their scores on the subdimensions of anxiety with clinical decision-making scale. Positive effects on clinical decision-making in the nursing process can be achieved if the tendencies of pediatric nurses toward lifelong learning are sufficient. Assessing nurses' lifelong learning perceptions is an essential step toward implementing evidence-based care for pediatric patients. Clinical decision-making skills can be supported by increasing nurses' lifelong learning awareness.

Design, methods, and baseline characteristics of the Brain Injury Education, Training, and Therapy to Enhance Recovery (BETTER) feasibility study: a transitional care intervention for younger adult patients with traumatic brain injury and caregivers

OBJECTIVES

We developed a patient- and family-centered traumatic brain injury (TBI) transitional care intervention, called BETTER (Brain Injury Education, Training, and Therapy to Enhance Recovery), to improve quality of life (via SF-36) of younger TBI patients of different racial groups discharged home from acute hospital care and caregivers. We describe our design, methods, and baseline characteristics for our feasibility study.

METHODS

We co-developed BETTER with input from key stakeholders (TBI patients and caregivers, healthcare providers, and interdisciplinary research team members). BETTER is guided by the Individual and Family Self-Management Theory, our team's prior research, as well as literature used to support, educate, and train patients and families recovering from TBI and other conditions. The intervention is delivered by trained clinical interventionists (transitional care managers), beginning 24-72 h pre-discharge to 16 weeks post-discharge. BETTER offers tailored transitional care support to patient/family dyads, including assessing needs; establishing goals; coordinating post-hospital care, services, and resources; and providing patient/family education and training on brain injury coping skills. The majority of the intervention is delivered remotely via phone and remote video conferencing platform (Clinicaltrials.gov: NCT04584554).

RESULTS

We enrolled 15 dyads (N = 31, 15 patients, 16 caregivers) in this single arm, single center feasibility study. Most patients were men (n = 11, 73.33%), had a mean age of 39.07 (SD: 15.15), and were Black (n = 9, 60%), White (n = 5, 33.3%), or American Indian (n = 1, 0.66%). Injury severities were mild (n = 6, 40%), moderate (n = 4, 26.6%) or severe (n = 5, 33.33%). Most patients were insured (n = 10; 66.7%), had a high school education (n = 6; 40%); and earned $30,000 or less per year (n = 11; 73.3%). Most caregivers were married (n = 9, 56.25%) women (n = 14, 87.5%) with a mean age of 43.38 (SD: 10.45) and were Black (n = 8, 50%), White (n = 7, 43.75%), or American Indian (n = 1, 0.62%). Most caregivers identified as the spouse (n = 7; 43.75%) or parent (n = 6; 37.5%) of the patient.

CONCLUSIONS

BETTER is among the first TBI transitional care intervention to address needs/preferences for younger TBI patients of different racial groups after discharge home from acute hospital care and families. Findings can be used to inform future work.

Effect of an Educational Intervention on the Knowledge about Traumatic Brain Injury Guidelines among Clinical Nurses

Objective Traumatic brain injury (TBI) is a major cause of death and disability throughout the world including developing countries like India. Adherence to guideline based TBI management has proven to decrease death rate and improve neurological outcomes. This study aimed to assess the knowledge of TBI guidelines among clinical nurses caring for TBI patients, and to determine the effect of an educational intervention on their knowledge.

Methods Preexperimental, one group pretest and posttest design was used. A purposive sample of 60 nurses was included in the study. A structured questionnaire was prepared to assess the knowledge of nurses. Educational intervention was given in the form of a planned teaching program that was prepared based on the national TBI guidelines.

Results There was a significant gain in the knowledge scores of the nurses after the educational intervention when compared with the knowledge scores before the intervention (p = 0.001) Nurses who were experienced more than 10 years were found to have significantly higher knowledge score than others with lesser years of experience.

Discussion This study demonstrates important knowledge gap about TBI guidelines among clinical nurses. Educational interventions can be effectively used to improve the knowledge about TBI guidelines among nurses.

Mental workload of frontline nurses aiding in the COVID-19 pandemic: A latent profile analysis

Aims

To investigate the mental workload level of nurses aiding the most affected area during the Coronavirus disease 2019 (COVID‐19) pandemic and explore the subtypes of nurses regarding their mental workload.

Design

Cross‐sectional study.

Methods

A sample of 446 frontline nurses participated from March 8 to 19, 2020. A latent profile analysis was performed to identify clusters based on the six subscales of the Chinese version of the National Aeronautics and Space Administration Task Load Index. The differences among the classes and the variables including sociodemographic characteristics, psychological capital and coping style were explored.

Results

The level of mental workload indicates that the nurses had high self‐evaluations of their performance while under extremely intensive task loads. The following three latent subtypes were identified: ‘low workload & low self‐evaluation’ (8.6%); ‘medium workload & medium self‐evaluation’ (35.3%) and ‘high workload & high self‐evaluation’ (56.1%) (Classes 1, 2, and 3, respectively). Nurses with shared accommodations, fewer years of practice, junior professional titles, lower incomes, nonmanagement working positions, lower psychological capital levels and negative coping styles had a higher likelihood of belonging to Class 1. In contrast, senior nurses with higher psychological capital and positive coping styles were more likely to belong to Classes 2 and 3.

Conclusion

The characteristics of the ‘low workload & low self‐evaluation’ subtype suggest that attention should be paid to the work pressure and psychological well‐being of junior nurses. Further research on regular training program of public health emergency especially for novices is needed. Personnel management during public health events should be focused on the allocation between novice and senior frontline nurses.

Impact

This study addresses the level of mental workload of frontline nurses who aid in the most severe area of the COVID‐19 pandemic in China and delineates the characteristics of the subtypes of these nurses.

Strategies nurses use when caring for patients with moderate-to-severe traumatic brain injury who have cognitive impairments

AIMS AND OBJECTIVES

Adults with moderate-to-severe traumatic brain injury (TBI) may have immediate and chronic cognitive impairments that require use of specific nursing strategies. Nurses must be knowledgeable about strategies to use to accommodate these impairments. However, available clinical guidelines and research lack information to direct nonacute nursing management of cognition, limiting guidance for nurses when developing their care plans. The purpose of this study was to investigate strategies nurses use when caring for patients with moderate-to-severe TBI who have cognitive impairments.

DESIGN

Cross-sectional, exploratory study.

METHODS

A total of 692 nurses from three hospitals answered the following open-ended question via electronic survey: "Imagine you are caring for a patient with moderate-to-severe TBI who has problems with cognition (e.g., issues with memory, attention, and executive function). Please state your typical nursing routine to care for this type of patient." Data were analysed using summative content analysis. Methods are reported using COREQ guidelines (See File S1).

RESULTS

Most respondents were female (89%), middle-aged (40.3 years), staff registered nurses (77%) practicing on an inpatient unit (51%) with prior experience caring for patients with moderate-to-severe TBI (95%). Nurses described 189 strategies used in their care plan when caring for patients with TBI who have cognitive impairments, including the following: (a) cognitive techniques; (b) communication techniques; (c) patient safety techniques; (d) agitation and behaviour management techniques; and (e) education techniques.

CONCLUSIONS

Findings have implications for education and training of nurses, direction for future research aimed at determining the effectiveness of nursing strategies with this patient population, and for development of clinical guidelines for nonacute nursing management of patients with moderate-to-severe TBI who have cognitive impairments.

RELEVANCE TO CLINICAL PRACTICE

Findings provide foundational knowledge on strategies nurses use when caring for patients with TBI who have cognitive impairments, which could be used to direct evidence-based nursing care of this patient population.