[Experience of Implementing ABCDEF Bundle Care to Reduce Delirium in a Traumatic Brain Injury Patient].

Patients with traumatic brain injury (TBI) have a high incidence rate of delirium, which leads to poor prognoses. This case study describes a nursing experience of implementing ABCDEF bundle care to reduce delirium in a patient with TBI. The period of nursing care was April 23 to April 30, 2019. A comprehensive assessment of this patient's physical, psychological, familial, social, and spiritual dimensions was conducted via consultation, observation, and physical assessment. The assessment results showed that the patient suffered from acute delirium and cerebral perfusion impairment. In addition, the results showed that the patient's wife suffered from caregiver role strain that was further exacerbated by family difficulties. Multiple, individualized patient-tailored nursing interventions were developed under ABCDEF bundle care to alleviate delirium during the period of nursing care. These interventions included spontaneous awakening trials, spontaneous breathing trials, coordination, delirium assessment, early mobilization, and family engagement. Furthermore, family involvement and interprofessional cooperation with social workers were conducted concurrently to alleviate economic and care burdens and mitigate caregiver role strain in the patient's wife. It is hoped that this nursing care experience helps promote increased attention towards delirium, helps improve early detection of delirium in patients with TBI, and promotes the provision of individualized bundle care that draws on different perspectives in order to achieve holistic health care.

Spirituality and outcomes in caregivers of persons with traumatic brain injury (TBI).

PURPOSE/OBJECTIVE: Spiritual well-being has been associated with better quality of life outcomes in caregivers, but the associations among the care recipient's functional status, the caregiver's spiritual well-being, and the caregiver's health-related quality of life (HRQOL) is unknown. Research Method/Design: The study examined the Spiritual Well-Being Scale in caregivers of persons with traumatic brain injury (TBI; n = 335). Participants completed measures from the Patient-Reported Outcomes Measurement Information System, the Quality of Life in Caregivers of TBI, and the Caregiver Appraisal Scale. The Mayo-Portland Adaptability Inventory-4 (MPAI-4) measured care recipient's functional status. The association between religious well-being and existential well-being and HRQOL were examined with Pearson correlation coefficients. Multiple linear regressions examined the interaction between caregiver well-being and care recipient functional status on HRQOL outcomes accounting for demographic variables. RESULTS: Less favorable caregiver HRQOL was associated with military affiliation, male status, spousal caregiver relationship, and White race. MPAI-4 was moderately associated with all HRQOL subdomains. For spiritual well-being, existential well-being was moderately correlated with 9 of 16 HRQOL subdomains in comparison to religious well-being that demonstrated small correlations with 3 of 16 subdomains. MPAI-4 had negative effects on HRQOL regardless of spiritual well-being with higher existential well-being reducing the negative impact of the care recipient's functional impairment on HRQOL for significant HRQOL interactions. CONCLUSIONS/IMPLICATIONS: Interventions that encourage development and maintenance of life purpose and meaning in caregivers of persons with TBI, and less so, spirituality, might have beneficial effects on HRQOL when the person with injury has more functional limitations. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Gender Differences in Longitudinal Associations Between Intimate Care, Resiliency, and Depression Among Informal Caregivers of Patients Surviving the Neuroscience Intensive Care Unit.

BACKGROUND/OBJECTIVE: Informal caregivers (e.g., family and friends) are at risk for developing depression, which can be detrimental to both caregiver and patient functioning. Initial evidence suggests that resiliency may reduce the risk of depression. However, gender differences in associations between multiple psychosocial resiliency factors and depression have not been examined among neuroscience intensive care unit (neuro-ICU) caregivers. We explored interactions between caregiver gender and baseline resiliency factors on depression symptom severity at baseline through 3 and 6 months post-discharge. METHODS: Caregivers (N = 96) of neuro-ICU patients able to provide informed consent to participate in research were enrolled as part of a prospective, longitudinal study in the neuro-ICU of a major academic medical center. Caregiver sociodemographics and resiliency factors (coping, mindfulness, self-efficacy, intimate care, and preparedness for caregiving) were assessed during the patient's hospitalization (i.e., baseline). Levels of depressive symptoms were measured using the Hospital Anxiety and Depression Scale at baseline, 3 months, and 6 months post-discharge. RESULTS: Baseline depressive symptoms predicted depressive symptoms at both 3- and 6-month follow-ups, with no difference at any time point in rates of depression by gender. At baseline, greater levels of coping, mindfulness, and preparedness for caregiving were individually associated with lower levels of concurrent depression regardless of gender (ps < 0.006). The main effect of baseline coping remained significant at 3-month follow-up (p = 0.045). We observed a trend-level interaction between gender and baseline intimate care, such that among male caregivers only, high baseline intimate care was associated with lower depression at 3-month follow-up (p = 0.055). At 6-month follow-up, we observed a significant interaction between caregiver gender and baseline intimate care, such that male caregivers reporting high intimate care reported lower symptoms of depression than females reporting high intimate care (p = 0.037). CONCLUSIONS: Results support implementation of psychosocial resiliency interventions for caregivers of patients admitted to the neuro-ICU early in the recovery process. Male caregivers may particularly benefit from strategies focused on increasing intimate care (e.g., physical and emotional affection with their loved one) and quality of the patient-caregiver dyadic relationship.

Perceptions of an Adapted Mindfulness Program for Persons Experiencing Substance Use Disorders and Traumatic Brain Injury.

BACKGROUND: Of the 1.4 million Americans who sustain traumatic brain injuries (TBIs) each year up to half experience substance use disorders (SUDs). This often leads to various issues such as increased rates of mental health problems and delay or lack of return to full employment. AIMS: The purpose of this program evaluation was to describe Vinland National Center's (Vinland's) client and staff perceptions of a 4-week mindfulness-based intervention adapted from the original mindfulness-based stress reduction program for persons experiencing SUDs and TBIs. It focused on the possible relevance and applicability of mindfulness practice for this population. METHOD: Four focus groups were conducted based on Krueger's methods in conducting focus groups: two with Vinland staff members and two focus groups with residents. RESULTS: The analysis of staff focus groups revealed general staff satisfactions with the intervention. A general consensus was that the mindfulness intervention fitted well with the needs of Vinland's clients and their current program. Client feedback further revealed general satisfaction with the mindfulness curriculum. No adverse effects were noted related to the mindfulness intervention. CONCLUSIONS: The results of this program evaluation suggest that implementing a mindfulness-based intervention for persons experiencing SUDs/TBIs warrants further investigation.

Effectiveness of direct and non-direct auditory stimulation on coma arousal after traumatic brain injury.

The aim of this study was to evaluate the effect of direct and non-direct auditory stimulation on arousal in coma patients with severe traumatic brain injury and to compare the effects of direct vs. non-direct auditory stimulation. A crossover intervention study design was used. Nine participants who were comatose after a severe traumatic brain injury underwent direct and non-direct auditory stimulation. Direct auditory stimulation requires a higher level of interpersonal interaction between the patient and stimuli such as voices of family members, orientation by a nurse or family member and familiar music. In contrast, non-direct auditory stimuli were characterized as more general, less familiar, less interactive, indirect and not lively such as general music and TV sounds. Participants received both direct and non-direct auditory stimulation in randomized order for 15 minutes. Recovery of consciousness was measured with the Glasgow Coma Scale (GCS) and Sensory Stimulation Assessment Measure (SSAM). The Friedman test with post hoc analysis by Wilcoxon's signed-rank test comparisons was used for data analysis. Patients who received both direct and non-direct auditory stimulation exhibited significantly increased GCS (p = 0.008) and SSAM scores (p = 0.008) over baseline. The improvement in SSAM scores after direct auditory stimulation was significantly greater than that after non-direct auditory stimulation (p = 0.021), but there was no statistically significant difference in GCS scores (p = 0.139). Auditory stimulation, in particular direct auditory stimulation, might be useful for improving the recovery of consciousness and increasing the arousal of comatose patients. The SSAM is more useful for detecting subtle changes from stimulation intervention than the GCS.

Actuación de enfermería en reanimación cardiopulmonar cerebral en pacientes críticamente enfermos en un servicio de terapia intensiva / Nursing actuation in cerebral cardiopulmonary resuscitation in critical illness patients in a intensive therapy service

Introducción: Al realizar reanimación cardiopulmonar cerebral (RCPC) lo básico es suministrar respiración artificial y masaje cardiaco, para establecer circulación y ventilación que eviten lesión cerebral irreversible. Objetivo: Determinar la importancia de la actuación de enfermería durante la reanimación cardio pulmonar cerebral en niños críticamente enfermos. Método: La población estuvo conformada por dos sub poblaciones, una de 40 enfermeras y otra de 74 pacientes pediátricos que ingresaron al servicio de terapia intensiva los meses de Julio, Agosto y Septiembre de 2.005. La muestra fue de tipo probabilística donde 15 pacientes ameritaron RCPC; dada sus condiciones criticas. Se diseñaron dos instrumentos de recolección de datos, para evidenciar la actuación de enfermería. Resultados: Un 33,3 por ciento de las profesionales que actuaron en reanimación básica pediátrica (RBP) pedían ayuda al medico quien en un 66,7 por ciento atendió al llamado, un 86,7 por ciento en la reanimación avanzada pediátrica (RAP) mantenía un vía permeable, 66,7 por ciento utilizo una posición adecuada para ventilar al niño, 60 por ciento libero el tubo tragual de secreción, 53,3 por ciento administro oxigeno al 100 por ciento, 46,7 por ciento uso las drogas oportunamente. Conclusión: Dadas las características de estas poblaciones pequeñas y finitas donde 15 pacientes ameritaron RCPC, se concluye que la principal función de la enfermera es valorar la gravedad de la urgencia para iniciar RCPC, el trabajo en equipo, mantener la comunicación con el medico, para reestablecer las funciones vitales del niño.