Nursing Interventions For Critically Ill Brain Injury Patients

A key priority when caring for a patient with an altered level of consciousness is “giving the patient a chance”, in which interventions are focused on learning about the patient, protecting and monitoring patient status, talking to the patient and working with the family (Villanueva, 1999).

Neuroscience intensive care unit nurses carry numerous interventions when caring for a critically ill traumatic brain injured patient. In this study, their specific interventions, that they routinely perform, are identified. Quantitatively and qualitatively, nurses regularly monitor hemodynamic considerations such as O2 saturation, BP and temperature and other physiological parameters, monitor intracranial pressure and cerebral perfusion, and providing emotional support. While qualitative analyses solely showed that the other nursing interventions that they do could be classified as neurophysiological interventions, psychosocial interventions, injury prevention interventions, and interventions that maintains therapeutic environment. This study would present proofs of the comprehensive role of the neuroscience intensive care unit nurses caring for Traumatic Brain Injured patients and can be used in future researchers that would like to investigate the contribution of neuroscience intensive care unit nurses’ interventions to the progression of the patient’s condition.

After gaining an approval from the institutional review boards and nursing administration, a survey was done to 67 nurses who work in 3 different ICUs from two level-I trauma centers who regularly care for critically ill TBI patients. Those two trauma centers were chosen because they were both comparable in terms of delivery and organization of nursing care, employment ratios, and nurse characteristics so as to not have bias on the study. The respondents were registered nurses that worked for at least 3 months as a full-time or part-time clinical bedside nurse in an ICU that handles critically ill Traumatic Brain Injured patients. They were approached during their unit staff meetings and change-of-shift report times and invited to take part in the study. They were then given a questionnaire which was comprised of 3 parts: Part A was comprised of series of questions about their previously handled TBI patient, part B contained case scenarios wherein they used nursing judgments, and part C gathered demographic information about the nurse respondents.

For the quantitative data, all neuroscience intensive care unit nurses indicated that they were responsible for the monitoring of the patient’s blood pressure, oxygen saturation, and temperature. And approximately 50% of the nurses indicated that they were also responsible for the monitoring of the ICP and CPP. For the qualitative data, there were 4 categories where in the nurse’s interventions were grouped. The first one is the Neurophysiological Interventions. It is comprised of monitoring and maintaining the physiological parameters to guarantee neurological stability in TBI patients. In addition to that parameter, they also monitored pulmonary artery and central venous pressure reading, cerebral spinal fluid drainage, serial laboratory values, and carbon dioxide parameters. Keeping these values within the normal range, nurses help TBI patient to prevent secondary brain injury and to uphold neurological stability. The second one is the Psychosocial Interventions. In this category, nurses make meetings between the family member and various members of the healthcare team. Meetings between the family members are held to provide education and background of the plan of care being rendered to the patients and also to give information about the possible patient outcomes and rationales for the therapies. The third one is the Injury Prevention Interventions. This category aims to prevent additional complications to the patient and to ensure patient’s safety. The primary interventions for this category are maintenance of spine precautions and frequent reorientation of the patient. Other interventions like prevention of skin breakdown and ventilator-associated pneumonia, prevention of falls and evaluation for the need of restraints to prevent disruption of medical devices are considered usual care for any vitally ill patient. The fourth and the last category is Maintaining Therapeutic Milieu. In this category, nurses give suitable environment for the patient and provide their special needs. Limiting visitors, decreasing lighting, minimizing noise, avoiding disruption of the patient’s sleep-wake cycle are the interventions done in this group. All of which are carried out to provide optimal care and rest periods to the patient thus limits further increase in ICP.

Neuroscience nurses indeed have an essential part in the care of the critically ill traumatic brain injured patients. Their interventions address the prevention of secondary brain injury and complications and provide significant support and guidance for the family members. Therefore, they have a big contribution to the patient’s positive outcomes, but there is still no research documenting their multifaceted role on the patient’s progression. These data are needed to recognize the exceptional contribution of neuroscience ICU nurses as part of the interdisciplinary team caring for TBI patients and as a foundation for future research investigating how ICU nurses impact patient and family recovery from TBI during the acute stage of injury.