Agitation in Patients Recovering From Traumatic Brain Injury: Nursing Management

Mortimer, Diane; Berg, Wesley

doi:10.1097/jnn.0000000000000253

Cited by 28 publications

(24 citation statements)

References 28 publications

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Section: Discussionsupporting

confidence: 55%

“…Our findings add to the literature by documenting nonpharmacological strategies nurses use to manage agitation and behaviour problems in patients with TBI who have cognitive impairments (Alverzo, ; Mortimer & Berg, ). Recent research on nursing management of agitation in patients with TBI also recommends nurses promote patients' sleep–wake cycles and use alternative strategies such as aromatherapy, massage therapy and music to prevent and address agitation in this patient population (Mortimer & Berg, ). As agitation is a common phase of recovery for patients with moderate‐to‐severe TBI (Mortimer & Berg, ) and can have an influence on short‐ and long‐term outcomes for persons with moderate‐to‐severe TBI (Babikian & Asarnow, ; Bogner, Corrigan, Fugate, Mysiw, & Clinchot, ), it is important nurses have appropriate strategies to use when faced with this issue.…”

Section: Discussionsupporting

confidence: 55%

“…Recent research on nursing management of agitation in patients with TBI also recommends nurses promote patients' sleep–wake cycles and use alternative strategies such as aromatherapy, massage therapy and music to prevent and address agitation in this patient population (Mortimer & Berg, ). As agitation is a common phase of recovery for patients with moderate‐to‐severe TBI (Mortimer & Berg, ) and can have an influence on short‐ and long‐term outcomes for persons with moderate‐to‐severe TBI (Babikian & Asarnow, ; Bogner, Corrigan, Fugate, Mysiw, & Clinchot, ), it is important nurses have appropriate strategies to use when faced with this issue. However, few nurses in our sample (12.8%) described using strategies to manage agitation and behaviour problems.…”

Section: Discussionmentioning

confidence: 99%

“…However, few nurses in our sample (12.8%) described using strategies to manage agitation and behaviour problems. Our low reports from nurses on strategies to address agitation and behaviour problems may be due to the unpredictable nature of behaviour after an individual sustains a moderate‐to‐severe TBI (Mortimer & Berg, ); management of agitation can be challenging for the nurse, especially if the patient becomes physically aggressive (Oppikofer & Geschwindner, ). Low reports of strategies to manage agitation and behaviour problems may also be due to limited training and education focused on management of patients with moderate‐to‐severe TBI who have cognitive impairments in nursing school curriculum and on the job (Oyesanya, Brown, et al, ; Oyesanya, Thomas, et al, ).…”

Section: Discussionmentioning

confidence: 99%

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

Oyesanya

Thomas

2019

Journal of Clinical Nursing

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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.

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Section: Discussionsupporting

confidence: 55%

Section: Discussionsupporting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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

Oyesanya

Thomas

2019

Journal of Clinical Nursing

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“…Sleep hygiene programs have shown significant improvements on sleep, agitation, and cognitive functions in the ICU, 42 including noise reduction and dynamic light. 43 Different attempts have been made to improve sleep in patents with TBI. A protocol for quiet time in neurointensive care has been shown to have a positive effect on sleep, 44 and a nurse-driven sleep hygiene protocol with fewer interruptions has also been beneficial.…”

Section: Discussionmentioning

confidence: 99%

Sleep and agitation during subacute traumatic brain injury rehabilitation: A scoping review

Poulsen

Langhorn

Egerod

et al. 2021

Australian Critical Care

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Background: Sleep disturbance and agitation are frequent conditions during the subacute period of recovery in moderate to severe traumatic brain injury (TBI). Clarity is needed regarding the association between the two conditions to improve fundamental nursing care. Aim: The aim of our scoping review was to identify the evidence for potential associations between sleep disturbance and agitation during subacute inpatient rehabilitation of adult patients with moderate to severe TBI. Design: We conducted a five-step scoping review. Methods: Sources of evidence were PubMed, CINAHL, PsycINFO, Cochrane, and Web of Science databases. Eligibility criteria were as follows: English or Scandinavian language articles describing sleep and/or agitation during inpatient rehabilitation of adult patients with moderate to severe TBI and published in the period 2000e2019. Results: We identified 152 articles of which we included six. The included articles were all affiliated with the USA using quantitative methodology. The association between sleep disturbance and agitation is highly complex, with disturbed sleep affecting cognitive and emotional functions. Sleep disturbance was associated with posttraumatic amnesia (PTA)/posttraumatic confusional state, cognitive function, and agitation. Our review suggested a bidirectional association between these symptoms during early TBI rehabilitation. We inferred that improved sleep might be a contributing factor to the resolution of PTA, cognitive impairment, and agitation. Conclusion: The association between sleep disturbance and agitation is still undetermined, but we assume that improved sleep may protect against neuropsychiatric problems in patients with moderate to severe TBI. Larger controlled interventional studies are needed to provide the evidence of modifiable factors for improving sleep during inpatient TBI rehabilitation. Owing to the current lack of publications, it is probably too early to perform a systematic review on the topic.

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Effectiveness of Non-Pharmacological Interventions for Agitation during Post-Traumatic Amnesia following Traumatic Brain Injury: A Systematic Review

et al. 2022

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Agitation is common in the early recovery period following traumatic brain injury (TBI), known as post-traumatic amnesia (PTA). Non-pharmacological interventions are frequently used to manage agitation, yet their efficacy is largely unknown. This systematic review aims to synthesize current evidence on the effectiveness of non-pharmacological interventions for agitation during PTA in adults with TBI. Key databases searched included MEDLINE Ovid SP interface, PubMed, CINAHL, Excerpta Medica Database, PsycINFO and CENTRAL, with additional online reviewing of key journals and clinical trial registries to identify published or unpublished studies up to May 2020. Eligible studies included participants aged 16 years and older, showing agitated behaviours during PTA. Any non-pharmacological interventions for reducing agitation were considered, with any comparator accepted. Eligible studies were critically appraised for methodological quality using Joanna Briggs Institute Critical Appraisal Instruments and findings were reported in narrative form. Twelve studies were included in the review: two randomized cross-over trials, three quasi-experimental studies, four cases series and three case reports. Non-pharmacological interventions were music therapy, behavioural strategies and environmental modifications, physical restraints and electroconvulsive therapy. Key methodological concerns included absence of a control group, a lack of formalised agitation measurement and inconsistent concomitant use of pharmacology. Interventions involving music therapy had the highest level of evidence, although study quality was generally low to moderate. Further research is needed to evaluate non-pharmacological interventions for reducing agitation during PTA after TBI.Systematic review registration number: PROSPERO (CRD42020186802), registered May 2020.

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Agitation in Patients Recovering From Traumatic Brain Injury: Nursing Management

Cited by 28 publications

References 28 publications

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

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

Sleep and agitation during subacute traumatic brain injury rehabilitation: A scoping review

Effectiveness of Non-Pharmacological Interventions for Agitation during Post-Traumatic Amnesia following Traumatic Brain Injury: A Systematic Review

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