Nurses' Beliefs About Caring for Patients With Traumatic Brain Injury

Conscious care: a proposed model to improve interprofessional care of patients with disorders of consciousness in the acute hospital setting

BACKGROUND

Forty percent of individuals within the Disorders of Consciousness (DoC) spectrum are misdiagnosed as in a vegetative state/unresponsive wakefulness syndrome (VS/UWS) when in fact they are minimally conscious or emerged, underscoring a need to optimize evaluation techniques and interprofessional care management.

PRIMARY OBJECTIVE

Conscious Care is a proposed care model that aims to improve interprofessional care of patients with DoC in the hospital setting. The aim of this paper is to describe this model's key ingredients and various components.

CONCLUSIONS

This care model will advance clinician and caregiver preparedness to manage the complexities of this population and advocate for equal access to post-hospital medical and rehabilitative services. Evaluation and treatment of survivors of DoC should incorporate current evidence which drives continuous quality improvement and education to clinicians across the continuum of care. Immediate action must be taken to decrease the vulnerability and neglect of this marginalized population. Conscious Care is an innovative, sustainable solution that will improve interprofessional awareness of best practices and available science, strengthen care, and advocate for the right to quality of life that this population is so often denied.

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.

Knowledge and practice of nurses regarding the care of patients with head trauma in intensive care units in the West Bank

Background

Nurses in the intensive care unit are responsible for the continuous assessment and management of physiological parameters associated with head trauma. Nurses have a vital and significant role in the care of patients suffering from moderate-to-severe head trauma, both during acute and non-acute care.The purpose of this study was to investigate the Knowledge and Practice of nurses regarding the care of patients with head trauma in an intensive care unit.

Design and methods

The study was designed as a cross-sectional study. The study recruited 165 nurses who work at intensive care unit (ICU) nurses in Palestinian hospitals. The data collected by a self-administered questionnaire developed by the researcher.

Results

Among the 165 intensive nurses, the study findings revealed the majority of nurses 99 (60.0%) have low level knowledge regarding Care of Patients with a head trauma, and showed that most of the nurses 115 (69.7%) have poor level practice regarding Care of Patients with a head trauma.

Conclusions

According to the results of the current study, approximately two-thirds of the studied nurses had unsatisfactory knowledge level regarding head trauma care. More than two-thirds of the studied nurses had poor level practice regarding head trauma care. Also, the study confirmed no statistical significant relation between knowledge and demographic characteristics. There was significant differences between total practice scores and both experience in general and experience in ICU.

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.

Severity and correlates of brain fog in people with traumatic brain injury

Brain fog is one symptom that has been underexplored in traumatic brain injury (TBI). We explored the cognitive and affective correlates of brain fog in people with symptomatic mild TBI (n = 15), moderate-to-severe TBI (n = 15), and a healthy control group (n = 16). Measures across the studies assessed "brain fog" (Mental Clutter Scale), objective cognition (Useful Field of View® and Cogstate Brief Battery®), post-concussive symptoms (Post-Concussion Symptom Scale), and depressive symptoms (Profile of Moods Scale). Brain fog was higher in symptomatic mild TBI and moderate-to-severe TBI compared with healthy controls. Greater brain fog corresponded to greater depressive symptoms in symptomatic mild TBI. Greater brain fog corresponded to poorer episodic memory and working memory in moderate-to-severe TBI. Brain fog appears to reflect challenges in recovery, including depressive symptoms and worse cognitive function. Screening for brain fog might be worthwhile in people with brain injuries.

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.

Development, Reliability, and Validity of the Perceptions of Brain Injury Survey

BACKGROUND AND PURPOSE

The purpose of this study was to assess psychometric properties of the Perceptions of Brain Injury Survey (PBIS), an instrument designed to assess nurses' perceptions and preparation to care for patients with traumatic brain injury (TBI).

METHODS

We adapted two instruments to create the PBIS, and 724 nurses completed the PBIS at three hospitals.

RESULTS

Final instrument has 66 items and is composed of four subscales, which can be used independently. Results showed Cronbach's alpha for the overall scale was excellent (.93) and alphas for each composite subscale were acceptable to excellent (.73-.93). Findings also suggest good discriminant validity and evidence of external validity.

CONCLUSIONS

The PBIS is a reliable and valid measure for assessing nurses' perceptions of caring for patients with TBI in practice or research.

Misconceptions about traumatic brain injury among nursing students in India: implications for nursing care and curriculum

Background

Despite the devastating consequences of Traumatic brain injuries (TBIs), TBI misconceptions are common among healthcare professionals. As an essential member of multi-professional team providing TBI care, it is important that nurses have correct information and adequate skills to achieve the best possible outcomes for TBI. For example, some common misconceptions about TBIs are that a second blow to the head can improve memory functioning and wearing seatbelts can cause as many brain injuries as it prevents. In India, perhaps such misconceptions towards TBI among nursing professionals were not yet documented. As nursing students form the future health workforce, understanding TBI misconceptions among nursing students in resource-limited settings like India will provide useful information for strengthening the nursing curricula for improved care and rehabilitation of TBIs.

Methods

We used a cross-sectional survey to study the TBI misconceptions among nursing students in India. A Common Misconceptions about Traumatic Brain Injury (CM-TBI) questionnaire was administered to 154 nursing students from a nursing college of a tertiary care neuro-centre in India. The mean percentage of misconceptions were calculated for 7-domains of CM-TBI. T-test for independent samples and ANOVA were used to study the association of misconception with socio-demographic variables using total score for each respondent.

Results

Of the 143 nursing students who completed the survey, majority of them were female (97%) and in the 19-20 year age-group (95.1%). Domain on brain damage (81.1%) had highest rate, while amnesia domain (42.0%) had lowest rate of misconception. The overall mean-score was 22.73 (Standard Deviation: 4.69) which was significantly higher than the median score of 19.5. The study did not show significant differences on overall misconceptions about TBI for any of the socio-demographic characteristics.

Conclusions

Misconceptions about TBIs were common among nursing students and it was pervasive irrespective of age, gender, place of residence and year of education. A need to strengthen nursing curriculum in the area of TBIs has been emphasized for improved care and management of TBIs. The study findings also suggest the need for understanding such misconceptions among other healthcare professionals involved in TBI care.

Veterans Health Administration nurses' training and beliefs related to care of patients with traumatic brain injury

BACKGROUND

Veteran patients with traumatic brain injury (TBI) and their family members regularly receive care from nurses. Understanding nurses' training and beliefs can provide direction for intervention work aimed at ensuring the best possible care is delivered to this population.

AIMS

We examined Veterans Health Administration (VHA) nurses' training and beliefs related to care of patients with moderate-to-severe TBI.

DESIGN AND METHODS

We conducted an exploratory, cross-sectional survey with 211 VHA nurses and analyzed data using descriptive statistics.

RESULTS

The average years of nursing experience was 18 years, and 90% reported ever caring for a patient with TBI. Most nurses (70%) reported only seeing patients with TBI ≤1-2 times per year in their current role; 20% reported seeing these patients 1-2 times per month. Even with infrequent care, almost 50% reported previously receiving TBI-related training. Beliefs items with the highest accuracy indicated nurses agreed that they need specialized training to care for patients with TBI and that TBI recovery may continue for several years (96.39% accuracy respectively). The beliefs item with the lowest accuracy indicated focus on whether nurses agreed that TBI severity was important in developing care plans (27.84% accuracy). Nurses reported the need for clarity of the nursing role in caring for patients with TBI (77.32% agreement).

CONCLUSION

VHA nurses do have accurate beliefs about caring for Veteran patients with moderate-to-severe TBI; however, there is the need for further role clarification regarding nursing care of patients with TBI.

IMPACT

These findings have implications for development of education and training interventions for nurses who care for Veteran patients with TBI.

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.

Validation of the Nursing Diagnosis "Labile Emotional Control" in Traumatic Brain Injury

OBJECTIVE

To validate the defining characteristics of the nursing diagnosis "labile emotional control" in traumatic brain injury (TBI) outpatients.

DESIGN

This was a descriptive, cross-sectional, quantitative study.

METHODS

Thirty-one Brazilian nurses who were experts in the area of TBI answered a semistructured questionnaire on the diagnosis "labile emotional control" based on NANDA-International (NANDA-I) Taxonomy II (2015-2017) using a Likert-type scale to rate the 13 defining characteristics. Based on Fehring's model, the weighted average of ≥80 was used to define the main characteristic and the mean of ≥0.50 was considered for total content validation.

RESULTS

Out of the 13 defining characteristics of the nursing diagnosis studied, "leaving a social situation" (0.80) and "expression of emotions inconsistent with the triggering factor" (0.81) were classified as principal characteristics, while the 11 others were classified as secondary characteristics. The diagnosis "labile emotional control" obtained a total score of 0.69, which was considered valid according to NANDA-I Taxonomy II.

CONCLUSIONS

Because this is a new diagnosis with subjective characteristics, there is a need to train nurses to recognize the defining characteristics for the diagnosis.

CLINICAL RELEVANCE

The validation of this diagnosis helps nurses understand and identify the subjective characteristics of the emotional impressions expressed by patients with TBI. These defining characteristics will help improve TBI nurses' clinical practice.

A survey across four European countries to determine rheumatology health professionals' awareness of physical activity measures in people with inflammatory joint diseases

OBJECTIVES

The objectives of this study were to determine rheumatology health professionals' (HPs)' awareness of and confidence in using physical activity (PA) measures in people with inflammatory joint diseases (IJDs), their own self-reported PA levels and to identify HP-related educational needs.

METHODS

Rheumatology HPs in Denmark, Sweden, Ireland and Belgium participated in an on-line survey. Descriptive statistics and latent class analysis (LCA) were undertaken SPSS (v21and SASv9.4) to describe data aggregates and range and to identify subclasses of groups with respect to use of PA measures.

RESULTS

322 (n=322, 75.5% women) HPs responded from Denmark (n=50, 15.5%), Sweden (n=66, 20.5%), Ireland (n=28, 8.7%) and Belgium (n=178, 55.3%) and the majority of respondents (n=286, 91.7%) reported it was important to measure PA in people with IJDs. Only 28.2% of HPs used simple body worn sensors to measure PA levels in their patients. The majority were interested in on-line education on measuring PA (82.9%). LCA, used to generate classes of PA measures employed by HPs, revealed three distinct classes reflecting differences in self-reported PA levels, awareness of PA measures, further education requirements and professional background.

CONCLUSIONS

The majority of respondents reported that they considered measuring PA as important in people with IJDs; however, the majority lacked confidence in how to measure it. There was strong interest in further education around measuring PA. Three distinct respondent classes were identified to inform targeted education on how to measure PA.

Nurses' concerns about caring for patients with acute and chronic traumatic brain injury

AIMS AND OBJECTIVES

As a first step in developing traumatic brain injury-specific nursing education, the purpose of this study was to investigate nurses' concerns about caring for patients with moderate-to-severe traumatic brain injury.

BACKGROUND

Patients with moderate-to-severe traumatic brain injury typically have significant immediate and chronic cognitive impairments. These cognitive impairments can negatively affect their inpatient stay after an acute traumatic brain injury and affect their health care later in life when seeking care for other acute health conditions during the chronic phase of traumatic brain injury. Nurses must be knowledgeable about modifying care to accommodate the cognitive impairments of these patients throughout the continuum of care. Yet, current guidelines focus exclusively on acute care and do not address nurses' central role in dealing with residual cognitive impairments of these patients. Thus, educational and training interventions are needed to ensure nurses have adequate knowledge to care for these patients.

DESIGN

We conducted a cross-sectional, exploratory survey of 692 nurses across hospital departments at three hospitals between October 2014-August 2015. Nurses answered the following qualitative open-ended question: "What are your primary concerns about providing care to patients with moderate-to-severe traumatic brain injury?"

METHODS

Conventional qualitative content analysis was used to analyse nurses' responses.

RESULTS

Findings showed nurses reported multiple concerns about caring for patients in the acute phase after traumatic brain injury, but few concerns about caring for patients in the chronic phase. Some of the concerns nurses reported included: (i) preventing physical injury; (ii) missing changes in condition; (iii) providing adequate education; (iv) providing support; and (v) promoting recovery. Barriers to providing adequate care were as follows: (i) lack of knowledge; (ii) limited staffing; and (iii) inadequate resources.

CONCLUSIONS

Findings have implications for education of nurses and development of nursing guidelines for management of patients with traumatic brain injury, including providing direction for nurses on development of care plans for patients in the chronic phase after a moderate-to-severe traumatic brain injury.

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

PURPOSE

Pediatric nurses play a significant role in all phases of traumatic brain injury (TBI) recovery, particularly during the hospital stay. Although evidence-based nursing practice is known to improve patient outcomes, limited research exists on nurses' evidence-based perceived knowledge and beliefs specific to TBI care. As nurses' perceived knowledge and beliefs are known to guide their practice behaviors, this assessment is important to overall TBI outcomes. The purpose of this study was to evaluate pediatric nurses' evidence-based perceived knowledge and beliefs in providing care for children and adolescents with moderate-to-severe TBI.

DESIGN AND METHODS

Data for this study were obtained from a larger parent study on nurses' perceptions of caring for patients of all ages with moderate-to-severe TBI. The parent study was an exploratory, cross-sectional electronic survey of registered nurses across all hospital departments within a large Midwestern health system. Only data specific to pediatric nurses (n = 330) were analyzed for this study. Descriptive statistics and latent class analysis (LCA) were performed.

RESULTS

Pediatric nurses, on average, were 38.79 years, female (90.37%), had over a decade of nursing experience (13.55 years), and practiced as a staff nurse (80.07%) on an inpatient unit (45.51%). Findings indicated pediatric nurses reported overall low levels of evidence-based perceived knowledge and had inaccurate beliefs about caring for patients with TBI. LCA indicated two distinct homogenous subgroups specific to evidence-based perceived knowledge: low (41%) and high (59%). Nurses in the low evidence-based perceived knowledge group were younger, had less nursing experience, worked primarily on an inpatient unit, and cared for patients with TBI at a higher frequency compared to high evidence-based perceived knowledge nurses. Additionally, there were significant differences in beliefs about sex-based patient differences after TBI and the role of nurses in caring for patients with TBI based on level of evidence-based perceived knowledge.

PRACTICE IMPLICATIONS

Assessing nurses' perceived knowledge and beliefs of evidence-based practice is a foundational step toward implementing evidence-based care for patients with moderate-to-severe TBI. Implications of these findings indicate the need to provide additional education to increase pediatric nurses' perceived knowledge and ensure accurate beliefs about evidence-based TBI care.

Experiences of giving and receiving care in traumatic brain injury: An integrative review

AIMS AND OBJECTIVES

To synthesise the literature on the experiences of giving or receiving care for traumatic brain injury for people with traumatic brain injury, their family members and nurses in hospital and rehabilitation settings.

BACKGROUND

Traumatic brain injury represents a major source of physical, social and economic burden. In the hospital setting, people with traumatic brain injury feel excluded from decision-making processes and perceive impatient care. Families describe inadequate information and support for psychological distress. Nurses find the care of people with traumatic brain injury challenging particularly when experiencing heavy workloads. To date, a contemporary synthesis of the literature on people with traumatic brain injury, family and nurse experiences of traumatic brain injury care has not been conducted.

DESIGN

Integrative literature review.

METHODS

A systematic search strategy guided by the PRISMA statement was conducted in CINAHL, PubMed, Proquest, EMBASE and Google Scholar. Whittemore and Knafl's (Journal of Advanced Nursing, 52, 2005, 546) integrative review framework guided data reduction, data display, data comparison and conclusion verification.

RESULTS

Across the three participant categories (people with traumatic brain injury/family members/nurses) and sixteen subcategories, six cross-cutting themes emerged: seeking personhood, navigating challenging behaviour, valuing skills and competence, struggling with changed family responsibilities, maintaining productive partnerships and reflecting on workplace culture.

CONCLUSIONS

Traumatic brain injury creates changes in physical, cognitive and emotional function that challenge known ways of being in the world for people. This alters relationship dynamics within families and requires a specific skill set among nurses.

RELEVANCE TO CLINICAL PRACTICE

Recommendations include the following: (i) formal inclusion of people with traumatic brain injury and families in care planning, (ii) routine risk screening for falls and challenging behaviour to ensure that controls are based on accurate assessment, (iii) formal orientation and training for novice nurses in the management of challenging behaviour, (iv) professional case management to guide access to services and funding and (v) personal skill development to optimise family functioning.

Knowledge, Confidence, and Practice Patterns of Speech-Language Pathologists Working With Adults With Traumatic Brain Injury

PURPOSE

Although speech-language pathologists (SLPs) are important members of the health care team serving adults with traumatic brain injury (TBI) with cognitive-communication disorders, little is known about services SLPs deliver and how they rate their own knowledge and skills. The aims of this study were to identify practice patterns, knowledge, and confidence levels of SLPs working with adults with TBI with cognitive-communication disorders.

METHOD

We surveyed 100 SLPs from rural and urban hospitals, skilled nursing facilities, and outpatient clinics in Wisconsin and analyzed data descriptively.

RESULTS

SLPs in this sample had a combination of accurate and inaccurate knowledge related to TBI. Although all participants reported working with individuals with TBI, many participants rated themselves as lacking confidence or knowledge in this practice area. SLPs reported variable use of evidence-based procedures and training related to TBI.

CONCLUSION

Results confirmed the high prevalence of TBI-related practice among SLPs in medical settings, but there was variable knowledge, confidence, and use of current evidence in practice. SLP graduate training programs, individual providers, health care administrators, and the American Speech-Language-Hearing Association can use results from this study to advance and improve SLP clinical services for adults with TBI.