Readiness for hospital discharge perceived by caregivers of patients with traumatic brain injury: A cross-sectional study.

Background: There is a growing emphasis on evaluating discharge readiness, particularly for those involved in the care of patients in transition. Caregivers supporting individuals with traumatic brain injury are a specific focus due to the potential impact of adequate discharge preparation on patient recovery and post-discharge outcomes. Objective: This research aimed to evaluate the preparedness of caregivers for the discharge of patients with moderate or severe traumatic brain injury from the hospital. Methods: This cross-sectional study was carried out in a tertiary hospital in Indonesia from January to April 2023 using the Indonesian adaptation of the Preparedness for Caregiving Scale. The study comprised seventy-four caregivers of individuals with traumatic brain injury, chosen through a purposive sampling approach based on pre-established inclusion and exclusion criteria. Data collection involved a questionnaire covering caregiver information (gender, age, education level, income, and psychological status) and discharge readiness. Descriptive statistics and correlation analyses, employing Pearson and chi-square, were conducted. Results: Most caregivers were female (83.8%), spouses of patients (50%), and had a moderate education level (52.7%). The average age of caregivers was 43.7 ± 8.7 years, with an average duration of patient care of 4.22 ± 1.2 days and a monthly income of 220 US dollars. The mean score for readiness for hospital discharge was low (10.08 ± 1.91), indicating that caregivers were not adequately prepared for discharge. Age and education were significant factors (p <0.05) related to hospital discharge readiness. Conclusion: This study emphasizes the importance of assessing caregiver readiness for the discharge of patients with traumatic brain injury from the hospital. Findings indicate a concerning trend of inadequate preparedness among caregivers, with factors such as age and education level significantly influencing readiness. The predominance of female caregivers, often spouses of patients, indicates the need for tailored support strategies. Prioritizing caregiver preparation and support, especially by nurses, is crucial for optimizing patient recovery and post-discharge outcomes.

Factors related to changes in severity among adult and older adult patients at an internal medicine department clinic: an embedded mixed-method study.

The changes in aging plus the pathology of diseases can influence the changes in severity levels. This study aimed to examine the changes in levels of severity in patients while waiting to see a doctor. The study was conducted at an outpatient clinic in northeastern Thailand with a total of 421 patients who were assessed twice for levels of severity using the Emergency Severity Index. The 38 triage nurses screened patients, and 18 were interviewed when severity level changes were observed. Data were collected April 1-30, 2021. Quantitative data were analyzed by Chi-square test, Fisher's exact test, and logistic regression. Qualitative data were analyzed by content analysis. Most patients were female, between 18 and 59 years old. Most patients did not change their level of severity. However, increasing levels of severity were found in older adults. Factors related to the changes in severity levels were age group, chronic disease, chief complaint, educational level, the duration of travel to the outpatient clinic, type of vehicle, aging process and comorbidity, pathology of diseases, reassessment interval, nurse's experience, bypassing the patient triage process, patient's self-preparation, management of triage nurses, and assignment of direct healthcare staff until the end of the treatment. Increased severity was more frequently found in older adults, so closely monitored during waiting times at a clinic is needed. Setting rescreening as a policy and having sensitive screening guidelines and tools specific to older adults would contribute to early detection and immediate treatment of deteriorating symptoms and illness to help reduce complications and morbidity.Trial registration: https://osf.io/fp3j2 .

A Mobile Health Transitional Care Intervention Delivered by Nurses Improves Postdischarge Outcomes of Caregivers of Patients with Traumatic Brain Injury: A Randomized Controlled Trial.

OBJECTIVE: Caring for patients with traumatic brain injury (TBI) during the transition from hospital to home can be psychologically challenging to caregivers. This study aimed to assess the effectiveness of a novel mobile health (m-health) transitional care intervention to reduce stress and burden of caregivers of patients with TBI and to reduce readmissions. METHODS: A randomized controlled trial was conducted with 74 caregivers of adult patients with moderate or severe TBI admitted to a referral hospital in Indonesia. An m-health application for Android mobile phones was designed including education and information for caregivers. The application included an online chat feature with weekly monitoring. The m-health transitional care intervention also included face-to-face education before hospital discharge. Primary outcomes were caregivers' stress and burden. Outcomes were measured at 3 time points: at hospital discharge, 2 weeks postdischarge, and 4 weeks postdischarge. Random Allocation Software was used for randomization of study participants. RESULTS: Final analysis included data of 37 caregivers in the intervention group and 37 caregivers in the control group. Stress within the intervention group decreased over time (P < 0.001, mean difference = 11.05). Between both groups, stress was significantly different at 2 weeks and 4 weeks postdischarge (P < 0.001). Caregiver burden showed similar results (2 weeks postdischarge P < 0.001 and 4 weeks postdischarge P < 0.001). Only 1 patient in the control group was readmitted to the hospital. CONCLUSIONS: The m-health transitional care intervention reduced stress and burden of caregivers of patients with moderate or severe TBI. Nurses should consider using m-health technologies to support caregivers in the transition from the hospital into the community.

Prevalence, severity, and self-management of depressive mood among community-dwelling people with spinal cord injury in Nepal.

Background: Depression is a common psychological condition after spinal cord injury. There are increased incidences of self-harm, suicidal behavior, and lower quality of life among people with spinal cord injury and depression. However, self-management of depressive symptoms in the community is less explored. Objective: This study aimed to examine the prevalence, severity, and self-management of depressive mood in community-dwelling people with spinal cord injury. Methods: A descriptive study was conducted in 2019 among 115 people with spinal cord injury discharged from three health centers and living in the 13 districts of Bagmati Province. Participants were selected using stratified random sampling. Questionnaires were related to demographics, health and environment, depressive mood, and self-management. Descriptive statistics and quantitative content analysis were used to analyze the data. Results: Ninety-seven (84.3%) people with spinal cord injury had a depressive mood. Of these, 60.8% had moderate to severe depressive moods. They mainly used the internet and social media, shared feelings with family members, and practiced Hindu religious activities for depressive mood management because of the physical barriers to accessing a healthcare facility and easiness to use of non-pharmacological methods. Nearly half of participants who used sharing of feelings felt their depressive mood disappeared when they often used the method. Conclusion: Depressive mood following initial hospitalization is highly prevalent among people with spinal cord injury in Nepal, most of whom live in rural settings. Therefore, nurses and other health professionals should provide psychoeducation for this population and their family members to better address mental health problems. Facilitating pathways for those in rural areas to engage in social activities and timely treatment access may improve depressive mood. Nurses and other rehabilitation professionals can use social media to assess depressive moods and deliver management approaches in the community.

Discharge readiness and its associated factors among first-time mothers undergoing cesarean section in China.

Background: Helping first-time mothers who have just undergone cesarean section and transitioning from hospital to home with their infant is a complex process. Therefore, understanding what contributes to discharge readiness is necessary. Objective: This study aimed to determine discharge readiness level and its associated factors among first-time mothers who have undergone cesarean section. Methods: A descriptive cross-sectional study was conducted among 233 first-time mothers who had undergone cesarean sections selected using quota sampling from the two largest referral centers in China. Data were collected from March to June 2021 using a demographic characteristics form, Readiness for Hospital Discharge Scale-New Mother Form (RHDS-NMF), and Quality Discharge Teaching Scale-New Mother Form (QDTS-NMF). Descriptive and inferential statistics were used for data analysis. Results: The discharge readiness of the respondents was at a moderate level. Age (r = -0.129, p = 0.049) and complications after cesarean section (r = -0.136, p = 0.038) had a negative correlation with discharge readiness. In contrast, the subscales of QDTS-NMF, particularly the content (r = 0.519, p = 0.000) and delivery (r = 0.643, p = 0.000), had a positive correlation with discharge readiness. Conclusion: The findings enable nurses, midwives, and other healthcare professionals to understand discharge readiness and its related factors among first-time mothers undergoing cesarean section. It is also suggested that the quality of discharge teaching with a comprehensive assessment of first-time mothers preparing for discharge from the hospital and following the guideline to prevent post-cesarean section complications should be reinforced.

Evidence-practice gaps in initial neuro-protective nursing care: A mixed methods study of Thai patients with moderate or severe traumatic brain injury.

AIMS: This paper aims to identify the frequency and nature of evidence-practice gaps in the initial neuro-protective nursing care of patients with moderate or severe traumatic brain injury provided by Thai trauma nurses. BACKGROUND: Little is known about how Thai trauma nurses use evidence-based practice when providing initial neuro-protective nursing care to patients with moderate or severe traumatic brain injury. DESIGN: A mixed methods design was used to conduct this study. METHODS: Data were collected from January to March 2017 using observations and audits of the clinical care of 22 patients by 35 nurses during the first 4 h of admission to trauma ward. The study site was a regional hospital in Southern Thailand. RESULTS: The major evidence-practice gaps identified were related to oxygen and carbon dioxide monitoring and targets, mean arterial pressure and systolic blood pressure targets and management of increased intracranial pressure through patient positioning and pain and agitation management. CONCLUSION: There were evidence-practice gaps in initial neuro-protective nursing care provided by Thai trauma nurses that need to be addressed to improve the safety and quality of care for Thai patients with moderate or severe traumatic brain injury.

Thai trauma nurses' knowledge of neuroprotective nursing care of traumatic brain injury patients: A survey study.

Thai trauma nurses play a vital role in neuroprotective nursing care of patients with moderate or severe traumatic brain injury. Nurses' knowledge of the evidence underpinning initial neuroprotective nursing care vital to safe and high-quality patient care. However, the current state of knowledge of Thai trauma nurses is poorly understood. In this study, we investigated Thai nurses' knowledge of neuroprotective nursing care of patients with moderate or severe traumatic brain injury. Data were collected by a survey, comprising a section on participant characteristics and series of multiple-choice questions. All registered nurses (n = 22) and nursing assistants (n = 13) from the trauma ward of a regional Thai hospital were invited to participate: the response rate was 100%. Participants had limited knowledge of carbon dioxide monitoring; causes and implications of hypercapnia; mean arterial pressure and cerebral perfusion pressure targets; management of sedatives and analgesics; and management of hyperthermia. Improving their knowledge focusing on knowledge deficits through educational training and implementation of evidence-based practice is essential to improve the safety and quality of care for Thai patients with moderate or severe traumatic brain injury.

Community Integration After Traumatic Brain Injury and Related Factors: A Study in the Nepalese Context.

INTRODUCTION: Community integration is an essential component for rehabilitation among traumatic brain injury (TBI) survivors, which yields positive outcomes in terms of social activities, community participation, and productive work. A factor that usually facilitates community integration among TBI survivors is social support, whereas physical environment and fatigue are most often found as barriers. OBJECTIVES: This study aimed to (1) describe the level of community integration, fatigue, physical environment, and social support of persons after TBI, and (2) examine the relationship between community integration and these three factors. METHODS: This is a descriptive correlational study. One hundred and twenty TBI survivors living in the communities of Province Number Three, Nepal were enrolled using the stratified sampling technique. The data were collected using the Community Integration Questionnaire, Modified Fatigue Impact Scale, Craig Hospital Inventory of Environmental Factors, and the Multidimensional Scale of Perceived Social Support. Descriptive statistics and Pearson's correlation were used to analyze the data. RESULTS: Community integration, fatigue, and physical environment showed a moderate level, while social support revealed a high level. Fatigue was significantly correlated with overall community integration, whereas physical environment was found to correlate with two subscales of community integration, home integration and productive activities. CONCLUSION: To enhance the level of community integration among TBI survivors, health care providers, in particular rehabilitation nurses and community nurses, should plan and implement strategies such as follow-up appointments or continued rehabilitation at home.

The Effectiveness of Oral Care Guideline Implementation on Oral Health Status in Critically Ill Patients.

Intubated patients need specific oral care due to the use of endotracheal tubes. An oral nursing care guideline needs to be implemented to guide nurses in oral care in intubated patients. To test the effectiveness of oral nursing care guideline implementation. The Rogers' Diffusion of Innovations Theory was used to introduce an oral nursing care guideline to 28 nurses working in an intensive care unit in a hospital within 2 months, using mass and private communication within a hospital management system. The oral care guideline was introduced to 47 intubated patients. The accuracy of oral care practice was assessed by nurse research assistants, and patients' oral health status was examined by dental nurse research assistants. The accuracy of practice among nurses was found between 88% and 100%. Total 97.47% (n = 46) of patients had an acceptable oral health status after receiving oral care based on the oral nursing care guideline. The oral nursing care guideline was effectively implemented with high accuracy and could increase patient oral integrity after its implementation.

Chronic pain experience and pain management in persons with spinal cord injury in Nepal.

BACKGROUND AND AIMS: Chronic pain is the frequent and significantly challenging complications in persons with spinal cord injury (SCI). Socio-cultural background may lead people perceive and manage pain differently. The study aims to describe the chronic pain experience and pain management of SCI persons in Nepal. METHODS: A descriptive cross sectional study was conducted among purposively selected sample of 120 SCI persons with chronic pain living in the eight districts of Bagmati Zone of Nepal. The data were collected using the International Spinal Cord Injury Pain Basic Data Set Version 2 (ISCIPBDS-2) and Open-ended Pain Management Questionnaire. The data were analyzed using descriptive statistics and content analysis method. RESULTS: The back (n=84), lower legs/feet (n=63) and buttocks/hips (n=51) was found as the common pain locations. In common, the onset of pain was found within the first 6 month of the injury. Overall pain intensity and pain interference were found to be at the moderate level. The SCI persons used pain medications and non-pharmacological pain management. Ibuprofen was the commonly used pain medication and commonly used non-pharmacological pain management methods included physical support (e.g. massage, exercise), relaxation (e.g. distraction, substance abuse), coping (e.g. acceptance, praying), and traditional herbs. CONCLUSIONS: SCI persons had chronic pain experience which interfered with their daily living. They used pain medications and non-pharmacological pain management methods based on their beliefs, knowledge, and community resources in Nepal. IMPLICATIONS: This study provides some evidence to help the team of rehabilitation professional to plan and help SCI persons with chronic pain. Based on these findings, chronic pain management intervention for SCI persons should be developed and supported continuously from hospital to home based community context of Nepal.

Pain-management strategies among hospitalized trauma patients: a preliminary study in a teaching hospital in Indonesia

The incidence of trauma has been high and is considered to have increased throughout the years. This study aimed to describe the pain intensity and pain-management strategies of hospitalized trauma patients. Ninety-five adults presenting trauma with full consciousness, and who were admitted to surgical wards were recruited. Outcomes were assessed in a 3-day follow-up of pain and pain management from January to February 2016 by using questionnaires for interviews. Data were analyzed using descriptive statistics and repeated measures ANOVA. Preliminary research found that hospitalized trauma patients perceived mild to severe pain intensity. The trend of pain at its worst, pain at its least, average pain, and current pain decreased from Day 1 to day 3, which were statistically and significantly different (p < .001). The pain management often used by patients were: praying (84.2%), slow and deep breathing (78.9%), and at an attempt at toleration (46.3%). The least frequent method of pain management included immediately informing nurses about the pain (15.8%), reading (15.8%), and changing position (17.9%). Besides the pharmacological and nonpharmacological interventions received from physicians and nurses, strategies were crucial to alleviating pain in hospitalized trauma patients related to cultural context

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Using an evidence-based care bundle to improve initial emergency nursing management of patients with severe traumatic brain injury.

AIMS AND OBJECTIVES: To test the feasibility of an evidence-based care bundle in a Thai emergency department. The specific objective of this study was to examine the impact of the implementation of the care bundle on the initial emergency nursing management of patients with severe traumatic brain injury. BACKGROUND: A care bundle approach is one strategy used to improve the consistency, quality and safety of emergency care for different patients groups, however, has not been tested in patients with severe traumatic brain injury. DESIGN: A pretest/post-test design was used. The study intervention was an evidence-based care bundle for initial emergency nursing management of patients with severe traumatic brain injury. METHODS: Nonparticipant observations were conducted between October 2012-June 2013 at an emergency department of a 640 bed regional hospital in Southern Thailand. The initial emergency nursing care was observed in 45 patients with severe traumatic brain injury: 20 patients in the pretest period and 25 patients in the post-test period. RESULTS: There were significant improvements in clinical care of patients with severe traumatic brain injury after implementation of the care bundle: (1) use of end-tidal carbon dioxide monitoring, (2) frequency of respiratory rate assessment, (3) frequency of pulse rate and blood pressure assessment, and (4) patient positioning. CONCLUSION: This study demonstrated that implementation of an evidence-based care bundle improved specific elements of emergency nurses' clinical management of patients with severe traumatic brain injury. RELEVANCE TO CLINICAL PRACTICE: The study suggests that a care bundle approach can be used as a strategy to improve emergency nursing care of patients with severe traumatic brain injury.

Nurses' perceptions of using an evidence-based care bundle for initial emergency nursing management of patients with severe traumatic brain injury: A qualitative study.

Evidence to guide initial emergency nursing care of patients with severe traumatic brain injury (TBI) in Thailand is currently not available in a useable form. A care bundle was used to summarise an evidence-based approach to the initial emergency nursing management of patients with severe TBI and was implemented in one Thai emergency department. The aim of this study was to describe Thai emergency nurses' perceptions of care bundle use. A descriptive qualitative study was used to describe emergency nurses' perceptions of care bundle use during the implementation phase (Phase-One) and then post-implementation (Phase-Two). Ten emergency nurses participated in Phase-One, while 12 nurses participated in Phase-Two. In Phase-One, there were five important factors identified in relation to use of the care bundle including quality of care, competing priorities, inadequate equipment, agitated patients, and teamwork. In Phase Two, participants perceived that using the care bundle helped them to improve quality of care, increased nurses' knowledge, skills, and confidence. Care bundles are one strategy to increase integration of research evidence into clinical practice and facilitate healthcare providers to deliver optimal patient care in busy environments with limited resources.

Using an evidence-based care bundle to improve Thai emergency nurses' knowledge of care for patients with severe traumatic brain injury.

There is known variation in Thai nurses' knowledge regarding the best available evidence for care of patients with severe traumatic brain injury. The purpose of this study was to examine the impact of an evidence-based care bundle on Thai emergency nurses' knowledge regarding management of patients with severe traumatic brain injury. A pre-test/post-test design was used. The study intervention was an evidence-based care bundle for initial nursing management of patients with severe traumatic brain injury. Data were collected from 31 Registered Nurses using multiple choice questions. Results revealed a statistically significant improvement in overall knowledge scores after care bundle implementation (p < 0.001). There were statistically significant improvements in five areas of knowledge: understanding of target end-tidal carbon dioxide levels (p < 0.001), implications of hypocapnia in severe traumatic brain injury (p = 0.01), implications of hypercapnia in severe traumatic brain injury (p = 0.02), importance of maintaining head and neck in neutral position (p = 0.05), and administration of sedatives and analgesics in severe traumatic brain injury (p = 0.01). This study suggested that implementation of an evidence-based care bundle improved emergency nurses' knowledge regarding management of patients with severe traumatic brain injury.

Initial emergency nursing management of patients with severe traumatic brain injury: development of an evidence-based care bundle for the Thai emergency department context.

BACKGROUND: Thai emergency nurses play a vital role in caring for patients with severe TBI, and are an important part of the healthcare team throughout the resuscitation phase. They are also responsible for continuous physiological monitoring, and detecting deterioration associated with increased intracranial pressure and preventing secondary brain injury. However, there is known variation in Thai nurses' knowledge and care practices for patients with severe TBI. In addition, there are no specific evidence-based practice guidelines available for emergency nursing management of patients with severe TBI. AIM: The aim of this paper is to describe the development of an evidence-based care bundle for initial emergency nursing management of patients with severe TBI for use in a Thai ED context. RESULTS: An evidence-based care bundle focused on seven major elements: (1) establish a secure airway along with c-spine protection, (2) maintain adequacy of oxygenation and ventilation, (3) maintain circulation and fluid balance, (4) assessment of GCS, and pupil size and reactivity, (5) maintain cerebral venous outflow, (6) management of pain, agitation, and irritability, and (7) administer for urgent CT scan. CONCLUSIONS: A care bundle is one method of promoting consistent, evidence-based emergency nursing care of patients with severe TBI, decreasing unnecessary variations in nursing care and reducing the risk of secondary brain injury from suboptimal care. Implementation of this evidence-based care bundle developed specifically for the Thai emergency nursing context has the potential to improve the care of the patients with severe TBI.

Thai emergency nurses' management of patients with severe traumatic brain injury: comparison of knowledge and clinical management with best available evidence.

BACKGROUND: In Thailand, the rate of TBI-related hospitalisation is increasing, however, little is known about the evidence-based management of severe TBI in the developing world. The aim of this study was to explore Thai emergency nurses' management of patients with severe TBI. METHODS: An exploratory descriptive mixed method design was used to conduct this two stage study: survey methods were used to examine emergency nurses' knowledge regarding management of patients with severe TBI (Stage 1) and observational methods were used to examine emergency nurses' clinical management of patients with severe TBI (Stage 2). The study setting was the emergency department (ED) at a regional hospital in Southern Thailand. RESULTS: 34 nurses participated in Stage 1 (response rate 91.9%) and the number of correct responses ranged from 33.3% to 95.2%. In Stage 2, a total of 160 points of measurement were observed in 20 patients with severe TBI over 40 h. In this study there were five major areas identified for the improvement of care of patients with severe TBI: (i) end-tidal carbon dioxide (ETCO2) monitoring and targets; (ii) use of analgesia and sedation; (iii) patient positioning; (iv) frequency of nursing assessment; and (v) dose of Mannitol diuretic. CONCLUSIONS: There is variation in Thai nurses' knowledge and care practices for patients with severe TBI. To increase consistency of evidence-based TBI care in the Thai context, a knowledge translation intervention that is ecologically valid, appropriate to the Thai healthcare context and acceptable to the multidisciplinary care team is needed.