Living in limbo: the low-level brain-injured patient and the patient's family.

One hallmark of severe traumatic brain injury (TBI) is a loss of consciousness followed by varying states of consciousness. Estimates suggest that 30-40% of individuals who survive severe TBI will stay in low-level or reduced states of consciousness for prolonged periods. The state of coma is relatively easy to diagnose; however, differential diagnosis of other states of reduced consciousness have proven to be much more difficult, precipitating a number of problems related to prognosis, treatment, and rehabilitation. Accurate diagnosis is critical in determining the prognosis for persons with severe TBI because it has significant implications for the patient, family, clinician, and payer. Studies have shown that prognosis directly influences numbers and types of treatments recommended. Often, families find themselves being forced to make critical decisions with little knowledge and a great deal of uncertainty. Understanding reduced states of consciousness and facilitating accurate evaluation of such states allow neuroscience nurses to help families effectively cope during this difficult time.

Brain attack: correlative anatomy.

Approximately 500,000 people suffer a new or recurrent brain attack each year. Despite advanced treatments, stroke continues to be the third leading cause of death in the United States. Survivors of stroke experience many different clinical problems and neurological deficits. Individual symptomatology varies according to specific vessel involvement and the location of brain tissue infarction or hemorrhage. Understanding basic cerebral anatomy provides a foundation for the neuroscience nurse to plan effective nursing care for the victim of brain attack.

Establishing outreach health services for homeless persons: an emerging role for nurse managers.

Nurse-managed clinics can be an effective strategy for addressing the health care needs of homeless and indigent populations. The role of the nurse manager in the establishment of a clinic involves community leadership--specifically, it involves addressing strategic planning, financial and manpower issues. The collaborative relationship of nurse managers, educators, and the community laid the groundwork for accessible and affordable health care for the homeless and indigent of one northwest Georgia community. Specific tools and strategies are presented.

Bicycle safety programs: targeting injury prevention through education.

Children especially are prone to bicycle injuries, many of which are preventable. Data from an assessment of pediatric bicycle-related injuries at a major Southeastern Tennessee trauma center were used to support the need for a public awareness program about children's bicycle safety. Results of the assessment are reviewed and program planning, implementation, and evaluation are described.

Traumatic brain injury: a family experience.

Traumatic brain injury (TBI), sometimes referred to as a silent epidemic, affects thousands of people each year. A head injury not only affects the patient, but the entire family system as well. Families experience a myriad of needs during this time of crisis. With the immediate focus on the patient's physical or cognitive state, the family's needs may go unnoticed or unrecognized. It is imperative health care professionals understand the emotional impact on family needs, and the unique grieving patterns which influence their ability to cope with this situation. Caregivers are advised to assess, formulate and implement a plan of care for the family as well as the patient. Since families play such an integral role in the patient's recovery process, it is crucial to recognize the scope of the TBI experience and provide care within the context of the individual family system.