RESUMO
The cue-response theory is herewith proposed to replace the coma cue-response conceptual framework as a nursing theory for care of patients with acquired brain injury (ABI). After ABI, nurses assess patients and develop an understanding of their condition by interpreting meaning from physiologic and observational or behavioral cues. These interpretations form the basis for optimizing the timing of discrete nursing interventions; the outcome of which influences the trajectory toward recovery or toward secondary brain injury. The cue-response theory applies specifically for nurses' use to determine which interventions should be used and when those interventions should be carried out. The theory recognizes the knowledge potential and knowledge produced in the context of nursing care of all patients with ABI, not just those with coma, and broadens our understanding of how the timing of nursing interventions directly impacts secondary brain injury and the brain entropy state.
Assuntos
Lesões Encefálicas/enfermagem , Sinais (Psicologia) , Enfermagem em Neurociência , Cuidados de Enfermagem , Teoria de Enfermagem , Adulto , Feminino , Humanos , Masculino , Avaliação em Enfermagem , Fatores de TempoRESUMO
BACKGROUND: Traumatic brain injury and cerebrovascular disease may lead to motor, behavioral, and/or cognitive disabilities. The associated neurologic and vascular damage triggers a chain of events that lead to a secondary brain injury (SBI), a preventable cause of adverse neurological outcomes. Proper prevention of these factors may limit undesirable outcomes. This article presents a concept analysis that aims to form a single definition of the term secondary brain injury for nursing personnel. METHODOLOGY: Concept analysis was used to clarify the concept of SBI. An electronic search was performed on existing nursing literature dating from 1995 to 2016 on PubMed, MEDLINE, Ovid Journal, Wiley, and ProQuest. RESULTS: A clear definition and description of the attributes, antecedents, and consequences of SBI increases the knowledge and level of recognition of the secondary injuries. This may lead to strategies that reduce the risk of long-term effects (disability) and poor clinical outcomes. CONCLUSIONS: This concept analysis contributes to the endeavor of identifying phenomena that are pertinent for nursing; it also provides a basis for future research that leads to improving nursing interventions and creating educational programs and healthcare policies that prevent or eliminate the consequences of SBI.
Assuntos
Lesões Encefálicas/fisiopatologia , Enfermagem em Neurociência , Terminologia como Assunto , Adulto , Lesões Encefálicas/enfermagem , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Acquired brain injury (ABI) during childhood typically causes behaviour problems in the child and high levels of stress in the family. OBJECTIVES: (1) To investigate the feasibility and effectiveness of a parenting programme to: improve behaviour and self-regulation (SR) in Mexican children with ABI, enhance parenting skills, and decrease parental stress in parents of children with ABI; (2) to explore the impact of parent SR on child. METHODS: Case study design with four participants post-ABI, aged 7-12 years, recruited in Mexico City. A parenting programme (Signposts for Building Better Behaviour) was delivered and provided parents with strategies to manage child behaviour. Child behaviour, child self-regulation, parental stress and parenting practices were measured before, immediately post-intervention, and three months post-intervention. RESULTS: At immediate and three months post-intervention improvements in parenting skills, reduction in parental stress, and improvement in child behaviour were identified. CONCLUSIONS: The programme is feasible in a Mexican population and was effective in improving parenting skills and reducing stress in parents of children with ABI, as well as improving child behaviour and behavioural SR. These domains continue improving three months after the intervention. The improvements in challenging behaviour at home did not transfer to the school environment.
Assuntos
Lesões Encefálicas , Transtornos do Comportamento Infantil/etiologia , Relações Pais-Filho , Poder Familiar/psicologia , Adulto , Lesões Encefálicas/complicações , Lesões Encefálicas/enfermagem , Lesões Encefálicas/psicologia , Criança , Transtornos do Comportamento Infantil/enfermagem , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Masculino , México , Testes Neuropsicológicos , Avaliação de Resultados em Cuidados de Saúde , Inquéritos e QuestionáriosRESUMO
Research has documented the deleterious effects on caregivers of providing care for an individual with traumatic brain injury (TBI). TBI caregivers in Mexico specifically have reduced health-related quality of life (HRQOL) across both physical and mental health domains. The purpose of the current study was to uncover the system of connections between Mexican TBI caregivers' HRQOL and their mental health. A cross-sectional survey was conducted at a public medical facility in Guadalajara, México. Ninety family caregivers of individuals with TBI completed measures of HRQOL, satisfaction with life, depression, and burden. A canonical correlation analysis revealed that the better the caregivers' HRQOL, the better their mental health was, with the effect reaching a large-sized effect. A distinct pattern emerged linking caregivers' higher energy levels and better social functioning to lower depression and greater satisfaction with life. A series of multiple regressions similarly uncovered that the most robust independent HRQOL predictors of caregiver mental health were vitality and social functioning. Especially for TBI caregivers with poor health, behavioral health interventions in Latin America that target the HRQOL domains of social functioning and vitality may significantly improve caregiver mental health, and as a result, informal care for TBI.
Assuntos
Lesões Encefálicas/enfermagem , Cuidadores/psicologia , Saúde Mental , Qualidade de Vida , Adulto , Depressão/psicologia , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Satisfação Pessoal , Inquéritos e QuestionáriosRESUMO
PURPOSE: This study examined relationships between caregiver mental health and the extent to which needs were met in families of individuals with traumatic brain injury (TBI) in Mexico City, Mexico. METHOD: Sixty-eight TBI caregivers completed Spanish versions of instruments assessing their own mental health and whether specific family needs were met. RESULTS: Twenty-seven per cent of caregivers reported clinically significant depression levels, 40% reported below-average life satisfaction and 49% reported mild-to-severe burden. Several of the most frequently met family needs were in the emotional support domain, whereas the majority of unmet needs were in the health information domain. Family needs and caregiver mental health were significantly and highly related. When family needs were met, caregiver mental health was better. The strongest pattern of connections in multivariate analyses was between family instrumental support (assistance in the completion of daily life tasks) and caregiver burden, such that caregivers with less instrumental support had greater burden. Additional results suggested that instrumental support uniquely predicted caregiver satisfaction with life, burden and depression. CONCLUSIONS: Interventions for TBI caregivers, especially in Latin America, should help family members determine how best to meet their health information and instrumental needs, with the former being likely to improve caregiver mental health.
Assuntos
Adaptação Psicológica , Lesões Encefálicas/enfermagem , Cuidadores , Depressão/epidemiologia , Família , Saúde Mental/estatística & dados numéricos , Adulto , Lesões Encefálicas/epidemiologia , Cuidadores/psicologia , Cuidadores/estatística & dados numéricos , Depressão/etiologia , Depressão/psicologia , Família/psicologia , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Avaliação das Necessidades , Satisfação Pessoal , Guias de Prática Clínica como Assunto , Apoio Social , Estresse Psicológico/etiologia , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: The goal of the present study was to assess the health-related quality of life of a group of family caregivers of individuals with traumatic brain injury from Guadalajara, Mexico. PATIENTS AND METHODS: Ninety family caregivers of individuals with traumatic brain injury and 83 healthy controls completed the Short-Form 36, a self-report health-related quality of life measure composed of 8 component areas: physical functioning, role-physical, bodily pain, general health, vitality, social functioning, mental health, and role-emotional. The samples were statistically similar with respect to age, gender, marital status, and education. However, caregivers had significantly lower household income than controls. RESULTS: After controlling for income, results showed significantly lower scores for traumatic brain injury caregivers compared with healthy controls on 6 Short-Form 36 subscales: role-emotional, vitality, mental health, social functioning, bodily pain, and general health. CONCLUSION: Caregivers of individuals with traumatic brain injury living in Guadalajara, Mexico report having poorer health-related quality of life across various domains including mental and general health. Future studies should be conducted to determine which specific factors (e.g. lack of services, physical strain of providing care) are responsible for reduced health-related quality of life in these areas. It is likely that resources, such as respite services, adult day-care, aides, outpatient rehabilitation, psycho-educational programs, and support groups would increase health-related quality of life for these individuals.
Assuntos
Lesões Encefálicas/enfermagem , Cuidadores/psicologia , Qualidade de Vida , Adulto , Lesões Encefálicas/reabilitação , Emoções , Feminino , Nível de Saúde , Assistência Domiciliar , Humanos , Masculino , México , Pessoa de Meia-Idade , Papel (figurativo) , Autorrelato , Fatores SocioeconômicosRESUMO
OBJECTIVE: The aim of the present study was to determine the most and least important family needs in a group of family caregivers of individuals with TBI from Cali, Colombia, and to examine which of those needs were more likely to be met and unmet. DESIGN: Cross-sectional descriptive study. SETTING: Valle University Hospital in Cali, Colombia. PARTICIPANTS: Twenty-nine family caregivers of individuals with traumatic brain injury. OUTCOME MEASURE: The Family Needs Questionnaire, a 40-item questionnaire divided into six sub-scales. RESULTS: Health Information, Community Support Network and Professional Support Network sub-scales were the most important needs reported by this group of Colombian TBI family caregivers. The most frequently met needs in the present study fell within Health Information, Involvement with Care and Instrumental Support sub-scales and the most frequently unmet needs fell within the Emotional Support, Instrumental Support and Professional Support sub-scales. CONCLUSIONS: Family needs in caregivers of individuals with TBI from Colombia are similar, but more likely to be unmet, than those reported in previous studies. Interventions designed to meet family caregivers' needs in these areas should be implemented in Colombia.
Assuntos
Lesões Encefálicas/enfermagem , Cuidadores/psicologia , Família/psicologia , Avaliação das Necessidades , Adulto , Lesões Encefálicas/reabilitação , Colômbia , Estudos Transversais , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Apoio Social , Inquéritos e QuestionáriosRESUMO
The purpose was to study changes in the caregiver's social roles after traumatic brain injury (TBI), relating them with the degree of importance of these roles and with the condition of the victim six months or more after the TBI. The research was developed at the Brain Trauma Clinic of the University of São Paulo Hospital das Clínicas with 50 caregivers and 50 victims of TBI, by means of interviews and patient file analysis. A checklist was used for the interview with the caregiver, in order to identify the changes and importance of their social roles. The roles that had suffered most interruption due to the trauma were: friend, amateur/entertainment, family member and worker. The role of being a caregiver was the one that presented more modification. No association was found between change of role and the variables: condition of victim after TBI and importance of the social roles for the caregiver.
Assuntos
Lesões Encefálicas/enfermagem , Cuidadores , Papel (figurativo) , Adulto , Feminino , Humanos , Masculino , Sociologia , Inquéritos e QuestionáriosRESUMO
The present study characterized the main family caregiver of 50 victims of traumatic brain injury on an outpatient follow-up program of a trauma center in São Paulo through interviews and record analyses. The results revealed that caregivers had average age of 44.9, were mostly female, single, Catholic, had not completed elementary school and had no paid occupation prior to the trauma. One half of the main caregivers was the victim's mother, 22 percent was the spouse and 18 percent was a sibling. The presence of a secondary caregiver was observed in 48 percent of the cases.
Assuntos
Lesões Encefálicas/enfermagem , Cuidadores/estatística & dados numéricos , Adulto , Idoso , Assistência Ambulatorial , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Trata-se de um estudo descritivo desenvolvido no CTI de um Hospital Municipal do Rio de Janeiro, de novembro/96 a março/98, com 103 familiares de pacientes com TCE, com os objetivos de avaliar o nível de estresse dos familiares e relaciona-los com as variáveis do paciente: idade, tipo de causa externa e grau de gravidade; dos familiares: sexo, idade, grau de parentesco, classe social, grau de instrução, experiência prévia com CTI e religião; identificar as necessidades dos familiares, relacionar o seu grau de satisfação com o nível de estresse, e descrever os estressores. Os instrumentos usados foram Inventário com Dados de Caracterização do paciente e familiares, Classificação de Classes Sócio-Econômicas no Brasil, Lista de Sintomas de Stress (LSS/VAS) e Inventário de Necessidades e Estressores de Familiares em Terapia Intensiva (INEFTI). Para análise estatística foi utilizado o SPSS....
Assuntos
Humanos , Masculino , Feminino , Adulto , Criança , Adolescente , Pessoa de Meia-Idade , Estresse Fisiológico , Lesões Encefálicas/enfermagem , Relações Profissional-Família , Hospitais Municipais , Unidades de Terapia IntensivaRESUMO
A prospective longitudinal study of traumatic brain injury (TBI) patients was conducted to identify the recovery pattern 1 year after trauma. Patients with all levels of injury and age between 12 and 60 years were observed. They were analyzed using the eight-point Glasgow Outcome Scale (GOS) as well as their return to productivity in that period. The majority of victims (77.2%) made good recovery, that is (GOS = 0 or 1) and complete recovery or GOS 0 was achieved in 38.6% of then. However at the 1 year mark, 22.8% of the victims showed disabilities. Overall, victims had returned to productivity in that period (83.3%) but 19.4% of them have had changes in their productivity and 16.7% didn't return to your job.).
Assuntos
Lesões Encefálicas/enfermagem , Atividades Cotidianas , Adolescente , Adulto , Lesões Encefálicas/reabilitação , Criança , Emprego , Escala de Coma de Glasgow , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
O estudo trata de uma experiência de cuidar registrada durante 50 dias, em diário de campo. Nesse período, enfermeiras(os), estudantes e docentes de enfermagem cuidaram de um cliente que tinha de prognóstico médico a morte como saída; e, no prognóstico de enfermagem, tinha a vida como possível e viável. As açöes de enfermagem foram consideradas como: cuidados de toque, cuidados de implementaçäo e cuidados sensuais, identificados como manutençäo de integridade física e mental, através de estímulos corporais, visuais e auditivos, incluindo a disponibilidade da enfermagem para querer CUIDAR, querer PENSAR, querer JULGAR o trabalho e saber INTERVIR, com a capacidade de COMPREENDER, AMAR, ACREDITAR e INTUIR, e a implementaçäo da terapêutica médica. Os resultados mostram que a permanente presença da enfermagem pode ter sido a responsável pela manutençäo da vida do cliente.
Assuntos
Humanos , Masculino , Adulto , Morte , Cuidados de Enfermagem , Lesões Encefálicas/enfermagem , Terapias Complementares , Registros de Enfermagem , Vida , Toque TerapêuticoRESUMO
Trata-se de um estudo prospectivo longitudinal sobre o padräo de recuperaçäo de vítimas de TCE de diferentes gravidades, com idade entre 12 e 60 anos. As vítimas foram examinadas aos 6 meses e 1 ano pós-trauma e suas limitaçöes funcionais mensuradas pela ERG em sua versäo de oito categorias. A maioria das vítimas apresentou como características ISS igual ou maior 16 (51,9 por cento); ECGI igual ou maior 13 (72,2 por cento) na primeira avaliaçäo feita pela equie de neurocirurgia; e, idade menor ou igual 35 anos (68,6 por cento). Total recuperaçäo ou pontuaçäo o na ERG foi obtida por 21,3 por cento das vítimas aos 6 meses e 38,6 por cento, no período de 1 ano. Globalmente, a maioria atingiu a classificaçäo boa recuperaçäo na escala aos 6 meses pós-trauma (64,8 por cento), ou seja, recebeu pontuaçäo o ou 1 na ERG, assim como, retornou a sua atividade produtiva nesse período (73,6 por cento). Por outro lado, embora a maioria (65,0 por cento) tenha atingido a pontuaçäo máxima na ERG, aos 6 meses pós-trauma, houve indícios estatísticos de melhora entre 6 meses e 1 ano. Da mesma forma, a freqüência de retorno à produtividade foi maior 1 ano após TCE do que aos 6 meses. A ERG mostrou ainda correlaçäo com a ECGI (correlaçäo negativa) e alguns pontos de correlaçäo ou de associaçäo com o ISS e a idade de vítima. Quanto ao retorno ao trabalho remunerado e nível de escolaridade ou tipo de ocupaçäo anterior, näo houve associaçäo estatística significativa
Assuntos
Humanos , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Lesões Encefálicas/enfermagem , Pesquisa em Enfermagem/educação , Lesões Encefálicas/reabilitação , Estudos Prospectivos , Estudos Longitudinais , Índices de Gravidade do TraumaRESUMO
The present study realized with 50 patients from an Intensive Care Unit, due to head injury and considering that the majority of them presented a score equal or below six (6) in the Glasgow Coma Scale, has shown that the utilization of invasive procedures is high. Regarding complications, there was predominance of fever, upper airway secretions, hematomas at the arterial puncture localization and diarrhea. Proportionally, the patients under a clinical treatment presented a lower number of invasive procedures and problems and the reverse occurred with those under surgery. The analysis of the association of the invasive procedures and problems compared to the level of consciousness has been affected.