Assignment5#2
Running head: LITERATURE REVIEW 1 1
Literature Review
Tania Gonzalez Diaz
Grand Canyon University: NRS 433V
April 27, 2017
Literature Review
Traumatic brain injury (TBI) is a serious event that greatly affects an individual’s ability to carry out normal functions. In extreme situations, TBI might also affect a person’s self esteem as well as cause him/her to sink into depression. The major issues that revolve around traumatic brain injuries (TBI) include loss of physical function, loss of self-awareness and self-esteem, depression, trauma and healing and support (Carroll & Coetzer, 2011). I chose this topic because it is important to explore the issues around TBI, which causes physical dysfunction, affecting one’s ability to work as well as to take good care of themselves. This topic is important to nursing as it helps to present the various interventions that would be effective in treating TBI patients.
Practice Problem/Issue and PICOT Question
The issue of TBI is important to consider in nursing because people who experience it often tend to lose their self-awareness and self-esteem, which significantly affects their ability to relate normally and freely with others. TBI events have a serious negative impact on personal and social lives of most of its victims. Therefore, it is important that care givers should have adequate knowledge on how to treat such TBI patients. Learning about this topic enables care givers to gain valuable knowledge on how to help TBI patients to regain physical function, to overcome trauma and depression, and to regain their self-esteem and self-awareness (Carroll & Coetzer, 2011).
In the case of traumatic brain injury (TBI) victims, aged between 40 and 70 years with multiple co-morbidities, will individualized care involving transitions from hospital to home environment, compared to hospitalized treatment, help to overcome depression and loss of physical activity over a period of 6 months.
Carroll, E., & Coetzer, R. (2011). Identity, grief and self-awareness after traumatic brain injury. Neuropsychological Rehabilitation, 21(3), 289-305. doi: http://dx.doi.org/10.1080/09602011.2011.555972
Abstract
The objective of this study was to investigate perceived identity change in adults with traumatic brain injury (TBI) and explore associations between identity change, grief, depression, self-esteem and self-awareness. The participants were 29 adults with TBI who were being followed up by a community brain injury rehabilitation service. Participants were longer post-injury than those more commonly studied. Time since injury ranged from 2.25 to 40 years (mean = 11.17 years, SD = 11.4 years). Participants completed a battery of questionnaires. Significant others and clinicians completed a parallel version of one of these measures. Questionnaires included the Head Injury Semantic Differential Scale (HISDS-III), Brain Injury Grief Inventory (BIGI), Hospital Anxiety and Depression Scale – Depression, Rosenberg Self-Esteem Scale (RSES) and the Awareness Questionnaire (Self/Significant other/Clinician versions). The main findings were that participants reported significant changes in self-concept with current self being viewed negatively in comparison to pre-injury self. Perceived identity change was positively associated with depression and grief and negatively associated with self-esteem and awareness. Awareness was negatively associated with self-esteem and positively associated with depression. These findings were consistent with previous research, revealing changes in identity following TBI. Further research is needed to increase our understanding of the psychological factors involved in emotional adjustment after TBI and to inform brain injury rehabilitation interventions, including psychotherapy approaches.
Conneeley, A. L. (2012). Transitions and brain injury: A qualitative study exploring the journey of people with traumatic brain injury. Brain Impairment, 13(1), 72-84.
Abstract
This qualitative study aimed to explore transitions from hospital to the home over a period of one year.
Methods and procedures: A longitudinal, phenomenological approach was employed and 18 individuals with severe traumatic brain injury, their family members and rehabilitation professionals were interviewed using semi structured interviews, when the person with brain injury was discharged from the ward, after 6 months and again after one year.
Results: Themes identified within the data included returning home, getting back to normal, moving forward and the role of rehabilitation in the transitional period. Further subthemes were also identified including issues of life-course disruption, self-identity, status and reconstruction.
Conclusions: Data suggested that access to rehabilitation programs employing individualized, contextual interventions following discharge to the home were integral in enabling the transition through to autonomy and independence. Consideration of issues of identity and status can enable a different and potentially important perspective on the experience of transitions for those with brain injury. Reclaiming personal autonomy and control appeared to be central to the reconstruction of a coherent sense of self, enabling a meaningful life after brain injury.
Douglas, J. M. (2012). Conceptualizing self and maintaining social connection following severe traumatic brain injury. Brain Injury, 27(1), 60-74. doi: http://dx.doi.org/10.3109/02699052.2012.722254
Abstract
Primary objective: To explore how adults who have sustained severe traumatic brain injury (TBI) conceptualize self-several years after injury.
Design: Self-conceptualization was explored from the perspective of the injured individual within a constructivist Grounded Theory approach using in-depth interviews. Qualitative analysis moved through a process of data-driven open and focused coding, identification of emergent self-related categories and exploration of relations between these categories.
Participants: Sixteen men and four women with severe–very severe injury participated in the study. Severity of injury was indexed by either a Glasgow Coma Scale (GCS) score ≤8 or duration of post-traumatic amnesia (PTA) ≥14 days. At the time of interview, the average age of participants was 35.2 years and a minimum of 5 years had elapsed since injury.
Main outcomes and results: Three main themes emerged from the data. The first two themes together described a model of self-concept. The third theme captured the insider's perspective on factors that had helped to create and maintain a sense of connection between self and society.
Conclusion: Conceptualization of self after brain injury is a dynamic and multi-faceted process. Insight into the process can guide the development of therapeutic endeavours to facilitate the ongoing construction of self after severe TBI.
Haneef, Z., Levin, H. S., Frost, J. D., & Mizrahi, E. M. (2013). Electroencephalography and quantitative electroencephalography in mild traumatic brain injury. Journal of Neurotrauma, 30(8), 653–656. http://doi.org/10.1089/neu.2012.2585
Abstract
Mild traumatic brain injury (mTBI) causes brain injury resulting in electrophysiologic abnormalities visible in electroencephalography (EEG) recordings. Quantitative EEG (qEEG) makes use of quantitative techniques to analyze EEG characteristics such as frequency, amplitude, coherence, power, phase, and symmetry over time independently or in combination. QEEG has been evaluated for its use in making a diagnosis of mTBI and assessing prognosis, including the likelihood of progressing to the post concussive syndrome (PCS) phase. We review the EEG and qEEG changes of mTBI described in the literature. An attempt is made to separate the findings seen during the acute, sub-acute, and chronic phases after mTBI. Brief mention is also made of the neurobiological correlates of qEEG using neuroimaging techniques or in histopathology. Although the literature indicates the promise of qEEG in making a diagnosis and indicating prognosis of mTBI, further study is needed to corroborate and refine these methods.
Johansson, B., Bjuhr, H., & Rönnbäck, L. (2012). Mindfulness-based stress reduction (MBSR) improves long-term mental fatigue after stroke or traumatic brain injury. Brain Injury, 26(13-14), 1621-1628. doi: http://dx.doi.org/10.3109/02699052.2012.700082
Abstract
Objective: Patients who suffer from mental fatigue after a stroke or traumatic brain injury (TBI) have a drastically reduced capacity for work and for participating in social activities. Since no effective therapy exists, the aim was to implement a novel, non-pharmacological strategy aimed at improving the condition of these patients.
Methods: This study tested a treatment with mindfulness-based stress reduction (MBSR). The results of the programme were evaluated using a self-assessment scale for mental fatigue and neuropsychological tests. Eighteen participants with stroke and 11 with TBI were included. All the subjects were well rehabilitated physically with no gross impairment to cognitive functions other than the symptom mental fatigue. Fifteen participants were randomized for inclusion in the MBSR programme for 8 weeks, while the other 14 served as controls and received no active treatment. Those who received no active treatment were offered MBSR during the next 8 weeks. Results: Statistically significant improvements were achieved in the primary end-point—the self-assessment for mental fatigue—and in the secondary end-point—neuropsychological tests; Digit Symbol-Coding and Trail Making Test.Conclusion: The results from the present study show that MBSR may be a promising non-pharmacological treatment for mental fatigue after a stroke or TBI.
Levack, W. M. M., Kayes, N. M., & Fadyl, J. K. (2010). Experience of recovery and outcome following traumatic brain injury: A metasynthesis of qualitative research. Disability and Rehabilitation, 32(12), 986-999. doi: http://dx.doi.org/10.3109/09638281003775394
Abstract
Purpose: To explore the use of qualitative metasynthesis to inform debate on the selection of outcome measures for evaluation of services provided to adults with traumatic brain injury (TBI).
Method: Fifteen databases were searched for qualitative research published between 1965 and June 2009, investigating the lived experience of recovery following TBI acquired during adulthood. Two reviewers independently screened all abstracts. Included studies were evaluated using methodological criteria to provide a context for interpretation of substantive findings. Data were extracted and synthesised by three reviewers, using QSR NVivo to assist with data management.
Results: From 23 studies, eight inter-related themes were identified to describe the enduring experience of TBI: 1) mind/body disconnect; 2) disconnect with pre-injury identity; 3) social disconnect; 4) emotional sequelae; 5) internal and external resources; 6) reconstruction of self-identity; 7) reconstruction of a place in the world; 8) reconstruction of personhood.
Conclusion: Currently, there are outcome measures for some but not all of the issues identified in qualitative research on surviving TBI. In particular, new outcome measures may be required to evaluate experiences of loss of personal identity, satisfaction with reconstructed identity and sense of connection with one's body and one's life following TBI.
