rehabilitation research traumatic brain injury model systems study H e a l t h M e d i c a l

  presentation 

Create a professional presentation of your evidence-based intervention and change proposal to be disseminated to an interprofessional audience of leaders and stakeholders. Include the intervention, evidence-based literature, objectives, resources needed, anticipated measurable outcomes, and how the intervention would be evaluated. Submit the presentation in LoudCloud for feedback from the instructor.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

You can use the following essay to do the presentation 

Benchmark, Capstone Project Change Proposal to Properly Manage Pain in Traumatic Brain Injuries Patients

Background

The rehabilitation process in patients with Traumatic Brain Injury will focus on physical impairment, weakness, poor endurance, poor balance, and inability to complete daily living activities by themselves. They also have altered mental status, psychological, personality, behavioral, cognitive, and emotional changes. The patient’s proper participation in therapy will warranty the success of the rehabilitation process. A common barrier that these patients must deal with is pain. However, this is not a simple pain, and it is a combination of muscle spasms, nerve pain, bone pain, and contractures. The pain is limited to the patient participation in therapy. The nurse can help by correctly identifying, characteristics and location of the pain to plan the solutions that reduce this pain as much as possible. Our change project is guided to propose interventions that help control this pain. 

Clinical Problem Statement

The admissions of Traumatic Brain Injuries patients have been on a constant rise at Encompass Rehabilitation Hospital of Scottsdale. The rehabilitation nurses working at this hospital have been aware that these patients regularly refuse therapy or do not correctly participate in the routine due to poor pain control. (Natural Institute of Neurological Disorders and Stroke, 2020). It is a nursing priority to find a solution for this problem because it will increase the functional status of these patients. 

       Patients with Traumatic Brain Injury present challenges to the nursing practice.  To effectively rehabilitate these patients, Encompass Rehabilitation Hospital of Scottsdale must ensure that there are no inherent health risks to the patients in the facility where they get administered (American Association for the Surgery Trauma, 2020). Furthermore, the rehabilitation program for the patients must ensure that the conditions and healthcare professionals who assist these patients have all the necessary qualifications to ensure a successful and speedy recovery. One of the main issues present is the poor control of the pain in patients with Traumatic Brain Injury. It is essential to raise the expertise of the registered nurses that care for these patients. The lack of pain control is a problem where the quality of the rehabilitation is put at risk. This is the main reason why various changes and improvements must be made to this facility to ensure that quality rehabilitation is given to patients with Traumatic Brain Injury (Encompass Rehabilitation Hospital of Scottsdale, 2021).

Purpose of the Change Proposal

The most important thing when promoting and improving the rehabilitation process inpatient with Traumatic Brain Injury. It ensures that patients admitted to these facilities get the best healthcare services and get the environment that can aid in their recovery. In many rehabilitation programs and centers, the environment plays a massive role in an individual’s recovery.  The nature of the environment and the severity of a person’s condition may help in speeding up their recovery. If the domain is safe and aesthetically pleasing to the patient, it helps them forget their pain (Radecki et al., 2018). Not only does it help them bypass some of their pain, but studies have also shown that exposure to pleasing environments may help in the healing process of the brain. While some brain injuries require the constant watch and care of healthcare professionals, studies have shown that some brain injuries are not easy to treat. In such cases, the most important thing for these patients is to enjoy their rehabilitation without pain. (Brain Injury Association of America, 2021).

           The proposed changes and improvements at Encompass Rehabilitation Hospital of Scottsdale are geared towards increasing the recovery process of patients. These changes will help reduce the number of patients refusing therapy. These changes will also be helpful in the evaluation of the effectiveness of the bladder and bowel program to enhance patient outcomes in the reduction of falls. The pain management effectiveness will be evaluated to ensure that the therapy offered to patients is used as a pain relief strategy and as a way of enhancing and promoting the patient’s recovery. The changes will provide solutions to some of the most common problems that patients with Traumatic Brain Injury develop when admitted to the institution (Fehlberg et al., 2017). 

PICOT Question

           The number of patients who refuse therapy due to uncontrolled pain has been on a constant increase. Pain management strategies at Encompass Rehabilitation Hospital of Scottsdale have been ineffective in managing some of the pain present in many patients. The effectiveness of the pain management strategies at the hospital has been brought to question. There have been calls to improve some of the methods used by the hospital to help patients with Traumatic Brain Injury overcome some of their pain. The pain reduces the ability of these patients to participate in their therapy. If the pain is managed effectively, these patients will get the opportunity to willingly participate in the therapy and increase their chances of recovery. Therefore, the following PICOT question guides the project: In patients diagnosed with Traumatic Brain Injury admitted at Encompass Rehabilitation Hospital of Scottsdale, what is the effect of the proper pain management on the improvement of their functional status compared with those that are not adequately medicated in two weeks?   

Literature Search Strategy

The literature strategy that we used in the study mainly involved searching for similar cases where patients have had problems with pain management and some of the strategies employed to help the patients manage the pain. Keywords used in the search will mainly be limited to pain that is related to Traumatic Brain Injury. The investigation also involved searching for ways in which pain management can be applied to individuals with Traumatic Brain Injury without further agonizing them (Gray et al., 2020). We analyzed the existing policy and procedure regarding pain management that are approved by Encompass corporation and customized to the hospital. 

Evaluation of the Literature

           The literature reviewed includes eight main articles that will support the idea that with proper planning, patient discharge will be effective in reducing the hospitalization rate. However, more research for this project is needed about the pain management techniques in patients with traumatic brain injury. The search should be guided by the nursing process establishing the role of the rehabilitation nurse in the pain control of patients with traumatic brain injury.

Applicable Change or Nursing Theory 

While various changes can be ascribed to these patients, specific differences are suitable for Traumatic Brain Injury. One of the best ways of promoting the health of these patients is to provide them with an environment that is welcoming and conducive to their condition. The best way of improving the environment is to ensure that nurses and healthcare professionals who attend to these patients are well trained in handling the specific issues that affect these patients (John Hopkins Medicine, 2021). Training nurses in effectively treating to these patients and using specialized care increases the chances of these patients recovering with minimal difficulties. In addition, the healthcare officials responsible for the treatment plans of these patients can explore alternative solutions to the clinical expectations for this disease. There are different ways that can be used to approach the subject of Traumatic Brain Injury. Some of the methods have been proven to work, and others have yet to be explored. The hospital can put research into identifying robust ways that can be applied to some of these patients. Suppose the hospital was to focus on finding a permanent solution that could be helpful to thousands of patients worldwide. In that case, it could join other researchers and work on different ways to improve healthcare provision to patients with Traumatic Brain Injury (Chen & Chen, 2018). 

     The nursing theory applicable to the rehabilitation environment is the “The Modeling and Role Modeling Theory” developed by Helen Erickson. It will see the patient as a whole using the holistic point of view. This theory will encourage the nurse to understand the patient’s needs to help the patients meet those needs. Under this theory scope, the requirements are met when the patient feels satisfied and feels that they were satisfied, especially the necessities. Rehabilitation is about meeting the patient’s needs and teaching the patients alternative to meet them. The patient’s satisfaction will help better reach the appropriate psychological stage of accepting the disability and changing it to ability. This project is about the benefits of controlling pain in patients with traumatic brain injury to participate in the rehabilitation process fully. 

Implementation Plan and Outcome Measures

           The hospital must implement nursing training regarding the rehabilitation process in traumatic brain injuries that are mainly focused on falls, pain management, bowel care, and bladder care. Implementing the identified strategies should focus on the specific issues that patients with Traumatic Brain Injury at the hospital have developed. A bladder-bowel program should be implemented at the hospital to increase the possibility of improvements in patient outcomes. Since many patients have an aversion to therapy due to their pain, a pain management strategy should be established to manage their pain without effectively placing them in any agony. The pain management strategy should slowly build nursing knowledge (De Goumoëns et al., 2019). 

      Further research by rehabilitation nurses will help improve their knowledge and area of expertise: uniform risk assessments and review processes and supported clinical decision-making to assist nurses. The development of:

A systematic approach where every member of the rehabilitation team helps to cope with pain and improve the quality of intervention. Increasing the awareness of the holistic practice. 

Intensive discharge planning to decrease the length of hospital stays heightens the need for intensive discharge care planning.  

Long-term health management interventions after traumatic brain injury.

Regardless, further research should help to elucidate the generalizability of this treatment model. The comparative cost-effectiveness of the two models tested within this trial is another important target for future research.

Use of Evidence-Based Practice in Creating the Intervention Plan

The intervention plans for the patients were developed using evidence-based practice. When implementing solutions and changes that could potentially affect a patient’s life, it is essential to use evidence-backed evidence. While many studies are present with different ideas on how healthcare outcomes can be improved for these patients, there are only a few studies with suggestions that have been proven to work. Therefore, the intervention plan was created using studies with information that can improve patients’ outcomes. In addition, the information can easily be verified with other sources and used in clinical practice (Lee et al., 2019).

Plans for Evaluating Proposed Nursing Interventions

           The implemented changes will be considered successful when there are potential changes and improved outcomes in the patients. One of the plans that can be made to evaluate the changes is to monitor the patients’ progress before and after the intervention plan has been instituted at the hospital. The rate of change in the patient’s healthcare outcome will determine whether the changes have been successful. One of the easiest ways of determining the changes is to consider how many patients will be open to therapy after the changes have been made. While many think that rehabilitation may help some of these patients, there are various conditions that are likely to develop during the rehabilitation process of these patients, which makes it difficult to determine whether the rehabilitation is expected to improve the patient’s condition or achieve nothing. Given the complexities present when taking care of these patients, it requires that they be taken care of by nurses and caregivers who meet the necessary skills and expertise to handle them (Dams-O’Connor et al., 2017).

Potential Barriers and Plan to Overcome Barriers.

           One of the potential barriers that may prevent the plan’s successful implementation is the complex nature of Traumatic Brain Injury. Another potential barrier is the limitations of the monetary resource of the patients. The medical insurance reimbursement will limit the patient’s time in the hospital up to 14 days. In many cases, this is not enough time to recover.  Even though the implementations expected to change the health outcomes of these patients, there is the possibility that the nature of the disease requires more specialized attention and medical interventions that are not currently present. 

Conclusions

    In conclusion, there is a lot to improve in the care of patients with traumatic brain injuries. Developing the multidisciplinary approach and evaluation of the prognosis will guide us to the correct route. Our next step will be starting the discussion at the hospital with the leadership team to align the implementation paths of this project to promote the change.  (American Association for the Surgery of Trauma, 2020). 

References

American Association of Neurological Surgeons. (2021) Traumatic brain injury.https:// Treatments/Traumatic-Brain-Injury

American Association for the Surgery of Trauma. (2020). Traumatic brain injury rehabilitation. https://

Brain Injury Association of America. (2021) Living with brain injury: Treatment. https://

Chen, Y. C., & Chen, B. J. (2018). Rehabilitation nursing for traumatic intracranial hemorrhage – Case report. Annals of Physical and Rehabilitation Medicine, 61(Supplement), e230. https://doi-org.lopes.idm.oclc.org/10.1016/j.rehab…

• Dams-O?Connor, K., Mellick, D., Dreer, L. E., Hammond, F. M., Hoffman, J., Landau, A., Zafonte, R., & Pretz, C. (2017). Rehospitalization Over 10 Years Among Survivors of TBI: A National Institute on Disability, Independent Living, and Rehabilitation Research Traumatic Brain Injury Model Systems Study. The Journal of head trauma rehabilitation, 32(3), 147–157. https://doi.org/10.1097/HTR.0000000000000263
• De Goumoëns, Véronique MScN, RN1,2,3; Didier, Amélia MScN, RN1,2; Mabire, Cédric PhD, RN1,3; Shaha, Maya PhD, RN2; Diserens, Karin PD3 (2019) Families’ Needs of Patients With Acquired Brain Injury: Acute Phase and Rehabilitation, Rehabilitation Nursing: 11/12 2019 – Volume 44 – Issue 6 – p 319-327 https://doi:10.1097/rnj.0000000000000122
• Encompass Rehabilitation Hospital of Scottsdale (2021) Welcome to our hospital. https://encompasshealth.com/scottsdalerehab

Fann, J. R., Hart, T., Ciol, M. A., Moore, M., Bogner, J., Corrigan, J. D., Dams-O’Connor, K., Driver, S., Dubiel, R., Hammond, F. M., Kajankova, M., Watanabe, T. K., & Hoffman, J. M. (2021). Improving transition from inpatient rehabilitation following traumatic brain injury: Protocol for the BRITE pragmatic comparative effectiveness trial. Contemporary Clinical Trials, 104. https://doi-org.lopes.idm.oclc.org/10.1016/j.cct.2021.106332

Fehlberg, E. A., Lucero, R. J., Weaver, M. T., McDaniel, A. M., Chandler, A. M., Richey, P. A., Mion, L. C., & Shorr, R. I. (2017). Impact of the CMS No-Pay Policy on Hospital-Acquired Fall Prevention Related Practice Patterns. Innovation in aging, 1(3), igx036. https://doi.org/10.1093/geroni/igx036

Gray, K., Burridge, L., & Borg, D. N. (2020). An exploration of the roles and perspectives of direct-care neurorehabilitation nurses on the process and actions of visual observation and safety monitoring for high risk brain injury patients. Journal of the Australasian Rehabilitation Nurses’ Association (JARNA), 23(2), 8–16. https://doi-org.lopes.idm.oclc.org/10.33235/jarna.23.2.8-16

John Hopkins Medicine. (2021) Rehabilitation after traumatic brain injury. https://doi.org/10.1080/02699052.2019.1641747

National Institute of Neurological Disorders and Stroke. (2020). Traumatic brain injury: Hope through research. Retrieved March 21, 2020, from https://

Nursing Theory (2021) The Modeling and Role Modeling Theory. https://nursing-theory.org/theories-and-models/erickson-modeling-and-role-modeling-theory.php

Nursing Theory (2021) Kurt Lewin, Nursing Theorist. https://nursing-theory.org/nursing-theorists/Kurt-Lewin.php

Radecki, B., Reynolds, S., & Kara, A. (2018). Inpatient fall prevention from the patient’s perspective: A qualitative study. Applied nursing research: ANR, 43, 114–119. https://doi.org/10.1016/j.apnr.2018.08.001