Nurses Knowledge and Self-Perceptions of Caring for Patients with TBI Tolu Oyesanya, MS, RN, PhD Candidate Roger Brown, PhD Lyn Turkstra, PhD, CCC-SLP 4/16/2015
Background TBI is a chronic disease process 1 5.3 million living with chronic conditions caused by TBI in the U.S. 2 Patients with TBI seen all over the hospital Severity of injury Comorbidities Time since injury New vs. old injury
Role of a Nurse Collaborate with interdisciplinary team Provide 24/7 care Responsibilities include: Coordination and communication of care Assessment of patient problems Therapy integration Technical and physical care Patient advocacy Involving the family in care plan Education of the patient and family 3 All nurses may see patients with TBI Important to be knowledgeable in these areas
Gap in Knowledge Nurses report self-perceived knowledge deficits and lack of confidence 5 Independent of actual knowledge level or practice abilities Not specific to caring for patients with TBI Limited literature on nurses perceptions of caring for patients with moderate-to-severe TBI 4
GRAPHIC: www.unocha.org
GRAPHIC: www.unocha.org
Purpose To determine nurses' perceived knowledge and confidence to care for patients with moderate-tosevere TBI Questions asked: Perceived Knowledge: Clinical guidelines for TBI care TBI epidemiology, characteristics, behavior, and recovery Perceived Confidence: Assessment and treatment procedures specific to patients with TBI
Study Procedures Online survey sent via email to all nurses at a large midwestern hospital Adapted two surveys Hux et al. (1996) 9 Watts et al. (2011) 5 N=513 (20.3% response rate)
Perceived Knowledge Items Asked participants to rate their perceived level of knowledge on each item Examples of Knowledge Items Types of traumatic events likely to cause moderate-to-severe TBI Neurological exams specific to moderate-to-severe TBI Medication management for patients with moderate-to-severe TBI Co-morbidities common with moderate-to-severe TBI Clinical guidelines for patients with moderate-to-severe TBI Nursing care plans for patients with moderate-to-severe TBI Stages of recovery for patients with moderate-to-severe TBI Treatment and therapy options for patients with moderate-to-severe TBI Educational needs and resources for patients with moderate-to-severe TBI
Statistical Analysis Structural equation modeling Latent class analysis Developed a 3-class structure based on perceived knowledge items Low Perceived Knowledge Moderate Perceived Knowledge High Perceived Knowledge
Results
Theme Within Results Nurses with highest perceived knowledge report the least: Training Experience Perceived confidence Findings are counterintuitive 4/16/2015 13
Current Work Setting 4.5% Emergency Room 16.9% Ambulatory Clinic/MD Office 2.6% Primary Care Clinic 21.9% Other 58% Inpatient Unit
Have you ever practiced with patients with TBI? P<0.001
Have you ever had specific TBI related training? P<0.001
Average of Frequency of Care *All groups saw an average of ~1-2 patients with TBI per month P<0.001
Perceived Confidence P<0.001
Interpretation of Findings: Conscious Competence Model *Other providers may experience this! GRAPHIC: http://www.leadershipsuccession.org
GRAPHIC: www.unocha.org
Clinical Implications Training focuses on knowledge and skills Beliefs not incorporated in training or measured in research Beliefs dictate practice Example: If provider believes that patients with TBI cannot learn new things after injury Not enough to focus on knowledge and skills Must incorporate providers beliefs To change the way you act, you must change the way you think. Applies to all healthcare providers!
Future Research Look at how nurses perceive practice and their receptiveness to training Test knowledge and training Current study only looked about perceptions of knowledge and confidence
References 1. Iavagnilio, C. L. (2011). Traumatic brain injury: Improving the patient s outcome demands timely and accurate diagnosis. Journal of Legal Nursing Consultation, 22(3), 3 10. 2. Vanderploeg, R. D., Schwab, K., Walker, W. C., Fraser, J. A., Sigford, B. J., Date, E. S., Warden, D. L. (2008). Rehabilitation of traumatic brain injury in active duty military personnel and veterans: Defense and Veterans Brain Injury Center randomized controlled trial of two rehabilitation approaches. Archives of Physical Medicine and Rehabilitation, 89(12), 2227 2238. 3. Long AF, Kneafsey R, Ryan J, Berry J. The role of the nurse within the multi-professional rehabilitation team. Journal of Advanced Nursing 2002;37(1):70 78. 4. Kennedy, J. E., Lumpkin, R. J., & Grissom, J. R. (2006). A survey of mild traumatic brain injury treatment in the emergency room and primary care medical clinics. Military Medicine, 171(6), 516 521. 5. Watts, D. D., Gibbons, S., & Kurzweil, D. (2011). Mild traumatic brain injury: A survey of perceived knowledge and learning preferences of military and civilian nurses. Journal of Neuroscience Nursing, 43(3), 122 129. 6. Fakhry SM, Trask AL, Waller MA, Watts DD, others. Management of brain-injured patients by an evidence-based medicine protocol improves outcomes and decreases hospital charges. Journal of Trauma-Injury, Infection, and Critical Care 2004;56(3):492 500. 7. Visvanathan R. Severe head injury management in a general surgical department. Australian and New Zealand Journal of Surgery 1994;64(8):527 529. 8. GRAPHIC: www.unocha.org 9. Hux, K., Walker, M., & Sanger, D. D. (1996). Traumatic Brain InjuryKnowledge and Self- Perceptions of School Speech-Language Pathologists. Language, Speech, and Hearing Services in Schools, 27(2), 171 184. 10. GRAPHIC: http://www.leadershipsuccession.org
Thank you! Any questions?