Nursing Care Plan for Acquired Brain Injury

Introduction

Acquired brain injury (ABI), represented by a range of cognitive, emotional and physical challenges, provides healthcare professionals with an arduous mission to address its management. Even though ABI is a unique, multi-dimensional condition that requires an interdisciplinary approach to care and incorporates the essential elements of nursing science principles, including patient assessment, prioritisation methodology followed by nursing diagnosis formulation and clinical reasoning. Also such a plan is crucial for the ABI individuals and must assist in effective recovery, rehabilitation as well as improved life quality. The cornerstone of this care plan is the development of a well-defined system which makes it easy to conduct in-depth evaluations and identify patients’ needs. Moreover, the plan focuses on patient-centric outcomes by characterising SMART (Specific Measurable Achievable Relevant Time-Bound) Goals, which ensure realistic and measurable results. The latter is supported by modern research, and recognised assessment tools including the Glasgow Coma Scale (GCS) and Montreal Cognitive Assessment (MoCA), aimed at providing a personalised treatment plan. Therefore, through such evidence-based methodologies, the nursing care plan for ABI patients is a critical tool in guiding an individual patient’s journey towards recovery.

Assessment Baseline

The sensitivity with which MoCA can detect cognitive dysfunctions following ABI makes it an irreplaceable part of the process, giving a synoptic representation of one’s cognitions and helping define the areas that require precise therapeutical intervention according to Hilgeman et al. (2019). On the other hand, in assessing baseline level of brain injury; evaluation begins at seconds elapsed since any GCS is also supportive. According to Barakat and Greene-Chandos (2019), based on verbal, motor and eye-opening stimuli, the GCS allows immediate clinical decisions and extended monitoring of neurological status. The tools used in conjunction offer an all-rounded resource for assessing ABI patients, enabling such practitioners to make generalisations from detailed knowledge of the exact patient condition. These analyses included in the rehabilitation plan base can be considered for a proper adaption to the patient’s specific needs.

Need/Diagnosis

Tools such as the Glasgow Coma Scale (GCS) and Montreal Cognitive Assessment(MoCA), among others, can be used to carry out complete exams that enable nurses to determine what two primary requirements and diagnoses an ABI patient has. First, the concept of cognitive impairment involving memory processes, brain functions, and attention is characterised by the inability to perform daily activities, which requires an individual approach that provides a unique rehabilitation program (Pavlovic et al., 2019). Thus, MoCA supports the above diagnosis, comprehensively analysing cognitive domains. Secondly, emotional dysregulation presents itself as either sadness or anxiety, which makes one more likely to self-harm and have suicidal thoughts (Hitchens, 2021). Cognitive behavioural therapy (CBT) and other types of psychological support may be used as the presence was diagnosed to help control emotional disturbance, thereby contributing to improving his efficiencies. Such a patient-centred care plan meets these needs to ensure faster recovery and better independence among ABI patients with improved quality of life.

SMART Goals

• Making SMART goals is valuable to ensure that the focal point of implemented care for an acquired brain injury occurs. The first aim is to restore cognitive functioning by 20% on the MoCA in three months. This objective is specialised to the cognitive performance functions such as memory and executive skills. It can be obtained with the help of MoCA scores, reached through individualised cognitive activities associated with the patient’s need for cognitive recovery and has a three-month limit.
• The second objective, which is aimed at the enhancement of mental stability, HADS will be utilised to reduce depressive episodes by about 30% over six months. The only objective here is enhancing mental health, which applies score measurement in the HADS. The goal of this kind of treatment is particular therapy and psychological support, as well as there are six months prescribed for it.

Rationale/Evidence-based

Cognitive Rehabilitation Therapy (CRT) has several studies supporting it as an effective intervention in recovering and restoring cognitive functions such as memory, attention and executive processes after ABI. Despite the above, systematic reviews and meta-analyses, including those from Carmichael et al. (2019), have demonstrated that some cognitive exercises & strategies could significantly help restore memory; hence, directed or targeted thinking is believed to be at the cornerstone of ABI rehabilitation (Carmichael et al., 2019). This type of therapy intervenes only on any possible cognitive deficits particular to a specific patient, thus providing more targeted enhancement than broad approaches. It has been established that the psychological module providing CBT is one of the most effective treatments able to support patients with ABI as they deal with such symptoms as depression and anxiety. This psychological intervention directly intervenes in the emotional dysregulation and associated mental health comorbidities that can negatively impede works of recovery from trauma affiliated with ABIs.

Implementation

The cognitive rehabilitation goal of the care plan is facilitated through everyday structured sessions addressing memory-focused activities and tasks related to improving the well-being of patients with ABI. In such cases, processes like spaced retrieval and visual imagery positively facilitate memory recall in executive function training, enabling better planning. Cognitive exercises will be based on everyday activities to encourage better application and generalisation of skills gained. Regarding the emotional stability goals, weekly CBT sessions will be appointed while presenting depressive symptoms and anxiety. These sessions will focus on identifying negative cognitions, challenging these patterns’ narrative and well-controlled positive enrichment competence. Relaxation approaches, such as progressive muscle relaxation and guided imagery, will be introduced to lower anxiety scores in the participants so that stress management is also improved. In addition to incorporating family education sessions with a conducive home environment, reinforcement will be witnessed in the interventions.

Monitoring and Evaluation

For a patient with ABI, monitoring and evaluation of its care plan’s effectiveness will occur during regular scheduled MoCA assessments after an agreed time interval as well as HADS assessment. The MoCA will be given in bi-monthly intervals as a quantitative measurement of cognitive benefits, including memory, attention and executive skills, thus enabling objective determination of achievement visioned for the rehabilitation target. In the same way, HADS scores will be measured monthly because such tests identify reductions in levels of depressive and anxiety symptoms, which is subject to the emotional stability goal. Also, the GCS will be applied intermittently to determine whether there is any change in the level of consciousness, taking cognisance of that critical aspect of neurological monitoring. During follow-up, qualitative feedback from the patient and their relations will be actively solicited to acquire insights into patients’ experience, satisfaction with cognition, and emotional functioning at change. The feedback will guide possible care plan revisions, guaranteeing this patient-centred and dynamic approach to their urgent needs.

Conclusion

Conclusively, a developed nursing care plan for an ABI patient provides structured and evidence-based methods to level the complexities specifically brought about by disorders associated with Acquired Brain Injury. By bringing in cognitive rehabilitation and psychological support supported by the significant evidence of its effectiveness, the care plan aims to improve bio-psycho functional outcomes. The customised interventions, which include Cognitive Behavioral Therapy programs and CBT therapy in mathematics care, are provided as part of a holistic treatment. Validated assessment tools such as the Montreal Cognitive Assessment (MoCA) and the Hospital Anxiety and Depression Scale (HADS), combined with patient and family feedback, create a practical framework for monitoring progress while making necessary adjustments. Lastly, the proposed patient-centred care plan is designed to promote cognitive recovery and emotional stability with ABI.

References

Barakat, A. and Greene-Chandos, D., 2019. The Neurological Assessment of the Critically Ill Patient. Neurocritical care. D4C9F416DCDF4E86C0E44F17FEB99451-libre.pdf (d1wqtxts1xzle7.cloudfront.net)

Carmichael, J., Gould, K., Hicks, A., Feeney, T. and Ponsford, J., 2019. Readiness of community ABI therapists to learn and implement Positive Behaviour Support: a mixed-methods study. Brain Impairment, 20, pp.289-376. ASSBI/NZRA AWARDS | Brain Impairment | Cambridge Core

Hilgeman, M.M., Boozer, E.M., Snow, A.L., Allen, R.S. and Davis, L.L., 2019. Use of the Montreal Cognitive Assessment (MoCA) in a rural outreach program for military veterans. Journal of Rural Social Sciences, 34(2), p.2. “MoCA Use in Rural Outreach” by Michelle M. Hilgeman, Eugenia M. Boozer et al. (olemiss.edu)

Hitchens, D., 2021. Stressful life events and deliberate self-harm: Exploring the specificity of stressful life events and emotion regulation facets. Stressful life events and deliberate self-harm: Exploring the specificity of stressful life events and emotion regulation facets (openrepository.com)

Pavlovic, D., Pekic, S., Stojanovic, M. and Popovic, V., 2019. Traumatic brain injury: neuropathological, neurocognitive and neurobehavioral sequelae. Pituitary, 22, pp.270-282. Traumatic brain injury: neuropathological, neurocognitive and neurobehavioral sequelae | Pituitary (springer.com)