Carrier Sarah L, Ponsford Jennie, McKay Adam
Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia.
Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia.
Disabil Rehabil. 2023 Nov;45(22):3686-3695. doi: 10.1080/09638288.2022.2135771. Epub 2022 Oct 25.
Agitated behaviours pose a significant challenge during early recovery following traumatic brain injury (TBI). This study aimed to gain a deeper understanding of how clinicians worldwide manage post-TBI agitation. Understanding the factors that influence how clinicians manage agitation can help inform the use of consistent and effective management strategies for reducing agitation in TBI care.
Using a qualitative design, semi-structured interviews were conducted with 33 clinicians (58% female, aged 23-71 years) from 16 countries who had experience working with agitated patients. The interviews explored the approaches used to manage agitation during early TBI recovery.
Interviews were analysed using thematic analysis. The central theme of the interviews was the effective management of agitation, consisting of three sub-themes: managing the safety of staff and patients, reducing triggers for agitation, and implementing behavioural principles for managing agitation. Two overarching themes influenced the effective management of agitation: clinician-related factors and systemic factors.
This study highlighted key approaches for effective agitation management during early TBI recovery, as described by clinicians working with these patients worldwide. There were similarities in the strategies described, although there were many challenges that impeded the consistent implementation of such strategies in TBI care settings.
IMPLICATIONS FOR REHABILITATIONEffective management of agitation during early traumatic brain injury (TBI) recovery continues to pose a significant challenge for clinicians worldwide.Healthcare services may improve the management of agitation by involving the patient's family in care delivery and implementing low-cost less-restrictive non-pharmacological interventions to reduce reliance on pharmacological interventions.Proactively addressing and removing potential sources of agitation (patient-related and environmental) may help reduce the risk of agitation occurring.The use of simple behaviour management strategies may be effective for reducing agitation, but strategies need to be implemented consistently and the approach should be flexible and tailored to the patient.Clinicians should develop an understanding of a patient's premorbid behaviours and interests to best inform the management approach.Management of agitation may be improved by increasing clinicians' agency in responding to agitated behaviours, through the provision of information and resources, ongoing training and skill development, supervision and support.
激越行为在创伤性脑损伤（TBI）后的早期恢复过程中构成重大挑战。本研究旨在更深入地了解全球临床医生如何管理TBI后的激越。了解影响临床医生管理激越的因素有助于为在TBI护理中使用一致且有效的管理策略以减少激越提供依据。
采用定性设计，对来自16个国家的33名临床医生（58%为女性，年龄23 - 71岁）进行了半结构式访谈，这些临床医生有处理激越患者的经验。访谈探讨了在TBI早期恢复过程中用于管理激越的方法。
采用主题分析法对访谈进行分析。访谈的中心主题是激越的有效管理，包括三个子主题：管理工作人员和患者的安全、减少激越的触发因素以及实施管理激越的行为原则。两个总体主题影响激越的有效管理：与临床医生相关的因素和系统因素。
本研究突出了全球处理这些患者的临床医生所描述的TBI早期恢复过程中有效激越管理的关键方法。尽管在TBI护理环境中存在许多阻碍一致实施此类策略的挑战，但所描述的策略仍有相似之处。
对康复的启示
在创伤性脑损伤（TBI）早期恢复过程中对激越进行有效管理，对全球临床医生来说仍是一项重大挑战。
医疗服务机构可通过让患者家属参与护理提供以及实施低成本、限制较少的非药物干预措施以减少对药物干预的依赖，来改善激越的管理。
积极应对并消除潜在的激越源（与患者相关的和环境方面的）可能有助于降低激越发生的风险。
使用简单的行为管理策略可能对减少激越有效，但策略需要一致实施，且方法应灵活并根据患者情况量身定制。
临床医生应了解患者病前的行为和兴趣，以便为管理方法提供最佳依据。
通过提供信息和资源、持续培训和技能发展、监督和支持，增强临床医生应对激越行为的能力，可能会改善激越的管理。
