CAUSES OF TRAUMATIC BRAIN INJURY

Learning what brain injury is all about.  It was nothing like I experienced as a nurse treating the patients with brain injury.  Little did I know I was about to enter the twilight zone at work on October 30, 1991.
It was such a bright and cheerful day.  It was my beautiful twin nieces eleventh birthday and that was something to celebrate! I arrived for work at least 30 minutes prior to my start time of 1:00 p.m.  My ten hour shift was from 1:00 p.m. until 11:00 p.m.   Again, I entered the unit with screams for help and  found the same 19 year old male patient who has been violent for weeks on end in the back hallway.  As I entered the unit he was attacking a physical therapist.  As unfortunate as it is, we as nurses just knew it was another day at work and you expect this type of behavior.  This is the norm for most nurses and healthcare workers. Many patients do have changes as a result of medications and disease processes but they are quickly treated and stabilized.  This patient was like this 24/7 regardless of every intervention possible.

He has assaulted every staff member at least once.  Every day security was called a minimum of two times to help deal with his behavior.  This was a slight built, but strong 19 year old man.  His family said he was at baseline and that was heavily documented in his chart for the previous two weeks. He was not released because he did not have a home to go to.  His family did not want him, or was he too dangerous for his family?  Is this type of violent patient for nurses and healthcare to deal with or is this our criminal systems job?

He did not have healthcare insurance but he was being treated so that definitely was not the issue.  This was a county hospital and we took everyone, hence I enjoyed the diversity of clients, patients and families and the many medical issues you may never see in a suburban hospital. Suburban hospitals and other places throughout the United States frequently transferred patients to this world renowned rehabilitation institution in Cleveland, Ohio. This rehabilitation unit was excellent with Neurological conditions and Traumatic Brain Injury immediately following the initial hospitalization and  acute injury or disease.  In this rehabilitation  center some nursing interventions included  taking patients off  ventilators gradually, teaching patients how to walk and talk,  and helping them regain simple bodily functions; such as retraining for bladder functions.  In other words, teaching patients every single thing we have learned as toddlers once again.  It all becomes new to these patients and they need to relearn everything as though they never knew it before.   Patients learned how to talk again, eat again, and just learn who they were again.  It was a very rewarding career to see everyone improve, sometimes more then others.  Every small improvement makes a huge difference.

I was fortunate to  observe these wonderful patients every working day and I found it personally rewarding.  It gives a lot of meaning to life helping others.

QUICK MOVEMENT FROM ONE SIDE TO THE OTHER ALSO CAUSES BRAIN INJURY

Since behaviors problems are common with head injury and neurological conditions we expected a certain level of inappropriate behaviors. I think our expectations overlooked safety on this unit.  Unfortunately, I feared nothing.  Why would I believe that I could be hurt?  I have been assaulted before (both at work and in my personal life) and recovered without incident, so I really did not have anything to fear.  In retrospect, a little fear here would have been better.

Since I have had time off of work for the nursing convention, the charge nurse assigned me to this patient again.  Now I was two for two.  I worked on Monday and was assigned this patient, and now I’m working for the second day this week on Wednesday and I am assigned this patient again.  It is hard enough working with a belligerent, combative, violent patient for 8 hours, let alone for 10 hours in one day. This time, I only made it 30 minutes into my shift.  By 1:30 p.m. I was assaulted.  As I arrived before 1:00 p.m. he was attacking a physical therapist in the hall and was subdued.  Now we were in an occupational therapy room as he was attending therapy.  I wonder what everyone was thinking to have him attend therapies with his violent outbursts and being mainstreamed with the rest of the rehabilitation patients that were nonviolent.  How safe do you think these patients felt?

Supervised Physical Therapy is Important with TBI

As a nurse I was much aware of how these patients felt.  Many patients expressed safety concerns, but those concerns were minimized as though they had nothing to fear.  They would not even come out of their room to walk the halls and get some exercise fearing this patient. Now I understand the real fear patients have, when they are weak , vulnerable and unable to protect themselves.  By minimizing their fears our  healthcare workers believe they are protecting the patients.  In reality, these patients have very little reserves of functioning and they cannot deal with any physical assaults or emotional outbursts that rob them of their energies.  Minimizing creates more anxiety instead of relieving their anxieties.  It is both my professional and personal suggestion that while all patients need therapies; violence is a hinderance to all patients in a rehabilitation unit especially when they are frequent by the same individual.  The safety of others is always jeopardized.

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