NURS FPX 6011 Traumatic Brain Injury Care Report IDA

NURS FPX 6011 Traumatic Brain Injury Care Report IDA

Traumatic Brain Injury Care Report

NURS FPX 6011 Traumatic Brain Injury Care Report IDA

There are various national public health initiatives (NHPII) and population health improvement initiative (PHII) programs situated around the country consisting of experts and stakeholders to create actions, plans, and strategies for addressing the nation’s most damaging public health problems. CDC started NPHII to inspire improved methods to increase positive performance and quality within the public health departments across the United States. Proposals are then created to ensure that public health departments align with national goals (Centers for Disease Control and Prevention [CDC], n.d.). From 2010 to 2014, NPHII provided funding and assisted health departments in reaching goals and objectives, such as performance, efficiency, and efficacy through performance management activities. PHII programs are designed using evidence-based methods to promote health by avoiding disease and supporting healthier lifestyle choices. Health care providers personalize care plans based on evidenced-based results received from their PHII to address the needs of patients treated by their organization.

Mr. Nowak’s Situation

Mr. Nowak, a patient of Uptown clinic, was referred to Safe Headspace by Janie, the Charge nurse of Uptown clinic. Mr. Nowak suffered a traumatic brain injury (TBI) after falling from a tree years ago. During his cholesterol check, he shared that he believed his increased imbalance resulted from deteriorating health from the TBI. Alicia Balewa, Director of Safe Headspace, founded the PHII organization to help people with traumatic brain injuries (TBIs) and post-traumatic stress disorder (PTSD). Alicia stated that Safe Headspace was a nonprofit organization established due to her father’s struggle with PTSD. Its purpose is to identify strategies to treat senior patients who have been afflicted for decades or years. (Capella University, n.d.). 

Evaluation of a Population Health Improvement Initiative’s Outcomes

The program’s participants were mostly men who were treated utilizing the CDC’s standards for moderate aerobic activity, medication, psychotherapy, and meditation (Capella University, n.d.).

Alicia reported progress in participants’ mood, memory, and motor control improved because of the therapies provided. Seventy-five out of 400 people completed the exercise for three months and saw a 15% improvement in muscle control, a 61% improvement in memory, and a 22% improvement in mood. In just six months, 40% of people started taking drugs such as antipsychotics and antidepressants, with 26% reporting improved mood and 6% improved memory. Meditation participants reported a 70% improvement in mood and memory and a 32% improvement in muscle control (Capella University, n.d.). Exercise and meditation appeared to be the most successful in creating positive change. In the United States, healthcare organizations recognize the need for population-based health improvement programs. 

NURS FPX 6011 Traumatic Brain Injury Care Report IDA

Information that was missing from Alicia Balewa’s information was: How many people participated, exercise details, limitations of participants, increased pain, and reasoning behind dropping out or being discouraged from the program. It is also important to note the lack of details on assessing cognitive abilities and physical disabilities and if the program is tailored individually based on these factors. The severity of TBIs was not disclosed, nor was it revealed whether individuals struggled to self-manage their therapy or experienced any other discontent. Better data would show areas for improvement and places that were irrelevant. TBI and PTSD data should have been separated into separate groups based on the diagnosis, with a third group could represent participants with a dual TBI and PTSD diagnosis. Even though PTSD and TBI victims have many similarities, it is important to note that etiologies differ. Activities must be customized to everyone’s disease processes and information built on the diagnosis and abilities of the participant. This is partly due to the many differences in patient demographics, diagnoses, and environment. These factors do not produce a clear picture and contribute to PHII knowledge gaps which could determine the best treatment for each person in the program. Missing information can better guide the best approach to constructing Mr. Nowak’s care plan. The effects of therapies on patients with PTSD or TBI were not independently evaluated. As a result, the findings of cases like Mr. Nowak’s, who does not have a history of PTSD, remain unclear and require additional study. Information regarding the severity of the TBIs or any limitations that participants may have. 

Personalized Evidence-Based Patient Care Plan
Mr. Nowak’s medical history includes TBI from a tree fall, hypertension, and balance issues without mentioning PTSD or other mental illnesses (Capella University, n.d.). Even though the nurse believes his imbalance is caused by hypertension, he considers it caused by the TBI. TBI is linked to an increased rate of impaired mental function, disability, and death and affects individual abilities to perform activities of daily living (ADL). (Kristensen et al., 2019). Describes,” The International Classification of Functioning, Disability, and Health (ICF) is a framework developed by the World Health Organization to categorize health and health-related areas, including mental functions. Attention, memory, psychomotor function, emotion, perception, thought, higher-level cognitive function (executive function), the mental function of language, calculation function, mental function of sequencing complex movements, and experience of self and time function are the subdomains of specific cognitive function subdomains in the ICF.” Mr. Nowak’s abilities were not recorded according to ICF, which is essential in developing a framework for a personalized care plan. According to (Morris et al., 2019, para. 1), As a healthcare provider, after assessing Mr. Nowak, I would ensure the exercise is included in his care plan. Physical activity is linked to a 20%–30% reduction in all-cause mortality and the occurrence of several chronic diseases (Centers for Disease Control and Prevention [CDC], n.d.). The beneficial effects of a physically active lifestyle strengthen multiple bodily systems. The long-term health consequences of TBI include cognitive, sensorimotor, behavioral, and social problems that can negatively affect the quality of life (James et al., 2016). The program also did not provide information if occupational or physical therapists were involved, which is beneficial in assessing and determining correct activities for individuals. To determine a care plan for Mr. Nowak, an occupational or physical therapist needs to complete an assessment to determine any other diagnosis, strengths and weaknesses, cognition level, and any physical impairments. The care plan is based on the assessment results with a baseline, measurable goals, and interventions. The care plan can address Mr. Novak’s balance problems and hypertension. As reported by (CDC, n.d.), exercise is beneficial in reducing blood pressure and improving his balance concerns. After reviewing all the research, the proposed interventions of combining aerobic exercise and meditation will increase Mr. Nowak’s motor control, improve his memory, and decrease his blood pressure. 

I would treat Mr. Novak using the “Triple Aim” framework. Triple Aims’ goal is to improve the U.S. health care system by enhancing the experience of care, health of populations, and reducing per capita costs of health care (Berwick et al., 2008, para. 5). By utilizing Safe headspace, Uptown Clinic uses the Triple Aim goal framework to deliver quality care for its patients recognizing that they need to utilize community resources to understate and satisfy the population’s needs. By combining medication, meditation, and exercise to decrease TBI/PTSD disparities, Safe headspace is a working PHII model which will reduce healthcare costs and inequities. This reflects the goals of the Triple Aims framework.

NURS FPX 6011 Traumatic Brain Injury Care Report IDA

Analysis of Evidence

In the United States, TBI affects at least 2.5 million people every year (Manley et al., 2017). “Clinical trials to date have included subjects with a broad range of severities and trial-specific parameters (inclusion/exclusion criteria, time for onset of treatment, dose, etc.)” (Manley et al., 2017, Introduction section). Frequently, these have not matched up with pre-clinical research that has backed up therapy possibilities. The current TBI trial techniques do not allow identifying patients with similar damage features or pathophysiology who may react more favorably to personalized medicine. TBI severity may be measured using a variety of techniques. The Glasgow Coma Score (GCS) is the most widely used technique, with scores ranging from 3 to 8 for severe injury, 9 to 13 for moderate damage, and 14 to 15 for light injury (which frequently includes concussion). The degree of awareness and the length of post-traumatic memory loss can also determine the severity of a TBI. However, these procedures have several weaknesses. They typically rely on the subjective interpretation of medical personnel, making it difficult to precisely determine the severity of the injury and the patient’s recovery prognosis. The degree of awareness and the length of post-traumatic memory loss can also choose the severity of a TBI. However, these procedures have several weaknesses. They typically rely on the subjective interpretation of medical personnel, making it difficult to precisely determine the severity of the injury and the patient’s recovery prognosis (Zhang et al., 2022). A study in 1999 in which 13 participants took part showed improvement in cognitive tests, anxiety, and depression. The exercise was moderate and performed in virtual reality. The study suggested that practice contributed to positive outcomes (Zhang et al., 2022).

Application for Other Cases

Overall, Mr. Nowak’s case is typical for many people suffering from debilitating illnesses. A sedentary lifestyle or hypertension causes his imbalance. He needs a more comprehensive evaluation to determine the most critical intervention. People with other chronic diseases can significantly improve their health with exercise and a more intensive healthcare approach. The Triple Aim initiative can work for all health challenges, and as healthcare becomes more complex, the Triple Aim framework is much needed.

References

Berwick, D. M., Nolan, T. W., & Whittington, J. (2008). The triple aim: Care, health, and cost. Health Affairs, 27(3), 759–769. https://doi.org/10.1377/hlthaff.27.3.759

NURS FPX 6011 Traumatic Brain Injury Care Report IDA

Capella University. (n.d.). Villa health evidence-based health evaluation and application. Villa health evidence-based health evaluation and application. Retrieved June 5, 2022, from https://media.capella.edu/CourseMedia/MSN6011/evidenceBasedHealthEvaluation/media.asp

Centers for Disease Control and Prevention. (n.d.). National public health improvement initiative. Centers for disease control and prevention. https://www.cdc.gov/publichealthgateway/nphii

Kristensen, L., Muren, M., Petersen, A., van Tulder, M. W., & Gregersen Oestergaard, L. (2019). Measurement properties of performance-based instruments to assess mental function during activity and participation in traumatic brain injury: A systematic review. Scandinavian Journal of Occupational Therapy, 27(3), 168–183. https://doi.org/10.1080/11038128.2019.1689291

Manley, G. T., Mac Donald, C. L., Markowitz, A. J., Stephenson, D., Robbins, A., Gardner, R. C., Winkler, E., Bodien, Y. G., Taylor, S. R., Yue, J. K., Kannan, L., Kumar, A., McCrea, M. A., Wang, K. K., & the TED Investigators. (2017). The traumatic brain injury endpoints development (ted) initiative: Progress on a public-private regulatory collaboration to accelerate diagnosis and treatment of traumatic brain injury. Journal of Neurotrauma, 34(19), 2721–2730. https://doi.org/10.1089/neu.2016.4729

Morris, T. P., Tormos Muñoz, J.-M., Cattaneo, G., Solana-Sánchez, J., Bartrés-Faz, D., & Pascual-Leone, A. (2019). Traumatic brain injury modifies the relationship between physical activity and global and cognitive health: Results from the Barcelona brain health initiative. Frontiers in Behavioral Neuroscience, 13. https://doi.org/10.3389/fnbeh.2019.00135

Zhang, Y., Huang, Z., Xia, H., Xiong, J., Ma, X., & Liu, C. (2022). The benefits of exercise for outcome improvement following traumatic brain injury: Evidence, pitfalls, and future perspectives. Experimental Neurology, 349, 113958. https://doi.org/10.1016/j.expneurol.2021.113958


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