Bay’s Article on MTBI Published in Advanced Emergency Nursing Journal

Submitted on Nov 4, 2011

A study by Dr. Bay investigates the need for standardizing discharge teaching practices for patients with mild traumatic brain injury. 
 
Dr. Esther BayAn article written by Clinical Associate Professor Dr. Esther Bay entitled, “Mild Traumatic Brain Injury: A Midwest Survey of Discharge Teaching Practices of Emergency Department Nurses,” appeared in the April/June 2011 issue of Advanced Emergency Nursing Journal.
 
The article details a study recently conducted by Bay investigating the practices of emergency department (ED) nurses when discharging patients who have suffered from Mild Traumatic Brain Injury (MTBI). The investigation was motivated by recent research indicating that current discharge teaching practices focus predominately on imparting injury-specific information to the patient. Troublingly, this focus does not align with guidelines suggested by the Center for Disease Control and Prevention (CDC) as presented in the Acute Concussion Evaluation (ACE) care plan, which calls for nurses to incorporate preventative education into their discharge practices as well.
 
Bay sees this trend as a consequence of the standards upheld in the nurses’ education experiences. “I believe that ED nurses focus on injury-specific details in their education because that is what their ED system has put forth as a standard,” she said. “It is inherent in the ED nurse's practice: providing instructions for the clinical problem that brought that person into the health system. Preventive education has not been emphasized, nor is it part of the standard discharge instruction sheet that most facilities use.”
 
The results of Bay’s survey supported the claim that ED discharge teaching practices for MTBI patients concentrated too heavily on injury-specific information alone. The study reported that the vast majority of respondents were unfamiliar with the CDC ACE guidelines and most lacked a systematic procedure for their discharge teaching. 
 
Bay argued that the delivery of consistent information about MTBI, the expected symptoms, and trajectory for recovery should become systematic to teaching procedures, in addition to education on ways to prevent further damage or injury. Also, it is imperative that nurses understand the CDC guidelines on “red flags” that may necessitate a return visit to the healthcare provider should the symptoms not improve or the patient’s state deteriorate. 
 
“The person who has a MTBI is often cognitively impaired and so may not clearly understand the discharge teaching,” she noted. “Therefore, it is imperative that the instructions be clear, be based on some evidence and research, and that they can refer to these discharge instructions as their cognitive state improves. Standardizing information that is evidence-based provides a way to ascertain that everyone receives basic information about their diagnosis.”