การจัดการภาวะสับสนเฉียบพลันของผู้ป่วยบาดเจ็บสมองโดยพยาบาลห้องฉุกเฉิน

Abstract

This study aimed to examine emergency nurses’ management of acute agitation in patients with traumatic brain injury. Participants were 65 patients with acute agitation after a traumatic brain injury (TBI) who were admitted in the emergency room. Data were collected by using 3 sets of tools: (1) Patients’ information including a. demographic data, b. information related to injury and treatment, (2) Agitated Behavior Assessment Scale (ABS) used to examine level of agiataion before and after nurses’ management, and (3) Observation checklist related to emergency nurses’ management of agitation in patients with TBI. The tools were tested for content validity by 3 experts and yielded content validity index of 1.00. The ABS yielded equivalence reliability of .89. Data were analyzed using frequency, percentage, mean, and standard deviation. Results: 1. All patients with TBI (100%) with any level of agitation were managed in these activities (1) assessement of agitation before nurses’ management, (2) physical restraint, (3) environment control, (4) short, concise, and clear speech, and informed the patient before the procedure, and (5) re-assessment after nurses’ management. 2. Emergency nurses’ management differed in patients with different levels of agitation, including (1) all patients (100%) with severe or moderate levels were notified to the physician, while 91.7% of patients with mild level were notified, (2) most of the patients (64.3%) with severe level of agitation were administered drugs followed by 32.0% of patients with moderate level and 16.7% with mild level of agitation, and (3) 17.9% of the patients with severe level were asked/reminded on perceptions about person and place. 3. The level of agitation of patients after TBI before and after nurses’ management revealed that before nurses’ management, 43.1% of patients were in a severe level, followed by moderate level (38.4%), and mild level (18.5%). After nurses’ management, 32.3% of patients were in a moderate level, followed by 33.8% in a mild level, and 18.5% with no agitation. The results could be used as basic information to develop a guideline to manage acute agitation in patients after TBI in order to improve the quality of emergency nurses’ management of agitation in patients with TBI.