Sample Nursing Paper on Traumatic Brain Injury

A traumatic brain injury (TBI) can be defined in literal terms as a hit or penetration on the head that causes an alteration of the normal functionalities of the brain. TBI can result when the head experiences an abrupt intense contact with a heavy object or is perforated through. The symptoms can be slight, mildly moderate or severe. Symptoms are dependent upon the extent of the damage caused to the brain. Mild incidences result in short term mental consciousness, coma and at times death (Fuentes et al., 2018).

The Biological Dimensions of Traumatic Brain Injury

Damage to the brain that is traumatized is as a result of the mechanical injury that may subsequently cause stimulation of secondary pathogenic cascades that influence the progression of the initial primary damage (Suter, 2016). Human TBI is a heterogeneous defect in which factors associated with pathogens may vary in magnitude and are manifested in different combinations. A generalized view as is in studies in various models considers four phases. The classification provides a broader context for a clear comprehension of the relationship between the initial and subsequent pathogenic scenarios.

Phase 1 is set to represent primary physical damage resulting in the rapture of the vascular and cellular membranes, the release of the contents of intercellular and cessation of blood. The destruction of blood flows and metabolism may result in anaerobic activities and the accumulation of lactic acid (Suter, 2016). The membrane ions may fail depending on energy as adenosine triphosphate that has been stored is used up.

Phase 2 mainly involves progressive worsening of the axis of neurons that emanates from both molecular and biochemical events that may promote the death of apoptotic and necrotic cells. The increment is an outcome of the rupture of the barrier between the blood and the brain and subsequent exposure of the brain to the excessive release of synaptic and decreased glutamate transporter (Suter, 2016). Glutamate is known to be the most abundant excitatory transmitter in the human brain. In the context of TBI, an increment in the glutamate results in simulations of ion channel and G-protein glutamate linked receptors. Excess activation of the ion channels results in ionic imbalances and at times prolonged ionization. Intracellular calcium tends to rise after TBI. This is attributed to increased Ca2+ from the components of extracellular and a release of Ca2+ from stores within the cells (Suter, 2016). The increase in intracellular calcium ions results in the activation of proteases within the cells. Those events may lead to cytoskeletal physical damages and result in the injury of cells and death.

Under physiologic situations, antioxidants that are endogenous such as glutathione peroxides and superoxide dismutase and catalase usually prevent the damage of oxidation from superoxide dismutase and catalyze the formation of hydrogen peroxide from the conversion of superoxide (Suter, 2016). A collection of genes known as vitagenes prevents the occurrence of homeostasis during strain. This group consists of a group of proteins, HO-1, and Hsp32 that absorbs heat. Generally, the inflammatory response occurring in the brain is different from that in other organs. On the contrary, brain microglia are activated and forced to release mediators of inflammation.

In phase 3, events including hypotension, ischemia, increase in intracranial pressure, swelling of the brain and failure of metabolism processes further perturb the functionalities of the brain as in phase 2, These insults occur in an extended period after the injury and are convenient targets of therapeutic intervention measure. In human TBI, hypotension and hypoxia occur in 30% of victims of TBI (Suter, 2016). Hypotension is similarly a result of poor outcomes after Traumatic Brain Injury. Incidences of hypoxia are particularly significant as they cannot be directly associated with death, notably, they are independently predictive of death and occur despite medical attention

Post-traumatic ischemia has been portrayed in both humans and animals. The factors causing post-traumatic ischemia are among others physical damages to the blood vessels, hypotension and insufficient endogenous vasodilators (Suter, 2016). Metabolic failure results from the dysfunction of mitochondria, insufficiency of a pool of nicotine coenzymes and intramitochondrial overload. It is a scenario in which transmembrane ionic fluxes and neuroexcitation are not met by the blood flow. Phase 4, is portrayed to represent functional and the recovery outcomes that are a result of both the primary and secondary damage responses. Efforts have been put in place to reverse pathogenesis with concern on treating the acute injury beyond this actual phase.

Psychosocial Issues Common to People Experiencing Traumatic Brain Injury

The problems associated with psychosocial consequences such as loneliness and depression occurring with a good number of TBI affected individuals create a major stumbling block for recovering patients. Despite the recovery of full functionalities of the brain within months ranging from four to six months after the recuperation from the time of injury, the above complications associated with psychology consistently remain persistent for extended periods of time. Research suggests that these mental problems linked to Traumatic Brain Injury are a principal concern facing efficient rehabilitation of affected individuals. The results of various studies propose that individuals experiencing TBI are more susceptible to significant anti socialization with other people or peers. The second finding indicates that the affected individuals find hard times setting up new social cycles. The third suggestion as in proposals relates to the drop in leisure activities for individuals with TBI. Finally, depression is affiliated with severe TBI that has lasted for a longer time.

Social Work Intervention Strategies

Patient Education

There is limited possible physical proof supporting the effectiveness of early education among TBI patients. The evidence remains factors and considerations as opposed to how they have been put in literature. The education component that is utilized as an intervention measure includes verbal communication or booklets explaining to the affected TBI patients on what diagnosis and possibles symptoms are. The purpose of closely educating TBI patients is recommended in order to make the symptoms appear normal. This minimizes distress about the symptoms (Brunner, Togher, Palmer, Dann, & Hemsley, 2019). The reassurance element of TBI intervention involves a verbal professional explanation of the possible signs that might come up and encouragement on positive recovery. The goal of this component provides clues on better ways to cope up. According to Brunner et al. (2019), patient education elements and reassurance have proven effective in minimizing distress.

Psychological Interventions

A review by Brunner et al. (2019) on TBI observed finite evidence of any beneficial impacts of nonsuicidal therapy on stress mental strain disorders after patients’ recovery from TBI. There is also limited proof of comprehensive behavioral therapy integrated with rehabilitation measures and apprehension among the early stages of TBI victims. Research has also reported good results associated with comprehensive behavioral therapy (CBT) after mild TBI but more designs are needed to better monitor the effect (Brunner et al., 2019). Due to the high prevalence of symptoms associated with the psychiatry after mild TBI, psychological interventions such as CBT are further modified to meet the needs of the affected individuals for further understanding.

Cognitive Rehabilitation

Cognitive rehabilitation after mTBI has been researched upon. Statistical trials on the effect of different programs of rehabilitation with elements of therapy signs and symptoms of TBI yields a positive result. A review by Weiss, Collett, Kaplan, Omert, and Leung (2018) on the effect of comprehensive rehabilitation of TBI claimed that training to compensate for memory recovery proves effective. These strategies involved both visual and imagery support aids. Due to the interventions involved in education that was in comparison with ordinary care, specific components and a good number of other concerns such as frequent contact of the mTBI individuals were responsible for the positive results (Weiss et al., 2018).

Policy, Organizational, and Biotechnological Issues

The National Association of County and City Health Officials (NACCHO) are in direct support for research, intense surveillance and advancement on strategies preventing traumatic brain injury (TBI). This support ensures improved long-term TBI management and minimizes its effects (Bhatnagar, Iaccarino, & Zafonte, 2016). NACCHO recognizes the fact that TBI is a social and global health concern and draws attention to a critical responsibility to respective departments. NACCHO recommends the local, state, and federal governments of the US to be in constant support of the general strategies such as the development of a standard definition for TBI. That is to research on longitudinal studies associated with prevention, management, and treatment in some cases.

Monitoring of TBI by creating and maintaining a national TBI database system is also a recommended strategy. Another recommendation is the allocation of sufficient resources to support prevention and treatment. Similarly, the adaptation, implementation, and evaluation of practice and evidence-based TBI intervention strategies for the vulnerable populations are recommended (Bhatnagar et al., 2016). Development of state systems entailing details of TBI victims that are coupled with public health systems to provide close care to TBI victims also proves a worthy strategy. Comprehensive and integrated effective community-based strategies to ensure that TBI survivors minimize further injury. Further, a close collaboration with various agencies and organizations is also a major strategy as proposed by research and experiments (Bhatnagar et al., 2016). Technological advancement is functional in neuroimaging. This, however, is associated with ethical derailments and setbacks and implications among the TBI patients.

Ethical Issues and Dilemmas

In various specific clinical environments handling rehabilitation services, the affected individuals must adhere to clinical evaluation that requires general homeostasis assessment.

The sequential psychosocial consequences that raise specific ethical concerns and dilemmas include the fact that TBI is sudden and in most cases unexpected. Physical functionalities of the body, emotional and behavioral systems are compromised as well. The outcome is in most cases not known nor defined. Only a small proportion of the population is affected hence the dilemma on how to address TBI patients. Life expectancy is likely to be shorter than it should be. Sensitivity and dignity for the affected individuals with respect to social boundaries also raise concerns. Treating their consequent impairments and socialization skills and weakness becomes a major challenge to worry about.



Critical Issues and Future Directions for Medical Treatment, Social Work

Intervention, and Policy Changes

According to Fuentes et al. (2018), a more modernized view on the interventions and policies of the state and general literature on research protocol attempts to simplify and define unresolved legal ethical issues pertaining to experiments with adults with traumatic brain injury. Remedies that protect the rights and prevent unnecessary impediments to the clinical inquiries are also demonstrated using standard protocols. Research protocol identifies a number of areas in the law affecting TBI among adults such as advanced directives on TBI, probate acts, power of attorney acts, surrogacy acts, health insurance portability and accountability (Fuentes et al., 2018). Bioethics literature that has been published and respective feedback responses from local Institutional Review Boards (IRBs) suggest that some of the unresolved ethical issues involved in experiments involve vulnerability, voluntary consent, choices and decision making using those who care as main subjects and multi-organizational agencies. There is a need for collaboration between members of IRB, administrators and other legal research institutions so as to develop strategies to resolve the dilemmas in TBI rehabilitation.

An urgent need for a clear regulatory law and guidelines on TBI has also been suggested by modern research experiments. TBI individuals’ rehabilitation has also been considered and has been given value for the quality of life and social interactions regarding outcomes of interventions and management of the disability. Although a cure is important, finding strategies on how to adapt has been fronted. This conceptualization has been of significant aid in promoting accommodation of individuals affected by traumatic brain injury. This consequently lures the medical and social and empowers people with the disability. The healthcare system has devised its policies as the industry adjusts to economic situations. Insurance companies continue to increase financing for the rehabilitation of TBI affected patients. There are several recognized alliances and organizations being registered making it more accommodative for TBI victims. Hospitals and hospital systems are also improving their service delivery by training their social workers and health care providers to cater for TBI victims.



Bhatnagar, S., Iaccarino, M. A., & Zafonte, R. (2016). Pharmacotherapy in rehabilitation of post-acute traumatic brain injury. Brain Research, 1640, 164-179.

Brunner, M., Togher, L., Palmer, S., Dann, S., & Hemsley, B. (2019). Rehabilitation professionals’ views on social media use in traumatic brain injury rehabilitation: Gatekeepers to participation. Disability and Rehabilitation, 1-10

Depression Anxiety Stress Scales (DASS-21): factor structure in traumatic brain injury rehabilitation. Journal of Head Trauma Rehabilitation, 32(2), 134-144.

Fuentes, M. M., Wang, J., Haarbauer-Krupa, J., Yeates, K. O., Durbin, D., Zonfrillo, M. R., … & Rivara, F. P. (2018). Unmet rehabilitation needs after hospitalization for traumatic brain injury. Pediatrics, 141(5).

Suter, P. S. (2016). Rehabilitation and management of visual dysfunction following traumatic brain injury. In Traumatic Brain Injury (pp. 323-370). CRC Press.

Weiss, E., Collett, A., Kaplan, M., Omert, L., & Leung, P. S. (2018). Complement inhibition mitigates secondary effects of traumatic brain injury (TBI). Critical Care Medicine, 46(1), 401.