Traumatic brain injury (TBI) affects over 1.4 million Americans every year. Interdisciplinary care focuses on treating the primary brain injury and limiting further brain damage from secondary brain injury. Intensive care unit (ICU) nurses have an integral role in preventing secondary brain injury; however, little is known about how ICU nurses make judgments when managing secondary brain injury. The purpose of this study was to examine how physiological, situational, and nurse variables influenced ICU nurse judgments about patient risk of secondary brain injury and determining appropriate levels of intervention.
This study was guided by social judgment theory and incorporated a multiple segment factorial survey design. Vignettes reflecting the complexity of real life patient scenarios were randomly generated using different values of each independent variable. Anonymous vignette surveys were administered to ICU registered nurses from two Level I trauma centers. Multiple regression was used to examine which variables influenced judgments about secondary brain injury.
Sixty seven nurses completed study surveys. Judgments about risk for secondary brain injury were influenced by oxygen saturation (O2sat), intracranial pressure (ICP), cerebral perfusion pressure (CPP), mechanism of injury, primary diagnosis, and nursing shift. Judgments about level of intervention were influenced by O2sat, CPP, and nursing shift. The initial judgments made by nurses were the most significant variable predicting follow up judgments.
Findings from this study provide information about factors influencing nurse judgments when managing secondary brain injury. This information will serve as the basis for future educational initiatives for nurses, which may improve management of secondary brain injury and improve patient outcomes.