Behavior Management And Traumatic Brain Injury
Having had a great deal of experience as a Registered Nurse on Rehab units for over 13 years, I was able to obtain a lot of knowldge and expereince related to head injuries. One of the most helpful and memorable inservices I attended was during the time I was on a Rehab unit that utilized a Rehab Psychiatrist in the case management of our patients. He gave a presentation about the anatomy, physiology of Truamatic Brain Injury and dealing with the behaviors created by the injury. For me, one of the most frustrating behaviors displayed by patients with traumatic brain injury was that of perserveration. One of my patients was a young man who had ben injured when on the job and one of the logs in the logging truck ahead of him broke loose from the truck and careened right into his windshield... and his forehead. When he arrived to our Rehab unit, he had minimal physical limitations, with some right sided weakness, but had many cognitive deficits. Our goal was to improve his cognition and behaviors so that he would be able to go home to his wife and 2 year old son. Usually mild mannered, his perseveration episodes would escalate into uncontrolled anger and personal discomfort. This young man would come up to the nurse's station and say over and over "I want to go home". At first I would try to explain why he couldn't go home, explain his injury and the criteria for his discharge. And who was brain damaged? This young man had an attention span of about 2 minutes, max; there was no way he was able to follow what I trying to relay to him. After listening to our psychiatrist's pressentation, I changed my approach with much better outcomes. When our patient would tell us repeatedly that he wanted to go home, I would set some boundaries about his behavion and our expectations. For instance, I would tell him we would talk about it in 15 minutes. Then every time he would tell us he wanted to go home, I would tell him he could watch tv or go to his room unti we would talk about it in 15 or 12 minutes, whatever the time was. I had my script, and I felt much more in control of the situation. Having that feeling of control, probably mostly of myself, I had much more patience and tolerance for my special patient and wa sable to be more open to his feelings.
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