Reflecting on a Self-Care Process in the Home Setting for Traumatic Brain Injury Survivors

Mary K. Coyle, MS APRN BC; Elisabeth Moy Martin, MA RNC

Disclosures

J Neurosci Nurs. 2007;39(5):274-277. 

In This Article

Abstract and Introduction

An estimated 5.3 million Americans are living with disabilities from traumatic brain injuries. Traumatic brain injury (TBI) can cause a wide range of functional changes affecting thinking, emotions, and behaviors, or a combination of any of these. Reflecting on a self-care process for patients in TBI home rehabilitation programs becomes critical for nurses who desire to optimize patient functioning. As the young patients' brain plasticity impacts adjustments to deficits and injury, applying the self-care process in the home setting provides a natural healing environment. As TBI survivors recognize and regulate their own behaviors, application of nursing actions dynamically match this change.

The goal of traumatic brain injury (TBI) rehabilitation is to improve the patient's ability to function at home (Chestnut et al., 1999). Reflecting on a self-care process for patients in TBI home rehabilitation programs becomes critical for nurses who desire to optimize patient functioning. Each year in the United States an estimated 1.5 million people sustain a traumatic brain injury; 80,000–90,000 people experience long-term or lifelong disability associated with a TBI. An estimated 5.3 million people are living with disabilities from TBI (Thurman, Alverson, Dunn, Guerrero, & Sniezek, 1999). Traumatic brain injury can cause a wide range of functional changes affecting thinking or emotions, or a combination of these. With direct medical costs and indirect costs such as lost productivity totaling an estimated $60 billion in the United States in 2000 (Finkelstein, Corso, & Miller, 2006), examining the rehabilitation process is vital.

Self-care has merit in TBI rehabilitation for several reasons. Home rehabilitation programs for young adults assume that brain plasticity influences the ability to respond to injury naturally with minimal intervention (Salazar et al., 2000). Moreover, time is needed for TBI survivors to recognize and regulate their own behaviors (Ben-Yishay, Silver, Piasetsky, & Rattock, 1987). The report of the NIH Consensus Development Conference on the Rehabilitation of Persons with Traumatic Brain Injury (Chestnut et al., 1999) recommends that individuals with TBI have appropriate timing of therapeutic interventions. Therefore, providing services to match one's needs, strengths, and capacities, and modifying these services as needs change over time (Chestnut et al.), can be addressed within the self-care process.

Self-care is defined as behaviors "engaged in over time, performed by persons in stable or changing environmental settings and within the context of their patterns of daily living" (Orem, 2001, p. 255). In a self-care process, an individual's engagement in self-care behaviors is linked with prevention of complications (Cohen, Saylor, Holzemer & Gorenberg, 2000). Within the self-care process, recognizing and regulating behaviors are learned and performed with intent and within a person's stages of growth, development, health, and environment (Orem, 2001). Self-care behaviors occur within a context of time sequences (Orem, 1991) and support life and healthy function. Nursing research has shown that self-care changes over time (Braden, 1992, 1993; Dodd & Dibble, 1993; Kreulen & Braden, 2004). When people perceive "a threat to life or health, they assume responsibility toward themselves" by applying self-care behaviors (Orem, 2001, p. 53). Therefore, initiating and performing self-care encourages patients to reach expected clinical outcomes and is applicable to patients recovering from a TBI. This approach is especially relevant as the assessment and prevention of unhealthy behaviors is paramount after TBI. In this article, a home rehabilitation program is viewed retrospectively to illustrate the application of a self-care process to TBI home rehabilitation. A case scenario is provided to demonstrate components of this dynamic process.

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