Caregiver stress in traumatic brain injury

Aims Many patients experience physical, behavioural, cognitive and emotional problems following traumatic brain injury (TBI). They may require continuing care for many years, most of which is provided by informal caregivers, such as spouses, parents, or other family members. The caregiving role is associated with a range of adverse effects including anxiety, depression, poor physical health and lowered quality of life. This article explores issues around caregiver stress; highlighting interventions for this group and areas for further research. Methods Literature exploring the impact of caregiving, its influencing and alleviating factors and interventions for caregivers of people with TBI is discussed, with brief critical analysis of key studies. Findings Research suggests that caregiver characteristics, coping strategies, their appraisal of the situation and social networks may be associated with the amount of distress experienced. Many caregivers have unmet needs such as respite care and information provision on TBI. Providing information may help to alleviate strain. Community-based family therapies providing education, support and counselling can help to decrease distress and improve aspects of family functioning, although evidence for these is lacking. Conclusions There is a need for more well-designed, controlled studies evaluating the impact of interventions to alleviate caregiver strain

Methodology in conducting a systematic review of systematic reviews of healthcare interventions

<p>Abstract</p> <p>Background</p> <p>Hundreds of studies of maternity care interventions have been published, too many for most people involved in providing maternity care to identify and consider when making decisions. It became apparent that systematic reviews of individual studies were required to appraise, summarise and bring together existing studies in a single place. However, decision makers are increasingly faced by a plethora of such reviews and these are likely to be of variable quality and scope, with more than one review of important topics. Systematic reviews (or overviews) of reviews are a logical and appropriate next step, allowing the findings of separate reviews to be compared and contrasted, providing clinical decision makers with the evidence they need.</p> <p>Methods</p> <p>The methods used to identify and appraise published and unpublished reviews systematically, drawing on our experiences and good practice in the conduct and reporting of systematic reviews are described. The process of identifying and appraising all published reviews allows researchers to describe the quality of this evidence base, summarise and compare the review's conclusions and discuss the strength of these conclusions.</p> <p>Results</p> <p>Methodological challenges and possible solutions are described within the context of (i) sources, (ii) study selection, (iii) quality assessment (i.e. the extent of searching undertaken for the reviews, description of study selection and inclusion criteria, comparability of included studies, assessment of publication bias and assessment of heterogeneity), (iv) presentation of results, and (v) implications for practice and research.</p> <p>Conclusion</p> <p>Conducting a systematic review of reviews highlights the usefulness of bringing together a summary of reviews in one place, where there is more than one review on an important topic. The methods described here should help clinicians to review and appraise published reviews systematically, and aid evidence-based clinical decision-making.</p

Head injury: long-term consequences for patients and families and implications for nurses

Background: Head injury as a result of trauma is an important cause of long-term disability. Recently published guidance from the National Institute for Clinical Excellence on Acute Head Injuries and a forthcoming National Service Framework for Long-Term Neurological Conditions provides renewed focus on this practice speciality. Aims and objectives: This article presents a narrative review of a range of quantitative and qualitative studies that have explored the impact of head injury and postinjury disabilities on patients' and families lives. Results: Patients may experience a range of physical, emotional, cognitive, social and behavioural problems after head injury that will have a significant impact on both their own and their families' everyday lives. It is important that the behavioural, physical and psychological aspects of head injury are addressed. Carers may be vulnerable to stress and anxiety as a result of their caring role. Conclusions: It is often in the longer term that the true complexity and impact of head injury may become apparent. Ongoing support, from a range of services, will be required to assist both patient and family to cope with their circumstances. Ensuring that practice is evidence based, it is necessary to conduct further research, both to explore the effectiveness of current service provision and investigate those aspects deemed important by patients and carers. Relevance to clinical practice: As nurses play an important role in both the acute and long-term care and support of those who have suffered a head injury, it is vital that they are aware of the wide ranging needs with which patients and families may present