Redirecting Maladaptive Behaviors in Brain Injury Patients in Nursing

Traumatic brain injuries (TBIs) are common causes of human disability provoked by sudden physical damage to the brain. They are usually unpredictable, and their consequences vary depending on various physiological, psychological, and environmental factors. Maladaptive behaviors may be observed in brain-injured patients, leading to challenges in adapting and understanding circumstances at any age. Nurses and other healthcare providers are responsible for recognizing the damage and applying pharmacological and non-pharmacological interventions to help people manage their challenging behaviors (Block et al., 2020). Identifying cognitive impairments is based on the continuum of care, which requires increased nursing knowledge and assessment (Oyesanya et al., 2018). Communication, education, family support, and clinical guidelines are also integral for patient improvement and redirecting maladaptive behaviors. This literature review aims to identify the major characteristics of brain injuries, maladaptive behaviors, and nursing roles in promoting effective communication, cognitive-behavioral therapies based on coping strategies, and medication treatment for TBI patients.

Project Importance

There are several reasons for choosing the theme of managing maladaptive behaviors in brain-injured individuals as the current nursing problem. First, Dash and Chavali (2018) define TBI as a long-lasting and serious but silent epidemic with high mortality and morbidity ratings. This problem does not depend on age, gender, or racial background and might affect any population in developed and developing countries. Second, brain injuries are characterized by lingering changes, unpredictable consequences, and disabilities (Cripe et al., 2021). Thus, despite the level of care offered to patients, some problems are hard to overcome. Nurses need to know what kind of help to provide for people with brain injuries and redirect their maladaptive behaviors.

Brain Injuries and Maladaptive Behaviors

Despite the intention to protect the human brain, some injuries happen suddenly and provoke serious damage to the body. In addition to evident physiological traumas, the effects of TBIs on people’s behaviors include difficulties in impulse control, inabilities to regulate emotions, agitation, apathy, and low self-esteem levels (Block et al., 2020; Cripe et al., 2021; Mueller et al., 2018). Sometimes, patients understand that their changes are caused by brain injuries and accept care from professionals to improve their physical and mental health conditions. However, most hospitalized patients with TBIs do not understand what has happened and what causes their temporary or constant disabilities, and the nursing staff should pay careful attention to their support and care (Dash & Chavali, 2018). Therefore, nursing interventions should be directed to manage such maladaptive behaviors as anger, aggression, anxiety, depression, sexual or social disinhibition, apathy, or absconding (Block et al., 2020; Mueller et al., 2018). Communication and cooperation with family members are usually required to clarify patients’ typical behaviors and health peculiarities to avoid unnecessary or ineffective treatment and choose the correct form of treatment.

Nursing Beliefs and Attitudes

Immediate or chronic cognitive impairments are observed in patients with brain injuries, and nursing care should include regular assessments and follow-ups to predict the worsening of health later. The role of nurses in treating TBI patients is great, underlying the level of knowledge and professionalism in modifying care and accommodating cognitive impairments (Oyesanya et al., 2018). Maladaptive behaviors should be timely redirected to prevent new physical injuries and behavioral changes (Oyesanya et al., 2018). Brain injuries might be mild, moderate, and severe, which explains impaired consciousness and post-traumatic amnesia in patients characterized by disorientation and confusion (Block et al., 2020). Behavioral disturbances and memory impairment create certain barriers in nurse-patient communication. However, nurses also admit that inadequate resources, limited staffing, knowledge gaps, and poor practice might negatively affect psychological interventions (Oyesanya et al., 2018). Guidelines for nurses to direct TBI patients and offer interventions based on the classification of brain injuries are necessary to enhance nursing care and examine the steps that bring more positive health outcomes with time.

Communication

Redirecting maladaptive behaviors in TBI patients is one of the primary responsibilities of nurses and clear pharmacological treatment plans. Nurses should follow doctors’ prescriptions, recommendations, and clinical guidelines in most cases. At the same time, effective communication is another vital factor that might affect recovery and predict the development of other unpleasant behavioral changes (Mueller et al., 2018). Brain injuries make it difficult for patients to cooperate and communicate, and a nurse must retain and comprehend information (Oyesanya et al., 2018). Coordination of care and the assessment of patients define how nurses ask questions, make observations, and talk to family members. Still, there are situations when patients with TBIs remain impulsive or get angered for no reason, and nurses should ensure safety in their working environment. Oyesanya et al. (2018) identify missing changes or small details in patients’ behaviors as the possible explanation. In addition to communication with patients and families, successful redirecting maladaptive behaviors depends on cooperation between nurses and reports about concerns.

Coping Strategies

Developing and analyzing effective psychosocial and cognitive-behavioral interventions to support patients with TBIs have become a regular topic for multiple nursing and healthcare projects. Most researchers support coping as a good solution for nurses to manage constantly changing behaviors and impulsive demands of brain-injured patients (Lazarus & Folkman, 1984; Bohnen et al., 1992, as cited in Mueller et al., 2018). Maladaptive consequences may be solved with the help of emotion-based or problem-focused cognitive-behavioral strategies. When nurses work with patients, they need to adjust negative emotional reactions to stress or avoidance (Mueller et al., 2018). Problem-focused interventions aim to cope with the roots of challenges and use strategies to find alternatives. According to Mueller et al. (2018), coping is a very individual process, and the worth of nursing care is not to interfere but to stay close to give answers or pose provoking questions. In both cases, TBI patients have to identify their maladaptive behaviors and learn what they can do to prevent the damage or gain control of their thoughts and actions.

Pharmacological Interventions

After being recognized, diagnosed, and properly treated, brain injuries remain a dangerous factor for human health. It is not enough to analyze human behaviors and give some recommendations to improve socialization and communication. In nursing, pharmacological treatment as a part of a follow-up plan for TBI patients plays an important role. Therefore, some researchers underline the effects of medications, including their financial burden of $9.2 billion in medical expenses in the United States in 2000 (Dash & Chavali, 2018). Sedatives, anti-depressants, and anti-convulsants are effective for managing maladaptive behaviors like aggression or agitation (Block et al., 2020). Beta-blockers and neuroleptics result in quick sedation, which allows patients to protect themselves from unnecessary injuries and harmful behaviors by blocking dopamine receptors in the body system (Block et al., 2020). At the same time, Mueller et al. (2018) admit that drug abuse can be another form of maladaptive behavior in patients with brain injuries, and nurses must control medication intake to avoid dependence and misuse. More evidence and knowledge should be gained to understand the effects of pharmacological interventions on managing patients’ behaviors after brain damage.

Conclusion

In general, redirecting maladaptive behaviors in patients with brain injuries is a crucial nursing intervention. Sometimes, pharmacological treatment positively affects the person’s condition, and families neglect some recommendations and cognitive-behavioral therapies. However, nurses must continue their education and training to recognize their impact on the patient’s health and offer the best options to deal with sudden behavioral changes and unwanted emotional and physiological shifts. Cognitive impairments affect the level and quality of communication and cooperation between patients and nurses. Coping strategies help find alternatives and protect patients who experience anger, aggression, loneliness, and low self-esteem. TBIs are never simple health problems, and their consequences may be temporal or far-reaching. In nursing, protecting patients against harmful environments and their uncontrolled behaviors and emotions introduces the core of redirecting. A lack of evidence and convincing factors about pharmacological and non-pharmacological interventions cannot be ignored, and more studies should be developed to provide brain-injured patients with high-quality care and professional help in managing their maladaptive behaviors.

References

Block, H., George, S., Milanese, S., Dizon, J., Bowen-Salter, H., & Jenkinson, F. (2020). Evidence for the management of challenging behaviours in patients with acute traumatic brain injury or post-traumatic amnesia: An umbrella review.Brain Impairment, 22(1), 1–19.

Cripe, C. T., Cooper, R., Mikulecky, P., Huang, J. H., & Hack, D. C. (2021). Improved mild closed head traumatic brain injury outcomes with a brain-computer interface amplified cognitive remediation training. Cureus, 13(5).

Dash, H. H., & Chavali, S. (2018). Management of traumatic brain injury patients.Korean Journal of Anesthesiology, 71(1), 12-21.

Mueller, C., Wesenberg, S., Nestmann, F., Stubbs, B., Bebbington, P., & Raymont, V. (2018). Interventions to enhance coping after traumatic brain injury: A systematic review. International Journal of Therapy and Rehabilitation, 25(3), 107–119.

Oyesanya, T. O., Bowers, B. J., Royer, H. R., & Turkstra, L. S. (2018). Nurses’ concerns about caring for patients with acute and chronic traumatic brain injury.Journal of Clinical Nursing, 27(7-8), 1408-1419.

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Introduction