• Lisa Letzkus, Jessica Keim-Malpass, Joel Anderson, and Christine Kennedy.
• University of Virginia School of Nursing, Charlottesville, VA, USA; University of Virginia Children's Hospital, Charlottesville, VA, USA. Electronic address: lmc8c@virginia.edu.
• J Pediatr Nurs. 2017 May 1; 34: e17-e21.

BackgroundParoxysmal sympathetic hyperactivity (PSH) produces symptoms of autonomic instability and muscle over-activity; however, the majority of nursing interventions used in clinical practice are anecdotal and not evidenced based.ObjectiveThe primary objective was to report nursing documentation of PSH events, and to describe the clinical nursing interventions and care provided to children who have suffered a severe brain injury and are exhibiting PSH. The secondary objective was to demonstrate how the Symptom Management Theory (SMT) can serve as a framework for research related to brain injury and PSH.MethodologyThe study consisted of a retrospective chart review of nursing progress notes using direct content analysis. The nested sample of ten randomly selected charts was chosen from a larger quantitative study of 83 children who had suffered severe brain injuries with and without PSH. Textual analysis of verbatim nursing progress notes was used to describe nursing interventions that were used and documented for this patient population.ResultsThe priority nursing interventions to manage these symptoms included medication administration, facilitation of family presence, and strategies to target auditory, tactile, and visual stimuli. The sample received different individual interventions for PSH. Additionally, individual subjects demonstrated different patterns of interventions.ImplicationsWhile tactile interventions were documented most frequently, there was not a uniform approach to interventions. The SMT can be useful to provide a framework that organizes and tests clinical care and management of PSH strategies.Copyright © 2017 Elsevier Inc. All rights reserved.

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