• Molly McNett, Margaret Doheny, Carol A Sedlak, and Ruth Ludwick.
• Department of Nursing Research, MetroHealth Medical Center, Cleveland, Ohio 44109, USA. mmcnett@metrohealth.org
• Am. J. Crit. Care. 2010 May 1;19(3):250-60.

BackgroundInterdisciplinary care for patients with traumatic brain injury focuses on treating the primary brain injury and limiting further brain damage from secondary injury. Intensive care unit nurses have an integral role in preventing secondary brain injury; however, little is known about factors that influence nurses' judgments about risk for secondary brain injury.ObjectiveTo investigate which physiological and situational variables influence judgments of intensive care unit nurses about patients' risk for secondary brain injury, management solely with nursing interventions, and management by consulting another member of the health care team.MethodsA multiple segment factorial survey design was used. Vignettes reflecting the complexity of real-life scenarios were randomly generated by using different values of each independent variable. Surveys containing the vignettes were sent to nurses at 2 level I trauma centers. Multiple regression was used to determine which variables influenced judgments about secondary brain injury.ResultsJudgments about risk for secondary brain injury were influenced by a patient's oxygen saturation, intracranial pressure, cerebral perfusion pressure, mechanism of injury, and primary diagnosis, as well as by nursing shift. Judgments about interventions were influenced by a patient's oxygen saturation, intracranial pressure, and cerebral perfusion pressure and by nursing shift. The initial judgments made by nurses were the most significant variable predictive of follow-up judgments.ConclusionsNurses need standardized, evidence-based content for management of secondary brain injury in critically ill patients with traumatic brain injury.

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