The experiences of nurses working with patients who are agitated following moderate-to-severe traumatic brain injury: a qualitative study

BACKGROUND: Nurses are at the forefront of managing agitation after moderate-to-severe traumatic brain injury (msTBI), but little is known about their experiences. This study aimed to explore how nurses understand, experience, and manage agitation after msTBI in an inpatient rehabilitation setting. METHODS: A qualitative descriptive study using semi-structured interviews was used to understand the experiences of agitation after msTBI for 15 nurses (aged 20-61 years, 80% female) on an inpatient brain injury rehabilitation unit. Reflexive thematic analysis was completed on interview transcripts. RESULTS: Nursing experiences were characterized into four key themes relating to: 1) what nurses considered to be core features and causes of agitation; 2) factors they considered important in shaping agitation; 3) strategies they used to manage agitation; and 4) the challenges and rewards of working with patients at an early stage of recovery after TBI. CONCLUSIONS: Nurses had a detailed understanding of agitation after msTBI and its management. Managing agitation and PTA more broadly was experienced as physically, cognitively, and emotionally draining, yet it was seen as vital for supporting recovery and was personally meaningful for nurses. A lack of formal training and organizational support was a barrier to feeling competent and confident in the role.