The growing realization that health is an antecedent of sustainable development has justified the need for countries across the world to be cautious of underlying determinants and constraints and invest in informed strategies in an attempt to deliver the desired outcomes. Veteran health lends itself to the topic as one of the issues gaining importance. This direction is particularly motivated by the debilitating nature of battlefield experiences that rob veterans of their resilience. Having surrendered their military careers, veteran men and women are still expected to play a leading role in their families. Long-serving veterans experience significant problems after retirement due to health issues associated with combat experience that deny them an opportunity to lead normal lives. Traumatic brain injury, which follows from forceful head blows or penetration by sharp objects, such as bullets, is one of the critical conditions affecting their health. Notwithstanding, the healthcare practice is characterized by concerns that the condition is not receiving a satisfactory response, an attribute of the escalating problem. This paper proposes a study to examine the significance of nurse training in the management of traumatic brain injury among veterans. The paper tentatively hypothesizes that nurse training, if done well, can significantly help address the underlying issues.
Background and Problem Statement
Traumatic brain injury is common among veterans. As documented by Lindquist, Love and Elbogen (2017), the condition is one of the signature injuries of military combat. Indeed, it accounts for 17.3 percent of veteran's injuries. Traumatic brain injury often primarily results from blasts, accounting for 33.1 percent of the cases. Other significant causes include hitting the head and falls, which are responsible for 31.7 percent and 13.5 percent of the traumatic brain injury cases respectively (Lindquist, Love & Elbogen, 2017). It has been linked to other conditions such as post-traumatic stress disorder (Williams et al., 2017). Therefore, with the rise in military interventions across the world, one can expect that the number of veterans with the conditions will increase. The healthcare system is mandated to provide services to all, a process that can be achieved by availing tailored intervention for diverse groups of people such as veterans. Besides, health support is one important way of reciprocating to the armed forces for their earnest sacrifice. Indeed, military service is one of the risky professions that involve sacrificing individual lives for the sake of their countries. Therefore, veteran soldiers can be conceived as the lucky survivors who must receive special health attention. However, there is a lacuna between the current health outcomes and desired goals. The training of nurses holds promise for a responsive practice but, as will later be elaborated in the literature review section, its practicality is potentially overshadowed by the lack of understanding on various substantive issues such as what the training should entail, the fragmented research evidence on what works, and how it should be implemented among others. Consequently, the question of how nurse training can be harnessed to improve the effectiveness of the practice in the management of traumatic brain injury becomes an issue of interest for research.
Literature Review
Although a plethora of literature facing the topic exists, it does not adequately respond to the underlying research questions. At its best, it only provides an opportunity to conceptualize the problem, draw a clear scope of the subject matter, unearth the knowledge gaps, reframe the research questions, hypothesize, and justify the need for research. The most prominent themes in literature are that traumatic brain injury is prevalent with far-reaching consequences on victims and counts on nursing competence, yet limited professional knowledge is one of the impediments to the effective management of the condition.
For instance, Seal et al. (2016) document the criticality of traumatic brain injury to veteran's resilience. Based on the survey of veterans returning from combat and peacekeeping missions in Afghanistan and Iraq, the study reports that many of the victims of traumatic brain injury reported various mental conditions such as post-traumatic stress disorder and generalized anxiety disorder, as well as reduced cognitive functions. As significant as 70 percent of the veterans with traumatic brain injury were found to be suffering from post-traumatic stress disorder, while 45 percent exhibited generalized anxiety disorder. These findings create an allowance to infer that traumatic brain injury is a serious condition that should not be overlooked. They also justify the need for early interventions.
Meanwhile, Orff, Hays and Twamley (2016) examined the satisfaction of society and families with how traumatic brain injuries are managed. The findings show that practice receives a low satisfaction rating. Issues of lack of patient-centered intervention, inaccurate condition assessment, lack of evidence-based information, and misconceptions about veteran care are notable impediments to providing the desired intervention. This information justifies the need to continue thinking about how the practice can be improved, including investing in research. Moreover, Oyesanya et al. (2016) reveal that nurses have various misconceptions regarding the management of traumatic brain injury. This misconception is attributed to the lack of adequate training, and it plays a crucial role in limiting the effectiveness of interventions. Several scholars, such as Fukada (2018) and Paradiso and Lally (2018), further cite the lack of responsive nurse training and preparedness to meet the demands of the knowledge economy. Retrospectively, the relevant literature provides an opportunity for one to speculate that there is still a lot that needs to be done concerning nursing knowledge and competence levels to enable them to respond effectively to the demands of the practice. In this regard, there is a need to conduct a study to test the significance of a training program tailored toward traumatic brain injury among veteran soldiers.
Summary of the Evidence for the Proposed Study
The evidence of the proposed study lies in primary research. The primary research provides an opportunity to test the theory and bridge the gaps in existing research information. An elaborate way to probe the subject is to inquire the self-efficacy on nurses before and after a basic training program.
Research Question, Hypothesis, and Variables
Research Question
The primary research question is, will basic nurse training on the traumatic brain injury assessment and symptom identification tailored towards veterans lead to a significant improvement in the self-efficacy relating to the management of the condition?
Hypothesis
The substantive hypothesis states that nurse training on the traumatic brain injury assessment and symptom identification tailored towards veterans lead to a significant improvement in professional self-efficacy. The alternative hypothesis states that nurse training on the traumatic brain injury assessment and symptom identification tailored towards veterans does not lead to significant improvement in professional self-efficacy.
Variables
In this case, the independent variable is nurse training. The dependent variable is improved self-efficacy.
Theoretical Model: Benner's From Novice to Expert Theory
This proposed study is underpinned by Benner's theory of From Novice to Expert. This model recognizes that nurses are not born all-knowing and competent people. Instead, knowledge and competence are a product of learning and experience. In the quest for competence, nurses progress through five stages, namely novice, advanced beginner, competent, proficient, and expert (Oshvandi et al., 2016). Knowledge applied in nursing is an extension of practical expertise that comes through research and clinical experience.
Application of Theory to Study
The proposed study valorizes Benner's From Novice to Expert Theory through its contention that nurse training can help foster competence in the management of traumatic brain injury. Indeed, the bottom-line of its motivation is that the current practice challenges are attributable to nurses lacking the desired level of knowledge. As a result, through training, these novices can be supported to progress through advanced beginner, competent, proficient, and become experts.
Methodology
Sample
The target population of interest is nurses working in veteran acute care settings. Notices regarding the research will be made and posted around local hospitals and letters sent to relevant faculties. Interested nurses will be subjected to inclusion and exclusion criteria. To be included in the research, the nurses must be certified professionals, working with veterans, and must have a working experience of at least 3 years. Nurses who do not meet this criterion will be excluded.
Research Design
The participants will be assessed regarding their knowledge of the traumatic brain injury assessment and symptom identification using a tailored self-efficacy and competence questionnaire. They will then be subjected to a 1-month basic training on traumatic brain injury management tailored to veterans.
Measurement Strategy
At the end of the training session, the participant's level of knowledge and self-awareness will be assessed using the tailored self-efficacy and competence questionnaire. Another assessment will be undertaken three months later to follow up on how the participants are fairing with practice. The bottom line will be to compare between pre and post-training levels of awareness and self-efficacy rating.
Data Collection Procedures
The data collection procedure will involve the use of a questionnaire. The questionnaire will be semi-structured to allow the researcher to capture the various elements for elaboration. It will also be designed to comprise the Linkert scale to allow objective assessment of various self-efficacies and competence constructs.
Data Analysis Plans
The proposed data analysis plan will be both qualitative and quantitative. Qualitative analysis will be used in analyzing variable elements that cannot be quantized, such as perceptions, views, and attitudes of the respondents. Quantitative analysis, which will involve the calculation of measures of central tendencies such as means and standard deviations, will be particularly used to assess the differences between pre-test and post-test self-efficacy ratings registered by participants.
Ethical Issues
Since the study will involve human participants, it is potentially sensitive to various research ethical issues such as privacy, confidentiality, beneficence, and non-maleficence. To address these issues, consent will be sought from participants ahead of research. The participants will sign a form to show they consented. They will be assured of confidentiality by keeping the data anonymous. Besides, they will be assured that the derivative information will not be used for any other purposes other than research. Finally, permission for research will also be sought from relevant authorities such as the faculties and veteran hospitals.
Implications for Practice
The proposed research is poised to go a long way in informing the practice regarding what needs to be done about the management of traumatic brain injury to assure desired outcomes among veterans. The findings will also bridge the gap in evidence-based information on what works regarding nurse training.
Conclusion
In conclusion, this paper proposes a study to examine the significance of nurse training for the management of traumatic brain injury among veterans. Its rationale is premised on the contention that there is a lacuna between the current health outcomes and desired goals. Moreover, although the training of nurses holds promise for a responsive practice, its practicality is potentially overshadowed by the lack of understanding on various substantive issues such as what the training should entail, the fragmented research evidence on what works, and how it should be implemented among others. The proposed research purposes to shed light on these grey areas.