title: Testing a reality orientation program in patients with traumatic brain injury in a neurointensive care unit.
abstract: OBJECTIVE
  The aim of this study was to examine the effect of a systematic reality orientation program (RO) introduced in a neurointensive care unit on duration of posttraumatic amnesia (PTA) and outcomes of patients with traumatic brain injury (TBI).
  
  
  METHODS
  This study used a quasiexperimental, prospective design.
  
  
  METHODS
  Twenty-four patients (intervention) with a significant TBI classified as moderate-to-severe injuries as measured by scores of less than 12 on the Glasgow Coma Scale underwent an RO program compared with a similar group of 38 patients (control) who received a conventional rehabilitation program. The Rancho Los Amigos Score was used to assess the cognitive level 24 hours after the end of sedation, and the Galveston Orientation and Amnesia Test was used daily to assess orientation and duration of PTA. The Glasgow Outcome Scale Extended was then used as an indicator of clinical outcome after 12 months.
  
  
  RESULTS
  The preliminary results indicated that patients who received the RO had a higher mean of the Glasgow Outcome Scale Extended (SD = 1.53) than those receiving the usual care (SD = 1.35) despite that the groups differed significantly (p = .01) in PTA duration.
  
  
  CONCLUSIONS
  Patients with TBI may benefit from early assessment and systematic RO nursing intervention. The RO may facilitate patients with PTA to regain orientation and interact with their surroundings in the neurointensive care unit to optimize the recovery. However, further studies with focus on timing, intensity, and duration are needed to evaluate the influence of an early RO approach on PTA and outcomes in patients experiencing TBI.
authors.affiliation: Dorte Holdgaard, RN SD MPA, is Head Nurse, Department of Neurosurgery, Aalborg, Aarhus University Hospital, Denmark. Lene Worning, RN, is a Nurse, Department of Neurosurgery, Aalborg, Aarhus University Hospital, Denmark. Jens C. Sørensen, MD PhD, is a Professor, Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark. Preben U. Pedersen, PhD, is a Professor, Director Centre of Clinical Guidelines, National Clearinghouse for Nursing, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
authors.forename: Leanne
authors.initials: L
authors.lastname: Langhorn
authors.forename: Dorte
authors.initials: D
authors.lastname: Holdgaard
authors.forename: Lene
authors.initials: L
authors.lastname: Worning
authors.forename: Jens C
authors.initials: JC
authors.lastname: Sørensen
authors.forename: Preben U
authors.initials: PU
authors.lastname: Pedersen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000647:Amnesia / Q000451:nursing*; D001930:Brain Injuries / Q000451:nursing*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D065816:Neuroscience Nursing; D009730:Nursing Assessment; D009949:Orientation; D017063:Outcome Assessment, Health Care; D011936:Reality Testing; D055815:Young Adult