title: Using an evidence-based care bundle to improve initial emergency nursing management of patients with severe traumatic brain injury.
abstract: OBJECTIVE
  To test the feasibility of an evidence-based care bundle in a Thai emergency department. The specific objective of this study was to examine the impact of the implementation of the care bundle on the initial emergency nursing management of patients with severe traumatic brain injury.
  
  
  BACKGROUND
  A care bundle approach is one strategy used to improve the consistency, quality and safety of emergency care for different patients groups, however, has not been tested in patients with severe traumatic brain injury.
  
  
  METHODS
  A pretest/post-test design was used. The study intervention was an evidence-based care bundle for initial emergency nursing management of patients with severe traumatic brain injury.
  
  
  METHODS
  Nonparticipant observations were conducted between October 2012-June 2013 at an emergency department of a 640 bed regional hospital in Southern Thailand. The initial emergency nursing care was observed in 45 patients with severe traumatic brain injury: 20 patients in the pretest period and 25 patients in the post-test period.
  
  
  RESULTS
  There were significant improvements in clinical care of patients with severe traumatic brain injury after implementation of the care bundle: (1) use of end-tidal carbon dioxide monitoring, (2) frequency of respiratory rate assessment, (3) frequency of pulse rate and blood pressure assessment, and (4) patient positioning.
  
  
  CONCLUSIONS
  This study demonstrated that implementation of an evidence-based care bundle improved specific elements of emergency nurses' clinical management of patients with severe traumatic brain injury.
  
  
  CONCLUSIONS
  The study suggests that a care bundle approach can be used as a strategy to improve emergency nursing care of patients with severe traumatic brain injury.
authors: School of Nursing and Midwifery, Deakin University, Burwood, Vic., Australia.|Faculty of Nursing, Prince of Songkla University, Songkhla, Thailand.
authors: Jintana
authors: J
authors: Damkliang
authors: Eastern Health - Deakin University Nursing & Midwifery Research Centre/Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Deakin University, Burwood, Vic., Australia.
authors: Julie
authors: http://orcid.org/0000-0003-3801-2456
authors: J
authors: Considine
authors: School of Nursing and Midwifery, University of Plymouth, Plymouth, UK.
authors: Bridie
authors: B
authors: Kent
authors: Eastern Health - Deakin University Nursing & Midwifery Research Centre/Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Deakin University, Burwood, Vic., Australia.
authors: Maryann
authors: M
authors: Street
mesh_terms: D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000451:nursing*; D016529:Emergency Nursing; D004636:Emergency Service, Hospital; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D064872:Patient Care Bundles; D013785:Thailand; D055815:Young Adult
keywords: Thailand; brain injury; care bundle; emergency nursing; evidence-based practice; neurotrauma; trauma