الفهرس 
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Abstract
SUMMARY
Traumatic brain injury (TBI) is a global health and socio-economic problem, resulting in significant disability and mortality. Malnutrition is common in TBI patients and is associated with increased vulnerability to infection, higher morbidity and mortality rates, as well as longer stays in the intensive care unit and hospital. Following TBI, various pathophysiological mechanisms, such as hypermetabolism and hypercatabolism, affect patient outcomes (Hipskind et al., 2020).
It is crucial to provide adequate nutrition therapy to prevent secondary brain damage and promote optimal recovery. The focus is on determining energy requirements, timing and methods of nutrition delivery, promoting enteral tolerance, providing enteral nutrition to patients receiving vasopressors, and implementing trophic enteral nutrition. Enhancing our understanding of the current evidence regarding appropriate nutrition practices will contribute to improving overall outcomes for TBI patients (Lewis, et al., 2020).
Aim of the study:
This study aimed to assess influences associated with altered nutrition among patients with traumatic brain injury through the following:
1. Assessing nurses’ related factors including nurses’ level of knowledge and practice related to altered nutrition among patient with traumatic brain injury.
2. Assessing patients’ related factors including risk factors and nutritional outcome among traumatic brain injury.
Research Question:
This study was conducted for answering the following question:
1. What are the influences affecting nutrition among patients with traumatic brain injury?
Research design:
A descriptive exploratory research design was used in conducting this study.
Setting:
This study was conducted at surgical ICU and Emergency ICU at Tanta university hospitals Tanta/ Egypt.
Subjects:
A convenience sample of all available nurses (50 nurses) who work in surgical ICU and in emergency ICU affiliated to Tanta University Hospital.
A purposive sample of 100 adult patients, with trauma were selected to conduct this study through the following inclusion criteria patients who suffering from moderate to severe traumatic brain injury with various level of consciousness after 48 hrs., from date of admission until discharge.
Tools for data collection:
Three tools were used in this study as the following:
1) Nurses’ self-administered structured questionnaire: (Appendix I).
This tool was developed by the investigator in a simple Arabic language after reviewing the relevant literature and it was divided into the following two parts:
Part I: This part was used to assess demographic characteristics of the studied nurses such as age, educational level, years of experience and previous training courses.
Part II: This part was concerned with assessing nurses’ knowledge regarding traumatic brain injury and its associated with altered nutrition. It was developed by the investigator based on the related literatures Hipskind, et al., 2020; AlEssa, et al., 2018; Zhao, et al., 2018; Bourgault et al., 2016; Damkliang, et al., 2013.
2) Nurses’ practice observational checklist. (Appendix II).
This tool was developed by the investigator in English language related to reviewing literature Gong, et al., 2019; Blaser, et al., 2018; Zanetti, 2018; Chapple et al., 2016; Varley & Muaureen 2014 to assess nurses’ practices regarding altered nutrition for patients with traumatic brain injury. This tool covered different procedure including (vital signs assessment, nasogastric tube feeding care, parenteral feeding administration and Glasgow coma scale assessment).
3) Patients’ related factors assessment tool. (Appendix III).
This tool was adapted from; Lewis, et al., 2020; Chakroun-Walha, et al., 2019; Simpson & Doig 2019; Wang, et al., 2017; Elia 2015; Hsu et al., 2015 and was modified by the investigator based on the related literature. It was filled by the investigator so it was written in English language. It was composed of three parts:
Part I: This part used to assess demographic characteristics of studied patients such as age, gender, marital status, occupation, level of education, family size, monthly income, total ICU length of stay, clinical discipline and reason for admission.
Part II: This part was concerned with assessing patients’ medical data; drugs used; it included also total intake and total output during day of collecting patient data.
Part III: This part was concerned with assessing patients’ nutritional status. It is used to assess: methods of food administration, physical examination, anthropometric measurement and biochemical measurements, nutritional related risks, gastrointestinal and nutritional related problems and complications of enteral and parenteral feeding.
Result of the study:
The main results of this study revealed that:
More than half of the studied nurses (82%) had satisfactory of total of nurses’ knowledge.
More than half of the studied nurses (74%) had satisfactory of total of nurses’ practice.
More than half of studied patients (76%) were on nasogastric tube.
More than half of studied patients (74%) were suffering from obesity on admission.
Majority of the studied patients (90%) were suffering from dehydration and electrolytes imbalance, (95%) suffering from hyperglycemia.
There was highly statistically positive significant correlation between nurses’ total knowledge of the studied nurses with their total practice.
There was a statistically significant negative correlation between total complications of the studied patients with their Albumin and Ca. Also there was a highly statistically significant negative correlation between total complications of the studied patients with their Hb.
Conclusion:
Based up on the result of current study, it concluded that:
The majority of studied nurses had satisfactory total level of knowledge and practice with statistically between them. Moreover, there were many influences associated with altered nutrition among patients with traumatic brain injury included; most of them suffering from obesity on admission. The most nutritional risks were inflammatory bowel diseases and gastritis, while, the lowest were liver diseases. As well as, the majority of them were suffering from vomiting, hyperglycemia, dehydration, electrolytes imbalance as consequences of enteral and parenteral feeding. Moreover, there was a significant negative correlation between total complications of studied patients and their Hb, Albumin and Ca.
Recommendations:
Based on the findings of the present study suggested the following recommendations:
In service:
1. Establishing health educational programs in the hospital concerned with nurses’ role in assessment and management of altered nutrition among patients with traumatic brain injury.
2. Provide educational media for patient post TBI including posters, handout, booklets or brochures about nutritional management as a part of a rehabilitation therapy.
In research:
1. Replication of the study on a large probability sample selected from different geographical areas in Egypt is recommended to obtain more generalizable data.
2. Further studies should test the relationship between the nutritional status and the length of stay in ICU, hospital and rehabilitation center stay.
In practice:
1. Developing a nutritional assessment sheet to evaluate nutritional status daily during patient’ hospitalization as a part of nurses’ assessment role.