Sentinel events during the transition from hospital to home: A longitudinal study of women with traumatic brain injury
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Objective: To describe the occurrence of sentinel events and their influence on community integration of women with traumatic brain injury (TBI) transitioning from hospital to home. Design: A longitudinal study was completed with data collected before and at 1, 3, and 6 months after hospital discharge. Setting: Brain injury rehabilitation unit and acute neuroscience ward. Participants: Women (NZ25) with severe TBI (aged between 17 and 50 years; duration of posttraumatic amnesia ranged from 1 to 123d). Sixteen family caregivers also participated. Interventions: Not applicable. Main Outcome Measures: Community integration was measured using the Mayo-Portland Adaptability Inventory. Depression, anxiety, and stress were measured using the Depression Anxiety Stress Scale. The Sentinel Events Questionnaire was used to record life events that potentially influence the transition process. Results: Most women (>16 at each time point) experienced mild to moderate impairments in psychosocial integration. A third of the sample reported symptoms of depression (nZ8), anxiety (nZ9), and stress (nZ7) that exceeded clinical cutoff levels on at least 1 occasion. At 6 months, 3 women reported clinically significant depression and anxiety (12%) and 2 reported significant stress levels (8%). Positive sentinel events such as return to meaningful occupation were common (nZ14). Negative sentinel events were also quite common. For example, reduced access to therapy, reported by 10 women, was associated with poorer participation levels. Conclusions: These findings suggest that the presence of sentinel events influences the transition experiences of women with TBI in this sample. Rehabilitation should consider the occurrence and impact of sentinel events because this may facilitate successful transitions.
Archives of Physical Medicine and Rehabilitation
© 2016 The American Congress of Rehabilitation Medicine. Published by Elsevier Ltd. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Licence (http://creativecommons.org/licenses/by-nc-nd/4.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, providing that the work is properly cited.
Clinical Sciences not elsewhere classified