This chapter describes maneuvers to access the internal system of the patient as well as means to accelerate or decelerate the work in that process of accessing the self-system. Eye movement desensitization and reprocessing (EMDR), ego state therapy, and somatic therapy fit together like hand and glove. An extended preparation phase is often necessary before trauma processing in complex traumatic stress presentations and attachment-related syndromes, particularly when dealing with the sequelae of chronic early trauma. Clinical practice suggests that the adjunctive use of body therapy and ego state interventions can be useful, during stabilization and later on in increasing the treatment response to EMDR. Traditional treatment of complex posttraumatic stress disorder (PTSD) and dissociative disorders has usually included hypnoanalytic interventions, during which abreaction is considered an important part of treatment.

This chapter discusses how delegation is a core competency for the nursing profession. It describes the principles of accountability applicable to effective delegation. The chapter then explores the key principles and four steps of the delegation process: (1) planning and assessment; (2) communication: "secret ingredient; of delegation"; (3) surveillance and supervision; and (4) evaluation and feedback. It discusses common pitfalls/challenges and both positive and negative outcomes resulting from delegation errors. Through reflective thinking and delegation activities using guidelines and algorithms, the readers can further strengthen their confidence and skill set. Further development and proficiency in delegation will continue throughout their commitment to lifelong learning and experiences. The "Five Rights of Delegation" are a guide for registered nurses to use to clarify the key elements of the delegation and decision-making process. The five rights are right task; right circumstances; right person; right direction/effective communication; and right supervision/evaluation.

Traumatic brain injury (TBI) causes two injury types: primary and secondary. In infants and young children, nonaccidental TBI is an important etiology of brain injury and is commonly a repetitive insult. TBI is by far the most common cause of acquired brain injury (ABI) in children and is the most common cause of death in cases of childhood injury. In 2009, the Pediatric Emergency Care Applied Research Network (PECARN) issued validated prediction rules to identify children at very low risk of clinically important TBI, which is defined as TBI requiring neurosurgical intervention or leading to death. The range of outcomes in pediatric TBI is very broad, from full recovery to severe physical and/or intellectual disabilities. Children and adolescents who have suffered a TBI are at increased risk of social dysfunction. Studies show that these patients can have poor self-esteem, loneliness, maladjustment, reduced emotional control, and aggressive or antisocial behavior.

Acquired brain injury (ABI), at any age, is a significant public health concern. It is particularly problematic in the elderly considering the increased rates of mortality and morbidity following ABI in this population. The aging brain demonstrates changes in the synthesis of key neurotransmitter, including dopamine and serotonin, and other chemicals important to brain health, such as brain-derived neurotrophic factors (BDNF). Formal diagnosis of various ABI causes may be relatively simple when given proper history and diagnostic tools. Prognosis following ABI is largely dependent on the etiology and the severity of injury and lesion location in the brain. Microvascular changes in the aging brain lead to attenuated cerebral blood flow, reduced vascularization of brain parenchyma, and increased cerebrovascular risk. Prevention of TBI for older adults should include behavioral and environmental adjustments to reduce fall risk.

This chapter explains paradigms of neurorehabilitation and explores the interdisciplinary and transdisciplinary nature of brain injury rehabilitation. Optimal rehabilitation of acquired brain injury (ABI) requires a multidisciplinary approach of trained rehabilitation specialists at appropriate timing and with appropriate intensity. Brain injury rehabilitation requires a comprehensive treatment program to reduce impairments and to restore function, participation and quality of life. Vocational rehabilitation specialist assesses an individual’s functional level and vocational potentials. Guiding principles for rehabilitation include all areas of therapy, namely, physical, occupational, cognitive, and speech-language therapy. Early functional rehabilitation in poststroke and traumatic brain injury (TBI) patients has been shown to improve functional outcomes and may decrease “learned nonuse.” Neurorehabilitation in the context of ABI continues to be a demanding challenge, which requires clinical translational approaches involving a multidisciplinary team.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) identifies 10 separate classes of substances related to significant substance abuse concerns. Of the 10 separate substance classes, four have more clearly documented patterns of pathophysiological sequelae and demonstrated impact on cognitive functioning. These substance categories include alcohol, inhalants, sedatives/hypnotics/anxiolytics, and stimulants. The remaining six substance clusters include caffeine, cannabis, opioids, hallucinogens, tobacco, and other or unknown substances. This chapter discusses the specific impact of each of these separate classes of drugs and related acquired brain injury on cognitive and emotional functioning. The clinical presentation associated with acquired brain injury related to substance use/misuse is variable. Most importantly, the patient will need to gradually reduce his benzodiazepine use so as not to facilitate “rebound anxiety.” Consideration should be given to anxiolytic medications that are not benzodiazepines, as well as to cognitive behavioral therapy, potentially including interceptive exposure.

Action Research (AR) is a “form of collective, self-reflective enquiry undertaken by participants in social situations in order to improve the rationality, coherence, adequacy or justice of their own social or educational practices, as well as the understanding of these practices and the situations in which these practices are carried out”. AR is a rich methodology and is a powerful approach for counselors to consider while improving their personal lives, counseling practice, and work with communities. This chapter introduces counselors to historical influences, key concepts, and essential approaches to AR. It discusses various approaches to inquiry in AR including first, second and third person approaches, participatory AR, and practitioner AR. First-person inquiry is a uniquely reflective process of inquiry. Through first-person inquiry one can develop their personal lives or professional practice through cycles of reflection, action, and evaluation.

The magnitude of U.S. healthcare spending has produced a crisis of epic proportions. In 2017, spending grew 3.9%, reaching $3.5 trillion or $10,739.00 per person and accounting for 17.9% of the national gross domestic product. Population health provides an opportunity to examine why people use or misuse the emergency department (ED) setting, and nurses can play a major role in reducing ED misuse. Regardless of the healthcare setting, all nurses have a responsibility to consider the health of the population and they have an opportunity to improve the same. Opportunities include teaching those who misuse the ED about more appropriate care settings and resources and initiating appropriate referrals. Nurses also can educate patients about health and disease management, guiding them on the path of wellness while showing concern, compassion, and caring. Nurses can educate these patients about ways to avoid future preventable hospitalizations or ED visits.

Nurses caring for people with dementia frequently address safety issues, including falls and unsafe wandering. Safety concerns are usually heightened when people with dementia are in unfamiliar environments and when they have medical problems. Although physical restraints have been used in the past, healthcare professionals now recognize that restraints are rarely an appropriate intervention for ensuring safety. Nurses need to address safety issues as an important aspect of care for people with dementia. This chapter helps the reader to learn how to assess fall risks in people with dementia. It discusses the interventions for preventing falls and fall-related injuries. The chapter helps the reader to learn how to avoid the use of restraints and address wandering.

This chapter opens with a brief discussion of interventions that students who have sustained concussions may receive outside of school in a rehabilitation setting and at home. Students who have sustained concussions typically require short-term adjustments while they are still symptomatic. The chapter discusses appropriate school-based educational plans in relation to symptom clusters. The chapter addresses extracurricular involvement of students and special grading considerations during recovery. It includes guidance to help school teams determine if a child with persistent postconcussion symptoms requires a 504 plan or further evaluation for an individualized education program (IEP). Students who are eligible for IEPs under the traumatic brain injury (TBI) category may require significant modifications to the curriculum in order to be successful academically. Finally, the chapter concludes with a note on dealing with students who may malinger or continue to report symptoms when they have actually resolved.