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.

Nursing practice is a symbiotic relationship between the art and science of professional care. One cannot exist in isolation from the other. Nurses are inclined to connect the art of nursing with terms such as compassion, caring attitudes, the therapeutic relationship, presence, professionalism, advocacy, and competence, otherwise known as the “soft or caring side of nursing”. The greatest threat to the disappearance of the art of nursing lies with the perceived “big three”: time, fiscal restraint, and failure of the system to support a full staff of nurses, so those employed are working at full capacity. It is important to recognize that different practice settings have varying needs. One size does not fit all. Yet the requirements for nursing assessments, developing a plan of care, coordinating care with other health care providers, implementing interventions, and evaluating care outcomes are a requirement of all.

This chapter provides examples of programs and services beyond the foundational elements and global resources that can be used to overcome traditional nursing research barriers. It is assumed that at least one doctorate-prepared nurse researcher is available to facilitate research opportunities and educate nurses about research and evidence-based practice. Many clinical nurses fully understand their clinical roles but are completely unaware of opportunities and resources in nursing research within their hospital. Since contributions of nursing research are vital to the science and art of nursing and provide foundation for evidence-based practices, it is important to overcome the traditional cluster of barriers that include problems with nursing research visibility/priority, time and money, and research education. Nurses need confirmation that nurse leaders support research; when it is visible, it is valued. Moreover, nurses need time, education, and resources to complete rigorous research that leads to discoveries and answers to important clinical problems.

This chapter addresses the need for dissemination of research and focuses on dissemination both inside the hospital organization and outside. Disseminating results of research is often the most exciting phase of the process, as it is the culmination and highlight of countless hours of work. Common areas for dissemination internally include presentations to colleagues on people’s unit, as well as across hospital organization. Internal presentations offer a direct way for people to provide new evidence for practice in their hospital organization. In addition, however, it is important that results of their research reach nurses and other health professionals nationally and internationally. Thus, people want to participate in media dissemination of their research, systematically look for calls for abstracts to present at professional conferences, and disseminate their research through professional publications. Disseminating results, whether internally or externally, by media, poster, oral presentation, or publication, requires effort and attention to detail.

Dorothea Lynde Dix was born into an upper-class, highly educated, intelligent, and politically connected Bostonian family. These opportunities provided the foundation necessary to propel her into a leadership role as national and international advocate for the most vulnerable groups in the mid-1800s. Dorothea utilized her Methodist father’s background to augment the teachings of her adopted religious calling, Unitarianism, which promises salvation through leading a directed life. This chapter explores her leadership role in this period of American history. It also shows how her family background, pursuit of education, personality, and religious commitment to humanitarianism enabled her to confront seemingly insurmountable obstacles to implement national and international reform of care for psychiatrically disabled and imprisoned populations. In the final phase of her career, Dorothea was chosen for a national role to lead nursing during the American Civil War, a role that she considered as within her scope of knowledge and skills.

Delirium, also known as acute confusional state, organic brain syndrome, brain failure, and encephalopathy, is a common occurrence among medical and surgical patients and causes extensive morbidity and mortality. This chapter provides an updated review of delirium, including pathophysiological correlates, clinical features, diagnostic considerations, and contemporary treatment options. The defining features of delirium include an acute change in mental status characterized by altered consciousness, cognition, and fluctuations. The chapter explores the risk factors for delirium. These can be divided into two categories: predisposing factors and precipitating factors. Imbalances in the synthesis, release, and degradation in gamma-aminobutyric acid (GABA), glutamate, acetylcholine, and the monoamines have also been hypothesized to have roles in delirium. GABA is the primary inhibitory neurotransmitter in the central nervous system (CNS) and medications such as benzodiazepines and propofol have known actions at GABA receptors and have been associated with delirium.

The researchers were specifically interested in whether they would get more incorrect responses depending on the type of sentence. From a certain perspective, passive sentences are more complicated than active sentences and so perhaps it is the case that passives are more difficult simply because they are more complicated. It appears that the important difference between subject cleft and actives on one hand, and passives on the other, is that the order of the roles is reversed between them: in active sentences, the agent comes first. Indeed, there is a growing body of evidence that languages allow English speakers to structure their utterances in a way that can flag certain parts of the sentence as particularly important or worthy of special attention. Recently, psycholinguists have been interested, too, in how information structure influences language processing.

The study of the properties of language can be divided up into roughly five, somewhat overlapping categories: sound system, word structure, sentence structure, meaning, and real-world use. In spoken languages, segments are sounds—each language has a set of sounds that are produced by changing the positions of various parts of the vocal tract. The sound system of language is actually studied in two main parts: phonetics, phonology. Phonemes can be combined to make words, and words themselves have an internal structure and can even be ambiguous based on this structure. Syntax is the study of how sentences are formed. There are two noun phrases (NPs) in the sentence—the artist and a paintbrush. The field of semantics is concerned with meaning in language and can be divided into two major parts: lexical and propositional.

This chapter examines disability identity as a unique area in which the clinician working with individuals with brain injuries must become culturally competent. It begins with an overview of the disability rights movement and its influence on disability identity as a construct. Legislative and regulatory scaffolding for societal responsiveness to and acceptance of individuals with disability exists, but it requires further refinement. Social agencies have been created to support the process of adaptation to disability culture and are attempting to foster development of disability identity through networking resources for employment and socialization. The chapter then discusses critical issues in cultural competence and how these intersect with ethical practice in working with individuals and families with neurorehabilitation needs. It concludes with suggestions regarding cultural competence that transcend individual diagnoses.

Primary progressive aphasia (PPA) is the term applied to a clinical syndrome characterized by insidious progressive language impairment that is initially unaccompanied by other cognitive deficits. This chapter describes several variants of PPA and more than one etiology. It explains three main variants of PPA, namely, semantic Variant of PPA (svPPA), nonfluent/agrammatic variant of PPA (nfvPPA) and logopenic variant of PPA (lvPPA), and also describes criteria for their diagnoses. The defining symptom of PPA is the presence of a language impairment for at least 2 years in the absence of any other significant cognitive problem. Assessment of other cognitive domains is challenging because many tests of memory, attention, executive functioning, and visual-spatial skills rely on language processes in some manner. There are no drug therapies proven to arrest progression of signs and symptoms of PPA due to frontotemporal lobar dementia (FTLD) or Alzheimer’s disease (AD) pathologies.