Concussion: Why Nurses Need to Understand This Hidden Injury

Ann Worley


Pediatr Nurs. 2019;45(5):235-243. 

In This Article

Patient Education

Current literature consistently supports evidence for the effectiveness of early concussion education to patients in improving care of concussed athletes (Halstead & Walter, 2010). In fact, educating patients regarding expectation of the recovery course has been demonstrated to reduce long-term symptoms (Watts et al., 2011), unnecessary patient anxiety, preoccupation with brain damage, and unwarranted return visits to the ED (Boutis, Weerdenburg, Koo, Schneeweiss, & Zemek, 2015). Discharge recommendations should be comprehensive, evidence-based, and consistent among providers. Pertinent topics should include warning signs/symptoms, when to return to the ED, the need for rest for the first 24–48 hours, the importance of avoiding a second injury, and expected duration of symptoms. Because prior concussion history is such a significant risk factor, Rivera and colleagues (2015) suggested incorporating concussion history as part of the child's routine well-child screening, thus opening up opportunities to educate the athlete/family, as well as to address pertinent concerns prior to the start of a season (see Figure 3).

Figure 3.

Responding to Pertinent Concerns of Patients/Families
Note: The information presented above is based on general practice principles; however, experts may present differing opinions. The responses to patients/families may need to be modified to be appropriate for each child's unique needs and individual recovery course.

Effective methods and techniques of instruction are essential in improving learning outcomes, particularly in the midst of a chaotic and confusing urgent care environment. Teach-back and return demonstration techniques reinforce patient/parent learning because they require verbalization/demonstration of the patient/caregiver's understanding and affirm assimilation. Follow-up phone calls post-discharge have also been effective in clarifying and addressing ongoing concerns (Zavala & Shaffer, 2011). Use of a standard discharge checklist for all providers is recommended to ensure essential instructions are not omitted (Thomas et al., 2018). Printed materials, including a copy of the care plan if available, can help patients/families recall verbal instructions and should be written in the patient's native language on a reading level on or below the 5th grade with readable font, shorter sentences, simple lay out, and illustrations (Thomas et al., 2018). The CDC's "Heads Up" website is an extensive source of free educational materials for the nurse to offer patients/parents, such as fact sheets, posters, videos, apps, and even learning games for a smart phone or tablet. Most are downloadable and many are available in Spanish (see Figure 2).