Page 17 - JSOM Fall 2022

Development and Evolution of a Comprehensive Mild Traumatic

Brain Injury Inpatient Rehabilitation Program
A Nursing Perspective

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Susan Modi, FNP *; Deanna Goff, RN ; Dara Guess, MSN, RN ;
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Karen Meigs, RN ; Areca Hoskin, MSN, RN ; Selina Doncevic, MSN, RN ;
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Lisa Perla, PhD, FNP ; Susan Pejoro, MSN, RN ; Cheryl Sallah, MSN/Ed, RN 9
ABSTRACT
The James A. Haley Veterans’ Hospital in Tampa, Florida has individualized rehabilitation community reintegration (IRCR)
developed an innovative approach to the unique rehabilitation treatment program.
needs of active duty Special Operations Forces (SOF) and vet­
erans with chronic conditions related to their military service.
Tampa’s program, the Post­Deployment Rehabilitation and History
Evaluation Program (PREP), was established in 2008. The in­ The Global War on Terror (GWOT), Operation Enduring
terdisciplinary team includes one nurse practitioner and eight Freedom (OEF) (2001–2014), and Operation Iraqi Freedom
staff registered nurses. The Veterans Health Administration (OIF) (2003–2011) led to an increased need for specialized
(VHA) is using Tampa’s established and successful PREP as a medical, surgical, and rehabilitative services for both the
model to actively expand the program to other Veterans Ad­ VHA and the Defense Health Agency/Department of Defense
ministration (VA) Polytrauma Rehabilitation Centers over the (DHA). In 2005, the VA established the PSC, an integrated
next several years. There are several important nursing and national network of specialized rehabilitation programs dedi­
rehabilitation team considerations for the successful develop­ cated to combat and non–combat­related TBI and polytrauma
ment of these mild traumatic brain injury (mTBI) inpatient for both active­duty Servicemembers and veterans.
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rehabilitation programs.
Utilizing an interdisciplinary team model with an individual­
Keywords: polytrauma; multiple trauma; cognition disorders; ized rehabilitation community reintegration (IRCR) treatment
traumatic brain injuries; veterans health services; military med- plan, the PSC developed and implemented advanced inpa­
icine; nursing care tient rehabilitation interventions. Inpatient polytrauma teams
soon recognized a cohort of patients with similar and com­
plex symptomology: persistent pain, headache, poor sleep,
cognitive challenges, and mental health sequelae (e.g., anger,
Introduction
irritability, posttraumatic stress disorder (PTSD), social/work
In 2008 the James A. Haley Veterans’ Hospital in Tampa, Flor­ interaction difficulties). Frequently “hidden,” these symptoms
ida, instituted a novel approach to inpatient rehabilitation for were often unmanaged, chronic in nature, and difficult to ad­
SOF and veterans suffering from mTBI. The PREP program dress in traditional inpatient acute rehabilitation programs. 3
has proved to be successful in improving patients’ physical and
mental health status. Because of the program’s success and a The Tampa VA Medical Center opened its PREP program in
request from the Special Operations Command (SOCOM), 2008 to address the needs of this population and their suffer­
a decision was made to expand the program. In January 2020, ing from chronic sequelae related to mTBI. PREP began with
a meeting was held to plan, develop, and expand national pro­ six inpatient rehabilitation beds for a 3­week program of com­
grams such as Tampa, Florida’s PREP program to the other prehensive symptom assessment, evaluations, and recommen­
four polytrauma rehabilitation centers within the VA Poly­ dations. Following completion of the program, patients were
trauma System of Care (PSC). 1 discharged to return to their designated military treatment fa­
cilities (MTF) or VA medical facilities with detailed plans for
Leadership from the VA’s polytrauma centers (Minneapolis, follow­up treatment and care.
MN; Palo Alto, CA; Richmond, VA; San Antonio, TX; and
Tampa, FL) met in Tampa with the PREP rehabilitation subject There has been extensive research on mTBI treatments since
matter experts to discuss expansion of the PREP therapeutic the early years of the GWOT. As described earlier, injured
model. Following the meeting, discipline­specific work groups Servicemembers or veterans with mTBI may, without special­
met to continue expansion plans and disseminate best prac­ ized rehabilitation, experience multiple acute or even chronic
tices. This paper aims to share the importance of rehabilitation symptomologies that can lead to difficulties in performing
nursing practice considerations in developing a comprehensive daily activities of living, both professionally and personally.
*Correspondence to susan.modi@va.gov
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1 Susan Modi is a family nurse practitioner and Deanna Goff, Dara Guess, Karen Meigs, and Cheryl Sallah are all registered nurses affiliated
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with the James A. Haley Veterans’ Hospital and Clinics, Tampa, FL. Areca Hoskin is a registered nurse affiliated with the Hunter Holmes
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McGuire VA Medical Center, Richmond, VA. Selina Doncevic is a registered nurse and Lisa Perla is a family nurse practitioner affiliated with
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the VA Medical Center, Washington, DC. Susan Pejoro is a registered nurse affiliated with the VA Palo Alto Health Care System, Palo Alto, CA.
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