Nursing Assignment Sample: Traumatic Brain Injury Case Study

This is a nursing assignment sample on traumatic brain injury (TBI) rehabilitation, written for a nursing and healthcare module. It works through one case study in four parts: recognising the effects of an acquired brain injury, responding to them in practice, the resources and support the patient needs, and recovery-oriented practice. Every clinical statement below is tied to a named piece of rehabilitation research, published between 1998 and 2025.

The patient is called Sarah throughout. The name is a pseudonym, and the case carries no hospital, no date, no location and no detail that could identify anyone. Your own nursing case study has to meet that standard too.

If you are writing something similar, our nursing and healthcare assignment help covers case studies, care-planning essays and reflective writing, and you can read more healthcare assignment samples first.

For scale, the US Centers for Disease Control and Prevention records about 214,110 TBI-related hospitalisations in 2020 and 68,663 TBI-related deaths in 2023, and notes that those counts leave out injuries treated only in emergency departments, urgent care or primary care.

What Does the Brief Ask?

The brief asks for an analysis of Sarah's recovery after a traumatic brain injury and for strategies in two areas, rehabilitation and overcoming stigma, each argued as a way to improve her outcomes. It lists her problems but gives no injury-severity data, so the answer has to state what severity it assumes before recommending anything.

Assignment task: Analyse the case study of Sarah, a traumatic brain injury (TBI) patient, focusing on her recovery. Propose strategies for rehabilitation and for overcoming stigma to improve patient outcomes.

Solution:

Background to Sarah's Case

Sarah is a young adult who sustained a traumatic brain injury in a road vehicle collision. Before the collision she lived independently and managed her own work and household. After it she had impaired balance and coordination, needed help with everyday activities, could not hold new information reliably, and had periods of emotional instability. She was referred for inpatient rehabilitation, moved to community follow-up, and is still seen for review.

The brief gives no injury-severity data: no Glasgow Coma Scale score, no duration of post-traumatic amnesia, no imaging result, no timeline. That matters, because rehabilitation recommendations are graded by severity and a plan for a mild injury looks nothing like a plan for a severe one. This sample treats Sarah as a moderate to severe case, which is what her recorded problems indicate, and says which severity band each piece of cited evidence applies to.

How Do You Recognise the Effects of a Traumatic Brain Injury?

Recognition covers four groups of effects: physical, cognitive, emotional and social. In Sarah's case the recorded problems were impaired balance and coordination, memory failure and wider cognitive impairment, emotional instability, and lost independence in everyday activities. Most of that is invisible to an onlooker, which is why misconceptions about brain injury persist.

Physical Effects

Sarah's balance and coordination were affected, and she could not manage washing, dressing and moving about without help. Reduced cardiorespiratory fitness is a further physical consequence after TBI, and the Cochrane review of fitness training by Hassett, Moseley and Harmer (2017) found low-quality evidence that a training programme improves that deconditioning. The same review found no evidence of harm, but also insufficient evidence to claim benefit for any other outcome, and it advises pre-exercise screening before a patient with a brain injury starts training.

Cognitive Effects

Memory was Sarah's most disabling problem. She could not reliably retain new information, which affected her ability to follow a therapy plan, take medication on time or resume the tasks she had managed on her own before. Attention, processing speed and executive function are the other domains that rehabilitation targets after moderate to severe TBI, and the INCOG 2.0 guidelines devote a separate volume to each of them (Bayley et al., 2023).

Emotional and Social Effects

Emotional instability after brain injury is not a personality flaw and is not under the patient's control. It also has a social cost, because it changes how conversations go. Togher, Douglas and colleagues (2023) describe this as a cognitive-communication disorder: impairments in cognition and social cognition, including reading other people's emotions and inferring what they are thinking, which limit a person's ability to socialise, work and study. That is the mechanism by which a cognitive injury becomes a social one.

Why the Injury Is Easy to Underestimate

Sarah's memory failure and emotional instability leave no visible mark, so people around her assume recovery is complete once she is walking. Misconceptions are documented inside the profession, not only outside it. Gurusamy et al. (2019) gave the Common Misconceptions about Traumatic Brain Injury questionnaire to 143 nursing students at a tertiary neuro-centre in India and found misconceptions common across all seven domains, highest in the domain on brain damage at 81.1 per cent and lowest in the amnesia domain at 42.0 per cent, with no significant difference by age, gender, place of residence or year of education. The authors conclude that the nursing curriculum needs strengthening in this area.

That finding is the honest basis for the stigma half of this brief. Education is worth proposing because there is evidence that trained nurses hold incorrect beliefs, not because stigma is a general evil. You may also like reading Communication in Healthcare (Pre-Nursing), which covers the information-exchange side of the same problem.

How Should a Nurse Respond to a Patient with a Traumatic Brain Injury?

With assessment first, then a plan built around her. INCOG 2.0 recommends daily assessment for post-traumatic amnesia with a validated tool until it resolves, a quiet and consistent environment to limit agitation, and sparing use of sedating medication. After that phase, nursing work is communication, goal setting and coordination of the team.

The Early Phase and Post-Traumatic Amnesia

Post-traumatic amnesia is the period of confusion, disorientation and poor attention that follows emergence from coma after moderate to severe TBI, often with agitation. Ponsford et al. (2023) set out six management recommendations for it. Patients should be assessed daily with a validated tool, the Westmead PTA Scale, until the amnesia resolves. No cognitive or pharmacological treatment is known to shorten it. Agitation and confusion can be reduced by environmental adaptation, which means a quiet, safe and consistent setting. Neuroleptics and benzodiazepines should be kept to a minimum and their effect on agitation and cognition monitored with standardised tools. Physical therapy and structured training in activities of daily living can be effective in this phase when they use procedural and errorless learning, and when their delivery is tailored to the patient's levels of cognition, agitation and fatigue on the day.

Nursing care during post-traumatic amnesia, applied to Sarah

1. 1 Assess every day Score the amnesia daily with the Westmead PTA Scale until it resolves, and record the score rather than a note that she seems brighter.
2. 2 Keep the setting quiet and consistent Environmental adaptation limits agitation and confusion: one consistent room, and consistent staff where rostering allows.
3. 3 Keep sedating drugs to a minimum Use neuroleptics and benzodiazepines sparingly and monitor their effect on agitation and cognition with standardised tools.
4. 4 Train daily activities with errorless learning Physical therapy and structured activities-of-daily-living training built on procedural and errorless learning: the same cues in the same order.
5. 5 Tailor each session to the day Match delivery to her cognition, agitation and fatigue on the day, which for Sarah means short sessions.

For Sarah's care plan that means one consistent room, consistent staff where rostering allows, short sessions, the same cues in the same order, and a daily amnesia score recorded rather than a note that she seems brighter.

Communicating with Sarah

The strongest evidence here is that the people around the patient should be trained as well as the patient. Togher et al. (2013) ran a three-arm trial with 44 outpatients who had severe chronic TBI. One group and their everyday communication partners were trained together over a ten-week conversational skills programme, a second group received the same programme alone, and a third waited. Blind ratings of the patient's participation in conversation improved more in the group whose partners were trained, and the gains were still there six months later.

The INCOG 2.0 recommendations for cognitive-communication and social cognition disorders make the same point at guideline level, with nine recommendations covering individualised and goal-oriented intervention, group treatment, telerehabilitation and cultural competence training for clinicians (Togher et al., 2023). Applied to Sarah, that means the nursing team is not only choosing how to speak to her but also teaching her family how to hold a conversation with her, and recording whether her participation improves.

Personalised Care Planning

Individualised care is a stated principle of the INCOG 2.0 guidelines rather than a slogan: interventions should be individualised, goal-oriented and suited to the context the person actually lives in. In practice that means Sarah's plan names her own tasks. If preparing her own meals again matters to her, the occupational therapy goals say so, the memory strategies are practised on that task, and the review date is set against it. Her preferences decide the order of the goals, and the team writes that order down so a new staff member inherits it.

What Resources and Support Does a TBI Patient Need?

A coordinated multidisciplinary programme, psychological support and support for the family. The Cochrane review of multidisciplinary rehabilitation after acquired brain injury found strong evidence of benefit from formal intervention in moderate to severe injury, and that more intensive programmes bring earlier functional gains. Sarah also needed occupational therapy, physiotherapy and continued outpatient contact.

The Rehabilitation Programme

Turner-Stokes et al. (2015) reviewed 19 studies covering 3,480 people aged 16 to 65 with acquired brain injury. Their findings split by severity. For predominantly mild injury, strong evidence showed most people recovered well once they were given appropriate information, without additional specific intervention. For moderate to severe injury, strong evidence showed benefit from formal intervention, and limited evidence suggested that starting rehabilitation early gives better outcomes. For patients already in rehabilitation, strong evidence showed more intensive programmes produce earlier functional gains, and moderate evidence supported continued outpatient therapy to sustain what was gained in the early post-acute phase. For severe injury the review found strong evidence for a milieu-oriented model, in which cognitive rehabilitation happens in a therapeutic environment alongside a peer group of other patients.

Multidisciplinary rehabilitation after acquired brain injury: findings by severity

Point of comparison	Applies to	Strength of evidence
Most people recover well once given appropriate information, with no further specific intervention	Applies to Predominantly mild injury	Strength of evidence Strong
Formal rehabilitation brings benefit	Applies to Moderate to severe injury	Strength of evidence Strong
Starting rehabilitation early gives better outcomes	Applies to Moderate to severe injury	Strength of evidence Limited
More intensive programmes produce earlier functional gains	Applies to Moderate to severe, already in rehabilitation	Strength of evidence Strong
Continued outpatient therapy sustains gains made in the early post-acute phase	Applies to Moderate to severe, already in rehabilitation	Strength of evidence Moderate
A milieu-oriented model, with cognitive rehabilitation in a therapeutic environment alongside a peer group	Applies to Severe injury	Strength of evidence Strong

The earlier trial by Semlyen, Summers and Barnes (1998) is the case for coordination specifically. Fifty-six consecutive severe head injury admissions were compared: one group received a coordinated multidisciplinary regional service, the other a single-discipline approach at local district hospitals. The coordinated group made significant gains on the Barthel Index, the Functional Independence Measure and the Newcastle Independence Assessment Form, and held those gains after input ended, while the comparison group did not, despite lower initial injury severity. Carers of the coordinated group also reported significantly less distress.

Read together, those two reviews support the structure of Sarah's programme rather than any single therapy in it: a named team working to one plan, started early, at an intensity she can tolerate, with outpatient contact kept open after discharge.

Occupational Therapy and Cognitive Rehabilitation

Occupational therapy is where Sarah's memory problem meets her daily tasks. Stephens, Williamson and Berryhill (2015) reviewed 37 empirical studies published since 2006 on cognitive rehabilitation for civilian adults with TBI and wrote it up as a reference for occupational therapists, because the research is spread across disciplines and hard to follow.

Note the terminology, because it is a common error in student work. The therapy is occupational therapy: retraining the activities a person needs to do. There is no such intervention as "occupational stimulation".

Psychological Support

Depression is more common after TBI than in the general population, so screening Sarah's mood is part of the plan. What to do about it is less settled than students usually assume. Gertler, Tate and Cameron (2015) reviewed six randomised trials covering 334 adults and reported that they found no compelling evidence in favour of any non-pharmacological intervention for depression after TBI. All six trials carried a high risk of bias.

The defensible position for a nursing case study is therefore narrow: monitor mood with a validated measure, refer to psychology, and do not claim that counselling has been shown to lift depression after brain injury. Saying the evidence is thin is the stronger answer.

Support for the Family

Sarah's family carried much of her care. Ting and Ahmed (2025) pooled 13 randomised trials of interventions aimed at the carers themselves and found improvements in carer burden, measured with the Zarit Burden Interview, and in carers' psychological distress. They also state plainly that the included trials had a high risk of bias and that the result should be treated with caution until better trials exist. Semlyen et al. (1998) add a second reason to support the family, which is that carers of the coordinated rehabilitation group reported significantly lower distress than carers in the comparison group.

Practically, that means the family is written into Sarah's plan as people with needs of their own, not only as a resource for her. For the policy side of a healthcare brief, see our sample on the critical analysis of national government policy in healthcare.

What Are Recovery-Oriented Practices in Brain Injury Rehabilitation?

Practice that starts from what the person can still do and from goals she sets herself. In brain injury rehabilitation that means goals agreed with the patient rather than for her, participation in her own community rather than progress measured only in the clinic, and honest review when a goal turns out to be wrong.

Goals Agreed with the Patient, Not Set for Her

Goal setting is treated as a core component of rehabilitation, and the evidence behind it is weaker than its status suggests. Levack et al. (2015) reviewed 39 studies covering 2,846 adults in rehabilitation for acquired disability. They found some very low quality evidence that goal setting may improve some outcomes, with the better part of that evidence favouring psychosocial outcomes, meaning health-related quality of life, emotional status and self-efficacy, rather than physical ones. They record considerable uncertainty about the size of the effect.

For Sarah that is still a reason to set goals with her, because the outcomes the evidence leans towards are exactly the ones her case turns on: how she feels about her recovery and whether she believes she can manage. It is not a reason to claim that goal setting will improve her balance.

Community Integration

Recovery-oriented practice takes the work outside the clinic. Dahlberg et al. (2007) randomised 52 people who were at least a year past their TBI to a group programme of twelve weekly 90-minute sessions on social communication, or to deferred treatment. The treated group improved significantly on seven of the ten subscales of the Profile of Functional Impairment in Communication compared with no treatment, and six of the ten were still significantly better than baseline at six-month follow-up. A community group programme, in other words, has trial evidence behind it.

Two further studies say something useful about the long run. Lu et al. (2023) followed working-age patients with moderate to severe TBI and found mean Community Integration Questionnaire scores rose from 18.7 at one year after injury to 19.8 at ten years, with age, cognitive function and bodily pain the significant predictors of long-term integration. Lama, Damkliang and Kitrungrote (2020), writing in a nursing journal about a Nepalese sample, report social support as the factor that facilitates community integration after TBI, with the physical environment and fatigue as the common barriers. Both point Sarah's plan at the same targets: her pain, her fatigue, her cognitive function and the support around her.

What the Evidence Does Not Settle

State the limits in your conclusion rather than hiding them. The Cochrane reviewers note that trial evidence does not tell us which treatments work best for which patients over the long term, nor which service models represent value for money across a lifetime of care, and that answering those questions needs long cohort studies in routine practice. They also report that the balance between intensity and cost has not been determined, so "more therapy" cannot be recommended without limit (Turner-Stokes et al., 2015). Several of the other reviews cited here rest on small trials with a high risk of bias.

Related samples and pages:

• Communication in healthcare, on how nurses and patients exchange information.
• Critical analysis of national government policy in healthcare, for the policy side of a healthcare brief.
• Reflection paper example, if your nursing module asks for a reflective piece rather than a case study.
• All nursing and healthcare assignment samples.

Need help with a similar nursing case study? Message us on WhatsApp with your brief, the condition you are writing about and your deadline.

Sources

• Bayley, M. T., Janzen, S., Harnett, A. et al. (2023) 'INCOG 2.0 guidelines for cognitive rehabilitation following traumatic brain injury: methods, overview, and principles', Journal of Head Trauma Rehabilitation, 38(1), pp. 7-23. Available at: doi.org/10.1097/HTR.0000000000000838 (repository record: research.monash.edu)
• Centers for Disease Control and Prevention (2026) TBI Data, last updated 27 April 2026. Available at: cdc.gov/traumatic-brain-injury/data-research. Source for the 2020 hospitalisation and 2023 death counts.
• Dahlberg, C. A., Cusick, C. P., Hawley, L. A. et al. (2007) 'Treatment efficacy of social communication skills training after traumatic brain injury: a randomized treatment and deferred treatment controlled trial', Archives of Physical Medicine and Rehabilitation, 88(12), pp. 1561-1573. Available at: doi.org/10.1016/j.apmr.2007.07.033
• Gertler, P., Tate, R. L. and Cameron, I. D. (2015) 'Non-pharmacological interventions for depression in adults and children with traumatic brain injury', Cochrane Database of Systematic Reviews, (12), CD009871. Available at: PubMed Central
• Gurusamy, J., Gandhi, S., Amudhan, S. et al. (2019) 'Misconceptions about traumatic brain injury among nursing students in India: implications for nursing care and curriculum', BMC Nursing, 18, 64. Available at: PubMed Central
• Hassett, L., Moseley, A. M. and Harmer, A. R. (2017) 'Fitness training for cardiorespiratory conditioning after traumatic brain injury', Cochrane Database of Systematic Reviews, 12, CD006123. Available at: PubMed Central
• Lama, S., Damkliang, J. and Kitrungrote, L. (2020) 'Community integration after traumatic brain injury and related factors: a study in the Nepalese context', SAGE Open Nursing, 6, 2377960820981788. Available at: PubMed Central
• Levack, W. M. M., Weatherall, M., Hay-Smith, E. J. C. et al. (2015) 'Goal setting and strategies to enhance goal pursuit for adults with acquired disability participating in rehabilitation', Cochrane Database of Systematic Reviews, (7), CD009727. Available at: PubMed Central
• Lu, J., Rasmussen, M. S., Sigurdardottir, S. et al. (2023) 'Community integration and associated factors 10 years after moderate-to-severe traumatic brain injury', Journal of Clinical Medicine, 12(2), 405. Available at: PubMed Central
• Ponsford, J., Trevena-Peters, J., Janzen, S. et al. (2023) 'INCOG 2.0 guidelines for cognitive rehabilitation following traumatic brain injury, part I: posttraumatic amnesia', Journal of Head Trauma Rehabilitation, 38(1), pp. 24-37. Available at: doi.org/10.1097/HTR.0000000000000840 (repository record: research.monash.edu)
• Semlyen, J. K., Summers, S. J. and Barnes, M. P. (1998) 'Traumatic brain injury: efficacy of multidisciplinary rehabilitation', Archives of Physical Medicine and Rehabilitation, 79(6), pp. 678-683. Available at: doi.org/10.1016/S0003-9993(98)90044-2
• Stephens, J. A., Williamson, K. N. C. and Berryhill, M. E. (2015) 'Cognitive rehabilitation after traumatic brain injury: a reference for occupational therapists', OTJR: Occupation, Participation and Health, 35(1), pp. 5-22. Available at: PubMed Central
• Ting, C. Y. and Ahmed, Z. (2025) 'Impact of caregiver interventions on caregiver burden in adult traumatic brain injury: a systematic review and meta-analysis', Frontiers in Public Health, 13, 1698592. Available at: PubMed Central
• Togher, L., McDonald, S., Tate, R., Power, E. and Rietdijk, R. (2013) 'Training communication partners of people with severe traumatic brain injury improves everyday conversations: a multicenter single blind clinical trial', Journal of Rehabilitation Medicine, 45(7), pp. 637-645. Available at: doi.org/10.2340/16501977-1173
• Togher, L., Douglas, J., Turkstra, L. S. et al. (2023) 'INCOG 2.0 guidelines for cognitive rehabilitation following traumatic brain injury, part IV: cognitive-communication and social cognition disorders', Journal of Head Trauma Rehabilitation, 38(1), pp. 65-82. Available at: doi.org/10.1097/HTR.0000000000000835 (repository record: research.monash.edu)
• Turner-Stokes, L., Pick, A., Nair, A., Disler, P. B. and Wade, D. T. (2015) 'Multi-disciplinary rehabilitation for acquired brain injury in adults of working age', Cochrane Database of Systematic Reviews, (12), CD004170. Available at: PubMed Central