Assessment of motor limb strength by neuroscience nurses: variations in practice and associated challenges.

BACKGROUND: Limb strength is a central component of neurological assessment and monitoring in nursing practice, yet there is a lack of research examining the tools used by nurses or challenges nurses encounter when using these tools. The evidence base is lacking to inform effective practice and the underpinning educational approaches. AIM: To determine which tools are used by UK and Irish neuroscience nurses in the assessment of limb strength and the associated challenges and variations in practice. METHODS: This study used an online self-reported survey design to ascertain which tools neuroscience nurses used and their experience of using these (n=160). FINDINGS: Practices varied, with a dominance of two tools being used in practice: the Medical Research Council scale and the 'normal power' to 'no movement' scale found on the neurological observation chart. Most respondents used the same tool across all conditions. CONCLUSION: This study highlights variations in assessment practice and the absence of a sound evidence base behind choice of motor limb strength assessment tools used.

Nurses' understanding and experience of applying painful stimuli when assessing components of the Glasgow Coma Scale.

AIMS AND OBJECTIVES: To evaluate nurses' application, understanding and experience of applying painful stimuli when assessing components of the Glasgow Coma Scale. BACKGROUND: The Glasgow Coma Scale has been subjected to much scrutiny and debate since its publication in 1974. However, criticism, confusion and misunderstandings in relation to the use of painful stimuli and its application remain. An absence of evidence-informed guidance on the use and duration of application of painful stimuli remains, with the potential to negatively impact on decision-making, delay responsiveness to neurological deterioration and result in adverse incidents. DESIGN AND METHODS: This international study used an online self-reported survey design to ascertain neuroscience nurses' perceptions and experiences around the application of painful stimuli as part of a GCS assessment (n = 273). The STROBE checklist was used. RESULTS: Data revealed varied practices and a sense of confusion from participants. Anatomical sites for the assessment of pain varied, but most respondents identified the trapezius grip/pinch in assessing eye-opening and motor responses. Most respondents identified they assess eye-opening and motor responses together and apply pain for <6 s to elicit a response. Witnessed complications secondary to applying a painful stimulus were varied and of concern. CONCLUSION: Neuroscience nurses in this study clearly required evidence-informed guidelines to underpin practice both in applying painful stimuli and in managing the experience of the person in their care and the family response. A standardised approach to education is necessary to ensure greater interrater reliability of assessment not only within nursing but across professions. RELEVANCE TO PRACTICE: Results of this study illustrate inconsistency and confusion when using the Glasgow Coma Scale in practice; this has the potential to compromise care. Clarity around the issues highlighted is necessary. Moreover, these results can inform future guidelines and education required for supporting nurses in practice.

Family members' experience with in-hospital health care after severe traumatic brain injury: a national multicentre study.

BACKGROUND: Family member's experience and satisfaction of health care in the acute care and in-patient rehabilitation are important indicators of the quality of health care services provided to patients with severe traumatic brain injury (TBI). The objective was to assess family members' experience of the health care provided in-hospital to patients with severe TBI, to relate experiences to family member and patient demographics, patients' function and rehabilitation pathways. METHODS: Prospective national multicentre study of 122 family members of patients with severe TBI. The family experience of care questionnaire in severe traumatic brain injury (FECQ-TBI) was applied. Independent sample t-tests or analysis of variance (ANOVA) were used to compare the means between 2 or more groups. Paired samples t-tests were used to investigate differences between experience in the acute and rehabilitation phases. RESULTS: Best family members` experience were found regarding information during the acute phase, poorest scores were related to discharge. A significantly better care experience was reported in the acute phase compared with the rehabilitation phase (p < 0.05). Worst family members` experience was related to information about consequences of the injury. Patient's dependency level (p < 0.05) and transferral to non-specialized rehabilitation were related to a worse family members` experience (p < 0.01). CONCLUSIONS: This study underscores the need of better information to family members of patients with severe TBI in the rehabilitation as well as the discharge phase. The results may be important to improve the services provided to family members and individuals with severe TBI.

The Glasgow Coma Scale and evidence-informed practice: a critical review of where we are and where we need to be.

AIMS AND OBJECTIVES: This paper aims to critically consider the evidence since the Glasgow Coma Scale was first launched, reflecting on how that evidence has shaped practice. It illustrates the lack of clarity and consensus about the use of the tool in practice and draws upon existing evidence to determine the route to clarity for an evidence-informed approach to practice. BACKGROUND: The Glasgow Coma Scale has permeated and influenced practice for over 40 years, being well-established worldwide as the key tool for assessing level of consciousness. During this time, the tool has been scrutinised, evaluated, challenged and re-launched in a plethora of publications. This has led to an insight into the challenges, and to some extent the opportunities, in using the Glasgow Coma Scale in practice but has also resulted in a lack of clarity. DESIGN: This is a discursive paper that invites readers to explore and arrive at a more comprehensive understanding of the Glasgow Coma Scale in practice and is based on searches of Scopus, Web of Knowledge, PubMed, Science Direct and CINAHL databases. RESULTS: While the Glasgow Coma Scale has been rivalled by other tools in an attempt to improve upon it, a shift in practice to those tools has not occurred. The tool has withstood the test of time in this respect, indicating the need for further research into its use and a clear education strategy to standardise implementation in practice. CONCLUSION: Further exploration is needed into the application of painful stimuli in using the Glasgow Coma Scale to assess level of consciousness. In addition, a robust educational strategy is necessary to maximise consistency in its use in practice. RELEVANCE TO CLINICAL PRACTICE: The evidence illustrates inconsistency and confusion in the use of the Glasgow Coma Scale in practice; this has the potential to compromise care and clarity around the issues is therefore necessary.

A comparison between intravenous and subcutmaneous immunogobulin.

Multifocal motor neuropathy (MMN) is a rare immune-mediated disease that presents with predominantly distal motor weakness in one or more limbs without sensory loss. Symptoms may give riseto functional impairment and consequently may affect quality of life. High-dose intravenous immunoglobulin's therapy (IVIg) is the current mainstay treatment, however, subcutaneous immunoglobuli(SCIg) is emerging as a viable alternative. The purpose of this study was to explore the patients' experience of SCIg and ascertain if those receiving it had an improved quality of life and treatmentsatisfaction compared to those receiving IVIg. Using a mixed method approach this paper will present its findings and key implications for clinical and research practice are considered. The results from this study suggest that home SCIg therapy may prove a more desirable treatment option than IVIg for a proportion of MMN patients.

Patterns of change and stability in caregiver burden and life satisfaction from 1 to 2 years after severe traumatic brain injury: A Norwegian longitudinal study.

OBJECTIVE: To assess burden and life satisfaction in family members of patients with severe traumatic brain injury (sTBI) at 1 and 2 years post-injury, examine if change in burden can be predicted by family member and patient demographics, patient's functional status, family members social network or level of burden at 1 year. METHODS: Prospective national multicenter study. Self-report from family members, patient data collected from a national cohort study on patients with sTBI. 80 family members participated. MAIN OUTCOME MEASURE: The Caregiver Burden Scale (CBS), life satisfaction. RESULTS: Total burden increased between years 1 and 2 post-injury (P = 0.04). Thirty percent of the family members reported an increased burden, 55% were stable, and 15% had a decrease in burden between the two follow-up times. Logistic regression analyses revealed that experiencing loneliness was an independent predictor of increased burden from 1 to 2 years post-injury (OR = 4.35, P < 0.05). Life Satisfaction was lower at the 2 year follow-up than at 1 year (p = 0.03). CONCLUSIONS: The results demonstrate a need for long-term follow-up of patients and family members that focuses on professional support to relieve burden and risk of loneliness or social isolation. This group may benefit from additional follow-up interventions tailored to their needs.

An evaluation of post-registration neuroscience focused education and neuroscience nurses' perceived educational needs.

BACKGROUND: People with complex neurological conditions require co-ordinated care provided by nurses educated in meeting service needs, understanding the pathophysiological processes of disease and the preparation to care for those with complex needs. However, evidence suggests that neuroscience specific education provision is largely unregulated and set outside of a cohesive professional development context. Furthermore, it largely seems to only address the induction phase into working within neurosciences. OBJECTIVES: To evaluate the nature of post-registration neuroscience focused education across Europe and neuroscience nurses' perceived educational needs. METHODS: Post qualifying nurses working in the field of neurosciences were invited to complete a self-reported 29-item on-line questionnaire that contained closed and open-ended questions exploring professional background, clinical and educational experience, educational opportunities available to them and their perspectives on their educational needs. RESULTS: 154 participants from fourteen countries across Europe completed the survey. 75% (n=110) of respondents had undertaken neuroscience focused education with the most accessible education opportunities found to be conferences 77% (n=96) and study days 69% (n=86). Overall, 52.6% of courses were multidisciplinary in nature, and 47.4% were exclusively nursing. Most identified that their courses were funded by their employer (57%, n=63) or partly funded by their employer. Results illustrate a significant variance across Europe, highlighting the need for more effective communication between neuroscience nurses across Europe. Implications for future education provision, recruitment/retention, and funding are discussed, resulting in recommendations for the future of neuroscience nursing. CONCLUSIONS: This study, the largest of its kind to survey neuroscience nurses, illustrates the absence of a cohesive career development pathway for neuroscience nurses in Europe. Nurses need quality assured specialist education to deliver high quality appropriate healthcare.

The experience of living with a family member with challenging behavior post acquired brain injury.

Acquired brain injury (ABI) can be a sudden, dramatic, and, sometimes, fatal event that instantly disrupts the lives of the patients and their families. Healthcare professionals and families are being confronted with the long-term effects of ABI. This article presents a descriptive phenomenological study that aimed to explore the families' meaning of living with the cognitive, emotional, and behavioral sequelae of ABI survivors. In-depth, face-to-face, semistructured interviews were conducted with a purposive sample of five family members of ABI survivors who displayed challenging behavior. Data collected were analyzed using A. Giorgi's (1985) descriptive phenomenological method of data analysis. Analysis and descriptions from the five participants revealed seven interrelated themes; one theme described the challenging behaviors of the people with ABI, and six themes described the experiences of the family members (emotional turmoil that these behaviors engendered, a profound sense of loss, concerns for their future and for the future of the person with ABI, a sense of loneliness, the effect on family functioning, and the family members' coping and adapting to the behaviors). This study contributes to healthcare providers' understanding and knowledge of families' experiences of living with a person with ABI and their cognitive, emotional, and behavioral sequelae and supports the need for continued research in this area.

Exploring student's perceptions and experience of personal tutors.

There are a variety of arrangements to support pre-registration nursing students whilst they engage with the theoretical and practical elements of their course; these includes academic supervisor and a personal tutor. The personal tutor system is recognized as an effective method of ensuring that each student has access to a wide range of support services and that the individual's academic progress and personal development are monitored by a skilled member of academic staff (Harrison, 1990). However, there is a dearth of studies relating to the role of the personal tutor in nurse education from the students' perspective. This study set out to explore the pre-registration students nurse's experience of personal tutoring at one School of Nursing and Midwifery in a Higher Education Institution (HEI) in the UK. Focus groups and a semi-structured questionnaire were used to collect data from pre-registration nursing participants. Data analysed revealed both positive and negative experiences; most rated their advice and support good with many positive aspects to their personal tutoring expressed however many felt the need for more contact time, more support academically and whilst on clinical placements, and more structured support with their personal development planning. This paper also describes how the study was conducted, the importance that students place on the role, and the need for further research and areas for improvement.

Exploring new nurse teachers' perception and understanding of reflection: an exploratory study.

Reflection and the development of reflective practitioners are integral in many nursing programmes. This study set out to explore new lecturers' perception and understanding of reflection and how well they are preparing nurses to be reflective practitioners. Using a mixed method, new lecturers appointed to the school of nursing within the last 18 months were questioned using a semi-structured questionnaire. Participants were recruited from the purposeful sample and two focus groups interviews were carried out. Data analysis revealed five major themes: (1) perceived lack of efficacy in teaching reflection; (2) skills required for reflection: (3) reflection in the curriculum: (4) strategies used in teaching reflection and (5) educators preparation. It is suggested that new lecturers need more preparation in the highly complex skill of reflection in order to facilitate the reflective learning process in their students. The use of more overt and innovative ways of facilitating reflection in the nursing curriculum is advocated.