Reporting on Neurological Decline as Identified by Hourly Neuroassessments.

ABSTRACT: BACKGROUND: Hourly neurological examinations (neuro exam) have been widely used to monitor for a decline in neurological status, allowing for timely intervention. There are, however, limited data behind this common practice. The objective of this study was to identify how frequently neurological decline occurred across various diagnoses and whether that decline (1) was identified by a scheduled neurocheck and (2) altered management. METHODS: A cross-sectional survey was performed in a neurological intensive care unit at a tertiary care academic medical center. Clinical neuroscience nurses caring for patients with hourly neurological assessments completed a brief survey at 12-hour shift completion. RESULTS: Data were collected from 212 nurse's shifts. Neurological changes were identified by nurses in 14% (n = 30) of shifts. The neurological change was identified during a scheduled neurocheck 67% of the time, with the detection of changes more likely to occur during a scheduled neuro exam than at other times ( P < .05). There was no change to the care plan in 55% of the cases of neurological decline. Patients with subarachnoid hemorrhage were more likely to have a decline detected. CONCLUSION: Findings suggest that many patients undergo hourly neurological exams without ever identifying a neurological deterioration. In many instances of neurodeterioration, there was no change to the treatment plan pursued. Primary diagnoses and neurological changes may not be entirely independent, and therefore, hourly neuro exams may have greater yield in some diagnoses than others. Replication is warranted with a larger sample to evaluate the risks and benefits of neuroassessments.

Sustainability of a Pediatric Neurointensive Care Unit Model Within a Mixed Pediatric Intensive Care Unit and Its Effect on Nursing Sentiment.

ABSTRACT: BACKGROUND: Pediatric neurocritical care (PNCC) and pediatric neurointensive care units (neuro-PICU) are growing fields. Although some institutions have established independent neuro-PICUs meeting most Neurocritical Care Society (NCS) standards for neurocritical care units, many centers lack the resources to do so. We describe an alternative neuro-PICU model as a designated unit within a mixed pediatric intensive care unit (PICU) and its effects on nursing sentiment. METHODS: We established a 6-bed neuro-PICU within a 36-bed noncardiac PICU. Charge nurses were tasked with admitting PNCC patients into these beds. For nursing expertise, we used a core group of 12 PNCC specialty nurses and instituted PNCC nursing education to PICU nurses. We observed the number of PNCC patients admitted to neuro-PICU beds and surveyed charge nurses to identify barriers to assigning patients. We surveyed PICU nursing staff to explore sentiment regarding PNCC before and after establishing the neuro-PICU. Nursing criteria were compared with NCS standards. RESULTS: In the 40-month period, our PICU saw 2060 PNCC admissions. Overall, occupied neuro-PICU beds housed PNCC patients 74.1% of the time. The biggest barriers to patient placement were too many competing placement requests, not enough neuro-PICU beds when specialty census was high, and difficulty assigning one nurse to two PNCC patients. In surveys after establishing the neuro-PICU, compared to before, experienced nurses reported being more interested in obtaining Emergency Neurological Life Support certification (94.2% vs 80.6%, P = .0495), and inexperienced nurses reported being more familiar with PNCC clinical pathways (53.5% vs 31.7%, P = .0263). Most NCS criteria related to nursing organization were met. CONCLUSIONS: Focused neuro-PICUs should be developed to complement advances in the field of PNCC. Alternative neuro-PICU models are possible and can increase nursing interest in further education and awareness of clinical pathways, but barriers exist that require institutional commitment to nursing development to sustain the delivery of specialized care to this population.

Increasing the Volume of Delivered Enteral Feeds Using a Volume-Based Feeding Protocol in a Neuroscience Intensive Care Unit.

BACKGROUND: Iatrogenic malnutrition is a significant burden to patients, clinicians, and health care systems. Compared with well-nourished patients, underfed patients (those who receive less than 80% of their daily energy requirement) have more adverse outcomes related to nutritional status. Volume-based protocols allow for catch-up titrations, are consistently superior to rate-based protocols, and can be implemented in most settings. LOCAL PROBLEM: This project was conducted in an 8-bed neuroscience intensive care unit in which up to 41% of patients who required enteral feeding were underfed. METHODS: This quality improvement clinical practice change project used a before-and-after design to evaluate (1) the effect of implementing a volume-based feeding protocol on the delivery of enteral feeds and (2) the effect of a nutrition-based project on staff members' attitudes regarding nutrition in critical care. The effectiveness of a volume-based feeding titration protocol was compared with that of a rate-based feeding protocol for achieving delivery of at least 80% of prescribed nutrition per 24-hour period. Staff members' attitudes were assessed using a survey before and after the project. RESULTS: During 241 enteral feeding days (n = 40 patients), the percentage of delivered enteral feeding volume and the percentage of days patients received at least 80% of the prescribed volume increased after volume-based feeding was implemented. After project implementation, 74 staff members reported increased emphasis on nutrition delivery in their practice and a higher level of agreement that nutrition is a priority when caring for critically ill patients. CONCLUSIONS: Using a volume-based feeding protocol with supplemental staff education resulted in improved delivery of prescribed enteral feeding.

The Use of the Acute Stroke Management Questionnaire to Measure Acute Care Nurses' Stroke Knowledge.

ABSTRACT: BACKGROUND: Nurses are key in identifying and treating in-hospital strokes (IHSs). Delayed treatment times and poor patient outcomes are associated with IHSs. Information is needed on nurses' stroke knowledge and the objective measurement of stroke knowledge using a validated tool. The Acute Stroke Management Questionnaire (ASMaQ) was recently developed to test stroke knowledge of healthcare professionals but has not been used on a nursing-specific population. METHODS: Through online surveying and use of ASMaQ, we will measure stroke knowledge of nurses caring for adult, hospitalized patients in an urban, southeast US health system. RESULTS: Total N is 196. Most participants (74.5%, n = 146) never worked on a stroke floor; however, almost all (95.9%, n = 188) cared for a stroke patient in the past. Most participants (65.3%, n = 128) reported receiving prelicensure stroke education, and 98.5% (n = 193) received postlicensure stroke education. Acute Stroke Management Questionnaire total scores ranged from 93 to 133 (mean [SD], 117.35 [8.15]). Most participants scored in the good stroke knowledge range for all 3 ASMaQ domains and total ASMaQ score. CONCLUSION: The online delivery of the ASMaQ was successful in testing nurses' stroke knowledge, and nurses were shown to have good stroke knowledge. Future initiatives should focus on discerning whether certain nurse characteristics predict higher or lower levels of stroke knowledge to help inform educational initiatives to improve IHS outcomes.

Validation of a Novel Neurologic Assessment Test for Healthcare Staff.

ABSTRACT: BACKGROUND: To measure the effectiveness of an educational intervention, it is essential to develop high-quality, validated tools to assess a change in knowledge or skills after an intervention. An identified gap within the field of neurology is the lack of a universal test to examine knowledge of neurological assessment. METHODS: This instrument development study was designed to determine whether neuroscience knowledge as demonstrated in a Neurologic Assessment Test (NAT) was normally distributed across healthcare professionals who treat patients with neurologic illness. The variables of time, knowledge, accuracy, and confidence were individually explored and analyzed in SAS. RESULTS: The mean (standard deviation) time spent by 135 participants to complete the NAT was 12.9 (3.2) minutes. The mean knowledge score was 39.5 (18.2), mean accuracy was 46.0 (15.7), and mean confidence was 84.4 (24.4). Despite comparatively small standard deviations, Shapiro-Wilk scores indicate that the time spent, knowledge, accuracy, and confidence are nonnormally distributed ( P < .0001). The Cronbach α was 0.7816 considering all 3 measures (knowledge, accuracy, and confidence); this improved to an α of 0.8943 when only knowledge and accuracy were included in the model. The amount of time spent was positively associated with higher accuracy ( r2 = 0.04, P < .05), higher knowledge was positively associated with higher accuracy ( r2 = 0.6543, P < .0001), and higher knowledge was positively associated with higher confidence ( r2 = 0.4348, P < .0001). CONCLUSION: The scores for knowledge, confidence, and accuracy each had a slightly skewed distribution around a point estimate with a standard deviation smaller than the mean. This suggests initial content validity in the NAT. There is adequate initial construct validity to support using the NAT as an outcome measure for projects that measure change in knowledge. Although improvements can be made, the NAT does have adequate construct and content validity for initial use.

Implementing a Critical Thinking Tool to Evaluate Educational Needs for Inpatient Rehabilitation Nurses.

ABSTRACT: BACKGROUND: Most critical thinking assessment tools are resource intensive and require significant time and money to administer. Moreover, these tools are not tailored to evaluate critical thinking skills among inpatient rehabilitation facility (IRF) nurses. This pilot study explores the efficacy of using short videos to evaluate critical thinking for nurses working in an IRF. METHODS: We developed and filmed 3 clinical scenarios representative of common IRF events that require critical thinking on behalf of the nurse. Thirty-one IRF nurses participated in the study and independently scored their own critical thinking skills using a visual analog scale. Using the same scale, nurse managers and assistant managers who worked closely with the nurses also rated the critical thinking ability of each nurse. The nurse then viewed and responded in narrative form to each of the 3 videos. A scoring rubric was used to independently evaluate the critical thinking skills for each nurse based on the nurses' responses. RESULTS: Nurses rated their own critical thinking skills higher than mangers rated them (m = 85.23 vs 62.89). There was high interrater reliability for scoring video 1k (0.65), video 2k (0.90), and video 3k (0.84). CONCLUSION: The results demonstrate efficacy for further study of low-cost alternatives to evaluate critical thinking among neuroscience nurses providing IRF care.

Essential Components of a Neuroscience Nursing Orientation: A Delphi Study.

ABSTRACT: BACKGROUND: The essential components of an effective neuroscience nurse orientation program for those caring for the adult general care population have not been well defined or standardized. METHODS : Using a 2-round, modified Delphi methodology, electronic surveys were distributed to 53 experts in neuroscience nursing orientation to gain consensus on the essential components of orientation for the neuroscience nurse. Survey data included demographics of the expert, literature-based components of neuroscience nurse orientation, and an opportunity to agree/disagree or write in additional components. RESULTS : Round 1 of the consensus survey elicited a response rate of 55% (29/53), and round 2 had a 51% (27/53) response rate. On the basis of round 1 expert responses, 4 new orientation components were added, and 36 components of a neuroscience nursing orientation were revised to include only the elements with ≥75% agreement. Twenty-two elements in round 2 met the criteria of ≥75% very important and important to include as components of a neuroscience nursing orientation. CONCLUSION : An expert consensus was reached on the necessary components of a neuroscience nursing orientation. The identified neuroscience nursing orientation components concentrated on improving nursing practice and provision of care to adult neuroscience patients. This study demonstrates priority components within a standardized orientation program for neuroscience nurses based on literature and expert consensus. A comprehensive neuroscience nursing orientation is a vital step in sustaining high-quality care for patients and improving neurological outcomes.

Time Is Survival: Continuing Education on Sepsis for Neurosurgical Critical Care Nurses.

BACKGROUND: Early identification of sepsis among neurosurgical critical care patients is a significant challenge because of the many possible confounding variables that lead to altered mental status in this specific patient population. Nurses' knowledge, attitudes, confidence, and practices related to the early identification and management of sepsis are crucial to patients' survival. METHOD: This evidence-based intervention project implemented continuing education for neurosurgical critical care nurses on the early signs and symptoms of sepsis and the management of sepsis according to the Surviving Sepsis Campaign (SSC) Guidelines. RESULTS: Continuing education on sepsis increased neurosurgical critical care nurses' knowledge of the SSC 1-hour sepsis bundle, reported confidence in the management of sepsis, and likelihood of assessing for sepsis. CONCLUSION: Continuing education for neurosurgical critical care nurses on the signs and symptoms of sepsis and the SSC Guidelines is necessary and may improve patient outcomes. [J Contin Educ Nurs. 2024;55(5):224-230.].

Family Role in Care of Patients With Neurological Conditions: International Neuroscience Nursing Research Symposium Proceedings.

ABSTRACT: BACKGROUND: Discussions during the 2022 International Neuroscience Nursing Research Symposium highlighted the impact of family in the care of neuroscience patients. This sparked conversations about the need for understanding global differences in family involvement in the care of patients with neurological conditions. METHODS: Neuroscience nurses from Germany, India, Japan, Kenya, Singapore, Saudi Arabia, the United States, and Vietnam collaborated to provide a short summary of family involvement in caring for patients with neurological conditions in their respective countries. RESULTS: Family roles for neuroscience patients vary across the globe. Caring for neuroscience patients can be challenging. Family involvement in treatment decisions and patient care can be affected by sociocultural beliefs and practices, economic factors, hospital policies, manifestation of the disease, and long-term care requirements. CONCLUSION: Understanding the geographic, cultural, and sociopolitical implications of family involvement in care is of benefit to neuroscience nurses.

An International Study on Violence and Aggression in Neuroscience Nursing.

ABSTRACT: INTRODUCTION: The primary rationale for this study was to evaluate neuroscience registered nurses' (RNs') experience of violence and aggression internationally. The objectives were to determine how prevalent violence and aggression is in neuroscience nursing and the support and education provided. METHODS: Two online surveys were developed for neuroscience RN educators and RNs through SurveyMonkey. The questionnaires were distributed through RN organizations internationally in 2021. RESULTS: Two hundred seventy-two RNs responded to the survey. Most staff felt safe at work but had experienced some type of violence or aggression, with most experiencing verbal aggression. A variety of support existed for staff but lacked consistency, with some of the staff receiving more support from colleagues than their manager. Most RNs had received education in the management of violence and aggression, but some mentioned this was not specific to their neuroscience patient population, and most required further training. Thirty-one RN educators completed the survey, and the results were similar to those of the RN for education provision. Surprisingly, many neuroscience areas did not have a code system or personal alarms to alert staff to a violence or aggression emergency. CONCLUSION: Most RNs felt safe at work despite the high prevalence of violence and aggression experienced. Education was considered beneficial, but they desired more and further research into effective RN education. Effective support post incident needs to be determined. Protection for staff is paramount: few areas had code systems to raise an alarm for agitation, and few places of work had personal alarms that, if implemented, might enable a quicker response to prevent harm.

A Literature Review: Violence and Aggression in Neuroscience Nursing.

ABSTRACT: BACKGROUND: Violence and aggression is commonly encountered in nursing worldwide and is an increasing concern, although it is largely underreported by staff. Violence and aggression can take many forms, from verbal and physical abuse to sexual assault. This study aims to define agitation, violence, and aggression and to explore the prevalence of violence and aggression among neuroscience patients. This review also examines why violence and aggression occurs for neuroscience patients and to determine the effects on the patients, the environment, and the nursing staff. METHODS: A review of articles was conducted using CINAHL, PubMed, the Cochrane Database, and Google Scholar between 2012 and 2022. DISCUSSION: Agitation can escalate to violence and aggression. The reasons a neuroscience patient may become agitated are multifactorial. An injury to the brain may not cause agitation; however, the effect on the frontal lobe, hypothalamus, and hippocampus may cause a lack of self-control, impulsivity, an inability to control emotions, and an uncontrolled release of hormones, leading to a heightened sympathetic response. The effects of violence and aggression can be detrimental to the patient and include isolation, increased sedation, reduced observations, and even death. The effects on the nurse are profound including a decline in productivity at work, an increased risk of drug errors, and posttraumatic stress disorder or burnout as longer-term consequences. CONCLUSION: Violence and aggression is commonly experienced within neuroscience nursing, and the contributing factors are multifactorial. The effects for the patients and staff can be profound, and this is why prevention of agitation is fundamental to ensure the safety and retention of nursing staff.

Neurological patient and informal caregiver quality of life, and caregiver burden: A cross-sectional study of postdischarge community neurological nursing recipients.

Neurological conditions produce considerable disease burden.To describe quality of life in patients with neurological conditions and informal caregivers receiving postdischarge generic community neurological nursing services, and caregiver burden.A descriptive cross-sectional design was used with researchers administering the WHOQOL-BREF Australian Version questionnaire and Zarit Burden Interview.Most patients and caregivers rated quality of life as 'Good'. The patients' physical, psychological and environment domain scores, and caregivers' physical domain scores, were below norms. Half of the caregivers experienced burden and 42% had risk for depression.A heterogeneous group of patients with neurological conditions had considerable care and support needs for fundamental functioning postdischarge. Quality of life and caregiver burden measures highlight the impact of their circumstances on their health and wellbeing. Research is warranted to determine a comprehensive set of generic needs to guide integrated community nursing services for building patient and caregiver self-management capacity.

Challenges and Opportunities in Stroke Nursing Research: Global Views From a Panel of Nurse Researchers.

ABSTRACT: INTRODUCTION: A diverse group of neuroscience nurse experts discussed stroke nursing research at the 5th International Neuroscience Nursing Research Symposium. Panel experts from Singapore, India, Australia, New Zealand, the Philippines, Malawi, Germany, Palestine, Kenya, Japan, and the United States collaborated to examine similarities and differences in nurse-led stroke research conducted in their home countries. This article reflects panel insights on challenges and opportunities for nurse-led stroke research. DISCUSSION: The research challenges discussed include nursing independence, the processes of informed consent and randomization process, obtaining adequate independent funding, recruiting research subjects, and working with vulnerable groups. The major opportunities to leverage and improve stroke nursing research include facilitating the nurse investigator role, information digitalization, improving health literacy, and collaboration between nurse researchers. SUMMARY: We are living in a volatile, uncertain, complex, and ambiguous world, and the COVID-19 pandemic has accentuated many challenges. There is a need to allow for creativity around recruitment and conducting stroke research. The use of technology reduces travel needs and mitigates many safety, financial, and transportation-related problems. Although the pandemic has highlighted the challenges faced when conducting stroke-related research, there are remarkable similarities in opportunities to improve outcomes.

A Delphi Study to Establish Research Priorities for Neuroscience Nursing.

ABSTRACT: BACKGROUND: Establishing research priorities is essential not only to support evidence-based nursing practice but also to direct research agendas for nursing organizations such as the American Association of Neuroscience Nursing. METHODS: A 6-member Research Agenda Task Force selected potential research priorities based on a literature search of neuroscience nursing research. Using a 2-round, modified Delphi methodology, electronic surveys were distributed to 53 neuroscience nursing experts to gain consensus on the research priorities for neuroscience nursing. Survey data included demographics, agreement with selected gaps in neuroscience nursing research, and impact of selected neuroscience nursing research topics on the field. RESULTS: Twenty-six of 53 experts (49% response rate) participated in round 1, and 30 of 53 experts (57% response rate) participated in round 2. In round 1, the Research Agenda Task Force members revised the list of gaps in neuroscience nursing research to include only the top 39 ranked topics with greater than or equal to 73% agreement, created a new category "Professional Practice Issues," and added 1 additional topic. In round 2, 14 topics were ranked greater than or equal to 70% impactful and identified as the top neuroscience nursing research priorities. CONCLUSION: The results of this study served as an effort for creating research priorities and enhancing research collaboration that focuses on neuroscience nursing. Focusing on gaps in the literature and setting research priorities can ultimately improve patient outcomes. Neuroscience nursing research priorities can be used to inform, guide, and aid nurse scientists, educators, and providers, and to inform agencies that provide research and program funding.