Diagnósticos de enfermagem em pós-operatório de neurocirurgia / Nursing diagnostics in neurosurgery post-operative

Objetivo: verificar os diagnósticos de enfermagem em pacientes em pós-operatório de neurocirurgia. Método: trata-se de um estudo bibliográfico, descritivo, tipo revisão integrativa da literatura, com a busca nas bases de dados LILACS, CINAHL e na Biblioteca Virtual SciELO. Apresentaram-se os resultados em forma de figuras. Resultados: encontraramse, no total, 256 artigos. Incluíram-se, ao final, três, com níveis de evidência B2 e B3. Caracterizaram-se, quanto ao tipo de delineamento, dois estudos como transversal prospectivo e o terceiro, retrospectivo. Apresentaram-se os dez DE encontrados predominantemente relacionados aos domínios "atividade/repouso" (domínio 4) e "segurança/proteção" (domínio 11), com quatro DE em cada. Conclusão: identificaram-se, embora ainda sejam escassas as publicações, DE propostos especificamente para o cuidado ao paciente em pós-operatório de neurocirurgia. Torna-se imprescindível, dentre as ações do enfermeiro no momento perioperatório, a identificação dos diagnósticos e o planejamento, de forma apropriada, do cuidado de Enfermagem para, assim, atender às necessidades de cada paciente de forma holística.(AU)

Objective: to verify nursing diagnoses in patients in the postoperative period of neurosurgery. Method: this is a bibliographic, descriptive, integrative literature review study, searching the LILACS, CINAHL databases and the SciELO Virtual Library. The results were presented as figures. Results: a total of 256 articles were found. At the end, three were included, with levels of evidence B2 and B3. Regarding the type of design, two prospective cross-sectional studies and the third retrospective study were characterized. The ten ND found predominantly related to the domains "activity / rest" (domain 4) and "safety / protection" (domain 11), with four NDs in each. Conclusion: we identified, although the publications are still scarce, specifically proposed for the care of patients in the postoperative period of neurosurgery. It is essential, among the actions of nurses in the perioperative period, the identification of diagnoses and the appropriate planning of nursing care to thus meet the needs of each patient holistically.(AU)

Objetivo: verificar los diagnósticos de enfermería en pacientes en el postoperatorio de neurocirugía. Método: este es un estudio de revisión bibliográfica, descriptivo, integrador de la literatura, que busca en las bases de datos LILACS, CINAHL y la Biblioteca Virtual SciELO. Los resultados se presentaron en forma de figuras. Resultados: se encontraron un total de 256 artículos. Al final, se incluyeron tres, con niveles de evidencia B2 y B3. En cuanto al tipo de diseño, se caracterizaron dos estudios transversales prospectivos y el tercer estudio retrospectivo. Los diez ND se encuentran predominantemente relacionados con los dominios "actividad / descanso" (dominio 4) y "seguridad / protección" (dominio 11), con cuatro ND en cada uno. Conclusión: identificamos, aunque las publicaciones aún son escasas, propuestas específicamente para la atención de pacientes en el postoperatorio de neurocirugía. Es esencial, entre las acciones de los enfermeros en el período perioperatorio, la identificación de diagnósticos y la planificación adecuada de la atención de Enfermería para satisfacer las necesidades de cada paciente de manera integral. (AU)

The Benefits of Implementing an Early Mobility Protocol in Postoperative Neurosurgical Spine Patients.

: Background: Despite the known benefits of early postsurgical mobility, there are no clear recommendations on early mobility among uncomplicated postoperative neurosurgical spine patients. PURPOSE: The purpose of this quality improvement initiative was to establish an NP-led early mobility protocol to reduce uncomplicated postsurgical spine patients' length of stay (LOS) in the hospital and eliminate the variability of postsurgical care. A secondary objective was to educate and empower nursing staff to initiate the early mobility protocol independently and incorporate it in their practice to improve patient care. METHODS: Two neurosurgery NPs led an interprofessional team to develop the early mobility protocol. Team members provided preadmission preoperative education to communicate the necessity for early mobility and provide information about the protocol. New nursing guidelines called for patient mobility on the day of surgery, within six hours of arrival on the medical-surgical unit. Nurses were empowered to get patients out of bed independently, without a physical therapy consultation; they also removed urinary catheters and discontinued IV opioids when patients' status permitted. RESULTS: Over a one-year period, implementation of the protocol resulted in a nine-hour reduction in LOS per hospitalization in neurosurgical spine patients who underwent lumbar laminectomies. The protocol also allowed nurses more autonomy in patient care and was a catalyst for patient involvement in their postoperative mobility. Given the success of the protocol, it is being replicated by other surgical services throughout the organization. CONCLUSIONS: This low-cost, high-reward initiative aligns with the strategic plan of the organization and ensures that high-quality, patient-centered care remains the priority. NPs in other institutions can modify this protocol to promote postoperative mobility in their organizations.

Evaluation of a wireless, portable, wearable multi-parameter vital signs monitor in hospitalized neurological and neurosurgical patients.

Unrecognized changes in patients' vital signs can result in preventable deaths in hospitalized patients. Few publications or studies instituting routine patient monitoring have described implementation and the setting of alarm parameters for vital signs. We wanted to determine if continuous multi-parameter patient monitoring can be accomplished with an alarm rate that is acceptable to hospital floor nurses and to compare the rate of patient deterioration events to those observed with routine vital sign monitoring. We conducted a prospective, observational, 5-month pilot study in a 26-bed adult, neurological/neurosurgical unit (non-ICU) in an academic medical center. A patient surveillance system employing a wireless body-worn vital signs monitor with automated nursing notification of alarms via smartphones was used to gather data. Data collected included: alarm rates, rapid response team (RRT) calls, intensive care unit (ICU) transfers, and unplanned deaths before and during the pilot study. Average alarm rate for all alarms (SpO2, HR, RR, NIBP) was 2.3 alarms/patient/day. The RRT call rate was significantly reduced (p < 0.05) from 189 to 158 per 1000 discharges. ICU transfers per 1000 discharges were insignificantly reduced from 53 to 40 compared to the previous 5-month period in the same unit. Similar measures of comparison units did not change over the same period. Although unplanned patient deaths in the study unit were also reduced during the intervention period, this was not statistically significant. Continual, multi-parameter vital signs monitoring can be customized to reduce a high alarm rates, and may reduce rapid response team calls.

[Glioblastoma and nursing care in neurosurgery]. / Glioblastome et soins infirmiers en neurochirurgie.

Nurses in neurosurgical departments play a critical role as they are involved in the first stages of the care pathway of patients with glioblastoma. Indeed, surgery enables a definitive histopathological diagnosis to be established and the size of the tumour to be significantly reduced, thereby improving the prognosis.

[Glioblastoma, innovations in surgery]. / Glioblastome, des innovations en chirurgie.

One of the innovative principles in glioblastoma surgery consists in making the tumour fluorescent in order for it to be more easily visualised during the procedure. 5-aminolevulinic acid (5-ALA) undergoes an enzyme transformation, turning into another molecule, protoporphyrine IX (PPIX) whose property is fluorescence. It emits red light when it is stimulated by blue light.

[Efficacy of early neurological and neurosurgical rehabilitation : Evidence-based treatment, outcome and prognostic factors]. / Wirksamkeit der neurologisch-neurochirurgischen Frührehabilitation : Evidenzbasierte Therapieformen, Outcome und Prognosefaktoren.

BACKGROUND: Early neurological and neurosurgical rehabilitation (ENNR) as a complex post-acute form of treatment for patients with severe neurological diseases and continued need for intensive care is well established in Germany. OBJECTIVE: To assess the efficacy of ENNR from the perspective of evidence-based medicine as well as to present data on the outcome of ENNR patients including the analysis of prognostic factors. MATERIAL AND METHODS: A search was carried out in PubMed databases to identify early rehabilitation treatment forms evaluated by randomized controlled trials and with respect to large multicenter surveys of outcome and prognostic factors. RESULTS: For ENNR as a complex treatment concept, effectiveness not has been shown with regard to evidence-based medicine but it includes individually effective treatment forms. In two large multicenter evaluations the average duration of treatment was between 51 and 57 days and mortality was between 6 % and 10 %, increasing with the proportion of mechanically ventilated patients. Lower need for nursing support on admission indicated better outcome, whereas mechanical ventilation was more likely to be associated with poor outcome. Long-term outcome was negatively influenced by mechanical ventilation as well as severe neurogenic dysphagia with and without the need for a tracheal cannula and/or percutaneous endoscopic gastrostomy (PEG) and also by severely impaired communication at the end of ENNR. DISCUSSION: These prognostic factors indicate the primary aims of ENNR, which are to reduce the need for nursing support and to establish the capability for rehabilitation. If these aims are achieved, favorable functional and long-term outcome can be expected for ENNR patients. The presented studies verify the sustained efficacy of ENNR as an essential part of the overall treatment concept for severely neurologically impaired patients.

Staff Nurses Eliminated Catheter-Associated Urinary Tract Infections in a Neurosurgical Intensive Care Unit.

Catheter-associated urinary tract infections (CAUTIs) are among the leading causes of health care-associated infections in neurosurgical populations. Successful reduction of CAUTIs involve the development of staff nurses as front-line change agents equipped with preventative strategies, educational interventions, and sustainable maintenance for positive patient outcomes.

Measuring workload of nurses on a neurosurgical care unit.

AIM OF THE STUDY: The aim of this study was to create a model of workload that could be used to manage workload and increase satisfaction of workload for nurses on a neuroscience care unit. BACKGROUND: No study was found that delineated a model of workload that could be used to manage or improve satisfaction with workload for a neuroscience care unit at either the individual nurse or unit level. METHODS: Staff, management, and a researcher collaboratively developed a model to examine workload on a neuroscience care unit. Forty-three independent variables of workload and the dependent variable of satisfaction with workload were studied over 28 days using stepwise regression. Stepwise regression is appropriate for model building. Criteria to enter any independent variable into a regression equation included correlating with the dependent variable of satisfaction with workload, validation of central tendency assumptions, and good data fit using residual diagnostics. RESULTS: Independent variables of workload that explained the variance of satisfaction with workload included time (15.9%), undelegated work (4.0%), number of isolation patients (2.9%), individual employees (2.1%), number of patients (1.3%), and number of postoperative neurosurgical patients (1.1%). On the unit level, satisfaction with workload was predicted by time (42.5%) and the number of nurses on duty (7.7%). CONCLUSIONS: Satisfaction with workload as reported by staff nurses is predicted by both individual- and unit-level factors of workload. Staff input is crucial to the development of a model of workload on clinical specialty units like neuroscience care. Staff nurses identify key variables, otherwise overlooked, affecting workload and satisfaction and satisfaction with workload. IMPLICATIONS FOR NURSING MANAGEMENT: It is vital to develop unit-specific models of workload and consider both individual- and unit-level factors. Such models have potential for deeper research into both management and increasing satisfaction of workload at the level of clinical specialty/unit.

Critical care nursing in acute postoperative neurosurgical patients.

The nursing discipline is vital throughout patients' hospital progression. One of the most critical moments in the hospital stay is the postoperative period. Neurosurgical patients require a high level of nursing care and vigilance and additional postoperative monitoring in intensive care units designed specifically for this demographic. In the postoperative setting, patient care must be transferred from anesthesia to nursing in a manner that is continuous and safe. This article focuses on neurosurgical patients in the postoperative period, the assessment of these patients, and critical care nursing, with emphasis on common issues and interventions for this dynamic patient population.

The effect of nocturnal patient care interventions on patient sleep and satisfaction with nursing care in neurosurgery intensive care unit.

BACKGROUND: Sleep disturbance in an intensive care unit is a common problem. One of the main factors causing sleep disturbances in an intensive care unit is nocturnal patient care interventions. AIMS AND OBJECTIVES: This study aims to determine the impact of patient care interventions performed at night in a neurosurgical intensive care unit on patients' sleep and their nursing care satisfaction. METHODS: The descriptive study was conducted on 82 patients in a neurosurgical intensive care unit between January 2009 and March 2010. The data were collected by data collection instruments and Newcastle Satisfaction with Nursing Scales. The data were statistically analyzed by frequency, mean, standard deviation, chi-square, and Mann-Whitney U test. RESULTS: The study showed that 53.7% of the patients experienced sleep disturbances in the neurosurgical intensive care unit. Because of nursing interventions at night, 39.1% of these patients had their sleep affected, but this problem did not cause any negative impact on the patients' satisfaction (Newcastle Satisfaction with Nursing Scales score = 88.21 ± 9.83). The patients received, on average, 42.21 ± 7.45 times patient care interventions at night; however, the frequency of patient care interventions at night showed no effect on sleep disturbances in this study (p > .05). The most frequently given patient care interventions were, respectively, vital signs monitoring, neurological assessment, and repositioning in bed. These interventions were performed commonly at 6 a.m., 12 a.m., and 7 p.m. CONCLUSION: In this study, despite the patients reporting sleep disturbances in the neurosurgical intensive care unit because of nocturnal patient care interventions that prevented them from sleeping, the patients' satisfaction on the given nursing care was not negatively impacted. To reduce sleep disturbances because of nursing care initiatives and promote uninterrupted sleep in the intensive care unit, it can be useful to develop new protocols regulating night care activities.

Implementing family communication pathway in neurosurgical patients in an intensive care unit.

OBJECTIVE: Family-centered care provides family members with basic needs, which includes information, reassurance, and support. Though national guidelines exist, clinical adoption often lags behind in this area. The Geisinger Health System developed and implemented a program for reliable delivery of best practices related to family communication to patients and families admitted to the intensive care unit (ICU). METHOD: Using a quasiexperimental study design and the 24-item Family Satisfaction in the Intensive Care Unit questionnaire (FSICU-24©) to determine family satisfaction, we measured the impact of a "family communication pathway" facilitated by tools built into the electronic health record on the family satisfaction of neurosurgical patients admitted to the ICU. RESULTS: There was no statistically significant difference noted in family satisfaction as determined by FSICU-24 scores, including the Care and Decision Making constructs between the pre- and post-intervention pilot population. The percentage of families reporting the occurrence of a family conference showed only minimal improvement, from 46.5% before to 52.5% following the intervention (p = 0.565). This was mirrored by low numbers of documented family conferences by providers, suggesting poor uptake despite buy-in, use of electronic checklists, and repeated attempts at education. SIGNIFICANCE OF RESULTS: This paper reviews the challenges to and implications for implementing national guidelines in the area of family communication in an ICU coupled with the principles of clinical reengineering.

Validation of the use of the Critical-Care Pain Observation Tool (CPOT) with brain surgery patients in the neurosurgical intensive care unit.

UNLABELLED: Many critically ill patients are unable to self-report their pain. In such situations, the use of valid behavioral pain scales is recommended. OBJECTIVE: To validate the use of the Critical-Care Pain Observation Tool (CPOT) with brain surgery adults in the neurosurgical intensive care unit. DESIGN: Repeated-measure within subject prospective design. SETTINGS: Forty-three elective brain surgery patients of a Canadian university hospital participated. METHOD: Participants were video recorded and scored with the CPOT before, during and after a non-nociceptive (non-invasive blood pressure using cuff inflation) and a nociceptive (turning) procedure for a total of six assessments. Self-reports of pain were also obtained. RESULTS: Discriminant validation was supported with higher mean CPOT scores during the nociceptive procedure compared with the non-nociceptive one. More participants reported higher pain intensity during turning compared with cuff inflation. Criterion validation was supported with a moderate positive correlation between self-reports of pain intensity and CPOT scores during turning. Interrater and intrarater reliability of CPOT scores through the viewing of participants' videos by two trained raters was supported with high Intraclass Correlation Coefficients. CONCLUSION: The CPOT appears to be valid for the detection of pain in elective brain surgery patients in the neurosurgical intensive care unit.

Extent of the burden of caregiving on family members of neurosurgical inpatients in a tertiary care hospital in north India.

PURPOSE OF THE STUDY: Taking care of admitted patients has usually been as much a responsibility of family members as that of hospital staff in India, but caregiver burden in caregivers of admitted patients has seldom been explored. The current study attempts to understand the prevailing situation in terms of burden of caregiving, among caregivers of neurosurgical inpatients of a tertiary care hospital, through identification and quantification of the same. All dimensions of the expected impact were recognized and explored among family caregivers. DESIGN AND METHODS: This study followed a cross-sectional design and included adult caregivers of 100 neurosurgery inpatients from the neurosurgery ward of Post Graduate Institute of Medical Education and Research, Chandigarh. Both qualitative and quantitative data were collected and analyzed accordingly. RESULTS: Univariate analysis showed most caregivers to be male young adults. More than 70% were immediate family members of the patients. Severe disturbance in the lives of caregivers was observed through thematic analysis of qualitative data, although less than 20% accepted caregiving to be a burden on them. Ninety percent of respondents mentioned disturbed sleep patterns, and average Caregiver Strain Index scores came out to be 11.65, depicting the overall strain levels to be moderate. CONCLUSIONS: Burden of caregiving in caregivers of neurosurgery patients is a real problem, with deep-rooted causes and far-reaching potential consequences. Efforts need to be made to take stock of this issue, for the benefit of both neurosurgery patients and their caregivers.

Management for the case of twice ruptured anterior communicating artery aneurysm: from nursing perspective.

The anterior communicating artery (ACoA) is the most common site of cerebral aneurysms, accounting for as much as 36% of aneurysms. Microsurgical clipping and coil embolization are treatment modalities for ruptured and nonruptured cerebral aneurysms. Compared with surgical clipping, coil embolization has a relatively lower mortality and incidence of cognitive impairment in patients. However, successful management of the patient with twice ruptured ACoA aneurysm is facing critical challenges.This article has described a case of twice ruptured aneurysm with the first rupture occurring when the patient was admitted and the second rupture occurring during coil embolization. Perioperative nursing assessment, monitoring, intervention, patient teaching, and the nurse's role are discussed from a nursing perspective.

Does preoperative scalp shaving result in fewer postoperative wound infections when compared with no scalp shaving? A systematic review.

Preoperative scalp shaving has been a well-established practice among neurosurgeons based on the belief that hair removal prevents postoperative infections. Apart from aiding in improved visualization of the incision line, ease of closure, and dressing application, there are concerns that the presence of hair at the surgical site may interfere with the surgical procedure. Preoperative scalp shaving is a controversial practice, and many neurosurgeons are moving toward not removing any hair or clipping minimal hair along the incision line rather than shaving the scalp. The following is a systematic review of articles related to preoperative scalp shaving before cranial surgeries and the implications for postoperative wound infections. Eighteen articles were identified as potentially relevant based on the search criteria. These articles were selected based on the inclusion and exclusion criteria to provide concise background information and an explanation of scalp-shaving practices in neurosurgery leading to the clinical question posed. An evidence table was compiled to organize the study data and identify key points. The review brings strong evidence that preoperative scalp shaving does not confer any benefit against postoperative wound infection and, paradoxically, may lead to higher rates of infection. Because hair removal neither contributes benefits to the surgery itself nor decreases the risk of wound infection but has considerable cosmetic value for the patient, many of the authors recommended that cranial surgeries should be done without hair shaving.

[Nursing care in the neurosurgical patient]. / Cuidados de enfermería en el paiente neuroquirúrgico.

The Neurosurgery patient is the one who has been undergone to surgery in the brain or in the peripheral nervous system, and might suffer complications during per operative period. They are patients who require attention in areas specialized in critical health care and who will need advanced monitorization, due to it is a high risk postoperative. It is in this point, in the one in which the nurse develops a function of vital importance in the health care, through the constant and specialized attention, to get the best quality of health care. The nurse should be able to evaluate, prevent, control and identify risk situations, avoiding complications and helping patient recovery

Experiences of the relatives of patients undergoing cranial surgery for a brain tumor: a descriptive qualitative study.

The functional changes that develop because of neurological sequelae in patients with a brain tumor have a negative effect on daily activities and self-care. This situation in turn has a negative effect on the lives of the patients' relatives and increases their work load. We interviewed 10 relatives of patients who had undergone cranial surgery for a brain tumor as part of a descriptive qualitative study and asked them to describe their experiences during the perioperative period and home care. The data obtained from the patients' relatives were evaluated using Colaizzi's analysis method and divided into three categories and eight themes: (a) personal feelings (first reactions, decision for surgery, first meeting with the patient after surgery, ambiguity), (b) management of the changes (management of the side effects of the tumor, management of role and behavioral changes, management of care at home, social support), and (c) need for knowledge about managing the disease process. We found that brain tumor surgery can be more frightening for patients and their relatives than other surgical interventions. Also, because the patient requires prolonged postoperative care, the patient's family plays an important role at every stage of the patient's treatment and care.

Nurse experts jump-start clinical simulation in rehabilitation nursing: supporting new graduate transition to competence.

This article outlines a high-fidelity simulation project developed and implemented by expert staff nurses at a specialty rehabilitation hospital. The project is designed to educate new graduate nurses on appropriate care for patients after a rare spinal cord surgical procedure. Due to the complicated nature of the surgery, patients are highly acute and may present with specific complications that need to be addressed for positive patient outcomes. Expert staff nurses imparted their knowledge in developing a scenario emphasizing common and unusual postsurgery patient presentations. The scenario was implemented as a teaching exercise for new graduate nurses, with experienced staff nurses as facilitators of learning in a safe, nonthreatening environment. New graduate nurses were overwhelmingly positive in the postsimulation debriefing, reporting increased confidence and knowledge necessary to care for these patients. Future endeavors include expanding involvement of staff nurses in simulation education and researching new graduate transition through simulation.

Safe positioning for neurosurgical patients.

Positioning the patient for surgery is an important part of perioperative nursing care that should not be underemphasized. The combined factors of time, mechanical pressure, and immobility increase the risk of tissue damage. The objectives of perioperative positioning activities are to balance optimal surgical exposure with the prevention of any injury related to position and to maintain normal body alignment without excess flexion, extension, or rotation. After providing general principles of positioning, specific considerations with surgical rationale are presented for each of the commonly used neurosurgical positions (eg. supine, knee-chest, prone, lateral, park-bench, sitting).