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Abstract: BACKGROUND: Neuroleadership in nursing is a specialized leadership approach that integrates insights from social neuroscience with nursing leadership practices, aiming to proficiently lead healthcare teams to enhance patient care, staff productivity, and organizational outcomes. Yet, the exploration of neuroleadership in nursing remains limited. AIM: The aim of this study was to provide an analysis of the concept of neuroleadership and its implications in the nursing context. METHODS: Walker and Avant's 8-step methodology was used for this concept analysis, including identifying the concept, clarifying the purpose of the analysis, exploring the uses of the concept, and defining its attributes, model and contrary cases, antecedents and consequences, and its empirical referents. A comprehensive search included PubMed, CINAHL, and ERIC, between 2000 and 2023. RESULTS: This concept analysis significantly contributes to the literature by providing a comprehensive overview of neuroleadership as a distinct form of nursing leadership. It covers key aspects such as definition, attributes, uses, cases, antecedents, consequences, and empirical evidence, and highlights the importance of specialized education, practical experience, and leadership attributes in this domain. The findings could serve as determinants for establishing a neuroleadership framework and developing a structured questionnaire to measure neuroleadership among nurses and nurse leaders, thereby addressing existing empirical reference gaps. CONCLUSION: Nurse leaders adopting a neuroleadership approach can gain insights into how cognitive processes shape nurses' behaviors and motivation, which directly impact patient outcomes and care quality. Further research is needed to assess the practical impact of neuroleadership and validate its factors and model case in clinical nursing practice., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 American Association of Neuroscience Nurses.)

Abstract: BACKGROUND: Idiopathic intracranial hypertension (IIH) is a neurological disorder characterized by elevated intracranial pressure, affecting predominantly obese women of childbearing age. Early recognition and comprehensive management are vital for preventing severe complications, particularly vision loss. METHODS: This study reports a case of a 27-year-old woman who presented with chronic headaches and blurred vision. Notable findings included headaches that were intensified upon waking and exacerbated by activities that elevated intracranial pressure. The patient also reported nausea, vomiting, transient visual obscurations, and pulsatile tinnitus. After a clinical examination, she was given a diagnosis of IIH. RESULTS: The patient underwent a lumbar-peritoneal shunt procedure to alleviate her symptoms in conjunction with medication treatment. This case study highlights the importance of a multidisciplinary approach in diagnosing and treating IIH. In particular, weight management emerged as a crucial preventive measure against IIH recurrence. CONCLUSION: A multidisciplinary team strategy can enhance outcomes and quality of life, accentuating the need for continued research into IIH recurrence, treatments, and wider implications., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 American Association of Neuroscience Nurses.)

Abstract: BACKGROUND: Clinical practice guidelines (CPGs) and evidence-based clinical reviews help guide nursing practice. The American Association of Neuroscience Nurses (AANN) has published guidelines for more than 25 years. METHODS: The AANN CPGs are developed using predefined search terms based on PICO (population, intervention, comparison, outcome) questions formulated a priori followed by evaluation of the evidence and creation of recommendations using methodologies of the Grading of Recommendations Assessment, Development, and Evaluation. DISCUSSION: Neuroscience nurses provide care for a specialized population with unique nursing care considerations. The CPG series has been rigorously developed to provide relevant context and practice recommendations to improve this care. CONCLUSION: This article establishes the methodology by which AANN CPGs are developed., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 American Association of Neuroscience Nurses.)

Abstract: BACKGROUND: Ictal and postictal testing is an essential aspect of clinical care when diagnosing and treating seizures. The epilepsy monitoring unit (EMU) has standard operating procedures for nursing care during and after seizure events, but there is limited interrater reliability. Streamlining ictal and postictal testing processes may enhance care consistency for patients in the EMU unit. The purpose of this study was to create an ictal and postictal seizure assessment tool that would increase the consistency of nursing assessment for EMU patients. METHODS: This prospective study had 4 phases: baseline assessment, instrument development, staff education, and field testing. During baseline assessment, an advanced practice provider and an epilepsy fellow graded nurse ictal and postictal assessment via survey questions. After instrument development, education, and implementation, the same survey was administered to determine if nursing consistency in assessing seizure events improved. The tool used in this study was created by a team of clinical experts to ensure consistency in the assessment of seizure patients. RESULTS: A total of 58 first seizure events were collected over a 6-month intervention period; 27 in the pretest and 31 in the posttest. Paired t test analyses revealed significant improvement in the clinical testing domains of verbal language function ( P < .005), motor function ( P < .0005), and item assessment order ( P < .005) postintervention. There was nonsignificant improvement in the domains of responsiveness (feeling [ P = .597], using a code word [ P = .093]) and visual language function ( P = .602). CONCLUSION: The data captured in this study support the need for this instrument. There is strong need to increase consistency in assessing seizure events and to promote continued collaboration among clinical teams to enhance care to EMU patients. Validation of this instrument will further improve team collaboration by allowing nurses to contribute to their fullest extent., Competing Interests: Conflict of interest: Dr Olson is the Editor for the Journal of Neuroscience Nursing . The remaining authors report no conflict of interest., (Copyright © 2024 American Association of Neuroscience Nurses.)

Abstract: BACKGROUND: Medication documentation falls under the "7 rights" of medication administration, but strategies to prevent medication administration documentation errors (MADEs) related to route of administration are underreported in the literature. This study aimed to report the outcomes of a nurse-initiated protocol designed to prevent MADEs and align both actual and documented medication administration routes in hospitalized stroke patients with feeding tubes (FTs). METHODS: This was a retrospective descriptive study conducted at a Comprehensive Stroke Center and large academic medical center in the Western United States. Adults admitted with the diagnosis of stroke between February 2022 and August 2023, who had an FT on arrival, or placed during admission, and received at least 1 enteral medication ordered for by mouth (PO) administration, were included. The protocol allowed nurses to place a communication order to a pharmacist via the electronic health record, requesting all enteral medications ordered for PO administration be changed to FT administration. RESULTS: There were 481 patients included with a median age of 68 years (interquartile range, 58-76 years). The nurse-initiated protocol was used in 170 patients (35.3%), with 99 patients (58.2%) having all enteral medication orders converted completely by a pharmacist. Of the 170 patients in which the protocol was initiated, 145 (85.3%) had all scheduled enteral medication orders converted. For the 71 patients who did not have all enteral medication orders converted completely, the median number of potential MADEs was 2 (1-4.5). CONCLUSION: A nurse-initiated protocol designed to prevent MADEs and improve the accuracy of actual and documented route of medication administration for patients hospitalized for stroke with FTs had modest use. The nurse-initiated protocol in this study is the first of its kind and may help guide further research on preventing and reducing MADEs., Competing Interests: Financial disclosures/conflicts of interest statement: The authors of this manuscript received no sources of funding and have no conflicts of interest to disclose., (Copyright © 2024 American Association of Neuroscience Nurses.)

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., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 American Association of Neuroscience Nurses.)

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., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 American Association of Neuroscience Nurses.)

Competing Interests: The authors declare no conflicts of interest.

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., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 American Association of Neuroscience Nurses.)

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., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 American Association of Neuroscience Nurses.)

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., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 American Association of Neuroscience Nurses.)

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., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 American Association of Neuroscience Nurses.)

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., Competing Interests: The author declares no conflicts of interest., (Copyright © 2023 American Association of Neuroscience Nurses.)

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., Competing Interests: The author declares no conflicts of interest., (Copyright © 2023 American Association of Neuroscience Nurses.)

Competing Interests: The author declares no conflicts of interest.

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., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 American Association of Neuroscience Nurses.)

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., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 American Association of Neuroscience Nurses.)

Abstract: BACKGROUND: The American Association of Neuroscience Nurses established a 6-member Research Agenda Task Force in 2019 to identify neuroscience nursing research priorities to lead the field for the next 3 to 5 years. An early step in the process was a literature search to gain an understanding of the current landscape of neuroscience nursing research. METHODS: A search strategy was developed to locate relevant neuroscience nursing research. An experienced medical librarian performed a comprehensive systematic search of multiple databases. Task force members then further refined the search. A separate search was conducted to locate published research by 21 known neuroscience nurse researchers. RESULTS: An initial search located 466 qualitative articles and 1243 quantitative articles, with a further 655 articles published by known neuroscience nurse researchers. All 2364 citations were reviewed by task force members of the working in pairs to screen titles and abstracts for relevance. Nine categories of neuroscience nursing research were identified: quality of life, nursing practice, biomarkers, health promotion, professional development, technology, nursing care outcomes, assessment, and caregivers. Most of the research used descriptive methods, including both quantitative and qualitative methods of inquiry, providing a foundation for more rigorous investigation and interventional research. Research following stroke and the critical care setting were most prevalent. DISCUSSION: New and emerging trends in neuroscience nursing research include the use of technology, biomarkers, lay caregivers, strategies, and tools, including measure development for neurological assessment, and the evaluation of nursing practice including the practice environment and advanced practice nurse providers. Gaps were also evident. CONCLUSION: There is a significant need to expand neuroscience nursing in areas of emerging trends and to use rigorous methods to evaluate nursing practice effects on patient outcomes. The results of this search were used to revise the neuroscience nursing priorities last determined in 2011., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 American Association of Neuroscience Nurses.)

Abstract: BACKGROUND: The emergence of neuroscience intensive care units (NSICUs) for the past decades has led to growing interest in targeted training for NSICU nurses. We sought to evaluate the use of video instruction on NSICU nurses' skills in case presentations and neurological examinations, which has timely advantages as an asynchronous and distanced learning modality. METHODS: We enrolled NSICU and surgical intensive care unit nurses who took shifts in the NSICU at our institution. Participants were observed by a neurocritical care attending physician presenting the clinical details of an admitted patient and conducting a neurological examination, with both parties completing a 10-item evaluation on NSICU nursing presentation and examination skills. Participants randomized to an intervention group were given access to an instructional video on NSICU nursing skills. A median of 21 days later, participants were observed by a physician blinded to study randomization, with both parties recompleting the evaluation. Differences between day 1 and day 21 scores were analyzed using paired sample t tests. RESULTS: Fifteen NSICU and 55 surgical intensive care unit nurses were enrolled. Surgical intensive care unit nurses in both the intervention and control groups had statistically significant improvement between day 1 and day 21 physician-rated scores, with a greater increase in the intervention group; self-rated scores did not change. For NSICU nurses, there were no differences in physician-rated or self-rated scores for either group. CONCLUSIONS: Surgical intensive care unit nurses who underwent direct observation and self-evaluation had improvement in physician-rated NSICU nursing skills, likely as these activities allowed for reflective observation in Kolb's experiential learning cycle. Greater improvement in participants who viewed an instructional video highlights its value as a teaching modality for nurses., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 American Association of Neuroscience Nurses.)

Background: Electroencephalography (EEG) enables the precise evaluation of a neonate's condition. Three factors that determine the quality of care during this procedure are knowledge, experience, and attitude. The role of the nurse during EEG recordings was evaluated in this study, and the requirements for successfully performing neonatal EEGs, along with practical suggestions, are presented., Methods: Evidence in the literature as well as clinical expertise forms the basis for this review., Results: From our observations and practice during EEGs, we found that the following conditions must be met to successfully perform an EEG examination in a newborn: safety, a period of sleep and calm wakefulness of the neonate, good technical conditions, and no external interferences. Key conditions include the maintenance of safety rules and cooperation between nurses, EEG technicians, and parents., Conclusion: The EEG examinations in neonates weighing less than 1500 g or those requiring respiratory support should only be performed by a trained neonatal intensive care unit nurse.

Background: Neurogenic orthostatic hypotension (nOH) is a common source of disability but is an often untreated nonmotor symptom of Parkinson disease. The key manifestations of nOH include lightheadedness, dizziness, weakness, and fatigue when standing and engaging in activities in the upright position and result in falls, impaired activities of living, decreased quality of life, and short-term cognitive impairment. Early diagnosis and treatment of nOH are necessary to mitigate its adverse effects and reduce nOH-related symptom burden., Case Study: The management of nOH is illustrated through a case study., Management Considerations: Alerting providers about the impact and treatment of nOH, accurate measurement of orthostatic blood pressure, and educating patients and caregivers about nonpharmacological treatment options are important strategies to manage nOH. The goal of nOH treatment is to mitigate symptoms and improve the patient's quality of life., Conclusions: Nurses can play a crucial role in the recognition and management of nOH. Nurses who are educated about nOH are well suited to partner with care providers to treat disabling motor and nonmotor symptoms of Parkinson disease.

Background: Traumatic brain injury (TBI) is a significant source of morbidity and mortality in children. Transcranial Doppler (TCD) ultrasound measures the cerebral arterial circulation allowing for the calculation of pulsatility indices (PIs) that provide an assessment of cerebral blood flow alterations. However, the use of PI in children with TBI is poorly understood and may be an important measure for the nursing care of children., Objectives: The purpose of this article is to define day-to-day PI change and to describe its relationship to injury characteristics and functional outcomes in children with TBI., Method: We performed a secondary analysis of a prospective observational parent study of 40 children aged 2 months to 15 years with mild or moderate-severe TBI who had serial TCDs. Sequential TCD PI measurements of day-to-day change revealed several consistencies among the TBI severity groups., Results: Day-to-day PI change was higher in children with a moderate-severe injury (40%) when compared with those with a mild injury (21%). Greater day-to-day PI change was seen in children whose Glasgow Outcome Scale-Extended Pediatrics scores worsened (25%) compared with those who had an improved (19%) or unchanged (23%) scores., Discussion: This study is the first to report day-to-day PI change in children with TBI and provides early insights into anterior cerebral artery circulation alterations of children with TBI. Although further research is needed, this study provides early evidence that TCD may be a valuable noninvasive neuromonitoring option in the management of children with TBI.

Introduction: A qualitative assessment of discharge resource needs is important for developing evidence-based care improvements in neurocritically ill patients., Methods: We conducted a quality improvement initiative at an academic hospital and included all patients admitted to the neuroscience intensive care unit (ICU) during an 18-month period. Telephone assessments were made at 3 to 6 months after admission. Patients or caregivers were asked whether they had adequate resources upon discharge and whether they had any unanswered questions. The content of responses was reviewed by a neurointensivist and a neurocritical care nurse practitioner. A structured codebook was developed, organized into themes, and applied to the responses., Results: Sixty-one patients or caregivers responded regarding access to resources at discharge with 114 individual codable responses. Responses centered around 5 themes with 23 unique codes: satisfied, needs improvement, dissatisfied, poor post-ICU care, and poor health. The most frequently coded responses were that caregivers believed their loved one had experienced an unclear discharge (n = 11) or premature discharge (n = 12). Two hundred four patients or caregivers responded regarding unanswered questions or additional comments at follow-up, with 516 codable responses. These centered around 6 themes with 26 unique codes: positive experience, negative experience, neutral experience, medical questions, ongoing medical care or concern, or remembrance of time spent in the ICU. The most frequent response was that caregivers or patients stated that they received good care (n = 115). Multiple concerns were brought up, including lack of follow-up after hospitalization (n = 15) and dissatisfaction with post-ICU care (n = 15)., Conclusions: Obtaining qualitative responses after discharge provided insight into the transition from critical care. This could form the basis for an intervention to provide a smoother transition from the ICU to the outpatient setting.

Background: In-hospital stroke events account for 2% to 17% of all ischemic strokes in the United States. Current stroke guidelines do not provide guidance on how to care for in-hospital stroke. Use of checklists during high-acuity events reduces error and provides clarity for responding staff. We sought to determine whether the use of an evidence-based checklist to guide in-hospital stroke response improved intervention times and patient outcomes., Methods: This study used a retrospective chart review of patients hospitalized between January 1, 2016, and December 31, 2018, at a community hospital certified as a primary stroke center with the Joint Commission. Encounters were sorted into preintervention and postintervention groups to evaluate for change in treatment rates, new or worsened disability, and mortality. Nursing staff who respond to in-hospital stroke calls ("response staff") were also surveyed regarding their perception of benefit and firsthand experience when using the checklist., Results: A total of 168 patient charts were reviewed (18 prechecklist, 150 postchecklist). After checklist implementation, treatment with intravenous thrombolytics for in-hospital stroke events increased from 0% to 11%. All-cause mortality decreased from 23.1% to 15.0%, whereas ambulatory disability at discharge increased from 38.0% to 62.1%. The increase in disability likely reflects the reduction in mortality, improved data collection, and the increase in postimplementation reporting., Conclusions: Use of a checklist during inpatient stroke events can potentially increase adherence to guidelines for appropriate treatment and reduce mortality. Hospital response teams should consider use of a structured response system with an evidence-based checklist for high-acuity, low-frequency events such as in-hospital stroke.

Background: Stereoelectroencephalography (SEEG) is an invasive diagnostic surgical procedure used to identify specific areas of seizure activity in the brain. SEEG has been shown in both adult and pediatric populations to be a safe and effective tool for preoperative decision making. USES: This is used in patients with medically refractory epilepsy who are potential candidates for brain surgery to control seizures. It is preferred over other invasive diagnostic procedures because of lower risk, reduced discomfort, and shorter operating times., Outcomes: It has a distinct role in obtaining meaningful data that leads to more precise surgical options. All of this results in better seizure control and improved quality of life for the patients., Conclusion: Knowledge of the SEEG procedure, its benefits, complications, and the neuroscience nurse's role will improve care for surgical patients and improve outcomes.

Introduction: Spinal cord injuries (SCIs) and pregnancy can present a challenging scenario for healthcare professionals. Information regarding the management of patients who become pregnant and have SCIs is limited in the nursing literature, and therefore, more case studies must be presented and research must be conducted to build evidence-based care. Physiologic changes in pregnancy can increase a patient's risk for serious complications during pregnancy and, consequently, may put the fetus at a greater risk. Neuroscience healthcare providers must take into consideration the level of the SCI and how this may impact a pregnancy., Case Study: This article highlights an interdisciplinary approach by presenting a case study and provides neuroscience nurses with a foundation on which to base their practice when managing a pregnant woman with an SCI through the antepartum, intrapartum, and postpartum phases of pregnancy., Conclusion: By understanding the physiologic changes after an SCI, patients and their healthcare teams can work together to have a healthy pregnancy and a healthy baby.

Background: Stroke outpatients have a high risk of falling. However, fall prevention measures in the community are insufficient to effectively reduce the fall rate among outpatients with stroke. We aimed to determine the correlation between fall prevention knowledge and behavior among outpatients with stroke and provide new strategies for community fall prevention., Methods: We recruited 124 patients with stroke who were followed up in the outpatient department of a tertiary hospital in Zhuhai, China. Patients were assessed using a general information questionnaire, a fall prevention knowledge questionnaire for patients with stroke, and the Stroke Fall Prevention Behavior Scale. IBM SPSS 22.0 software was used for statistical analysis., Results: The median fall prevention knowledge was 82.76 (68.97, 93.10) points, out of 100. The mean (SD) score for fall prevention behavior was 2.90 (0.52; range, 1-4) points. Fall prevention knowledge scores were positively related to those fall prevention behavior (Spearman r = 0.454, P < .01)., Conclusion: Levels of fall prevention knowledge among outpatients with stroke were adequate, and this population had medium to high levels of fall prevention behavior. Better knowledge was accompanied with better prevention of falls. However, whether enriching the knowledge could lead to improvement of fall prevention is still undetermined.

Introduction: The report summarizes the intraoperative rescue and nursing intervention of malignant hyperthermia (MH) in the correction surgery for 3 patients with spinal deformity. Although rare, MH may occur in up to 1 of 5000 cases., Intervention: The key points of nursing care include preoperative MH risk assessment, MH early warning, cessation of anesthetic, use of a validated scoring system, and initiation of cooling measures., Conclusion: Prompt nursing recognition and team-fcoused interventions provided successful rescue of 3 patients with MH.

Background: Gastrointestinal (GI) adverse events (AEs) are commonly encountered with delayed-release dimethyl fumarate (DMF), an approved treatment for relapsing multiple sclerosis (MS)., Methods: Two hundred thirty-nine MS nurses from 7 countries were asked to complete a 2-round Delphi survey developed by a 7-member steering committee. Questions pertained to approaches for mitigating DMF-associated GI AEs., Results: Ninety-six percent of nurses followed the label recommendation for DMF dose titration in round 1, but 77% titrated the DMF dose more slowly than recommended in round 2. Although 86% of nurses advised persons with relapsing forms of MS (PWMS) to take DMF with food, patients were not routinely informed of appropriate types of food to take with DMF. Most nurses recommended both pharmacologic and nonpharmacologic symptomatic therapies for PWMS who experienced GI AEs on DMF. Pharmacologic and nonpharmacologic symptomatic therapies were regarded as equally effective at keeping PWMS on DMF. In round 2, 58% of nurses stated that less than 10% of PWMS who temporarily discontinued DMF went on to permanently discontinue treatment. Sixty-six percent of nurses stated that less than 10% of PWMS permanently discontinued DMF because of GI AEs in the first 6 months of treatment in round 1. Most nurses agreed that patient education on potential DMF-associated GI AEs contributes to adherence., Conclusion: This first real-world nurse-focused assessment of approaches to caring for PWMS with DMF-associated GI AEs suggests that, with implementation of slow dose titration, symptomatic therapies, and educational consultations, most PWMS can remain on DMF and, when necessary after temporary discontinuation, successfully restart DMF.

Objective: The aim of this study was to describe and compare the recovery and disability trajectory at 1 year post injury for younger and older adults with traumatic brain injury (TBI)., Methods: This was a prospective longitudinal cohort study. Individuals 21 years and older with mild to moderate TBI were recruited from the emergency department (n = 33). We measured symptoms, function (Glasgow Outcome Scale-Extended, Functional Status Examination), and health-related quality of life (HRQOL) at 1 week and 1, 3, 6, and 12 months post injury., Results: Whereas the total number of symptoms does not differ between younger and older adults after TBI, the specific constellation of symptoms experienced does. Older adults are more likely to experience physical symptoms such as fatigue, balance, and coordination problems as well as complain of being bothered by noise. Younger adults, in contrast, endorse more psychological symptoms such as anxiety. Functioning as measured by the Glasgow Outcome Scale-Extended and Functional Status Examination was lower in older adults at 1 year post injury. Physical HRQOL was consistently poorer in the year post injury among older adults compared with younger adults after TBI. Mental HRQOL, in contrast, was higher in older adults post TBI at 1 year., Conclusions: During the first year post TBI, older adults report different symptom clusters than do younger adults post TBI. To foster improved recovery and HRQOL in the older adult post TBI, nursing management strategies should focus on balance, coordination, and energy conservation.

Introduction: Nonketotic hyperglycemia-related seizures are not uncommonly encountered in clinical practice. Their presentation varies, and they may cause serious consequences if they remain unnoticed., Case: We report a case of nonketotic hyperglycemia-related seizures of unique left parieto-occipital origin and semiology, presenting as focal aware (simple partial) and impaired awareness (complex partial) seizures, including contralateral limb convulsion and apraxialike behavior., Discussion: Nonketotic hyperglycemia-related seizures can present with a relatively unique semiology. Careful education to the patients and family regarding attention to the paroxysmal symptoms and an effort to maintain good glycemic control are mandatory in clinical practice.

Background: Patients with pituitary macroadenoma commonly experience symptoms such as headache, visual disturbance, and olfactory dysfunction due to tumor effects. Even after undergoing surgery for tumor removal, patients continue to experience these symptoms and have difficulty resuming their general activities, decreasing their quality of life (QOL). Although some studies have focused on QOL in pituitary macroadenoma, few studies have examined the relationship between postoperative symptoms and patient QOL in the period after surgery. This study aimed to identify the relationships between postoperative symptoms and QOL among pituitary macroadenoma patients., Methods: This study used a descriptive cross-sectional design to identify relationships between postoperative symptoms and QOL in pituitary macroadenoma patients. Medical records of 62 patients with pituitary macroadenomas who had undergone surgery were retrieved and reviewed 3 months after surgery; at that time, all participants completed a self-report survey addressing their current symptoms and QOL. The researchers then evaluated patient QOL and 3 common symptoms-headache, objectively measured visual disturbance, and olfactory dysfunction-using correlation analysis and multiple linear regression., Results: Three months after surgery, patients still experienced headache and lack of olfactory function. Headache showed a strong negative correlation with physical (r = -0.501, P < .001, R = 36%) and mental (r = -0.448, P < .001, R = 26%) QOL. Headache was a significant factor influencing QOL., Conclusion: Study findings show that continuous assessment and intervention for headache are essential for improving QOL in pituitary macroadenoma patients after surgery. Nurses should prioritize assessment and management of postoperative headache in long-term care for such patients. The study findings support development of a clinical guideline for managing headache in such patients and thus improving their QOL.

Charcot-Marie-Tooth (CMT) is a hereditary condition that affects the myelin sheath of peripheral nerves causing muscle weakness, atrophy, and peripheral neuropathy. This is a firsthand reflection of living with CMT disease from my personal experience and through my family. I hope this provides informative education to practitioners or individuals who may not be familiar with CMT.

Background: Exertional heat stroke (EHS) is defined by a core body temperature that exceeds 40°C with associated central nervous system dysfunction, skeletal muscle injury, and multiple organ damage. The most important initial focus of treatment involves reduction of patient temperature. First approaches to achieve temperature reduction often include ice packs, water blankets, and cold intravenous fluid administration. When these measures fail, more advanced temperature management methods may be deployed but often require surgical expertise. Esophageal temperature management (ETM) has recently emerged as a new temperature management modality in which an esophageal heat transfer device replaces the standard orogastric tube routinely placed after endotracheal intubation and adds a temperature modulation capability. The objective of this case study is to report the first known use of ETM driven by bedside nursing staff in the treatment of EHS., Method: An ETM device was placed after endotracheal intubation in a 28-year-old man experiencing EHS over a 5-day course of treatment., Results: Because the ETM device was left in place, when the patient experienced episodes of increasing temperature as high as 39.1°C, which required active cooling, nursing staff were able to immediately adjust the external heat exchange unit settings to achieve aggressive cooling at bedside., Conclusion: This nurse-driven technology offers a new means to rapidly deploy cooling to critically ill patients without needing to implement advanced surgical approaches or obstruct access to the patient, freeing the provider to continue optimal care in high-morbidity conditions.

Background: Prehospital delay remains an important reason for low intravenous tissue plasminogen activator administration rates. Study of ischemic stroke patients' responses to stroke onset may be hampered by lack of a questionnaire designed specifically to examine their cognitive, emotional, and behavioral responses to symptoms., Methods: We provide evidence for content validity and reliability for the Responses to Ischemic Stroke Symptoms Questionnaire (RISQ) through, expert panel review and calculation of a content validity index and a study to examine stability reliability among hospitalized acute ischemic stroke patients., Results: Expert panel review demonstrated agreement on the relevance of questionnaire items and an overall content validity index of 0.97. The study to examine stability reliability demonstrated acceptable stability of the items on the RISQ over the short term in a sample of white and black stroke patients., Conclusion: Preliminary evidence was gathered to support the content validity and stability reliability of the RISQ. Study of the RISQ with other population groups is needed.

Background: A practice was changed to elevate the head of bed from day 1 to day 3 on children after selective dorsal rhizotomy (SDR) surgery to improve pain control. Multiple methods to address pain post SDR include a continuous epidural infusion, medication administration, and repositioning/distraction. The length of time for the patient to remain flat was increased to potentially improve pain management. However, no studies in the literature were found to support the practice change. Nurses inquired whether this change resulted in optimal pain control. The primary research aim was to determine whether the change in positioning resulted in a difference in pain control., Methods: A retrospective cohort design was used to compare pain medication administered before and after the practice change. Patients between the ages of 2 and 15 years and admitted to the neuroscience unit after SDR surgery were included. Data were electronically retrieved to record the amount of medications given for pain. Descriptive and univariate statistics were used to detect differences., Results: The retrospective component of the study analyzed a total of 385 patients. There were no statistically significant differences between the number of intermittent doses of medication administered for pain between the 2 groups (P = .661)., Discussion: Results support return to practice of 1 day of flat time. Nurses perceive that lying flat contributes to child and parent anxiety and limits options for distraction; therefore, decreasing flat time may lower anxiety without affecting pain control. These results are limited to postsurgical SDR patients but have implications for postoperative positioning and pain management. On the basis of these results, the neurosurgeon changed practice to zero days of flat time.

Background: Scholarship is a hallmark of all professions and includes research and practice scholarship. Building the science for practice and care is a major responsibility of each profession., Methods: The purpose of this article is to define clinical science as it applies to neuroscience nursing as well as to establish the foundation for the work of the Clinical Science Committee of the American Association of Neuroscience Nursing., Conclusions: Research scholars conduct investigations for discovery of new knowledge. Practice scholars develop clinical knowledge through clinical practice and experience and an inquiring mindset that questions why and how certain methods or processes contribute to the achievement of certain outcomes; they look for better ways to improve processes of care and practice that will achieve optimal evidence-based outcomes. Scholarship in both research and practice domains is critical to the advancement of neuroscience nursing. Many opportunities exist for neuroscience nurses to contribute to clinical science.

Chronic inflammatory demyelinating polyneuropathy (CIDP), an immune-mediated peripheral neuropathy, is frequently treated with long-term maintenance intravenous immunoglobulin (IVIG). However, disadvantages of IVIG are the systemic adverse reactions, lengthy infusions, and need for vascular access. Subcutaneous immunoglobulin (SCIG) addresses many of the issues encountered by those unable, or unwilling, to tolerate the treatment burden of long-term IVIG. Subcutaneous immunoglobulin, a 20% solution stabilized with L-proline, is US Food and Drug Administration-approved for CIDP maintenance therapy in patients after being stabilized with IVIG. Approval was based on a randomized, double-blind, placebo-controlled trial where SCIG demonstrated superiority over placebo and was safe and efficacious in maintaining function. In addition to reviewing the primary efficacy results from the clinical trial, this article aims to update the neurology nursing community on a new option for long-term management of CIDP, including the practicalities of initiating and maintaining patients on SCIG therapy.

Acute flaccid myelitis is a poliolike illness affecting mainly children, which seems to occur every 2 years in the late summer and early fall. The 2018 outbreak was alarming to parents and healthcare providers because the etiology is still under investigation and long-term outcomes are unclear. Becoming familiar with what is known about the epidemiology and clinical characteristics of acute flaccid myelitis enables neuroscience nurses to disseminate accurate information and recognize and report suspicious symptoms.