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Background It is recommended that patients with progressive neurological disease (PND) receive general and specialized palliative care. The purpose of this study was to determine the effect of neuropalliative care on quality of life (QoL) and satisfaction with provided care in both patients with PND in advanced stages of disease and their family caregivers. Methods The sample consisted of 151 patients with PND and 140 family caregivers. The PNDQoL questionnaire was used for data collection. Patients and family caregivers completed the questionnaires both before and 3 months after the intervention. Results Before intervention, there were no statistically significant differences in the individual domains of QoL in patients and family caregivers in either the intervention or the control group. After intervention, differences were identified in the sample of patients in the domains of symptoms burden (p emotional (p social functioning (p = 0.046), spiritual area (nonreligious) (p = 0.050), and in QoL. In the sample of family caregivers, there were differences in the domains of symptoms burden (p emotional functioning (p = 0.016), spiritual area (nonreligious) (p = 0.042), and in the assessment of health (p = 0.002), and QoL (p = 0.002). Patients and family caregivers from the intervention group evaluated their satisfaction with the quality of care provided significantly more positively in all five analyzed domains. Conclusion The provision of neuropalliative care to patients with advanced stages of PND helped to maintain and slightly improve their QoL, and symptoms burden, and resulted in a more positive assessment of satisfaction with the quality of care provided.

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 (PI) 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 forty children aged 2 months to 15 years of age 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 moderate-severe injury (40%) when compared to mild injury (21%). Greater day-to-day PI change was seen in children whose Glasgow Outcome Scale-Extended Pediatrics (GOS-E Peds) scores worsened (25%) compared to those who had an improved (19%) or unchanged GOS-E Peds scores (23%). 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 nursing research is needed, this study provides early evidence that TCD may be a valuable non-invasive neuromonitoring option in the management of children with TBI.

In response to the COVID-19 pandemic epicenter in Bronx, NY, the Montefiore Neuroscience Center required rapid and drastic changes when considering the delivery of neurologic care, health and safety of staff, and continued education and safety for house staff. Health care leaders rely on principles that can be in conflict during a disaster response such as this pandemic, with equal commitments to ensure the best care for those stricken with COVID-19, provide high-quality care and advocacy for patients and families coping with neurologic disease, and advocate for the health and safety of health care teams, particularly house staff and colleagues who are most vulnerable. In our attempt to balance these principles, over 3 weeks, we reformatted our inpatient neuroscience services by reducing from 4 wards to just 1, in the following weeks delivering care to over 600 hospitalized patients with neuro-COVID and over 1,742 total neuroscience hospital bed days. This description from members of our leadership team provides an on-the-ground account of our effort to respond nimbly to a complex and evolving surge of patients with COVID in a large urban hospital network. Our efforts were based on (1) strategies to mitigate exposure and transmission, (2) protection of the health and safety of staff, (3) alleviation of logistical delays and strains in the system, and (4) facilitating coordinated communication. Each center's experience will add to knowledge of best practices, and emerging research will help us gain insights into an evidence-based approach to neurologic care during and after the COVID-19 pandemic.

Thai trauma nurses play a vital role in neuroprotective nursing care of patients with moderate or severe traumatic brain injury. Nurses' knowledge of the evidence underpinning initial neuroprotective nursing care vital to safe and high-quality patient care. However, the current state of knowledge of Thai trauma nurses is poorly understood. In this study, we investigated Thai nurses' knowledge of neuroprotective nursing care of patients with moderate or severe traumatic brain injury. Data were collected by a survey, comprising a section on participant characteristics and series of multiple-choice questions. All registered nurses (n = 22) and nursing assistants (n = 13) from the trauma ward of a regional Thai hospital were invited to participate: the response rate was 100%. Participants had limited knowledge of carbon dioxide monitoring; causes and implications of hypercapnia; mean arterial pressure and cerebral perfusion pressure targets; management of sedatives and analgesics; and management of hyperthermia. Improving their knowledge focusing on knowledge deficits through educational training and implementation of evidence-based practice is essential to improve the safety and quality of care for Thai patients with moderate or severe traumatic brain injury.

Background The outcome focus for survivors of critical care has shifted from mortality to patient-centered outcomes. Multidimensional outcome assessments performed in critically ill patients typically exclude those with primary neurological injuries. Objective To determine the feasibility of measurements of physical function, cognition, and quality of life in patients requiring neurocritical care. Methods This evaluation of a quality improvement initiative involved all patients admitted to the neuroscience intensive care unit at the University of Cincinnati Medical Center. Interventions Telephone assessments of physical function (Glasgow Outcome Scale-Extended and modified Rankin Scale scores), cognition (modified Telephone Interview for Cognitive Status), and quality of life (5-level EQ-5D) were conducted between 3 and 6 months after admission. Results During the 2-week pilot phase, the authors contacted and completed data entry for all patients admitted to the neuroscience intensive care unit over a 2-week period in approximately 11 hours. During the 18-month implementation phase, the authors followed 1324 patients at a mean (SD) time of 4.4 (0.8) months after admission. Mortality at follow-up was 38.9%; 74.8% of these patients underwent withdrawal of care. The overall loss to follow-up rate was 23.6%. Among all patients contacted, 94% were available by the second attempt to interview them by telephone. Conclusions Obtaining multidimensional outcome assessments by telephone across a diverse population of neurocritically ill patients was feasible and efficient. The sample was similar to those in other cohort studies in the neurocritical care population, and the loss to follow-up rate was comparable with that of the general critical care population.

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.

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.

Highlights • Neurology teams can care for patients with COVID-19 in lieu of being redeployed. • Maintaining team structures has advantages to redeployment during pandemic surges. • Streamlining neurological services increases capacity to care for COVID-19 patients., The COVID-19 pandemic dramatically affected the operations of New York City hospitals during March and April of 2020. This article describes the transformation of a neurology division at a 450-bed tertiary care hospital in a multi-ethnic community in Brooklyn during this initial wave of COVID-19. In lieu of a mass redeployment of staff to internal medicine teams, we report a novel method for a neurology division to participate in a hospital’s expansion of care for patients with COVID-19 while maintaining existing team structures and their inherent supervisory and interpersonal support mechanisms.

INTRODUCTION: A qualitative assessment of discharge resource needs is important for developing evidence-based care improvements in neurocritically ill patients. We hypothesized that standardized, open-ended assessments of patients or caregivers after neurocritical care would result in themes that reflect post-intensive care concerns. METHODS: We conducted a quality improvement initiative at an academic hospital and included all patients admitted to the Neurosciences Intensive Care Unit (NSICU) over an 18-month period. Telephone assessments were made at 3–6 months following admission. Patients or caregivers were asked if they had adequate resources upon discharge and if they had any unanswered questions. The content of responses was reviewed by a neurointensivist and neurocritical care nurse practitioner. A structured codebook was developed, organized into themes, and applied to the responses. RESULTS: 61 patients or caregivers responded regarding access to resources at discharge with 114 individual codable responses. Responses centered around five 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). 204 patients or caregivers responded regarding unanswered questions or additional comments at follow-up, with 516 codable responses. These centered around six 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.

Supplemental digital content is available in the text., 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.

Background: An ICU Neuroscience Nursing Committee was formed to function as a unit-based council, empowering nurses to impact unit decision-making and problem-solving. The committee members serve as neuroscience leaders in the Neuro ICU (NICU). Purpose: To determine the impact of the ICU Neuroscience Nursing Committee on staff education, quality of care, staff morale and empowerment, and health outcomes in a large NICU. Methods: Staff-led committee interventions include: A quarterly comprehensive neuroscience newsletter Curriculum development for an annual Neuroscience Symposium and other education eventsAnnual neurological competency review for unit staffNew employee neurological orientation and educationICU protocol, pathway, process, and policy development and reviewParticipation in neuro patient roundsReal-time hands-on education in response to unit-specific needs and identified opportunities. Results: Mixed methodology was used to evaluate the impact of the committee. External Ventricular Drain infections less than 1% for the last 3 years Improved stroke symptom recognition and inpatient stroke alert times Best practice recognition from The Joint Commission on nursing knowledge and expertise in caring for complex stroke patients Improved collaboration between nursing and physicians Increase in national neuroscience nursing certifications Decrease in nurse-sensitive events Abstract submission and poster presentations at premier conferences Improved neurocritical care physician satisfaction with nursing care Enhanced nurse morale and empowerment Improved patient satisfaction Input and development of new policy and procedures Duplication of neuroscience committee efforts in other departments. Conclusion: Establishment of the ICU Neuroscience Nursing Committee has proven to have a significant impact in improving the quality of care, patient health outcomes and enriching staff morale.

Aim Study aimed to analyse how rehabilitation staff spends working time on specific activities in a neurorehabilitation hospital and to determine the number of direct activities received by patients with different levels of disease severity. Background Few studies have investigated how clinical staff spends their time on activities in rehabilitation hospitals without considering at the same time all working categories and without reporting the number of direct activities received by patients with respect to their disease severity. Design Self-reported observational study. Method Work Sampling Technique was used to record direct, indirect, unit-related and personal activities every 5 min for 2 days. Results Total of 6,974 activities were recorded over 581 working hours. Physiotherapists and nurses spent 75.2% and 54.8% of their time in direct activities and medical doctors only 25.4%. Total time of direct activities was significantly different among worker categories (p = 0.001) and depended on patients' disease severity (p = 0.020) in a different manner among worker categories (interaction: p = 0.010). This time ranged from almost 4 hr up to 6½ hr for the most severely affected patients. Conclusion Type of work differed among professionals. Workload greatly depended on degree of patients' disability. Implications for nursing management Nurses and therapists spent most of their time in direct activities with patients. Economic burden of neurorehabilitation may vary greatly depending on disease severity.

Background Physical restraint (PR) has to be performed in a well-organized, structured, and careful manner. The safety and effectiveness of the PR procedure in clinical practice are crucial to patient care. Purposes The aim of this study was to examine the effect in neurological intensive care units of a multidisciplinary PR reduction program on the overall incidence rate of PR, the monthly rate of PR, and the monthly rate of PR of more than and less than 24 hours, respectively, after controlling for associated factors. Methods A before-and-after study design was conducted in three neurological intensive care units (total of 45 beds) of a medical center in northern Taiwan. A multidisciplinary PR reduction program was implemented, with four phases of data collection. Data on the number and duration of PR were extracted from a database. In the first preintervention phase, data on the rate (number or frequency) and duration of PR were collected for 12 months before program implementation. The next three data collection phases were 1 month (introduction), 3 months (intermediate), and 6 months (maintenance) after program implementation. The chi-square test, one-way analysis of variance with Scheffe's post hoc tests, and logistic regression method were used for data analysis. Results The results showed that PR was used 72.8 mean times per month before program implementation. After implementation, the mean times per month fell to 40 after the first postimplementation month (introduction), 53.3 after 3 months (intermediate), and 36.2 after 6 months (maintenance). Implementation of the PR reduction program resulted in a decreased incidence rate of PR from 6.1% to 3.2% (event/total patient day) and a decrease in the percentage of patients who were restrained for more than 24 hours from 69.6% to 34.1%. The results of the logistic regression model showed that PR of more than 24 hours was significantly less in the postintervention phases: introduction phase (odds ratio [OR] = 0.31), intermediate phase (OR = 0.16), and maintenance phase (OR = 0.18). Moreover, PR of more than 24 hours was significantly higher in patients with endotracheal intubation (OR = 1.51) and nasogastric intubation (OR = 2.16) and with Glasgow Coma Scale scores of 6-8 (OR = 2.36), 9-12 (OR = 2.40), and 13-15 (OR = 2.15). Conclusions/implications for practice The results support that a multidisciplinary collaborative program has the potential to decrease the incidence of PR in neurological intensive care units. A standardized protocol and policies are essential for healthcare professionals to effectively use PR as well as to effectively improve the quality of care that is provided to intensive care patients.

AIMS AND OBJECTIVES: To study practice in consciousness assessment among neuroscience nurses in Europe.BACKGROUND: Over the years, several instruments have been developed to assess the level of consciousness for patients with brain injury. It is unclear which instrument is being used by nurses in Europe and how they are trained to use these tools adequately.DESIGN/METHODS: A cross-sectional questionnaire, created by the European Association of Neuroscience Nurses Research Committee, was sent to neuroscience nurses in 13 European countries. The countries participated in 2016 with a response period of 3 months for each country.RESULTS: A total of 331 questionnaires were completed by nurses in 11 different countries. Assessment of consciousness was part of the daily routine for a majority of bedside nurses (95%), with an estimated median frequency of six times per shift. The majority uses a standardised instrument, and the Glasgow Coma Scale is the most common. Most participants assess consciousness primarily for clinical decision-making and report both total scores and subscores. The majority was formally trained or educated in use of the instrument, but methods of training were divers. Besides the estimated frequency of assessments and training, no significant difference was found between bedside nurses and other nurse positions, educational level or kind of institution.CONCLUSION: Our study shows that consciousness assessment is part of the daily routine for most nurses working in neurology/neurosurgery/neurorehabilitation wards in Europe. The greatest variation existed in training methods for the use of the instruments, and we recommend standardised practice in the use of assessment scales.RELEVANCE TO CLINICAL PRACTICE: In clinical practice, both managers and staff nurses should focus on formalised training in the use of assessment tools, to ensure reliability and reproducibility. This may also increase the professionalism in the neuroscience nurses' role and performance.

Background: Nurses have become increasingly involved in overseeing the management of patients with complex medical conditions, including those with epilepsy. Nurses who are not specialists in epilepsy can play a central role in providing optimal care, education, and support to their patients with epilepsy, given the proper tools. Objective: Our objective was to create a tool that can be used by nurses in the clinic setting to help facilitate discussion of topics relevant to enhancing medical care and management of patients with epilepsy. To address this need, a panel of epilepsy nursing experts used a patient-centered care approach to develop an Epilepsy Nursing Communication Tool (ENCT). Methods: An initial set of topics and questions was created based on findings from a literature review. Eight nurse experts reviewed and revised the ENCT using focus groups and discussion forums. The revised ENCT was provided to nurses who care for patients with epilepsy but had not been involved in ENCT development. Nurses were asked to rate the usability and feasibility on a 5-point scale to assess whether the tool captured important topics and was easy to use. Results: Ten nurses provided usability and feasibility assessments. Results indicated strong tool utility, with median scores of 4.5, 4, and 4 for usefulness, ease of use, and acceptability, respectively. Conclusions: The preliminary ENCT shows promise in providing a tool that nurses can use in their interactions with patients with epilepsy to help address the complexity of disease management, which may help improve overall patient care.

Neuro-palliative care is a newly emerging subspecialty in neurology and palliative medicine which as defined by World Health Organization, is the specialty that recognizes and attempts to alleviate physical, social, psychological, and spiritual suffering (1).

BackgroundAlthough the importance of secondary prevention after transient ischaemic attack (TIA) or minor stroke is recognised, research is sparse regarding novel, effective ways in which to intervene in a primary care context.AimTo pilot a randomised controlled trial (RCT) of a novel home-based prevention programme (The Healthy Brain Rehabilitation Manual) for patients with TIA or ‘minor’ stroke.Design and settingPilot RCT, home-based, undertaken in Northern Ireland between May 2017 and March 2018.MethodPatients within 4 weeks of a first TIA or ‘minor’ stroke received study information from clinicians in four hospitals. Participants were randomly allocated to one of three groups: standard care (control group) (n = 12); standard care with manual and GP follow-up (n = 14); or standard care with manual and stroke nurse follow-up (n = 14). Patients in all groups received telephone follow-up at 1, 4, and 9 weeks. Eligibility, recruitment, and retention were assessed; stroke/cardiovascular risk factors measured at baseline and 12 weeks; and participants’ views were elicited about the study via focus groups.ResultsOver a 32-week period, 28.2% of clinic attendees (125/443) were eligible; 35.2% of whom (44/125) consented to research contact; 90.9% of these patients (40/44) participated, of whom 97.5% (39/40) completed the study. After 12 weeks, stroke risk factors [cardiovascular risk factors, including blood pressure and measures of physical activity] improved in both intervention groups. The research methods and the programme were acceptable to patients and health professionals, who commented that the programme ‘filled a gap’ in current post-TIA management.ConclusionFindings indicate that implementation of this novel cardiac rehabilitation programme, and of a trial to evaluate its effectiveness, is feasible, with potential for clinically important benefits and improved secondary prevention after TIA or ‘minor’ stroke.

Preventing burnout and promoting resiliency are important for health professionals' well-being and quality of patient care, as individuals with high levels of burnout are more likely to self-report suboptimal patient interactions. The purpose of this study was to characterize resiliency and burnout among health care professionals in the neurosciences critical care unit (NCCU) at a tertiary care center.All NCCU clinical staff were invited to participate in a QualtricsA total of 65 participants (65/70, 93%) were included in the final analysis. Of respondents, 49 (75%) were nurses, 49 (75%) were female, and mean age was 34 years. Median emotional exhaustion, depersonalization, and personal accomplishment scores were as follows: 8 (IQR 6-11), 3 (IQR 0-6), and 15 (IQR 13-16). High emotional exhaustion scores and high depersonalization scores were reported in 45% (n = 29) and 28% (n = 18) of participants, respectively. Longer time working in the NCCU (1-5 years vs. less than 1 year) was independently associated with higher emotional exhaustion scores (p = 0.012). When compared to agnostic/atheist backgrounds, Catholicism was independently associated with higher personal accomplishment scores (p = 0.026). The median resiliency score was 31 (IQR 28-36). Older age was independently associated with higher resiliency scores (p = 0.044).This study is the first to characterize levels of burnout and resiliency among NCCU providers. A significant minority of participants reported high levels of emotional exhaustion and depersonalization, with those working longer in the NCCU more likely to experience emotional exhaustion. Efforts to improve the current work environments to optimally support the emotional needs of staff are needed to allow care providers to thrive and to promote longevity among NCCU providers.

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.

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

Trauma to the brain from injury or illness can cause sustained, raised intracranial pressure. In such patients, neurological observations are a fundamental aspect of nursing care and the ability to make and record such observations accurately is an essential nursing skill. Neurological observations are a collection of information on the function and integrity of a patient's central nervous system—the brain and and spinal cord. This article will discuss the tools used in their observation, including the Glasgow Coma Scale tool, pupillary response, and limb power observations, and provide a ‘how-to’ guide on neurological observations

In clinical practice, assessing patients with Parkinson's disease (PD) is a complex, time-consuming task. Our purpose is to provide a rigorous and objective evaluation of how motor function in PD patients is assessed by neurologists specialising in movement disorders, on the one hand, and by nurses specialising in PD management, on the other.We conducted an observational, cross-sectional, single-centre study of 50 patients with PD (52% men; mean age: 64.7 ± 8.7 years) who were assessed between 5 January 2016 and 20 July 2016. A neurologist and a nurse evaluated motor function in the early morning hours using the Unified Parkinson's Disease Rating Scale (UPDRS) parts III and IV and HoehnYahr (HY) scale. Tests were administered in the same PD periods (in 48 patients during the 'off' time and in 2 patients during the 'on' time). Inter-rater variability was estimated with the intraclass correlation coefficient (ICC).Forty-nine patients (98%) were classified in the same HY stage by both raters. Assessment times were similar for both raters. ICC for UPDRS-IV and UPDRS-III total scores were 0.955 (P.0001) and 0.954 (P.0001), respectively. The greatest variability was found for UPDRS-III item 29 (gait; ICC=0.746; P.0001) and the lowest, for item 30 (postural stability; ICC=0.918; P.0001).Motor function assessment of PD patients by a trained nurse is equivalent to that made by an expert neurologist and takes the same time to complete.

Research suggests that persons with multiple sclerosis (MS) are much less physically active than the general population and that increased physical activity in persons with MS is associated with numerous benefits such as improvements in fatigue, mobility and quality of life (Motl & Pilutti, 2012). Potentially modifiable theory-based determinants of physical activity behavior need to be identified so that researchers may study their effectiveness in randomized clinical trials and clinicians may integrate them into practice to promote physical activity in this population. The purpose of this study was to explore the multidimensional (physical, social, and self-evaluative) outcome expectations for physical activity among persons with longstanding MS. A sample of 369 participants diagnosed with MS for more than 15 years completed surveys to measure multidimensional outcome expectations for exercise, MS functional limitations, and physical activity using two different instruments – one measuring physical activity engagement and the other physical activity capability. Results indicated that MS functional limitation was the strongest predictor of both physical activity engagement and physical activity capability. Physical and social outcome expectations contributed to the model explaining 12% of the variation in physical activity engagement while none of the outcome expectancy dimensions (physical, social, or self-evaluative) contributed to the model explaining variation in physical activity capability. While analyses of cross-sectional data does not infer causation, these findings suggest that positive physical and social outcome expectations for physical activity are associated with engagement in physical activity as well as being potential sources of motivation for increasing physical activity behavior in individuals living with longstanding MS.

As a speciality practice area, neuroscience nursing is internationally recognised. In 2014 the Australasian Neuroscience Nurses Association celebrated its 40th anniversary. For Indonesian neuroscience nurses, 2014 marked the inaguration of the Indonesian Neuroscience Nurses Association. The following paper provides an overview of health care in Indonesia and development of neuroscience nursing as a specialty through educational and regional collaboration. Postgraduate educational opportunities are open to all nurses in Australia, including neuroscience as a specialty for nurses. However within Indonesia, the focus has been on meeting basic nursing demands, with postgraduate specialisation still in its infancy. The focus on training and producing large numbers of nurses at a basic level has resulted in little regard for the ongoing development and acknowledgement of speciality practice areas, such as neuroscience nursing. The following paper outlines the challenges faced by Indonesian nurses as they strive towards the recognition of neuroscience nursing as a speciality. Through the provision of an overview of current nursing and the health care system in Indonesia, this paper will explore the geographical, economic, political and cultural factors that require consideration when translating experience and expertise.

Our aim was to describe Chinese nurses' experiences of workplace distress and ethical dilemmas on a neurological ward. Qualitative interviews were performed with 20 nurses. On using latent content analysis, themes emerged in four content areas: ethical dilemmas, workplace distress, quality of nursing and managing distress. The ethical dilemmas were: (1) conflicting views on optimal treatment and nursing; (2) treatment choice meeting with financial constraints; and (3) misalignment of nursing responsibilities, competence and available resources. The patients' relatives lacked respect for the nurses' skills. Other dilemmas could be traced to the transition from a planned to a market economy, resulting in an excessive workload and treatment withdrawal for financial reasons. Lack of resources was perceived as an obstacle to proper patient care in addition to hospital organization, decreasing the quality of nursing, and increasing moral and workplace distress. The nurses managed mainly by striving for competence, which gave them hope for the future.

Colin is a neuroscience Registered Nurse originally from the United Kingdom (UK). He had his first seizure in the UK. He and his family emigrated to Christchurch, New Zealand in 2007. Whilst at work on the neuroscience unit, Colin had another seizure resulting in a significant head injury. He was in rehab when the deadly Christchurch earthquake hit. Both Sides of the Counter covers his experience as a neuroscience nurse caring for others and then how things can quickly change - as a neuroscience patient with a head injury. This is his story.

A major goal in the care of patients with neurological problems is to prevent or minimize episodes of increased intracranial pressure (ICP). Elevations in ICP in response to nursing interventions have been acknowledged since the 1960s when ICP monitoring was first introduced in the clinical setting. Until recently, few studies have specifically examined the effect of oral care on ICP, and oral care and other hygiene measures were combined or not specified, prohibiting a direct interpretation of the influence of oral care alone on ICP. The purpose of this study was to describe the relationship between routine oral care interventions and the changes in ICP specifically focusing on the effect of intensity and duration of this intervention. Twenty-three patients with a clinical condition requiring ICP monitoring were enrolled over a 12-month period. Oral care provided by neuroscience intensive care nurses was observed and videotaped. Characteristics of the intervention were documented including products used, patient positioning, and duration of the intervention. A 1-5 subjective scale was used to score intensity of oral care. Wrist actigraphy data were collected from the nurses to provide an objective measure of intensity. Patient physiologic data were collected at 12-second epochs 5 minutes before, during, and 5 minutes after oral care. The mixed-effect repeated measures analysis of variance model indicated that there was a statistically significant increase in ICP in response to oral care (p = .0031). There was, however, no clinically significant effect on ICP. This study provides evidence that oral care is safe to perform in patients in the absence of preexisting elevated ICP.

Suboptimal oral care is well documented in the literature and is linked to increased nosocomial pneumonia rates and prolonged hospitalization, negatively affecting patients' quality of life (Terezakis et al. 2011). A standardized approach to oral care can change these adverse outcomes. This project used best practice guidelines and evidence in the literature to guide the development of oral care best practice within an acute care inpatient unit. Based on the work of the interprofessional Clinical Neurological Sciences (CNS) Continuous Quality Improvement (CQI) Council at London Health Sciences Centre-University Hospital (LHSC-UH), an oral care policy and bedside assessment tool were implemented in line with Stroke Best Practice Recommendations (Heart and Stroke Foundation of Canada 2010). A validated, reliable and feasible oral health assessment tool (OHAT) was selected for implementation, and is now completed on every patient within 24 hours of admission to the CNS inpatient unit. Favourable outcomes to date include improved accessibility of oral health supplies, including regular and suction toothbrushes, toothpaste and bite blocks. Post-implementation audits indicate increased frequency and quality of oral care. This review provides a synopsis of how oral care best practice was implemented in an acute care neurology/neurosurgery setting.

Poor oral hygiene has been associated with ventilator-acquired pneumonia. Yet providing oral care for intubated patients is problematic. Furthermore, concerns that oral care could raise intracranial pressure (ICP) may cause nurses to use foam swabs to provide oral hygiene rather than tooth brushing as recommended by the American Association of Critical-Care Nurses. Evidence is needed to support the safety of toothbrushing during oral care. We therefore evaluated ICP and cerebral perfusion pressure (CPP) during oral care with a manual or electric toothbrush in intubated patients in a neuroscience intensive care unit (ICU). As part of a larger 2-year, prospective, randomized clinical trial, 47 adult neuroscience ICU patients with an ICP monitor received oral care with a manual or electric toothbrush. ICP and CPP were recorded before, during, and after oral care over the first 72 h of admission. Groups did not differ significantly in age, gender, or severity of injury. Of 807 ICP and CPP measurements obtained before, during, and after oral care, there were no significant differences in ICP (P = 0.72) or CPP (P = 0.68) between toothbrush methods. Analysis of pooled data from both groups revealed a significant difference across the three time points (Wilks' lambda, 12.56; P < 0.001; partial eta(2), 0.36). ICP increased significantly (mean difference, 1.7 mm Hg) from before to during oral care (P = 0.001) and decreased significantly (mean difference, 2.1 mm Hg) from during to after oral care (P < 0.001). In the absence of preexisting intracranial hypertension during oral care, tooth brushing, regardless of method, was safely performed in intubated neuroscience ICU patients.

A especialização na enfermagem parece ser uma preocupação de alguns profissionais como um meio para melhorar a prática profissional. Especificamente, a expressão enfermagem em neurociência faz pensar numa possível área na qual os enfermeiros poderiam desenvolver-se e tornar-se especializados. O presente trabalho traz alguns esclarecimentos sobre o que é enfermagem em neurociência, as possibilidades de atuação para o enfermeiro e o que poderia ser desenvolvido num curso de especialização, baseado na literatura americana. A specialization in nursing seems to be a preocupation of several professional as a means to improve the professional practical. Specifically, the neuroscience nursing expression makes thought in a possible area which the nurses could develop and specialize themselves. The present report shows some enlightenments on what neuroscience nursing is, the actuation possibilities for the nurses and what could be developed in a specialization course, based in american literature.