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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: 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.)

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: 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.)

Each year, millions of people suffer traumatic brain injury (TBI). It is not inherent to any country or group of people. It occurs as a result of falls, combat situations, sports injury, schoolyard playgrounds, and car accidents. It does not discriminate with age or status. Cost implications for health care settings and individuals are substantial. Management requires prompt neurologic assessment by a highly specialized multidisciplinary team of neuroscience practitioners. It is important to understand normal brain anatomy and physiology to identify what is unusual or abnormal. Keen observational skills and constant questioning aid in early detection of neurologic deterioration., Competing Interests: Disclosure The author has nothing to disclose., (Crown Copyright © 2020. Published by Elsevier Inc. All rights reserved.)

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.

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.

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.

Malignant hemispheric stroke occurs in 10% of ischemic strokes and has one of the highest mortality and morbidity rates. This stroke, also known as malignant middle cerebral artery stroke, may cause ischemia to an entire hemisphere causing edema, herniation, and death. A collaborative interdisciplinary team approach is needed to manage these complex stroke patients. The nurse plays a vital role in bedside management and support of the patient and family through this complex course of care. This article discusses malignant middle cerebral artery stroke pathophysiology, techniques to predict patients at risk for herniation, collaborative care strategies, and nursing care., Competing Interests: Disclosure The author has nothing to disclose., (Copyright © 2019 Elsevier Inc. All rights reserved.)

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: 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: 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.

Background: The Glasgow Coma Scale (GCS) is a tool used to aid in objectively measuring the neurological status of a patient. This study aimed to evaluate the limitations and discrepancies in GCS use among nurses in an academic medical center neurological intensive care unit and compile evidence for development of a standardized GCS educational program., Methods: Twenty nurse participants completed a survey before attending an educational intervention. Participants then attended a 90-minute educational intervention. In follow-up, participants were asked to complete a postsurvey., Results: The standardized GCS educational program significantly improved nurse knowledge of the GCS as measured by presurvey and postsurvey general GCS question scores. Educational programming improved application of the GCS as measured by presurvey and postsurvey GCS verbal component, motor component, and sum scores. GCS motor score performance was the least accurate component., Conclusion: Participants reported that the education has informed the unit culture and emboldened clinical nurses to speak to their practice with more authority. Educational interventions should be aimed toward applied transfer of knowledge to the case-based scenarios in the clinical setting.

Background and Purpose: Thirty-day hospital readmissions have been shown to be a measure of quality and result in higher mortality and increased costs. Readmissions are a target for hospitals and payers; thus, several centers have developed predictive readmission scores to identify high-risk patients. The purpose of this study was to evaluate the current hospital-wide readmission risk calculator and the ability of this tool to predict 30-day readmissions in the neurocritical care population., Methods: A retrospective chart review was performed that included 340 consecutive patients admitted to our neuroscience critical care unit. Data including readmission scores, reason for admission, length of stay, and whether they were readmitted were recorded., Results: After removing patients without readmission scores or who died at the end of the original admission, the records of N = 279 patients were analyzed. Patients were more likely to be readmitted if they were initially emergently hospitalized or if there was a history of malignancy. Readmitted patients had a longer original hospital length of stay. Furthermore, 65.8% of the patients who were given a "low risk" for readmission were readmitted within 30 days., Conclusions: This small set of data in a specific patient population found that the current risk prediction score was inaccurate in predicting readmission in the neuroscience intensive care unit population. Further evaluation is needed of a larger patient population to generalize these results for all neuroscience intensive care unit patients. To design an accurate readmission risk tool, centers should create unique readmission scores based on less heterogeneous patient populations.

The cue-response theory is herewith proposed to replace the coma cue-response conceptual framework as a nursing theory for care of patients with acquired brain injury (ABI). After ABI, nurses assess patients and develop an understanding of their condition by interpreting meaning from physiologic and observational or behavioral cues. These interpretations form the basis for optimizing the timing of discrete nursing interventions; the outcome of which influences the trajectory toward recovery or toward secondary brain injury. The cue-response theory applies specifically for nurses' use to determine which interventions should be used and when those interventions should be carried out. The theory recognizes the knowledge potential and knowledge produced in the context of nursing care of all patients with ABI, not just those with coma, and broadens our understanding of how the timing of nursing interventions directly impacts secondary brain injury and the brain entropy state.

Acute and chronic neurological disorders impair sleep. Despite the availability of theoretical/mathematical frameworks about sleep, the nursing profession rarely incorporates these models. The purpose of this article was to analyze the 2-process model of sleep regulation using Fawcett and DeSanto-Madeya's method, a systematic approach for determining whether a theory is relevant to nursing. The 2-process model has 3 concepts: process S (sleep-dependent process), process C (circadian-timing-dependent process), and total sleep propensity (summation of processes S and C). Nonnursing theories do not explicitly incorporate nursing metaparadigm concepts-person, health, environment, and nursing-but the 2-process model is congruent with nursing's philosophy. The model guided studies quantifying sleep and circadian patterns in other fields, and nurses could use this framework to measure the impact of nursing interventions. Strengths of the 2-process model include parsimony (conciseness without oversimplification) and the ability to empirically test propositions related to processes S and C. The 2-process model is relevant to neuroscience nursing-by measuring sleep/circadian-related variables (electroencephalogram, core body temperature, salivary melatonin). Nurses have opportunities to design, test, and use interventions that improve sleep in patients with neurological conditions.

Throughout the past 50 years, the role of the neuroscience nurse has become more specialized as we continue to keep pace with new innovations and improvement in care for our patients. This is evident when reviewing the hundreds of articles that have been published in the Journal of Neuroscience Nursing over the last half-century. These authors have had a tremendous influence over neuroscience nursing through dissemination of their expert knowledge. This article will review the areas of pediatric hydrocephalus, brain tumors, and epilepsy and the role neuroscience nurses have played in the advancement of these specialties.

Background: Traumatic brain injury and cerebrovascular disease may lead to motor, behavioral, and/or cognitive disabilities. The associated neurologic and vascular damage triggers a chain of events that lead to a secondary brain injury (SBI), a preventable cause of adverse neurological outcomes. Proper prevention of these factors may limit undesirable outcomes. This article presents a concept analysis that aims to form a single definition of the term secondary brain injury for nursing personnel., Methodology: Concept analysis was used to clarify the concept of SBI. An electronic search was performed on existing nursing literature dating from 1995 to 2016 on PubMed, MEDLINE, Ovid Journal, Wiley, and ProQuest., Results: A clear definition and description of the attributes, antecedents, and consequences of SBI increases the knowledge and level of recognition of the secondary injuries. This may lead to strategies that reduce the risk of long-term effects (disability) and poor clinical outcomes., Conclusions: This concept analysis contributes to the endeavor of identifying phenomena that are pertinent for nursing; it also provides a basis for future research that leads to improving nursing interventions and creating educational programs and healthcare policies that prevent or eliminate the consequences of SBI.

Background: Variance from guideline-directed care for glucose and temperature control remains unknown in the United States at a time when priorities have shifted to ensure rapid diagnosis and treatment of acute stroke patients. However, protocol-driven nursing surveillance for control of hyperglycemia and hyperthermia has been shown to improve patient outcomes., Methods: We conducted an observational pilot study to assess compliance with American guidelines for glucose and temperature control and association with discharge outcomes in consecutive acute stroke patients admitted to 5 US comprehensive stroke centers. Data for the first 5 days of stroke admission were collected from electronic medical records and entered and analyzed in SPSS using descriptive statistics, Mann-Whitney U test, Student t tests, and logistic regression., Results: A total of 1669 consecutive glucose and 3782 consecutive temperature measurements were taken from a sample of 235 acute stroke patients; the sample was 87% ischemic and 13% intracerebral hemorrhage. Poor glucose control was found in 33% of patients, and the most frequent control method ordered (35%) was regular insulin sliding scale without basal dosing. Poor temperature control was noted in 10%, and 39% did not have temperature recorded in the emergency department. Lower admission National Institutes of Health Stroke Scale score and well-controlled glucose were independent predictors of favorable outcome (discharge modified Rankin Scale score, 0-2) in reperfusion patients., Conclusion: Glucose and temperature control may be overlooked in this era of rapid stroke diagnosis and treatment. Acute stroke nurses are well positioned to assume leadership of glucose and temperature monitoring and treatment.

In 2018, the American Association of Neuroscience Nurses will celebrate its 50th anniversary as the premier member organization for neuroscience nurses. In recent decades, one of the highest rated member benefits has been the ability for members to join special focus groups (SFGs). The SFGs were initiated to allow an avenue for information sharing and communication for neuroscience nurses in a variety of subspecialties. In this anniversary edition, the neurotrauma SFG presents a review of trends in the publication of articles in the Journal of Neuroscience Nursing related to neurotrauma. Findings from this article illustrate how these publications have impacted the nursing care of patients who have sustained traumatic injuries of the central and peripheral nervous system and the integral role of neuroscience nurses throughout the decades.

Background: Trained medical practitioners have been assessing the pupillary light reflex for more than 2 millennia. However, the interrater reliability of the pupillary light reflex remains low. To overcome the drawbacks of a subjective interpretation of pupillary size and reactivity, automated pupillometers are becoming increasingly commonplace, but practitioners do not have adequate data from which to judge whether the numerical values provided by the pupillometer are "within reference limits.", Methods: This article details the methods used to create an extensive database of automated pupillometer readings and associated patient data (eg, intracranial pressure)., Discussion/conclusions: The "Establishing Normative Data for Pupillometer Assessments in Neuroscience Intensive Care" Registry will provide a large data set of pupillary size, reactivity, and speed of contraction in a cohort of patients admitted to a neuroscience intensive care unit with a variety of conditions. Analysis of this data set will help establish normative data for pupillometer readings for neurologically impaired patients. Exploratory analysis of this data set may also provide preliminary hypothesis generating data for future prospective studies on pupillary findings and trends in acute neurological conditions.

A young nurse reflects on her first year of practice, with its challenges and rollercoaster of emotions.chaLLenges and roLercoaster of emotions.

The concepts of reliability and validity are important for neuroscience nurses to understand, particularly because they evaluate existing literature and integrate common scales or tools into their practice. Nurses must ensure instruments measuring specified concepts are both reliable and valid. This article will review types of reliability and validity-sometimes referred to collectively as a psychometric testing-of an instrument. Relevant examples in neuroscience are included to illustrate the importance of reliability and validity to neuroscience nurses.

Objective: The objectives of this study were to assess incidence of verbal and physical abuse of neurology nurses, identify their coping strategies, and explore relationships between demographic characteristics, incidence, and coping strategies., Background: A 2011 U.S. Department of Justice survey found that average annual rates of nonfatal violent crime against nurses were greater than all occupations and identified nurses as having the highest percentage of workplace violence., Methods: A descriptive, exploratory research design utilizing an online survey of 112 neurology nurses in the United States was used for this study., Results: Results identified the presence of verbal and physical abuse against neurology nurses, avoidance coping strategies utilized, and gender differences on types of violence and effects of abuse., Conclusions: Administrative attention must address abuse of neurology nurses by patients and families and develop nursing practice that eliminates the use of avoidance as a way of dealing with this abuse.

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

The nursing discipline is vital throughout patients' hospital progression. One of the most critical moments in the hospital stay is the postoperative period. Neurosurgical patients require a high level of nursing care and vigilance and additional postoperative monitoring in intensive care units designed specifically for this demographic. In the postoperative setting, patient care must be transferred from anesthesia to nursing in a manner that is continuous and safe. This article focuses on neurosurgical patients in the postoperative period, the assessment of these patients, and critical care nursing, with emphasis on common issues and interventions for this dynamic patient population., (Copyright © 2015 Elsevier Inc. All rights reserved.)