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Intracranial pressure (ICP) monitoring can be an important assessment tool in critically and acutely ill patients. An external ventricular drain offers a comprehensive way to monitor ICP and drain cerebrospinal fluid. The Monro-Kellie hypothesis, Pascal's principle, and fluid dynamics were used to formulate an assumption that an open/monitor position on the stopcock is an adequate trending measure for ICP monitoring while concurrently draining cerebrospinal fluid. Data were collected from 50 patients and totaled 1053 separate number sets. The open/monitor position was compared with the clamped position every hour. An order for "open to drain" was needed for appropriate measurement and nursing care. Results showed the absolute average differences between open/monitor and clamped positions at 1.6268 mm Hg. This finding suggests that it is appropriate to use an open/monitor position via an external ventricular drain for adequate trending of patients' ICP.

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.

Background: Stroke is a leading cause of death and disability affecting nearly 800,000 people in the United States every year. Obstructive sleep apnea (OSA) is found in over 60% of patients with stroke/transient ischemic attack (TIA) and identified as an independent stroke risk factor in large epidemiology studies and Canadian Stroke Prevention Guidelines (SPG) but not in the United States. The 2014 Secondary SPG recommend OSA screening and treatment as a consideration only, not a requirement. The twofold purpose of this article is, first, to present the evidence supporting OSA as an independent stroke risk factor in national SPG with mandatory recommendations and, second, to engage neuroscience nurses to incorporate OSA assessment and interventions into the nursing process and thereby promote excellence in stroke/TIA patient care., Methods: A systematic literature search was conducted in Medline, CINAHL, and PubMed to identify research from 2003 through 2013 on the independent risk, mortality, and prevalence relationship between OSA and stroke/TIA including recurrence and recovery outcomes with continuous positive airway pressure (CPAP) therapy., Results: Twenty-eight research articles were reviewed: 14 observational cohorts, five case-control studies, four cross-sectional studies, and four randomized control trials representing 12 countries and 10,671 subjects., Discussion: OSA is highly prevalent in patients with stroke/TIA independently increasing stroke risk. CPAP studies revealed reduced stroke recurrence and improved recovery with feasible initiation in stroke units. Patients with stroke/TIA have less OSA-associated daytime sleepiness and obesity, making the usual screening tools insufficient and CPAP adherence challenging. Treating OSA decreases stroke prevalence and mortality. OSA initiatives empower neuroscience nurses to integrate this OSA evidence into clinical practice and improve stroke/TIA patient outcomes.

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.

Neurologic complications occur in 20%-40% of patients with infective endocarditis. Mycotic aneurysms are one example of these complications, and although rare, they can confound a patient's recovery and increase morbidity and mortality. This article will examine one patient's experience and the devastating effects that this complication had on his life. The information in this article will help to support neurological nurses in refining care and facilitating the best possible recovery for patients who develop this condition.

Objective: The logistics involved in administration of IV tPA for acute ischemic stroke patients are complex, and may contribute to variability in door-to-needle times between different hospitals. We sought to identify practice patterns in stroke centers related to IV tPA use. We hypothesized that there would be significant variability in logistics related to ancillary staff (i.e. nursing, pharmacists) processes in the emergency room setting., Methods: A 21 question survey was distributed to attendees of the AHA/ASA Southwest Affiliate Stroke Coordinators Conference to evaluate potential barriers and delays with regards to thrombolysis for acute strokes patients in the Emergency Department setting. Answers were anonymous and aggregated to examine trends in responses., Results: Responses were obtained from 37 of 67 (55%) stroke centers, which were located mainly in the Southwest United States. Logistical processes differed between facilities. Nursing and pharmacy carried stroke pagers in only 19% of the centers, and pharmacy responded to stroke alerts only one-third of centers. Insertion of Foley catheters and nasogastric tubes prior to tPA was routine in some of the sites. Other barriers to IV tPA administration included physician reluctance and inadequate communication between health care providers., Conclusion: Practices regarding logistics for giving IV tPA may be variable amongst different stroke centers. Given this potential variability, prospective evaluation to confirm these preliminary findings is warranted., (Copyright © 2015 Elsevier B.V. All rights reserved.)

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.)

Primary Objective: The aim of this study was to examine the effect of a systematic reality orientation program (RO) introduced in a neurointensive care unit on duration of posttraumatic amnesia (PTA) and outcomes of patients with traumatic brain injury (TBI)., Research Design: This study used a quasiexperimental, prospective design., Methods and Procedures: Twenty-four patients (intervention) with a significant TBI classified as moderate-to-severe injuries as measured by scores of less than 12 on the Glasgow Coma Scale underwent an RO program compared with a similar group of 38 patients (control) who received a conventional rehabilitation program. The Rancho Los Amigos Score was used to assess the cognitive level 24 hours after the end of sedation, and the Galveston Orientation and Amnesia Test was used daily to assess orientation and duration of PTA. The Glasgow Outcome Scale Extended was then used as an indicator of clinical outcome after 12 months., Main Outcomes and Results: The preliminary results indicated that patients who received the RO had a higher mean of the Glasgow Outcome Scale Extended (SD = 1.53) than those receiving the usual care (SD = 1.35) despite that the groups differed significantly (p = .01) in PTA duration., Conclusion: Patients with TBI may benefit from early assessment and systematic RO nursing intervention. The RO may facilitate patients with PTA to regain orientation and interact with their surroundings in the neurointensive care unit to optimize the recovery. However, further studies with focus on timing, intensity, and duration are needed to evaluate the influence of an early RO approach on PTA and outcomes in patients experiencing TBI.

The purpose of this study was to determine the effectiveness of processes and guidelines for the patient with acute stroke receiving care in New Jersey acute care hospitals in 2010. Lack of adherence to established protocols for acute ischemic stroke may significantly affect the outcomes of care. The lack of available literature providing evidence of prior practices for stroke care in the state of New Jersey precludes a comparison with current practices. This was a descriptive study utilizing an electronic survey developed by the researcher. A convenience sample was utilized for this study consisting of stroke healthcare professionals (N = 79) within the state of New Jersey. The survey yielded a response rate of 70%. Respondents provided information on level of education, average time in position, duties, issues impeding job performance, information related to hospital practices, and stroke core measure compliance within 30 days before the survey. Study results allow designated and nondesignated centers to address issues identified and change or revise protocols accordingly.

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.

An estimated 66,240 people in the United States are currently living with brain tumors. Most of these individuals are adults. The purpose of this first edition American Association of Neuroscience Nurses' Clinical Practice Guideline is to summarize what is currently known about brain tumors in adults and to provide the reader with nursing-specific recommendations based on supporting evidence from nursing and other disciplines. Care of the Adult Patient With a Brain Tumor includes information on epidemiology, classification of brain tumors, pathophysiology, clinical features, diagnostic tests, surgical management, radiation therapy, chemotherapy, symptom management, psychosocial and educational needs of the patient and family, and survivorship and end-of-life care.

The purpose of this first edition of the American Association of Neuroscience Nurses' Clinical Practice Guideline is to summarize what is currently known about brain tumors in children and to provide the reader with nursing-specific recommendations based on supporting evidence from nursing and other disciplines. "Care of the Pediatric Patient With a Brain Tumor" includes information on epidemiology, classification of brain tumors, risk factors, genetics, pathophysiology, clinical features, tumor types, diagnostic testing, acute management, surgery, radiation therapy, chemotherapy, psychosocial and educational needs of the patient and family, and long-term effects of the brain tumor or management of the brain tumor. Aspects of care unique to the pediatric patient are emphasized.

Objective: This article is an overview of the neurological diagnoses with highest attempt in suicide. The most common risk factors in suicidal ideation in neurology patients are identified, as well as the description of ways to assess and implement treatment of patients with suicidal ideation, including the recommendations for patients with specific neurological diagnosis. A guideline development is needed to address suicide concerns in these patients., Methods: A literature search was conducted to find published studies and patient guidelines that were relevant to suicidal ideation, assessment, and treatment in neurology patients., Results: Information found was not always exclusive for neurology patients. Findings often discussed psychiatric patients. The neurological diagnosis most associated with suicidal ideation includes multiple sclerosis, epilepsy, and Parkinson's disease. The most common risk factors for suicidal ideation are hopelessness, depression, and social isolation. As treatment factors, a therapeutic relationship, treatment for depression, assurance of patient safety, and specific interventions for suicidal prevention were identified to provide healthcare professionals in neurology ways to address suicidal issues for patients with neurological diagnoses. Three protocols highlighted staff prevention activities., Discussion: Because patients with neurological disorders experience suicidal ideation with a greater risk of suicide, particularly in multiple sclerosis, epilepsy, and Parkinson's disease, the potential risk for suicide requires active assessment, monitoring, and intervention by nurses and health professionals to address this clinical issue. The assessments available require further psychometric testing for reliability and validity with patient use. There is a need for more research to develop a guideline/protocol exclusively for neurological patients.

Depression is a common finding after an acute stroke and often interferes with the ability of the patient to participate in the rehabilitation process. A literature review was conducted to investigate the potential benefit of the early administration of antidepressant medication on the rate of depression after acute stroke. Current practices for screening and diagnosing post-stroke depression (PSD) were also reviewed. MEDLINE, CINAHL, Cochrane Library databases, and PsychInfo were searched for relevant articles published in English up to August 2012. One of the challenges identified was that although several studies suggest benefit to the addition of antidepressant medication, little consistency exists in the timing of the intervention, particularly in regards to rehabilitation. Although patients reporting fewer depressive symptoms have been shown to have higher levels of participation in post-stroke therapy, conclusions regarding the benefit of early intervention cannot be made at this time. However, several studies do suggest that, in addition to the benefit of treating PSD, different classes of antidepressant medication may actually facilitate the neural mechanisms of recovery in patients with stroke. Overall, although the current available research cannot recommend the routine administration of antidepressant medication for PSD, the current research can support the administration of this pharmaceutical intervention on an individual basis. Future research needs surrounding PSD are vast, and several questions need to be addressed before focusing on the timing and benefit of early intervention including developing a universally validated screening tool, developing a definitive definition, and establishing acceptable treatment recommendations. Once these topics are further explored, the potential for antidepressants to improve neural mechanisms of recovery can also be further investigated.