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Background: In 2008, the European Association of Neuroscience Nursing (EANN) initiated the NeuroBlend™ project, which aimed to delineate the roles and competencies of neuroscience nurses across Europe. This project resulted in the development of the European Competence Profile (ECP), intended to standardize educational pathways and professional recognition for this specialized field. Aim: This study examines the relevance of neuroscience nursing practices to the competencies outlined in NeuroBlend™ across different Italian care settings, including multiple sclerosis, pediatric neurosurgery, pediatric neurology, Alzheimer's disease, and substance addiction. Methods: A phenomenological approach was employed, utilizing focus groups to gather the perspectives of nurses on the competencies defined by the NeuroBlend™ model. The focus groups were conducted from May 2022 to September 2022. The data collected from the focus groups were analyzed using thematic analysis. Results: Thirty nurses participated in the focus groups. Thematic analysis revealed the core competencies, such as communication, empathy, flexibility, and reflective skills, as critical in all care settings. The main themes that emerged were relationships with patients and families, personalized care, and continuity of care. Conclusions: The competencies outlined in the NeuroBlend™ framework are vital to the role of neuroscience nurses in the settings studied and remain highly relevant in the context of Italian healthcare. [ABSTRACT FROM AUTHOR]

Background/Objectives: Empathy and emotional regulation (susceptibility and resistance) play an important role in a nurse's well-being and the provision of high-quality care. This phenomenon has not yet been studied in the context of nurses working in neuroscience. This study aimed to explore the perceptions related to empathy among nurses working in neuroscience contexts. Methods: Employing a mixed-methods approach, we conducted an online quantitative survey with 211 nurses working in various neuroscience settings using the Balanced Emotional Empathy Scale (BEES) and 15 online semistructured qualitative interviews to delve deeper into empathetic experiences. The mean and measures of dispersion, such as standard deviation, were used to analyze the quantitative data. Thematic analysis investigated qualitative data, and data triangulation was performed. Results: The quantitative findings revealed no significant differences in empathy or emotional regulation across the different neuroscience settings but highlighted an increase in susceptibility related to young age (under 29) and years of service (first 5 years). The interviews brought to light the challenges nurses face in highly emotional situations and the strategies they employ to manage empathy and maintain professional detachment, such as self-care strategies, awareness development, and team support. One hindering factor is managers. Conclusions: The findings of this study underscore the essential role of empathetic capability in nursing care in neuroscience. The experience of younger nurses and the first 5 years of employment are elements to be considered by managers for burnout risk. Nurses demonstrate susceptibility and resistance and maintain a balance in dealing with high-emotional-stress situations. The implications of these findings are significant and should guide future research and practice in the field of neuroscience nursing. [ABSTRACT FROM AUTHOR]

The literature suggests that when nurses are aware of their roles and responsibilities, it may contribute to the improved quality of healthcare services. However, the identified roles and responsibilities of nurses in preventing ventriculostomy-related infections (VRI) are limited in the literature, despite their active participation in the management of external ventricular drainage (EVD). The CINAHL Complete, Health Source: Nursing and Academic edition, and MEDLINE Complete were accessed simultaneously through the EBSCO database. The database was searched using the key search terms for peer-reviewed, full-text journal articles in English from 2016 onwards. More literature including some seminal articles were retrieved from the Scopus database after searching through the reference lists of relevant articles. The selected articles were appraised for quality and then thematically analysed. The thematic analysis of the 34 selected articles elucidated seven themes that inform certain nursing roles and responsibilities that could contribute to VRI prevention. [ABSTRACT FROM AUTHOR]

Background: Nurses in neurointensive care units (NCUs) commonly use physical restraint (PR) to prevent adverse events like unplanned removal of devices (URDs) or falls. However, PR use should be based on evidenced decisions as it has drawbacks. Unfortunately, there is a lack of research‐based PR protocol to support decision‐making for nurses, especially for neurocritical patients. Aim: This study developed a restraint decision tree for neurocritical patients (RDT‐N) to assist nurses in making PR decisions. We assessed its effectiveness in reducing PR use and adverse events. Study Design: This study employed a baseline and post‐intervention test design at a NCU with 19 beds and 45 nurses in a tertiary hospital in a metropolitan city in South Korea. Two‐hundred and thirty‐seven adult patients were admitted during the study period. During the intervention, nurses were trained on the RDT‐N. PR use and adverse events between the baseline and post‐intervention periods were compared. Results: Post‐intervention, total number of restrained patients decreased (20.7%–16.3%; χ2 = 7.68, p =.006), and the average number of PR applied per restrained patient decreased (2.42–1.71; t = 5.74, p <.001). The most frequently used PR type changed from extremity cuff to mitten (χ2 = 397.62, p <.001). No falls occurred during the study periods. On the other hand, URDs at baseline were 18.67 cases per 1000 patient days in the high‐risk group and 5.78 cases per 1000 patient days in the moderate‐risk group; however, no URD cases were reported post‐intervention. Conclusions: The RDT‐N effectively reduced PR use and adverse events. Its application can enhance patient‐centred care based on individual condition and potential risks in NCUs. Relevance to Clinical Practice: Nurses can use the RDT‐N to assess the need for PR in caring for neurocritical patients, reducing PR use and adverse events. [ABSTRACT FROM AUTHOR]

Neuropalliative care developed to address the needs of patients living with life‐limiting neurologic disease. One critical consideration is that disease‐related changes to cognition, communication, and function challenge illness experiences and care practices. We conducted an ethnography to understand neuropalliative care as a phenomenon; how it was experienced, provided, conceptualized. Personhood served as our conceptual framework; with its long philosophical history and important place in nursing theory, we examined the extent to which it captured neuropalliative experiences and concerns. Personhood contextualized complex losses, aligning the impact of functional and relational changes. Cognition, communication, and functional alterations stretched conceptions of personhood, insinuating it can be relational, fluid, adaptive. Although normative conceptions of personhood guided research and decision‐making, ethical considerations suggested personhood could be transformed, remade. We consider the implications of our findings through three themes. First, we examine how literature on illness experience fails to integrate the realities of people living with and dying from neurologic disease; we counter this by interrogating the concept of experience. Second, we turn to Ricoeur's work on recognition to illuminate relational conceptions of personhood to inform care practices. Finally, we reflect on how personhood can bridge the gap left by functional changes, enhance relational engagement, and promote dignity at the end of life. [ABSTRACT FROM AUTHOR]

Drug induced parkinsonism (DIP) is one of the most frequently occurring side effects of dopamine-receptor blocking agents such as antipsychotic (neuroleptic) and antiemetic drugs. It typically presents with extrapyramidal signs, such as slowed movements, reduced facial expression and muscle stiffness. In contrast to Parkinson's disease, which is caused by a progressive degeneration of pre-synaptic dopaminergic neurons that project from the substantia nigra in the brainstem, DIP is thought to usually occur due to the post-synaptic antagonism of dopamine receptors in the striatum. However, the two conditions can sometimes be clinically indistinguishable, and may even occur together, and thus it can be challenging to make an accurate diagnosis of DIP. It is important to consider DIP in the differential diagnosis of any person with extrapyramidal signs within the context of recent medication changes as the condition is reversible when the offending drug is withdrawn and, without early identification, there is substantial risk of increased morbidity, complications such as falls, and poor quality of life. Recent advancements in cerebral imaging have improved diagnostic accuracy but this technology is costly and not widely available. There is a dearth of literature pertaining to the role of neuroscience nurses and DIP. This is concerning as the potential for DIP presentations to occur within the neuroscience setting is high. Neuroscience nurses, particularly those working within the movement disorder speciality areas, need the skills to advocate and pursue further investigation for patients who present with extrapyramidal signs, especially if these begin in the context of the prescription of dopamine-blocking drugs. This review is written primarily for neurosciences nurses but will be applicable to a wide range of healthcare workers; it aims to outline potential causative drugs, risk factors and the key clinical characteristics of DIP. It also highlights useful features that help distinguish DIP from Parkinson's disease, summarises investigations and discusses management and care. [ABSTRACT FROM AUTHOR]

The transition period from hospital to home is a vulnerable time for rehospitalization and adverse events for patients. Follow-up clinic visits within 7-14 days of discharge is an effective strategy for reducing hospital readmissions. Neurocritical care patients have a unique set of needs to safely transition to home. We evaluated the feasibility of a Neuroscience Rapid Follow-Up Clinic with nurse practitioners (NPs) and physician associates (PAs) to meet transitional care gaps in neurocritical care patients and prevent rehospitalization. Clinic procedures and documentation templates were customized for the pilot clinic. Five NPs and one PA underwent a brief training course for the ambulatory care setting. Eligible patients were tracked throughout the hospitalization and the team made follow-up appointments. The pilot clinic took place from October 2022 to January 2023. Nine patients were seen in the clinic approximately 8 days after discharge. The clinic attendance rate was 90%. Among the clinic attendees, 66% received referrals to a primary care provider or other services, one third received medication changes or refills and all received patient-specific education. There were no rehospitalizations among the clinic patients. Implementation of this pilot clinic was possible with the current departmental resources. This innovative model of care has the potential to reduce hospital readmissions. [ABSTRACT FROM AUTHOR]

Background: A correlation exists between staff retention, staff and patient safety and effective prevention of violence and aggression in neuroscience nursing. Workplace violence leads to a lack of productivity amongst nurses and legally a hospital is required to provide a safe working environment. This literature review aims to determine the themes within the literature and effective patient management of agitation leading to violence and aggression. Aim: A literature review of articles was conducted using CINAHL, PubMed, Cochrane database and Google Scholar between 2007-2022. Discussion: The common themes within the literature included assessment of the patient to identify an unmet need, early referrals to members of the interdisciplinary team, effective communication, verbal de-escalation techniques and an understanding of restraint and pharmaceutical management, even though these should be the last resort. Education for staff is fundamental and should include effective communication, warning signs, triggers for aggression, simulation in the clinical context, and verbal de-escalation techniques. Debriefing should take place after an incidence of violence and aggression and effective hospital management should be considered with guidelines and systems in place to support and protect staff and patients. [ABSTRACT FROM AUTHOR]

Background: Structural planning is essential for the management of constipation in stroke patients. The current study aims to determine the impact of a care plan on the frequency of new-onset constipation following stroke. Materials and Methods: This clinical trial was conducted on 132 stroke patients (two groups of 66) in three phases (pre-intervention, during discharge, 1 month after discharge). Clients were randomly assigned to blocks based on gender, type of stroke, and age. The care plan according to the nursing process was conducted. Data collection tools included a demographic–clinical information questionnaire, Rome IV criteria (diagnosis of constipation), and Bristol scale (consistency of stool). Data were analyzed using the Chi-square, McNemar, Wilcoxon, Analysis of Variance (ANOVA), and a general estimated model. Results: The prevalence of new-onset constipation following stroke in the control group decreased from 66 (100%) at admission to 39 (67.20%) at discharge and in the intervention group from 66 cases (100%) to 18 cases (34%) (p = 0.001), but it was not significant at follow-up (p = 0.16). The trend of frequency of constipation from admission to follow-up was generally significant in the intervention group (p = 0.03) vs the control group (p = 0.21). The difference in the mean number of cases of constipation was statistically significant (2.89) 2.10) control group vs 1.58 (1.65) intervention group, p < 0.001). Conclusions: A significant impact of the care plan was observed from admission to discharge, but further follow-up was required with more client-side collaboration. Therefore, the present care plan is recommended in the hospital and home care.

Background: Limb strength is a central component of neurological assessment and monitoring in nursing practice, yet there is a lack of research examining the tools used by nurses or challenges nurses encounter when using these tools. The evidence base is lacking to inform effective practice and the underpinning educational approaches. Aim: To determine which tools are used by UK and Irish neuroscience nurses in the assessment of limb strength and the associated challenges and variations in practice. Methods: This study used an online self-reported survey design to ascertain which tools neuroscience nurses used and their experience of using these (n=160). Findings: Practices varied, with a dominance of two tools being used in practice: the Medical Research Council scale and the 'normal power' to 'no movement' scale found on the neurological observation chart. Most respondents used the same tool across all conditions. Conclusion: This study highlights variations in assessment practice and the absence of a sound evidence base behind choice of motor limb strength assessment tools used. [ABSTRACT FROM AUTHOR]

Background: Structural planning is essential for the management of constipation in stroke patients. The current study aims to determine the impact of a care plan on the frequency of new-onset constipation following stroke. Materials and Methods: This clinical trial was conducted on 132 stroke patients (two groups of 66) in three phases (pre-intervention, during discharge, 1 month after discharge). Clients were randomly assigned to blocks based on gender, type of stroke, and age. The care plan according to the nursing process was conducted. Data collection tools included a demographic–clinical information questionnaire, Rome IV criteria (diagnosis of constipation), and Bristol scale (consistency of stool). Data were analyzed using the Chi-square, McNemar, Wilcoxon, Analysis of Variance (ANOVA), and a general estimated model. Results: The prevalence of new-onset constipation following stroke in the control group decreased from 66 (100%) at admission to 39 (67.20%) at discharge and in the intervention group from 66 cases (100%) to 18 cases (34%) (p = 0.001), but it was not significant at follow-up (p = 0.16). The trend of frequency of constipation from admission to follow-up was generally significant in the intervention group (p = 0.03) vs the control group (p = 0.21). The difference in the mean number of cases of constipation was statistically significant (2.89) 2.10) control group vs 1.58 (1.65) intervention group, p < 0.001). Conclusions: A significant impact of the care plan was observed from admission to discharge, but further follow-up was required with more client-side collaboration. Therefore, the present care plan is recommended in the hospital and home care. [ABSTRACT FROM AUTHOR]

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

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

Neurological disorders are a leading cause of disease burden worldwide, placing a heavy demand on health systems. This study evaluated the impacts and cost savings of a community‐based nursing service providing supported discharge for neurological patients deemed high‐risk for unplanned emergency department presentations and/or hospital readmissions. It focused on adult patients with stroke, epilepsy, migraine/headache or functional neurological disorders discharged from a Western Australian tertiary hospital. An observational design was used comprising prospective enrolment of patients receiving nurse‐led supported discharge and follow‐up (Neurocare), 21 August 2018 to 6 December 2019 (N = 81), and hospital administrative data, 1 February 2016 to 31 January 2018, for patients in previous care model (N = 740). Healthcare utilisation and annualised cost savings from reduced rehospitalisation and/or emergency department presentations within 28 days post discharge were compared. Neurocare patients' postdischarge functional and health‐related quality of life outcomes, and perceived involvement in self‐management and integrated care were surveyed. The hospital's total cost savings are A$101,639 per annum and A$275/patient/year with a return on investment of 2.01. There was no significant difference in hospital length of stay (LOS) between models, but older age was associated with longer length of hospital stay and a predictor for non‐neurological readmissions. Neurocare patients showed improved functional status, less equipment and/or service needs, improved health‐related quality of life. They felt involved in self‐managing their condition with well‐integrated postdischarge care. This nurse‐led model of transitional care for neurology patients discharged from hospital produced cost savings and a positive return on investment compared with usual care. With service maturity, earlier supported hospital discharge and reduced LOS may follow. Patients' reduced service needs and improved functional status and health‐related quality of life may positively impact healthcare utilisation. Future research should include larger patient samples and multiple sites. [ABSTRACT FROM AUTHOR]

Neurological conditions produce considerable disease burden. To describe quality of life in patients with neurological conditions and informal caregivers receiving postdischarge generic community neurological nursing services, and caregiver burden. A descriptive cross-sectional design was used with researchers administering the WHOQOL-BREF Australian Version questionnaire and Zarit Burden Interview. Most patients and caregivers rated quality of life as 'Good'. The patients' physical, psychological and environment domain scores, and caregivers' physical domain scores, were below norms. Half of the caregivers experienced burden and 42% had risk for depression. A heterogeneous group of patients with neurological conditions had considerable care and support needs for fundamental functioning postdischarge. Quality of life and caregiver burden measures highlight the impact of their circumstances on their health and wellbeing. Research is warranted to determine a comprehensive set of generic needs to guide integrated community nursing services for building patient and caregiver self-management capacity. [ABSTRACT FROM AUTHOR]

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

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

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

Abstract: BACKGROUND: Pediatric neurocritical care (PNCC) and pediatric neurointensive care units (neuro-PICU) are growing fields. Although some institutions have established independent neuro-PICUs meeting most Neurocritical Care Society (NCS) standards for neurocritical care units, many centers lack the resources to do so. We describe an alternative neuro-PICU model as a designated unit within a mixed pediatric intensive care unit (PICU) and its effects on nursing sentiment. METHODS: We established a 6-bed neuro-PICU within a 36-bed noncardiac PICU. Charge nurses were tasked with admitting PNCC patients into these beds. For nursing expertise, we used a core group of 12 PNCC specialty nurses and instituted PNCC nursing education to PICU nurses. We observed the number of PNCC patients admitted to neuro-PICU beds and surveyed charge nurses to identify barriers to assigning patients. We surveyed PICU nursing staff to explore sentiment regarding PNCC before and after establishing the neuro-PICU. Nursing criteria were compared with NCS standards. RESULTS: In the 40-month period, our PICU saw 2060 PNCC admissions. Overall, occupied neuro-PICU beds housed PNCC patients 74.1% of the time. The biggest barriers to patient placement were too many competing placement requests, not enough neuro-PICU beds when specialty census was high, and difficulty assigning one nurse to two PNCC patients. In surveys after establishing the neuro-PICU, compared to before, experienced nurses reported being more interested in obtaining Emergency Neurological Life Support certification (94.2% vs 80.6%, P = .0495), and inexperienced nurses reported being more familiar with PNCC clinical pathways (53.5% vs 31.7%, P = .0263). Most NCS criteria related to nursing organization were met. CONCLUSIONS: Focused neuro-PICUs should be developed to complement advances in the field of PNCC. Alternative neuro-PICU models are possible and can increase nursing interest in further education and awareness of clinical pathways, but barriers exist that require institutional commitment to nursing development to sustain the delivery of specialized care to this population., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 American Association of Neuroscience Nurses.)

Abstract: BACKGROUND: Hourly neurological examinations (neuro exam) have been widely used to monitor for a decline in neurological status, allowing for timely intervention. There are, however, limited data behind this common practice. The objective of this study was to identify how frequently neurological decline occurred across various diagnoses and whether that decline (1) was identified by a scheduled neurocheck and (2) altered management. METHODS: A cross-sectional survey was performed in a neurological intensive care unit at a tertiary care academic medical center. Clinical neuroscience nurses caring for patients with hourly neurological assessments completed a brief survey at 12-hour shift completion. RESULTS: Data were collected from 212 nurse's shifts. Neurological changes were identified by nurses in 14% (n = 30) of shifts. The neurological change was identified during a scheduled neurocheck 67% of the time, with the detection of changes more likely to occur during a scheduled neuro exam than at other times ( P < .05). There was no change to the care plan in 55% of the cases of neurological decline. Patients with subarachnoid hemorrhage were more likely to have a decline detected. CONCLUSION: Findings suggest that many patients undergo hourly neurological exams without ever identifying a neurological deterioration. In many instances of neurodeterioration, there was no change to the treatment plan pursued. Primary diagnoses and neurological changes may not be entirely independent, and therefore, hourly neuro exams may have greater yield in some diagnoses than others. Replication is warranted with a larger sample to evaluate the risks and benefits of neuroassessments., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 American Association of Neuroscience Nurses.)

Competing Interests: The authors declare no conflicts of interest.

Background: Iatrogenic malnutrition is a significant burden to patients, clinicians, and health care systems. Compared with well-nourished patients, underfed patients (those who receive less than 80% of their daily energy requirement) have more adverse outcomes related to nutritional status. Volume-based protocols allow for catch-up titrations, are consistently superior to rate-based protocols, and can be implemented in most settings., Local Problem: This project was conducted in an 8-bed neuroscience intensive care unit in which up to 41% of patients who required enteral feeding were underfed., Methods: This quality improvement clinical practice change project used a before-and-after design to evaluate (1) the effect of implementing a volume-based feeding protocol on the delivery of enteral feeds and (2) the effect of a nutrition-based project on staff members' attitudes regarding nutrition in critical care. The effectiveness of a volume-based feeding titration protocol was compared with that of a rate-based feeding protocol for achieving delivery of at least 80% of prescribed nutrition per 24-hour period. Staff members' attitudes were assessed using a survey before and after the project., Results: During 241 enteral feeding days (n = 40 patients), the percentage of delivered enteral feeding volume and the percentage of days patients received at least 80% of the prescribed volume increased after volume-based feeding was implemented. After project implementation, 74 staff members reported increased emphasis on nutrition delivery in their practice and a higher level of agreement that nutrition is a priority when caring for critically ill patients., Conclusions: Using a volume-based feeding protocol with supplemental staff education resulted in improved delivery of prescribed enteral feeding., (©2024 American Association of Critical-Care Nurses.)

Abstract: BACKGROUND: Nurses are key in identifying and treating in-hospital strokes (IHSs). Delayed treatment times and poor patient outcomes are associated with IHSs. Information is needed on nurses' stroke knowledge and the objective measurement of stroke knowledge using a validated tool. The Acute Stroke Management Questionnaire (ASMaQ) was recently developed to test stroke knowledge of healthcare professionals but has not been used on a nursing-specific population. METHODS: Through online surveying and use of ASMaQ, we will measure stroke knowledge of nurses caring for adult, hospitalized patients in an urban, southeast US health system. RESULTS: Total N is 196. Most participants (74.5%, n = 146) never worked on a stroke floor; however, almost all (95.9%, n = 188) cared for a stroke patient in the past. Most participants (65.3%, n = 128) reported receiving prelicensure stroke education, and 98.5% (n = 193) received postlicensure stroke education. Acute Stroke Management Questionnaire total scores ranged from 93 to 133 (mean [SD], 117.35 [8.15]). Most participants scored in the good stroke knowledge range for all 3 ASMaQ domains and total ASMaQ score. CONCLUSION: The online delivery of the ASMaQ was successful in testing nurses' stroke knowledge, and nurses were shown to have good stroke knowledge. Future initiatives should focus on discerning whether certain nurse characteristics predict higher or lower levels of stroke knowledge to help inform educational initiatives to improve IHS outcomes., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 American Association of Neuroscience Nurses.)

Abstract: BACKGROUND: To measure the effectiveness of an educational intervention, it is essential to develop high-quality, validated tools to assess a change in knowledge or skills after an intervention. An identified gap within the field of neurology is the lack of a universal test to examine knowledge of neurological assessment. METHODS: This instrument development study was designed to determine whether neuroscience knowledge as demonstrated in a Neurologic Assessment Test (NAT) was normally distributed across healthcare professionals who treat patients with neurologic illness. The variables of time, knowledge, accuracy, and confidence were individually explored and analyzed in SAS. RESULTS: The mean (standard deviation) time spent by 135 participants to complete the NAT was 12.9 (3.2) minutes. The mean knowledge score was 39.5 (18.2), mean accuracy was 46.0 (15.7), and mean confidence was 84.4 (24.4). Despite comparatively small standard deviations, Shapiro-Wilk scores indicate that the time spent, knowledge, accuracy, and confidence are nonnormally distributed ( P < .0001). The Cronbach α was 0.7816 considering all 3 measures (knowledge, accuracy, and confidence); this improved to an α of 0.8943 when only knowledge and accuracy were included in the model. The amount of time spent was positively associated with higher accuracy ( r2 = 0.04, P < .05), higher knowledge was positively associated with higher accuracy ( r2 = 0.6543, P < .0001), and higher knowledge was positively associated with higher confidence ( r2 = 0.4348, P < .0001). CONCLUSION: The scores for knowledge, confidence, and accuracy each had a slightly skewed distribution around a point estimate with a standard deviation smaller than the mean. This suggests initial content validity in the NAT. There is adequate initial construct validity to support using the NAT as an outcome measure for projects that measure change in knowledge. Although improvements can be made, the NAT does have adequate construct and content validity for initial use., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 American Association of Neuroscience Nurses.)

Abstract: BACKGROUND: The essential components of an effective neuroscience nurse orientation program for those caring for the adult general care population have not been well defined or standardized. METHODS : Using a 2-round, modified Delphi methodology, electronic surveys were distributed to 53 experts in neuroscience nursing orientation to gain consensus on the essential components of orientation for the neuroscience nurse. Survey data included demographics of the expert, literature-based components of neuroscience nurse orientation, and an opportunity to agree/disagree or write in additional components. RESULTS : Round 1 of the consensus survey elicited a response rate of 55% (29/53), and round 2 had a 51% (27/53) response rate. On the basis of round 1 expert responses, 4 new orientation components were added, and 36 components of a neuroscience nursing orientation were revised to include only the elements with ≥75% agreement. Twenty-two elements in round 2 met the criteria of ≥75% very important and important to include as components of a neuroscience nursing orientation. CONCLUSION : An expert consensus was reached on the necessary components of a neuroscience nursing orientation. The identified neuroscience nursing orientation components concentrated on improving nursing practice and provision of care to adult neuroscience patients. This study demonstrates priority components within a standardized orientation program for neuroscience nurses based on literature and expert consensus. A comprehensive neuroscience nursing orientation is a vital step in sustaining high-quality care for patients and improving neurological outcomes., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 American Association of Neuroscience Nurses.)

Aim: The purpose of this study is to determine the health needs of individuals with autism spectrum disorder (ASD) using the Problem Classification Scheme (PCS), one of the main components of the Omaha System. The data obtained are expected to guide health programmes focusing on the needs of individuals with ASD. Method: This descriptive study was conducted at a special education implementation centre providing daytime education for individuals with ASD. Data obtained by the institutional nurse during the daily diagnosis and examination procedures of the ambulatory treatment unit in the centre were defined by another researcher according to the PCS forms. Routine health care was provided for all the individuals whose condition was diagnosed. Results: The 10 most frequently documented problems were personal care (83.78%), mental health (62.84%), speech and language (61.49%), social contact (50%), interpersonal relationship (42.57%), cognition (32.43%), income (28.38%), medication regimen (24.32 %), nutrition (22.30%) and neglect (18.92%). Conclusion: The results indicate that it is useful to use the Omaha System in determining the health needs of an individual with autism holistically, and in assessing and evaluating the individual's care, as it provides a standardised language. Impact statements: The Omaha PCS System can be used by nurses in the holistic diagnosis of the health status of individuals with ASD. [ABSTRACT FROM AUTHOR]

Apathy and depression are common neuropsychiatric disorders that can manifest themselves as comorbidities in patients affected by neurological diseases. Misdiagnosis may lead to unwanted clinical side effects, inappropriate rehabilitation, and may compromise the patient clinical outcome. The purpose of this article is to review features of apathy and depression, highlighting similarities and analysing discriminating factors between them. It also aims to raise nurses' awareness in relation to the management of apathy, highlighting a validated and consistent tool to be used during nursing assessment. A literature search was conducted in the MEDLINE, CINAHL, PsycINFO, Google Scholar, and Cochrane Library databases dating from 2014 to 2019. Publications were screened according to predetermined inclusion/exclusion criteria and reviewed. The relationship between apathy and depression is complex. Nurses could differentiate between them through education and a structured assessment, shaping the therapeutic/rehabilitative approach and ultimately making a difference in terms of patient wellbeing. [ABSTRACT FROM AUTHOR]

Neurological conditions represent leading causes of non‐fatal burden of disease that will consume a large proportion of projected healthcare expenditure. Inconsistent access to integrated healthcare and other services for people with long‐term neurological conditions stresses acute care services. The purpose of this rapid evidence assessment, conducted February–June 2016, was to review the evidence supporting community neurological nursing approaches for patients with neurological conditions post‐discharge from acute care hospitals. CINAHL Plus with Full Text and MEDLINE were searched for English‐language studies published January 2000 to June 2016. Data were extracted using a purpose‐designed protocol. Studies describing community neurological nursing care services post‐discharge for adults with stroke, dementia, Alzheimer's disease, Parkinson's disease, multiple sclerosis or motor neurone disease were included and their quality was assessed. Two qualitative and three quantitative studies were reviewed. Two themes were identified in the narrative summary of findings: (i) continuity of care and self‐management and (ii) variable impact on clinical or impairment outcomes. There was low quality evidence of patient satisfaction, improved patient social activity, depression scores, stroke knowledge and lifestyle modification associated with post‐discharge care by neurological nurses as an intervention. There were few studies and weak evidence supporting the use of neurology‐generalist nurses to promote continuity of care for people with long‐term or progressive, long‐term neurological conditions post‐discharge from acute care hospital. Further research is needed to provide role clarity to facilitate comparative studies and evaluations of the effectiveness of community neurological nursing models of care. [ABSTRACT FROM AUTHOR]

The aim is to describe the process of construction of a multimedia app to support the nursing care sistematization to neurological patient. It is a methodological research, wich focuses on development, evaluation and improvement of instruments and pedagogical strategies. The cerebrovascular diseases are the second biggest cause of death worldwide, behind only of cardiovascular diseases, the nurse is fundamental to pacients care, with the work overload and short time, it became necessary the development of a technology to support the nurse. It concludes that the app helped the nurse in their routine with agility, speed and eficiency to the neurological patiente, improving the quality of the assistence and promoting a better recovery to the patient. [ABSTRACT FROM AUTHOR]

The spectrum of traumatic brain injuries (TBI) is wide, ranging from minor concussions to major contusions. This heterogeneity of TBI encompasses a lot of uncertainty about the likelihood of worsening or improvement in individual patients. Predicting the outcome of individual patients with traumatic brain injury is therefore challenging. The objective of the study was to determine the accuracy of prediction of outcome in patients with TBI by clinical nurses in comparison to predictions made by a well-validated prognostic model, the International Mission for Prognosis and Analysis of Clinical Trials (IMPACT) model. A survey was conducted among 50 nurses working in an acute neurotrauma setting in a tertiary care hospital. Some 10 case vignettes describing the clinical data of patients with TBI were given to clinical nurses. The nurses were asked to predict the chance of mortality and unfavorable outcome (unfavorable outcome defined as mortality, vegetative state or severe disability with complete dependence for all physical needs) at 6 months for each case. Predictions made by nurses were compared to predictions made by the IMPACT prognostic calculator for each case. A total of 50 responses were used for analysis. The prognostication made by nurses differed significantly from the IMPACT score. The difference in prediction (expressed as a percentage) ranged from -6.3± 29.6 to 42± 20.5. For most of the cases, nurses tended to be more pessimistic about the outcome. The study provides an insight into the nurses' perception regarding outcome in patients with TBI. It also elucidates the importance of promoting the usage of prognostic models by nurses. [ABSTRACT FROM AUTHOR]

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.)