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Background: In the contemporary healthcare environment, optimizing patient care strategies is of importance, particularly in neurosurgical environments. While traditional nursing methods have the foundation of patient care, there exists a growing recognition of the potential benefits of comprehensive nurse management. Despite this acknowledgment, there remains a gap in understanding the comparative effectiveness of comprehensive nurse management versus traditional approaches in reducing postoperative psychological stress, enhancing patient satisfaction, and promoting adherence in neurosurgical patients., Objective: This study compares the efficacy of comprehensive nurse management against traditional methods in facilitating the postoperative recovery of neurosurgical patients., Methods: Taking the traditional nursing management and detailed nursing management of neurosurgical patients in a municipal neurosurgical hospital from March 2021 to March 2022 as an example, the neurosurgery was divided into 50 patients in the detailed nursing management group and 50 patients in the traditional nursing management group. In the clear nursing management group, there were 50 patients, 20 male patients, with an average age of 58.7 ± 3.8 years, and 30 female patients, with an average age of 60.4 ± 4.3 years; In the traditional nursing management group, there were 50 patients, 26 male patients, with an average age of 59.7 ± 3.7 years, and 24 female patients, with an average age of 59.4 ± 3.9 years; Among the 100 patients, there were 60 cases of cerebral infarction, 25 cases of intracerebral hemorrhage and 15 cases of other neurosurgical diseases., Results: Hundred neurosurgical patients were divided into two groups: comprehensive nursing management group and traditional nursing management group. The results showed that the comprehensive treatment effect of patients with detailed nursing management was better than that of the routine nursing group. At the same time, the complications were reduced, and the patient's satisfaction was higher., Conclusion: Through retrospective analysis and investigation of patients, this paper discusses the clinical application of a detailed nursing management model in neurosurgery, which can reduce the probability of infection and other complications and improve the quality of life and treatment effect of patients.

Unrecognized changes in patients' vital signs can result in preventable deaths in hospitalized patients. Few publications or studies instituting routine patient monitoring have described implementation and the setting of alarm parameters for vital signs. We wanted to determine if continuous multi-parameter patient monitoring can be accomplished with an alarm rate that is acceptable to hospital floor nurses and to compare the rate of patient deterioration events to those observed with routine vital sign monitoring. We conducted a prospective, observational, 5-month pilot study in a 26-bed adult, neurological/neurosurgical unit (non-ICU) in an academic medical center. A patient surveillance system employing a wireless body-worn vital signs monitor with automated nursing notification of alarms via smartphones was used to gather data. Data collected included: alarm rates, rapid response team (RRT) calls, intensive care unit (ICU) transfers, and unplanned deaths before and during the pilot study. Average alarm rate for all alarms (SpO 2 , HR, RR, NIBP) was 2.3 alarms/patient/day. The RRT call rate was significantly reduced (p < 0.05) from 189 to 158 per 1000 discharges. ICU transfers per 1000 discharges were insignificantly reduced from 53 to 40 compared to the previous 5-month period in the same unit. Similar measures of comparison units did not change over the same period. Although unplanned patient deaths in the study unit were also reduced during the intervention period, this was not statistically significant. Continual, multi-parameter vital signs monitoring can be customized to reduce a high alarm rates, and may reduce rapid response team calls.

: Background: Despite the known benefits of early postsurgical mobility, there are no clear recommendations on early mobility among uncomplicated postoperative neurosurgical spine patients., Purpose: The purpose of this quality improvement initiative was to establish an NP-led early mobility protocol to reduce uncomplicated postsurgical spine patients' length of stay (LOS) in the hospital and eliminate the variability of postsurgical care. A secondary objective was to educate and empower nursing staff to initiate the early mobility protocol independently and incorporate it in their practice to improve patient care., Methods: Two neurosurgery NPs led an interprofessional team to develop the early mobility protocol. Team members provided preadmission preoperative education to communicate the necessity for early mobility and provide information about the protocol. New nursing guidelines called for patient mobility on the day of surgery, within six hours of arrival on the medical-surgical unit. Nurses were empowered to get patients out of bed independently, without a physical therapy consultation; they also removed urinary catheters and discontinued IV opioids when patients' status permitted., Results: Over a one-year period, implementation of the protocol resulted in a nine-hour reduction in LOS per hospitalization in neurosurgical spine patients who underwent lumbar laminectomies. The protocol also allowed nurses more autonomy in patient care and was a catalyst for patient involvement in their postoperative mobility. Given the success of the protocol, it is being replicated by other surgical services throughout the organization., Conclusions: This low-cost, high-reward initiative aligns with the strategic plan of the organization and ensures that high-quality, patient-centered care remains the priority. NPs in other institutions can modify this protocol to promote postoperative mobility in their organizations.

Nurses in neurosurgical departments play a critical role as they are involved in the first stages of the care pathway of patients with glioblastoma. Indeed, surgery enables a definitive histopathological diagnosis to be established and the size of the tumour to be significantly reduced, thereby improving the prognosis., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

One of the innovative principles in glioblastoma surgery consists in making the tumour fluorescent in order for it to be more easily visualised during the procedure. 5-aminolevulinic acid (5-ALA) undergoes an enzyme transformation, turning into another molecule, protoporphyrine IX (PPIX) whose property is fluorescence. It emits red light when it is stimulated by blue light., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Background: Early neurological and neurosurgical rehabilitation (ENNR) as a complex post-acute form of treatment for patients with severe neurological diseases and continued need for intensive care is well established in Germany., Objective: To assess the efficacy of ENNR from the perspective of evidence-based medicine as well as to present data on the outcome of ENNR patients including the analysis of prognostic factors., Material and Methods: A search was carried out in PubMed databases to identify early rehabilitation treatment forms evaluated by randomized controlled trials and with respect to large multicenter surveys of outcome and prognostic factors., Results: For ENNR as a complex treatment concept, effectiveness not has been shown with regard to evidence-based medicine but it includes individually effective treatment forms. In two large multicenter evaluations the average duration of treatment was between 51 and 57 days and mortality was between 6 % and 10 %, increasing with the proportion of mechanically ventilated patients. Lower need for nursing support on admission indicated better outcome, whereas mechanical ventilation was more likely to be associated with poor outcome. Long-term outcome was negatively influenced by mechanical ventilation as well as severe neurogenic dysphagia with and without the need for a tracheal cannula and/or percutaneous endoscopic gastrostomy (PEG) and also by severely impaired communication at the end of ENNR., Discussion: These prognostic factors indicate the primary aims of ENNR, which are to reduce the need for nursing support and to establish the capability for rehabilitation. If these aims are achieved, favorable functional and long-term outcome can be expected for ENNR patients. The presented studies verify the sustained efficacy of ENNR as an essential part of the overall treatment concept for severely neurologically impaired patients.

Catheter-associated urinary tract infections (CAUTIs) are among the leading causes of health care-associated infections in neurosurgical populations. Successful reduction of CAUTIs involve the development of staff nurses as front-line change agents equipped with preventative strategies, educational interventions, and sustainable maintenance for positive patient outcomes., (Copyright 2015, SLACK Incorporated.)

Objective: Family-centered care provides family members with basic needs, which includes information, reassurance, and support. Though national guidelines exist, clinical adoption often lags behind in this area. The Geisinger Health System developed and implemented a program for reliable delivery of best practices related to family communication to patients and families admitted to the intensive care unit (ICU)., Method: Using a quasiexperimental study design and the 24-item Family Satisfaction in the Intensive Care Unit questionnaire (FSICU-24©) to determine family satisfaction, we measured the impact of a "family communication pathway" facilitated by tools built into the electronic health record on the family satisfaction of neurosurgical patients admitted to the ICU., Results: There was no statistically significant difference noted in family satisfaction as determined by FSICU-24 scores, including the Care and Decision Making constructs between the pre- and post-intervention pilot population. The percentage of families reporting the occurrence of a family conference showed only minimal improvement, from 46.5% before to 52.5% following the intervention (p = 0.565). This was mirrored by low numbers of documented family conferences by providers, suggesting poor uptake despite buy-in, use of electronic checklists, and repeated attempts at education., Significance of Results: This paper reviews the challenges to and implications for implementing national guidelines in the area of family communication in an ICU coupled with the principles of clinical reengineering.

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.

Background: Sleep disturbance in an intensive care unit is a common problem. One of the main factors causing sleep disturbances in an intensive care unit is nocturnal patient care interventions., Aims and Objectives: This study aims to determine the impact of patient care interventions performed at night in a neurosurgical intensive care unit on patients' sleep and their nursing care satisfaction., Methods: The descriptive study was conducted on 82 patients in a neurosurgical intensive care unit between January 2009 and March 2010. The data were collected by data collection instruments and Newcastle Satisfaction with Nursing Scales. The data were statistically analyzed by frequency, mean, standard deviation, chi-square, and Mann-Whitney U test., Results: The study showed that 53.7% of the patients experienced sleep disturbances in the neurosurgical intensive care unit. Because of nursing interventions at night, 39.1% of these patients had their sleep affected, but this problem did not cause any negative impact on the patients' satisfaction (Newcastle Satisfaction with Nursing Scales score = 88.21 ± 9.83). The patients received, on average, 42.21 ± 7.45 times patient care interventions at night; however, the frequency of patient care interventions at night showed no effect on sleep disturbances in this study (p > .05). The most frequently given patient care interventions were, respectively, vital signs monitoring, neurological assessment, and repositioning in bed. These interventions were performed commonly at 6 a.m., 12 a.m., and 7 p.m., Conclusion: In this study, despite the patients reporting sleep disturbances in the neurosurgical intensive care unit because of nocturnal patient care interventions that prevented them from sleeping, the patients' satisfaction on the given nursing care was not negatively impacted. To reduce sleep disturbances because of nursing care initiatives and promote uninterrupted sleep in the intensive care unit, it can be useful to develop new protocols regulating night care activities.

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.)

Unlabelled: Many critically ill patients are unable to self-report their pain. In such situations, the use of valid behavioral pain scales is recommended., Objective: To validate the use of the Critical-Care Pain Observation Tool (CPOT) with brain surgery adults in the neurosurgical intensive care unit., Design: Repeated-measure within subject prospective design., Settings: Forty-three elective brain surgery patients of a Canadian university hospital participated., Method: Participants were video recorded and scored with the CPOT before, during and after a non-nociceptive (non-invasive blood pressure using cuff inflation) and a nociceptive (turning) procedure for a total of six assessments. Self-reports of pain were also obtained., Results: Discriminant validation was supported with higher mean CPOT scores during the nociceptive procedure compared with the non-nociceptive one. More participants reported higher pain intensity during turning compared with cuff inflation. Criterion validation was supported with a moderate positive correlation between self-reports of pain intensity and CPOT scores during turning. Interrater and intrarater reliability of CPOT scores through the viewing of participants' videos by two trained raters was supported with high Intraclass Correlation Coefficients., Conclusion: The CPOT appears to be valid for the detection of pain in elective brain surgery patients in the neurosurgical intensive care unit., (Copyright © 2014. Published by Elsevier Ltd.)

Purpose of the Study: Taking care of admitted patients has usually been as much a responsibility of family members as that of hospital staff in India, but caregiver burden in caregivers of admitted patients has seldom been explored. The current study attempts to understand the prevailing situation in terms of burden of caregiving, among caregivers of neurosurgical inpatients of a tertiary care hospital, through identification and quantification of the same. All dimensions of the expected impact were recognized and explored among family caregivers., Design and Methods: This study followed a cross-sectional design and included adult caregivers of 100 neurosurgery inpatients from the neurosurgery ward of Post Graduate Institute of Medical Education and Research, Chandigarh. Both qualitative and quantitative data were collected and analyzed accordingly., Results: Univariate analysis showed most caregivers to be male young adults. More than 70% were immediate family members of the patients. Severe disturbance in the lives of caregivers was observed through thematic analysis of qualitative data, although less than 20% accepted caregiving to be a burden on them. Ninety percent of respondents mentioned disturbed sleep patterns, and average Caregiver Strain Index scores came out to be 11.65, depicting the overall strain levels to be moderate., Conclusions: Burden of caregiving in caregivers of neurosurgery patients is a real problem, with deep-rooted causes and far-reaching potential consequences. Efforts need to be made to take stock of this issue, for the benefit of both neurosurgery patients and their caregivers.

The anterior communicating artery (ACoA) is the most common site of cerebral aneurysms, accounting for as much as 36% of aneurysms. Microsurgical clipping and coil embolization are treatment modalities for ruptured and nonruptured cerebral aneurysms. Compared with surgical clipping, coil embolization has a relatively lower mortality and incidence of cognitive impairment in patients. However, successful management of the patient with twice ruptured ACoA aneurysm is facing critical challenges.This article has described a case of twice ruptured aneurysm with the first rupture occurring when the patient was admitted and the second rupture occurring during coil embolization. Perioperative nursing assessment, monitoring, intervention, patient teaching, and the nurse's role are discussed from a nursing perspective., (Copyright © 2013 Society for Vascular Nursing, Inc. Published by Mosby, Inc. All rights reserved.)

Preoperative scalp shaving has been a well-established practice among neurosurgeons based on the belief that hair removal prevents postoperative infections. Apart from aiding in improved visualization of the incision line, ease of closure, and dressing application, there are concerns that the presence of hair at the surgical site may interfere with the surgical procedure. Preoperative scalp shaving is a controversial practice, and many neurosurgeons are moving toward not removing any hair or clipping minimal hair along the incision line rather than shaving the scalp. The following is a systematic review of articles related to preoperative scalp shaving before cranial surgeries and the implications for postoperative wound infections. Eighteen articles were identified as potentially relevant based on the search criteria. These articles were selected based on the inclusion and exclusion criteria to provide concise background information and an explanation of scalp-shaving practices in neurosurgery leading to the clinical question posed. An evidence table was compiled to organize the study data and identify key points. The review brings strong evidence that preoperative scalp shaving does not confer any benefit against postoperative wound infection and, paradoxically, may lead to higher rates of infection. Because hair removal neither contributes benefits to the surgery itself nor decreases the risk of wound infection but has considerable cosmetic value for the patient, many of the authors recommended that cranial surgeries should be done without hair shaving.

The Neurosurgery patient is the one who has been undergone to surgery in the brain or in the peripheral nervous system, and might suffer complications during per operative period. They are patients who require attention in areas specialized in critical health care and who will need advanced monitorization, due to it is a high risk postoperative. It is in this point, in the one in which the nurse develops a function of vital importance in the health care, through the constant and specialized attention, to get the best quality of health care. The nurse should be able to evaluate, prevent, control and identify risk situations, avoiding complications and helping patient recovery

The functional changes that develop because of neurological sequelae in patients with a brain tumor have a negative effect on daily activities and self-care. This situation in turn has a negative effect on the lives of the patients' relatives and increases their work load. We interviewed 10 relatives of patients who had undergone cranial surgery for a brain tumor as part of a descriptive qualitative study and asked them to describe their experiences during the perioperative period and home care. The data obtained from the patients' relatives were evaluated using Colaizzi's analysis method and divided into three categories and eight themes: (a) personal feelings (first reactions, decision for surgery, first meeting with the patient after surgery, ambiguity), (b) management of the changes (management of the side effects of the tumor, management of role and behavioral changes, management of care at home, social support), and (c) need for knowledge about managing the disease process. We found that brain tumor surgery can be more frightening for patients and their relatives than other surgical interventions. Also, because the patient requires prolonged postoperative care, the patient's family plays an important role at every stage of the patient's treatment and care.

This article outlines a high-fidelity simulation project developed and implemented by expert staff nurses at a specialty rehabilitation hospital. The project is designed to educate new graduate nurses on appropriate care for patients after a rare spinal cord surgical procedure. Due to the complicated nature of the surgery, patients are highly acute and may present with specific complications that need to be addressed for positive patient outcomes. Expert staff nurses imparted their knowledge in developing a scenario emphasizing common and unusual postsurgery patient presentations. The scenario was implemented as a teaching exercise for new graduate nurses, with experienced staff nurses as facilitators of learning in a safe, nonthreatening environment. New graduate nurses were overwhelmingly positive in the postsimulation debriefing, reporting increased confidence and knowledge necessary to care for these patients. Future endeavors include expanding involvement of staff nurses in simulation education and researching new graduate transition through simulation.

Positioning the patient for surgery is an important part of perioperative nursing care that should not be underemphasized. The combined factors of time, mechanical pressure, and immobility increase the risk of tissue damage. The objectives of perioperative positioning activities are to balance optimal surgical exposure with the prevention of any injury related to position and to maintain normal body alignment without excess flexion, extension, or rotation. After providing general principles of positioning, specific considerations with surgical rationale are presented for each of the commonly used neurosurgical positions (eg. supine, knee-chest, prone, lateral, park-bench, sitting).

Patient falls are a serious problem in hospitals, resulting in substantial morbidity, mortality, length of stay, and costs. The results of a small trial of a patient vigilance system in a post-neurosurgery unit of a large acute care hospital are reported. The system includes two components: (a) passive sensor array placed under the patient in a hospital bed, and (b) a bedside unit that connects to the nurse call system already in place at the hospital. This trial demonstrated the overall effectiveness of the vigilance system in reducing the rate of patient falls. The cost-effectiveness analysis found that use of this system was associated with somewhat higher measured costs. It is likely that the system was cost-saving, due to unmeasured costs.

Families of patients need support when the hospital stay becomes more difficult than anticipated. Healthcare providers also need assistance when caring for them. A continuous improvement team, Caring for Exceptional Families, was initiated to develop a system with tools and interventions for a proactive multidisciplinary approach to identifying families at risk for negative behavior during the hospital experience. The process and outcomes of this team are described.

The aim of this study was to identify neurological disorders in 32 patients with diagnosis of brain tumor, and to evaluate the dependency of nursing care before and after the surgery. This study was carried out at the Neurosurgery Unit of São Paulo Hospital, Brazil, from June to December, 2004. One instrument was used to collect physical and neurological data, and another to evaluate the dependence degree. An increase of the dependence degree was observed after surgical intervention, which therefore needs to be correlated with nursing team size in order to optimize care.

The postoperative phase is a critical time for any neurosurgical patient. Historically, certain patients having neurosurgical procedures, such as craniotomies and other more complex surgeries, have been nursed postoperatively in the intensive care unit (ICU) for an overnight stay, prior to transfer to a neurosurgical floor. At the Hospital for Sick Children in Toronto, because of challenges with access to ICU beds and the cancellation of surgeries because of lack of available nurses for the ICU setting, this practice was reexamined. A set of criteria was developed to identify which postoperative patients should come directly to the neurosurgical unit immediately following their anesthetic recovery. The criteria were based on patient diagnosis, preoperative condition, comorbidities, the surgical procedure, intraoperative complications, and postoperative status. A detailed process was then outlined that allowed the optimum patients to be selected for this process to ensure patient safety. Included in this process was a postoperative protocol addressing details such as standard physician orders and the levels of monitoring required. Outcomes of this new process include fewer surgical cancellations for patients and families, equally safe, or better patient care, and the conservation of limited ICU resources. The program has currently been expanded to include patients who have undergone endovascular therapies.

Nurses working in neuroscience often have to manage patients whose behaviour puts themselves or others at risk of injury or compromises their care and treatment. The National Benchmarking Group has explored issues related to the restraint of patients and made some key recommendations. The aim was to develop guidelines for staff working in specialist areas on how to manage challenging behaviour while maintaining patient safety and dignity.

Magnetic resonance imaging (MRI) systems are becoming essential intraoperative tools in neurosurgery because they provide high-resolution, detailed images. Only a few institutions around the world currently have intraoperative MRI capabilities. Consequently, the body of knowledge with regard to safety procedures in such an environment is fragmented and often institution-specific. The components of the MRI system are described in relationship to surgical procedures. Perioperative nursing responsibilities are discussed and a case study is presented. The article concludes with a discussion about the present limitations of intraoperative MRI equipment.

Background: Dysfunctional psychosocial stress often follows standard treatment for aneurysmal subarachnoid hemorrhage (ASAH). An enhanced Specialist Liaison Nurse (SLN) service sought to reduce this stress in a 2-year comparative prospective study, and was designed to determine if such a service would be cost-effective?, Method: Clinical data based on consultant notes, included Glasgow Coma Scale (GCS) and high-risk bleed score. Psychosocial outcomes used a standardized patient/carer designed questionnaire to compare outcomes of the SLN cohort (n = 184) with retrospective 18/12 control ASAH cohort (n = 142). Costs-benefits analysis identified savings in reduced need for subsequent medical care, time-off-work, and contributions to the economy., Results: The cohorts were socio-clinically well matched; 54% aged less than 55 years, 83% were middle-class and 32% had children still in school; 65% of SLN patients had high risk bleeds, and 81% were Grade 1 and 2 on the G.C.S. The SLN patients and carers had statistically significantly reduced psychosocial trauma compared to controls, with early and easy accessibility being the key to success of SLN. Net savings of $280,000 per annum at 2003 prices, from reduced time-off work, re-admissions and saved medical time. Prospectively, more than $3.03 million is added to the national economy by the 80% of employed patients returning to work., Conclusions: We conclude that an integrated ASAH treatment yields major psychosocial and economic benefits. Dysfunctional stress after an ASAH is not inevitable in the majority of patients. High-technology neurosurgery is not just a public cost but also improves and saves lives and generates revenue.

The shift towards patient-centred care is the priority in health care today. Providing quality care that is highly efficient and patient-friendly while also being cost-effective is a difficult, but not impossible task. Since 1996, awake, image-guided day surgery for resection of brain tumors has been performed at Toronto Western Hospital in an attempt to combine the concept of patient-centred care with responsible resource allocation. Nurses can play a vital role in facilitating a shift in outpatient neurosurgery towards a more patient-care focused environment. By providing information and education to patients and families, nurses have enormous potential to improve satisfaction and outcomes for patients undergoing these procedures. Thoroughly preparing patients for their surgery and helping them manage their care post-operatively are the keys to decreased complications and re-admission. This would undoubtedly improve cost-effectiveness for the system while simultaneously improving the patients' quality of life.

Unnecessary blood work in critically ill patients can potentially reduce hemoglobin and circulating blood volume, causing blood replacement and increased care costs. The goals of this project were to (a) increase nursing and medical staff awareness of unessential or redundant blood work and (b) decrease the incidence of unnecessary and unordered blood work in the neurosurgical intensive care unit of an urban teaching hospital. Using the IDEA model of quality improvement, patient charts were reviewed and compared to physicians' orders. The audits found that blood was drawn without orders, duplicate tests were performed, and blood work continued long past medical need. Audit findings were aggressively communicated to nursing and medical staff through in-service training sessions, reminder posters, protocol reference sheets, and medical staff memorandums. Additional audits were conducted to assess the effectiveness of these measures, and other measures were implemented as a result. Identifying the time of day that requests for blood work were submitted and the individuals who sent the unordered tests was helpful in reducing the amount of unordered blood work. Although the goals of this quality improvement project were met using the IDEA model, continued surveillance is necessary to ensure lasting change for this collaborative effort.

Syringomyelia is a progressive degenerative disorder that results in numerous life-altering symptoms. People with this disorder frequently are misdiagnosed and most likely will experience intractable pain for many years. Surgical procedures may offer some relief from symptoms through spinal decompression or cerebrospinal fluid shunting; however, these procedures often are unsuccessful in altering the course or progression of the disease process. Information on the implications of the disease offers insight that is helpful for nurses providing care to these patients. This article presents relevant clinical information and discusses surgical procedures, as well as a patient's perspective on living with this relatively unknown disorder.

The meaning of the experience of being told you or a family member have/has a serious brain tumor was revealed during a descriptive research study conducted to determine preoperative education needs. Eighteen patients and 15 family members participated immediately following the office visit with the neurosurgeon and/or on admission to hospital, for a total of 29 interviews and 13 questionnaires. Twenty-four interviews were conducted with 13 patients and 11 family members in the pre-discharge phase of the research. The key themes of hearing the news, education needs and information needs were identified through content analysis of transcribed interviews and questionnaire data. Patients and family members portrayed experiences, revealed emotions related to hearing the news, and shared ways of coping. Interviews with patients and their family members that contained clear narratives were identified. From these interviews, three sets of narratives were selected. Each of the narratives was analyzed to determine how the patients and their key family members articulated and made sense of the diagnosis and surgical treatment of a skull base tumor. The themes of a sense of comfort, the known is better than the unknown, waiting for news of the surgical outcome, and quality of recovery emerged from the analysis. Lessons learned about the individuality of patients' and family members' needs and approaches to support effective coping were identified.

Objective: To improve clinical and financial outcomes for neuroscience patients by using an "outcomes-managed" model of care delivery and 2 acute care nurse practitioners as outcomes managers., Methods: Baseline data from the year before implementation of the care model were compared with data from the first 6 months of implementation. A random list of 122 adult patients admitted to the neuroscience intensive care unit or the acute care neurosurgery unit of a university teaching hospital between January and December 1998 was generated to provide the baseline data. The prospective sample included 402 patients admitted to either unit during the first 6 months of the project (January through June 1999). The acute care nurse practitioners used an evidence-based multidisciplinary plan of care to manage all patients., Results: No differences were found in age, sex, or ethnicity between groups. Patients managed by acute care nurse practitioners had significantly shorter overall length of stay (P = .03), shorter mean length of stay in the intensive care unit (P < .001), lower rates of urinary tract infection and skin breakdown (P < .05), and shorter time to discontinuation of the Foley catheter and mobilization (P <.05). The outcomes-managed group was hospitalized 2306 fewer days than the baseline group, at a total cost savings of $2,467328., Conclusions: Clinical and financial outcomes are improved significantly by identifying patients at risk, monitoring for complications, and having acute care nurse practitioners manage the patients.

During the implementation, the authors strived to clearly identify a person to focus on patient outcomes. Thus, they limited the ARNP's involvement in central functions and direct management of the staff. The overall implementation of the demonstration project has benefited patients, staff, and the health care team. The continuity provided allows the patient and family to interact with a consistent person. The ARNP functions as the key to directing patient care in a holistic manner while facilitating staff development. The demonstration project has given the authors an opportunity to evaluate the management structure and redefine roles to achieve those outcomes in the management arena.

Intensive care units are arguably one of the most costly resources a hospital has to maintain in terms of nursing staff, skills and technology. Given that the Government's agenda on quality remains one of obtaining cost-effective healthcare, it is imperative that nursing managers consider the implications of the new policy shift for how they currently provide services. The purpose in this paper is to compare the different staffing levels adopted by managers in generalized and neurosurgical intensive care in an acute hospital trust. The dilemmas facing managers making staffing decisions without any definitive guidelines for resourcing these specialized units are examined.

The differences in the knowledge and skills of 75 nurses working in a variety of practice settings were examined using a case study vignette of a neurosurgical patient developed by researchers. The case study tested nursing care throughout a patient's hospital experience, including admission, presurgery, postsurgery and discharge preparation. The findings showed that nurses who had specialised in neurosurgery scored markedly higher, in all aspects of practice knowledge, than expert nurses in other specialties and general nurses. Patients undergoing neurosurgery are safer if they have nurses who are experienced, skilled and knowledgeable to care for them.

This article describes the authors' experience using neuroendoscopes to perform a variety of intracranial procedures with minimal invasiveness to neural tissue. The article also presents the history of neuroendoscopy and provides information about current practice. Surgical technique and intraoperative and postoperative nursing considerations are reviewed.