Journal of Neuroscience Nursing最新文献

Abstract: BACKGROUND: Lack of mobilization in ventilated neurosurgery patients is problematic due to significant consequences. Although early mobility addresses these complications, few studies have been conducted in this population, resulting in infrequent mobilization efforts. Nurses prioritize and implement patient care interventions, including mobilization, with multidisciplinary teams. This integrative literature review examines what is known regarding nursing perceptions on mobilization and their role within a multidisciplinary team for mobilization in ventilated neurosurgery patients. METHODS: A comprehensive literature search was conducted using online databases to identify research articles on early mobility studies in ventilated critically ill and neurosurgical patients from 2010 to 2020. RESULTS: Twenty studies were identified and indicated a paucity of research specific to mobilizing ventilated neurosurgery patients. Nurses understand the purpose and benefits of early mobility in critically ill and mechanically ventilated patients. Mixed perceptions exist regarding the responsibility for prioritizing and initiating mobilization. Main barriers include patient safety concerns, untimeliness due to limited resources, unit culture, lack of nursing knowledge, and need for improved teamwork. Associations between teamwork-based interventions and decreased length of stay, increased rates of mobility, and faster time to early mobilization exist. Nurse-led interventions showed additional benefits including positive perceptions such as empowerment, confidence, increased knowledge, and a progressive shift in unit culture. CONCLUSION: This review demonstrates a continued need for understanding nursing perceptions and role in teamwork to mobilize ventilated neurosurgery patients. Future research should focus on testing nurse-led mobility interventions so higher rates of mobilization and provision of holistic patient care can be achieved.

Abstract: INTRODUCTION: Enteral nimodipine provides a neuroprotective effect in patients who have experienced an aneurysmal subarachnoid hemorrhage (aSAH). Nimodipine remains the only US Food and Drug Administration-approved medication for aSAH. CONTENT: Nimodipine has been prescribed for patients with aSAH; however, little is known about factors to consider regarding dosing or patient-specific variables that may affect tolerability to nimodipine. Clinical impact of dose or dosing frequency changes has also been much debated based on risk of hypotension with currently approved dosing regimens. CONCLUSION: This review article addresses factors to consider for dosing and administration, pharmacokinetic and pharmacogenetic impact on nimodipine, and, finally, drug interaction considerations to assess as patients are initiated on enteral nimodipine for aSAH.

Abstract: BACKGROUND: By 2030, there will be approximately 7.6 million stroke survivors (SSs) in the United States, yet comprehensive transitional care (TC) for stroke is not widely available. Stroke strikes without warning and leaves in its wake a "storm" of uncertainty for SSs and caregivers (CGs) as they encounter a myriad of unmet physical, mental, emotional, and financial needs that are not wholly addressed by passive healthcare delivery systems. Needed is a stroke-specific TC model that bridges this storm to active delivery of SS and CG postacute care. Naylor's Transitional Care Model (NTCM) has not been examined for how it can frame comprehensive stroke care. The purpose of this study was to solicit SS and CG descriptions of TC experiences to inform the NTCM with refined operational definitions and exemplars specific to stroke. METHODS: Focus groups conducted for this qualitative descriptive study were guided by interview questions based on the 8 NTCM operational definitions. Data were analyzed using inductive and deductive qualitative content analysis methods. RESULTS: Post-acute-stroke care does not comprehensively meet the needs of SSs and CGs. Participants described TC deficits across all 8 NTCM components. Two new subcomponents that could be applied for a stroke-specific NTCM emerged: psychological and transportation challenges. CONCLUSION: Unmet needs identified by SSs and CGs were used to extend NTCM specific to the stroke population and to develop the Recommendations and Exemplars for Stroke Specific Comprehensive Transitional Care Delivery (see Supplementary Digital Content, available at http://links.lww.com/JNN/A385). Researchers and practitioners can use the findings to develop and deliver more comprehensive TC to SSs and CGs.

Abstract: BACKGROUND: At the end of life, children with neurological conditions have complex healthcare needs that can be met by providing care of their life-limiting conditions concurrently with hospice care (ie, concurrent care). Given the limited literature on concurrent care for children with neurologic conditions, this investigation aimed to identify patterns of nonhospice, healthcare service needs and to assess characteristics of children within each group. METHODS: A nationally representative sample children with neurological conditions enrolled in concurrent hospice care was used. Latent class analysis and descriptive statistics were calculated to identify patterns of healthcare needs and characteristics of children within the groups. A subgroup analysis of infants was conducted. RESULTS: Among the 1601 children, the most common types of services were inpatient hospitals, durable medical equipment, and home health. Two classes of service needs were identified: moderate intensity (58%) and high intensity (42%). Children in the moderate-intensity group were predominantly between 1 and 5 years old, male, White, and non-Hispanic. The most common neurological condition was central nervous system degeneration. They also had significant comorbidities, mental/behavioral health conditions, and technology dependence. They commonly resided in urban areas in the South. Children in the high-intensity group had a wide range of neurological conditions and high acuity. The subgroup analysis of infants indicated a different neurological profile. CONCLUSIONS: Two distinct classes of nonhospice, healthcare service needs emerged among children with neurological conditions at the end of life. The groups had unique demographic profiles.

Abstract: BACKGROUND: Motivational interviewing has become a popular approach for relieving mood disturbances. We aimed to investigate whether motivational interviewing can effectively improve depression, anxiety, and quality of life among stroke patients. METHODS: Seven electronic databases were searched from inception to March 15, 2021. Other potentially related studies were identified through manually searching the reference lists of empirical articles and relevant review articles. Randomized controlled trials that investigated the effects of motivational interviewing on stroke patients with mood disturbances were deemed eligible. The Cochrane Handbook 5.1.0 was used to assess the risk of bias. Meta-analyses were conducted using the Review Manager Version 5.3. RESULTS: Six articles with 1419 participants were included. The subgroup analysis revealed that motivational interviewing was associated with improvement of depression (P < .00001) and quality of life (P = .0007) among patients having stroke at less than 12 months of follow-up. No significant differences were detected for improving depression (P = .40) and quality of life (P = .38) at 12 months of follow-up. Furthermore, the meta-analysis showed that motivational interviewing was not associated with alleviation of anxiety (P = .81) among stroke patients. CONCLUSION: This meta-analysis indicated that motivational interviewing might have beneficial effects on depression and quality of life in stroke patients at less than 12 months of follow-up. However, large and well-designed randomized controlled trials are needed to confirm these findings.

Abstract: BACKGROUND: Pupillary examinations provide early subtle signs of worsening intracranial pathology. Objective pupillomtery assessment, although not yet the standard of care, is considered best practice. However, inconsistent findings from objective pupillometry studies have caused a lack of consensus among clinicians; as such, no clinical guidelines are available to guide clinical use of objective pupillometer devices. To add to the body of evidence, the purpose of this project was to explore the relationship between objective pupillometry metrics and midline shift (MLS). METHODS: A retrospective chart review of pupillometer data was conducted. Midline shift was correlated with objective pupillometry metrics including Neurological Pupil Index (NPi), pupil size, and anisocoria. Midline shift was measured for the patient's initial neuroimaging and with any defined neurological change. Spearman ρ was used for statistical analysis of correlations between pupillometer metrics and MLS measured at both the septum pellucidum and pineal gland. RESULTS: A total of 41 patients were included in the analysis; most were White (58.5%) and male (58.5%), with a mean (SD) age of 58.49 (16.92) years. Spearman ρ revealed statistically significant positive correlations between right pupil NPi and anisocoria with MLS, and significant negative correlations between left pupil NPi and pupil size with MLS. CONCLUSIONS: Results from this project are consistent with previous studies. Objective pupillometry continues to be a valuable component of a comprehensive neurological examination, because it has the ability to discern early and subtle changes in a patient's neurological status, leading to lifesaving interventions.

Abstract: BACKGROUND: Constipation is the most frequently reported nonmotor gastrointestinal symptom of Parkinson disease and can precede motor symptoms by up to 20 years. The causes of constipation can be multifactorial, but the implications can lead to life-threatening complications. Early recognition of constipation can lead to better health outcomes and quality of life. MANAGEMENT CONSIDERATIONS: The combination of nonpharmacological management through screening tools, nursing assessment, and patient education as well as pharmacological management is considered best practice. IMPLICATIONS FOR PRACTICE: Nurses who are knowledgeable on the current treatment options for constipation in Parkinson disease will be better equipped as active multidisciplinary team players to provide optimal care to their patients and achieve the best health outcomes.

Abstract: BACKGROUND: Acquired brain injury (ABI) affects not only survivors but also their family members' quality of life in various ways. The Family Reported Outcome Measure (FROM-16), a self-reported instrument, has been developed to evaluate the impact of diseases on the lives of family members of patients. This study aimed to assess the reliability and validity of the Korean FROM-16 for family members of individuals with ABI. METHODS: A total of 200 family members of patients with ABI in South Korea participated in this study. Internal consistency was assessed using Cronbach α. To establish the validity, we evaluated the semantic equivalence, content, known-group, conduct, concurrent, and convergent validity of the Korean FROM-16. For exploratory factor analysis, common factor analysis with oblique rotation, parallel analysis, an eigenvalue greater than 1.0, and a scree plot were used. RESULTS: Exploratory factor analysis revealed 2 factors for the 16 items, which explained 67.4% of the total variance. Concurrent validity was established by comparison with the Korean World Health Organization Quality of Life Scale Brief (r = -0.57), and regarding the convergent validity, the Korean FROM-16 score positively correlated with the Korean Neurobehavioral Functioning Inventory. Known-group validity was confirmed by showing that family members with advanced age, the burden of caring, and insufficient income, as well as spouses, had a statistically higher score in the Korean FROM-16. Cronbach α was .92, indicating high internal consistency reliability. CONCLUSION: The Korean FROM-16 is a valid and reliable instrument for evaluating the impact of diseases on family members of individuals with ABI in South Korea.