Journal of Neuroscience Nursing最新文献

Abstract: BACKGROUND: Nonconvulsive seizures are a major source of in-hospital morbidity and a cause of unexplained encephalopathy in critically ill patients. Electroencephalography (EEG) is essential to confirm nonconvulsive seizures and can guide patient-specific workup, treatment, and prognostication. In a 208-bed community hospital, EEG services were limited to 1 part-time EEG technician and 1 EEG machine shared between inpatient and outpatient settings. Its use was restricted to typical business hours. A nursing-led quality improvement (QI) project endeavored to enhance access to EEG by introducing a point-of-care rapid-response EEG program. METHODS: For this project, a multidisciplinary protocol was developed to deploy a Food and Drug Administration-cleared, point-of-care rapid-response EEG platform (Ceribell Inc) in a community hospital's emergency department and inpatient units to streamline neurodiagnostic workups. This QI project compared EEG volume, study location, time-to-EEG, number of cases with seizures captured on EEG, and hospital-level financial metrics of diagnosis-related group reimbursements and length of stay for the 6 months before (pre-QI, using conventional EEG) and 6 months after implementing the rapid-response protocol (post-QI). RESULTS: Electroencephalography volume increased from 35 studies pre-QI to 115 post-QI (3.29-fold increase), whereas the median time from EEG order to EEG start decreased 7.6-fold (74 [34-187] minutes post-QI vs 562 [321-1034] minutes pre-QI). Point-of-care EEG was also associated with more confirmed seizure diagnoses compared with conventional EEG (27/115 post-QI vs 0/35 pre-QI). This resulted in additional diagnosis-related group reimbursements and hospital revenue. Availability of point-of-care EEG was also associated with a shorter median length of stay. CONCLUSION: A nurse-led, rapid-response EEG protocol at a community hospital resulted in significant improvements in EEG accessibility and seizure diagnosis with hospital-level financial benefits. By expanding access to EEG, confirming nonconvulsive seizures, and increasing care efficiency, rapid-response EEG protocols can enhance patient care.

Abstract: BACKGROUND: Parkinson disease (PD), a neurodegenerative disease characterized by motor and nonmotor symptoms, can affect the daily activities of individuals. This study was conducted to determine nonmotor symptom burden in patients with PD and to reveal the relationship of nonmotor symptom burden with activities of daily living and fear of falling. METHODS: This cross-sectional and correlational study was carried out with 309 patients given a diagnosis of PD. The data were collected using a personal information form, the Non-Motor Symptoms Scale, the Katz Activities of Daily Living Scale, and the Fear of Falling Questionnaire. RESULTS: Whereas 70.2% of the patients had very high nonmotor symptom severity levels, 33.7% were semidependent or dependent in terms of performing their activities of daily living. The fear of falling was experienced by 32.7% of the patients. A statistically significant inverse relationship was found between the mean Non-Motor Symptoms Scale scores of the patients and their mean Katz Activities of Daily Living Scale and Fear of Falling Questionnaire scores ( P < .05). Nonmotor symptom burden independently explained 66% of the total variance in the performance of activities of daily living and 69% of the total variance in fear of falling ( P < .01). CONCLUSION: Nonmotor symptom burden in PD patients is a significant determinant for participation in activities of daily living and fear of falling. Nurses should approach patients with PD with a focus not only on assessing motor symptoms but also on assessing nonmotor symptoms.

Abstract: BACKGROUND: Multiple sclerosis (MS) is an immune-mediated disease that affects the central nervous system, and is potentially disabling. Women experience MS more frequently than men at a 3:1 ratio. Current literature suggests that women may experience health, social determinants of health, and disability differentially, and there is a gap in the research examining how gender intersects with MS. METHODS: Interviews were conducted with 23 women with MS. van Manen's hermeneutic phenomenology was used to inform and analyze the data to understand the nature and meaning of health and well-being for participants. RESULTS: A key theme of "enhancing wholeness for women with MS" emerged from the data, which suggests that women with MS view themselves as healthy and "whole" despite living with MS. Supporting factors for physical, mental, and social well-being include the ability to enact human agency within social structures such as with employment or seeking care with MS clinics. The findings informed the development of a figure that depicts the supporting factors of health and well-being for women living with MS. CONCLUSION: The health and well-being of women with MS may be optimally supported by nurses and interdisciplinary healthcare teams through careful consideration as to how agency is enacted within social structures, for example, MS clinics, employment, and social support systems, as well as considerations for social determinants of health.

Abstract: BACKGROUND: Pain management and good sleep are essential for patients after surgical procedures. This study aimed to evaluate the effects of footbath on postoperative pain severity and sleep quality levels of patients who have undergone degenerative lumbar spine surgery. METHODS: Sixty patients were randomly assigned to the footbath intervention group or the control group. The intervention was a 20-minute footbath in 42°C water before patients fell asleep on the evening of the surgery day. On the morning of the surgery day and the morning of postoperative day, the patient's pain severity and sleep quality scores were obtained using the visual analog scale and the Visual Analog Sleep Scale. RESULTS: There was no significant difference between the pain severity scores of the study groups ( P > .05). The sleep quality level of the intervention group was statistically significantly higher than that of the control group ( P < .05). CONCLUSION: Consequently, a footbath is effective in increasing sleep quality levels of patients who have undergone degenerative lumbar spine surgery. It may be used as a simple and practical nonpharmacological nursing strategy for improving patients' sleep quality.

Abstract: BACKGROUND: Older people with debilitating degenerative spine disease may benefit from surgery. However, recovery is described as a circuitous process. In general, they describe feeling powerless and receiving depersonalized care during hospitalization. Institution of hospital no-visitor policies to reduce COVID-19 spread may have caused additional negative consequences. The purpose of this secondary analysis was to understand experiences of older people who underwent spine surgery during early COVID-19. METHODS: Grounded theory guided this study of people 65 years or older undergoing elective spine surgery. Fourteen individuals were recruited for 2 in-depth interviews at 2 time points: T1 during hospitalization and T2, 1 to 3 months post discharge. All participants were affected by pandemic-imposed restrictions with 4 interviews at T1 with no visitors, 10 with a 1-visitor policy, and 6 interviews at T2 rehabilitation setting with no visitors. Discriminate sampling of data in which participants described their experiences with COVID-19 visitor restrictions was used. Open and axial coding (consistent with grounded theory) was used for data analysis. RESULTS: Three categories, worry and waiting , being alone , and being isolated , emerged from the data. Participants had delays ( waiting ) in getting their surgery scheduled, which produced worry that they would lose more function, become permanently disabled, have increased pain, and experience more complications such as falls. Participants described being alone during their hospital and rehabilitation recovery, without physical or emotional support from family and limited nursing staff contact. Being isolated often occurred from institution policy, restricting participants to their rooms leading to boredom and, for some, panic. CONCLUSIONS: Restricted access to family after spine surgery and during recovery resulted in emotional and physical burden for participants. Our findings support neuroscience nurses advocating for family/care partner integration into patient care delivery and investigation into the effect of system-level policies on patient care and outcomes.

Abstract: BACKGROUND: Multiple sclerosis (MS) is the most common nontraumatic debilitating disease in young adults. This study aimed to determine the effect of distance empowerment programs on self-efficacy in MS patients. METHODS: Sixty-four MS patients participated in this quasi-experimental study. Patients were first entered into the study using the convenience sampling method and then were randomly allocated to control (32) and intervention (32) groups. The intervention group underwent a distance empowerment program (via WhatsApp, Telegram, and blog) and weekly telephone follow-up for 2 months. Self-efficacy was evaluated before, and immediately after, the empowerment program using the MS Self-Efficacy Scale. RESULTS : Data from 59 participants were analyzed. Before implementation of the empowerment program, the mean scores of self-efficacy in the intervention and control groups were not significantly different. After implementing the empowerment program, the mean score of self-efficacy in the intervention group was higher than that of the control group ( P < .05). CONCLUSION : Distance empowerment has an effect on the self-efficacy of patients with MS and may lead to an increase in self-efficacy scores after implementing an empowerment program.

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.