Journal of Neuroscience Nursing最新文献

Abstract: BACKGROUND: Delirium is associated with worse outcomes, but there is a gap in literature identifying nurse-led interventions to reduce delirium in postoperative (postop) surgical spine patients. Because family presence has been associated with a variety of beneficial effects, we aimed to examine whether family presence in the spine intensive care unit (ICU) during the night after surgery was associated with less confusion or delirium on postop day 1. METHODS: This is a prospective nonrandomized pilot clinical trial with pragmatic sampling. Group designation was assigned by natural history. The family-present group was designated as patients for whom a family member remained present during the first night after surgery. The unaccompanied group was designated as patients who did not have a family member stay the night. Data include the Richmond Agitation Sedation Scale, the Confusion Assessment Method for the ICU, the 4AT (Alertness, Attention, Abbreviated mental test, and Acute change) score, and confusion measured with the orientation item on the Glasgow Coma Scale. Baseline data were collected after admission to the spine ICU and compared with the same data collected in the morning of postop day 1. RESULTS: At baseline, 5 of 16 patients in the family-present group (31.3%) had at least 1 incidence of delirium or confusion. Similarly, 6 of 14 patients in the unaccompanied group (42.9%) had at least 1 incidence of delirium or confusion. There was a clinically relevant, but not statistically significant, reduction in postop day 1 delirium or confusion comparing the family-present (6.3%) and unaccompanied (21.4%) groups ( P = .23). CONCLUSION: Family presence may reduce delirium and confusion for patients after spine surgery. The results support continued research into examining nurse-led interventions to reduce delirium and improve outcomes for this population.

Abstract: PURPOSE: The aim of this study was to identify the learning needs of spinal surgery patients before hospital discharge. METHODS: This cross-sectional study consisted of 117 spinal surgery patients admitted to the neurosurgery department between October 2019 and March 2020. Data were collected using a descriptive information form, visual analog scale, and the Patient Learning Needs Scale. Data were analyzed using descriptive statistics, Mann-Whitney U and Kruskal-Wallis tests, and Spearman correlation analysis. RESULTS: The mean age of the participants was 54 years, 54.7% were male, and 59% underwent surgery because of spinal disc herniation. The mean Patient Learning Needs Scale score was 188.74. The primary learning needs of the patients were related to the dimensions of activities of living, medication, treatment, and complications, whereas the feelings related to condition were the least-demanded dimension of learning needs. Sex and occupation were the primary factors influencing learning needs. CONCLUSION: The level of learning needs in spinal surgery patients was relatively high. Therefore, discharge education may be planned in line with the learning needs and priorities of these patients, and sex and occupation may be considered while planning discharge education.

Abstract: BACKGROUND: Nationwide nursing shortages have spurred nursing research on burnout and resiliency to better understand the emotional health of nurses and allied staff to retain talent. Our institution implemented resilience rooms in the neuroscience units of our hospital. The goal of this study was to evaluate the effects of resilience room use on emotional distress among staff. METHODS: Resilience rooms opened to staff in the neuroscience tower in January 2021. Entrances were electronically captured via badge readers. Upon exit, staff completed a survey containing items on demographics, burnout, and emotional distress. RESULTS: Resilience rooms were used 1988 times, and 396 surveys were completed. Rooms were most used by intensive care unit nurses (40.1% of entrances), followed by nurse leaders (28.8%). Staff with >10 years of experience accounted for 50.8% of uses. One-third reported moderate burnout, and 15.9% reported heavy or extreme burnout. Overall, emotional distress decreased by 49.4% from entrance to exit. The greatest decreases in distress were recorded by those with the lowest levels of burnout (72.5% decrease). CONCLUSION: Resilience room use was associated with significant decreases in emotional distress. The greatest decreases occurred with the lowest levels of burnout, suggesting that early engagement with resilience rooms is most beneficial.

Abstract: BACKGROUND: Distinguishing features of our stroke network include routine involvement of a telestroke nurse (TSRN) for code stroke activations at nonthrombectomy centers and immediate availability of neuroradiologists for imaging interpretation. On May 1, 2021, we implemented a new workflow for code stroke activations presenting beyond 4.5 hours from last known well that relied on a TSRN supported by a neuroradiologist for initial triage. Patients without a target large vessel occlusion (LVO) were managed without routine involvement of a teleneurologist, which represented a change from the preimplementation period. METHODS: We collected data 6 months before and after implementation of the new workflow. We compared preimplementation process metrics for patients managed with teleneurologist involvement with the postimplementation patients managed without teleneurologist involvement. RESULTS: With the new workflow, teleneurologist involvement decreased from 95% (n = 953) for patients presenting beyond 4.5 hours from last known well to 37% (n = 373; P < .001). Compared with patients in the preimplementation period, postimplementation patients without teleneurologist involvement experienced less inpatient hospital admission and observation (87% vs 90%; unadjusted P = .038, adjusted P = .06). Among the preimplementation and postimplementation admitted patients, there was no statistically significant difference in follow-up neurology consultation or nonstroke diagnoses. A similar percentage of LVO patients were transferred to the thrombectomy center (54% pre vs 49% post, P = .612), whereas more LVO transfers in the postimplementation cohort received thrombectomy therapy (75% post vs 39% pre, P = .014). Among LVO patients (48 pre and 41 post), no statistical significance was observed in imaging and management times. CONCLUSION: Our work shows the successful teaming of a TSRN and a neuroradiologist to triage acute stroke patients who present beyond an eligibility window for systemic thrombolysis, without negatively impacting care and process metrics. This innovative partnering may help to preserve the availability of teleneurologists by limiting their involvement when diagnostic imaging drives decision making.

Abstract: BACKGROUND: Alzheimer disease (AD) is a neurodegenerative disease with no cure. The number of individuals living with AD doubles every 5 years. The current clinical practice relies on clinical history, mental status tests, cerebrum imaging, and physical and neurological examinations; however, recent advances in the field of biomarkers have provided clues for the early detection of AD. High levels of tau and low levels of amyloid-β (Aβ) in cerebrospinal fluid are well-known biomarkers for AD. METHODS: A database search of PubMed, Ovid MEDLINE, and CINAHL was conducted to identify relevant articles published within the last 5 years. The search was limited to articles concerning adults 65 years or older and published in the English language. Twelve articles were included in the review. RESULTS: Risk factors of sleep disruption, depression, and motor function are implicated. Cerebrospinal fluid parameters for biomarkers of tau and Aβ were universally lower among Blacks compared with Whites, raising concern that norm reference may not be accurate for all populations. Older adults are more at risk for AD. Results are inconclusive regarding whether depression is related to Aβ and tau pathology. CONCLUSION: Nurses should screen for sleep architecture, depression, and motor function in their patients and educate them on good sleep hygiene. Sleep studies should be advocated for people with suspected sleep apnea to mitigate the risk factor related to abnormal Aβ and tau pathology. Falls and decreased motor function require screening because they may be early indicators of abnormal biomarkers leading to AD.

Abstract: BACKGROUND: Acquired brain injury is caused by traumatic or nontraumatic factors and causes changes in cognition. Several reviews have described the influence of the head-of-bed (HOB) elevation on clinical indexes such as intracranial pressure (ICP) and cerebral perfusion pressure (CPP). However, the conclusions were inconsistent. Therefore, we aimed to evaluate the effects of HOB elevation in the care of the patients with ABI. METHODS: Two researchers independently screened the literature and extracted data. We searched PubMed, EMBASE, the Cochrane Library, Web of Science, and the Chinese Biological Literature Database to collect eligible randomized controlled trials published after September 2021. Reporting quality and methodological quality of the included studies were assessed by using the Preferred Reporting Items for Systematic Reviews and Meta-analysis and the Cochrane risk-of-bias tool. RESULTS : Eight studies were included in the meta-analysis. The results showed that, compared with the flat position, HOB elevation of 30° or 45° can significantly reduce ICP (mean difference [MD], -2.40 mm Hg; 95% confidence interval [CI], -3.19 to -1.61; P < .00001). However, there were no statistical differences in CPP (MD, -1.09; 95% CI, -3.93 to 1.75; P = .45), degree of disability at 90 days (relative risk, 1.01; 95% CI, 0.94-1.08; P = .83), and mean arterial pressure (MD, -0.44; 95% CI, -10.27 to 9.93; P = .93). CONCLUSION: Head-of-bed elevation of 30° can reduce ICP and maintain CPP, and may be an effective noninvasive nursing practice for the prognosis and rehabilitation of ABI patients. Owing to the lack of high-quality, large-sample randomized controlled trials, more rigorous trials are needed to support this conclusion.

Abstract: BACKGROUND: External ventricular drains (EVDs) are commonly used in severely brain-injured patients to diagnose intracranial hypertension. The accuracy of the intracranial pressure reading is dependent on zeroing the external transducer to air. Recent concern about zeroing techniques has been identified in the neuroscience community. The open method requires removing the nonvented cap, and the closed method requires zeroing through the filter at the top of the burette. This critical appraisal seeks to explore whether zeroing a transducer on an EVD through the filter of the burette provides the same baseline zero as opening the transducer to air. METHODS: Independent searches in CINAHL, PubMed, and Web of Science were conducted using "external ventricular drain* OR EVD AND transducer"; secondary search terms included "zero AND transducer" AND "ventric." RESULTS: Database search produced 1 single observation study and 2 clinical practice guidelines from neuroscience professional organizations. The single observation study provided no evidence of equivalence between the 2 zeroing methods; the 2 clinical practice guidelines reference the open method. The transducer manufacturer's instructions for use direct the clinician to open the transducer to air by removing the nonvented cap. CONCLUSION: The question "Does zeroing the transducer on an EVD through the filter of the burette provide the same baseline zero as opening the transducer to air?" cannot be answered with the results of this appraisal. However, evidence found in the literature does suggest an open method to ensure the most accurate physiological value for treatment decisions.