Journal of Neuroscience Nursing最新文献

Abstract: BACKGROUND: Ischemic stroke continues to be a leading cause of serious disability within the United States, affecting 795 000 people annually. Approximately 12% to 21% of post-ischemic stroke patients will be readmitted to the hospital within 30 days of discharge. Studies suggest that implementation of a follow-up appointment within 7 to 14 days of discharge improves 30-day readmission rates; however, implementation of these guidelines is uncommon, and follow-up visits within the recommended window are not often achieved. The purpose of this project was to evaluate the impact of an advanced practice registered nurse (APRN)-led stroke clinic on follow-up care for post-ischemic stroke patients. The aims were to improve time to follow-up visit and reduce 30-day unplanned readmissions. METHODS: A pre/post intervention design was used to evaluate the impact of a process to access the APRN-led stroke clinic. The intervention included a scheduling process redesign, and subsequent APRN and scheduler education. RESULTS: The time to clinic follow-up preintervention averaged 116.9 days, which significantly reduced to 33.6 days post intervention, P = .0001. Unplanned readmissions within 30 days declined from 11.5% to 9.9%; however, it was not statistically significant, P = .149. Age was not statistically different between preintervention and postintervention groups, P = .092, and other demographics were similar between the groups. CONCLUSION: An APRN-led clinic can improve follow-up care and may reduce unplanned 30-day readmissions for post-ischemic stroke patients. Further work is needed to determine the impact of alternative approaches such as telehealth.

Abstract: BACKGROUND : Prompt aneurysm repair is essential to prevent rebleeding after aneurysmal subarachnoid hemorrhage. To date, most studies on this topic have focused on 1 set of predictors (eg, hospital or patient characteristics) and on 1 outcome (either time to aneurysm repair or mortality). The purpose of this study was to test a model that includes hospital and patient characteristics as predictors of time to aneurysm repair and mortality, controlling for disease severity and comorbidity, and considering time to aneurysm repair as a potential influence in these relationships. METHODS : A sample of aneurysmal subarachnoid hemorrhage patients with a principal procedure of clipping or coiling was selected (n = 387) from a statewide administrative database for cross-sectional retrospective analysis. The primary study outcome was in-hospital mortality. Independent variables were level of stroke center, age, race, sex, and type of aneurysm repair. Hierarchical logistic regression was used to estimate the probability of in-hospital death. RESULTS : Patients who underwent a coiling procedure were more likely to be treated within the first 24 hours of admission compared with those undergoing clipping (odds ratio, 0.54; 95% CI, 0.35-0.84; P = .01). Patients treated at a certified comprehensive stroke center (CSC) had a 72% reduction in odds of death compared with those treated at primary stroke centers (odds ratio, 0.28; 95% CI, 0.10-0.77; P = .01), after controlling for disease severity and comorbid conditions. Time to aneurysm repair was not significantly associated with mortality and did not influence the relationship between hospital and patient characteristics and mortality. CONCLUSION : Our results indicate that treatment at a CSC was associated with a lower risk of in-hospital mortality. Time to aneurysm repair did not influence mortality and did not explain the mortality benefit observed in CSCs. Research is needed to explore interdisciplinary hospital factors including nursing and nurse-sensitive interventions that may explain the relationship between CSCs and mortality outcomes.

Abstract: AIM: The purpose of this study was to explore the perceived value of certification among those with a neuroscience or stroke nursing certification. METHODS: The Perceived Value of Certification Tool-12 (PVCT-12) consists of 12 value statements related to the benefits of certification, using a 4-point Likert scale ranging from strongly disagree to strongly agree. Descriptive statistics were used to determine the percentage of agreement among respondents with each of the PVCT-12 items. A generalized linear model approach was then used to estimate the associations between age, sex, race, experience, certification, highest degree earned, primary responsibility, and primary work setting with intrinsic and extrinsic values. An exploratory factor analysis was performed to identify factors on which related variables were found. RESULTS: The 632 certificants were predominantly female (90%) with a mean age of 54 years. Approximately 80% were White, followed by Asian (11%), Hispanic (4%), and Black (3%). Certification included certified neuroscience registered nurse (34%), stroke certified registered nurse (47%), or both (20%). Approximately 57% of the certificants work in critical care/medical-surgical units. Work setting included academic (46%) and community (42%). Responses indicated lower levels of agreement with the value statements regarding certification challenges, professional autonomy, being listened to, and monetary gain. Those in administration had statistically significant higher intrinsic and extrinsic value scores ( P = .005) as compared with those in nonadministrative roles. There was no significant difference on perceived intrinsic or extrinsic values for those who work in an academic environment versus those who work in a community environment ( P = .25). After factor analysis, the PVCT-12 was found to have 3 factors that accounted for 53.4% of the total variation in the data: recognition of specialization, personal achievement, and professional accomplishment. CONCLUSION: The PVCT-12 incorporated a Likert-type scale to provide levels of agreement for intrinsic and extrinsic values among stroke certified registered nurses and certified neuroscience registered nurses. To complement these findings, further research using open-ended questions is needed to improve our understanding of participant responses regarding complex values such as "autonomy" and the "extent of being listened to."

Abstract: INTRODUCTION: Parkinson disease (PD) affects approximately 1% of women and men worldwide, particularly older than 60 years. It is a multisystem and neurodegenerative disease with genetics and environmental factors that result in deficits in the production of neurotransmitters, including dopamine. The levodopa-carbidopa intestinal gel (LCIG) system delivers a continuous infusion of levodopa directly into the proximal small intestine via percutaneous endoscopic jejunostomy, largely bypassing gastric emptying and absorption problems and producing more stable plasma concentrations of levodopa, eliminating the development of motor complications (dyskinesias). The aim of this review was to summarize scientific evidence on the nursing role that, together with the multidisciplinary team, made the patient's choice in this therapeutic path (pre-LCIG phase). METHODS: A literature review was carried out, conducted on the MEDLINE databases (through PubMed), The Cochrane Library, Google Scholar, and CINAHL (through EBSCO). Relevant articles for the topic were found to identify indexed primary studies that investigated the relationship between the nurse and the patient/caregiver with PD who undertakes treatment with LCIG according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. RESULTS: Nineteen studies were included in the review. The selected studies suggested how the pre-LCIG phase of patient choice and the subsequent education and training could avoid selection errors for these therapeutic paths. CONCLUSION: Trained and specialized nursing staff who carry out an adequate pre-LCIG phase associated to the multidisciplinary team improved the choice of the patient and the start of treatment and, consequently, the quality of life of PD patients.

Abstract: BACKGROUND: Nurses play an essential role in coordinating the care of patients with multiple sclerosis (MS) throughout their disease trajectory in a complex treatment landscape. The aim of this study was to assess nurses' preferences toward different disease-modifying therapy attributes. METHODS: We conducted a multicenter, noninterventional, cross-sectional study in collaboration with the Sociedad Española de Enfermería Neurológica. Nurses actively involved in MS care were invited to participate in the study. Prevention of disability progression, preservation of cognitive function, side effect profile and safety monitoring, and method of administration were the treatment attributes tested. Conjoint analysis was used to assess preferences in 8 simulated treatment options and rank them from most to least preferred. RESULTS: A total of 98 nurses were included in the study. The mean (SD) age was 44.7 (9.8) years, and 91.8% were female with a mean (SD) time of experience in MS care of 7.5 (5.4) years. Participants prioritized preservation of cognition (38.6%), followed by preventing disability progression (35.2%) and side effect risk and safety monitoring (13.5%). Route and frequency of administration were the least preferred attributes (7.4% and 5.3%, respectively). Estimated utilities were consistent across the sample according to sociodemographic and professional practice characteristics. CONCLUSIONS: Nurses' preferences toward treatments were mainly driven by efficacy attributes. This information may support the role of nurses in the multidisciplinary management of MS facilitating shared decision making.