Journal of Neuroscience Nursing最新文献

Abstract: BACKGROUND: Analgesia monitoring is essential to preserve comfort in critically ill sedated patients with traumatic brain injury (TBI). Although pupil dilation (PD) and pain behaviors can be used to assess analgesia, these indicators require application of noxious stimulations for elicitation. Recently, the pupillary light reflex (PLR) has emerged as a nonnoxious parameter that may be used to predict analgesia requirements in non-brain-injured patients. Here, we explored whether PLR can be used for the purpose of analgesia monitoring in critically ill sedated TBI patients. METHODS: Fifteen mechanically ventilated TBI patients (11 men; 54 ± 20 years) under continuous analgesia and sedation infusions were assessed at predefined time within 72 hours of intensive care unit admission. Data collection was performed using video-pupillometry and the Behavioral Pain Scale. At each assessment, pupil size and PLR at rest were recorded followed immediately by the documentation of PD and pain behaviors elicited by a calibrated noxious stimulus. Blood concentrations of analgesics/sedatives were monitored. RESULTS: One hundred three assessments were completed. PLR resulted in an average decrease of 19% in pupil diameter, and PD resulted in an average increase of 10% in pupil diameter. Variations in PLR and PD were more pronounced in subjects who showed a Behavioral Pain Scale score greater than 3 (a recognized sign of subanalgesia) compared with those with no behavioral reaction. Multiple regression analyses suggest a significant overlap between fluctuations in pupillary reflexes and blood levels of fentanyl, not propofol. CONCLUSION: In our sample, percentages of variation in PLR and PD were found to be directly representative of TBI patients' fentanyl blood concentration. Considering information about blood drug concentration is generally not available at bedside, PLR could be used as a proxy to assess analgesia requirements before a nociceptive procedure in critically ill sedated TBI patients who are vulnerable to stress.

Abstract: BACKGROUND: Medication adherence is important in reducing the rate of secondary stroke in patients previously given a diagnosis of stroke. Therefore, there is a need to examine medication adherence and the factors affecting it in these patients. This study aimed to examine medication adherence in patients with stroke and the factors affecting it. METHODS: This study adopted a descriptive and cross-sectional design carried carried out on 183 stroke patients. Data were obtained between January and December 2019 using a sociodemographic and clinical characteristics form, the Morisky's Questions - Self-Reported Measure of Medication Adherence, the Turkish translation of the Beliefs about Medicines Questionnaire, the Nottingham Extended Activities of Daily Living Scale, and the revised Turkish version of Mini-Mental State Examination. RESULTS: The proportion of patients with high medication adherence was 33.9%. The sociodemographic and clinical characteristics of patients with stroke were found as not effective factors in medication adherence. Specific concerns and general overuse in the Turkish translation of the Beliefs about Medicines Questionnaire were found as factors affecting medication adherence. The Nottingham Extended Activities of Daily Living Scale and its subscales were found to be not effective factors in medication adherence. CONCLUSION: According to the results, the proportion of patients with high medication adherence was low. Patients' concerns about the possible side effects of their prescribed medications and beliefs about the overuse of medications negatively affected their medication adherence. It is recommended that nurses evaluate patients' medication adherence and beliefs about medications during hospitalization, discharge, or home visits. Structured nurse-led intervention programs are needed to enhance patients' medication adherence and beliefs about their medications.

Abstract: BACKGROUND: The Bispectral (BIS) monitor is a validated, noninvasive monitor placed over the forehead to titrate sedation in patients under general anesthesia in the operating room. In the neurocritical care unit, there is limited room on the forehead because of incisions, injuries, and other monitoring devices. This is a pilot study to determine whether a BIS nasal montage correlates to the standard frontal-temporal data in this patient population. METHODS: This prospective nonandomized pilot study enrolled 10 critically ill, intubated, and sedated adult patients admitted to the neurocritical care unit. Each patient had a BIS monitor placed over the standard frontal-temporal location and over the alternative nasal dorsum with simultaneous data collected for 24 hours. RESULTS: In the frontal-temporal location, the mean (SD) BIS score was 50.9 (15.0), average minimum BIS score was 47.0 (15.0), and average maximum BIS score was 58.4 (16.7). In the nasal dorsum location, the mean BIS score was 54.8 (21.6), average minimum BIS score was 52.8 (20.9), and average maximum BIS score was 58.0 (22.2). Baseline nonparametric tests showed nonsignificant P values for all variables except for Signal Quality Index. Generalized linear model analysis demonstrated significant differences between the 2 monitor locations (P < .0001). CONCLUSION: The results of this pilot study do not support using a BIS nasal montage as an alternative for patients in the neurocritical care unit.

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.