The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses最新文献

Background: Advanced practice providers (APPs) play a critical role in neuroscience patient care and system-level leadership. Despite their growing presence, the practice of neuroscience APPs throughout the United States is underexplored. This study aims to describe the current practice for neuroscience APPs in the United States. METHODS: An online survey was developed using the 2006 American Association of Neuroscience Nurses advanced practice survey as a starting point. The peer-tested survey used snowball recruitment, with an initial email to American Association of Neuroscience Nurses members or customers who identified as APPs (n = 4950). The survey was open to any neuroscience APP. The survey collected demographic, current practice, and system-level role data. RESULTS: A total of 350 respondents completed the survey. Respondent roles were nurse practitioner (76.6%), clinical nurse specialist (20.9%), and physician assistant (2.6%). Most worked in hospital settings (83.1%) and practiced in inpatient (56.3%) or ambulatory (31.1%) settings, with the southern region of the United States (31.1%) having the highest representation. Common practice elements included patient evaluation, management, procedures (intraventricular catheters, intracranial monitoring devices), and billing and coding practices across roles. CONCLUSION: This survey highlights the diverse roles and practice contributions of neuroscience APPs. Findings underscore the need for standardized practice measures and further research to define and optimize APP integration into neuroscience care. The results provide insights into opportunities to support the development and recognition of neuroscience APPs' impact on patient outcomes and health care systems.

Background: Care partners experience multiple psychosocial and physiological stressors while supporting patients with stroke. We aimed to adapt an existing care partner-focused support program for skill building and psychosocial support. We sought to examine the implementation of the support program in an early-supported stroke discharge clinic and investigate the effects of the support program on care partner-reported mental health and burden. METHODS: The study followed a type 2 hybrid implementation-effectiveness design. During the implementation phases, key stakeholders evaluated and adapted the support intervention for the stroke population and completed a prospective evaluation of care partner roles in the target stroke clinic. During the intervention phase, care partners participated in the support intervention per the parent study protocol. Implementation feasibility and acceptability were evaluated, and we evaluated care partner-reported measures of physical and mental health and burden measured at baseline, 12, and 24 weeks. RESULTS: The support program was determined suitable for implementation in the target stroke clinic with a scaling-out implementation strategy. In the target stroke clinic, care partners primarily supported instrumental activities of daily living. Of 17 care partners enrolled in the support intervention, 12 completed baseline assessments. Participants who completed the intervention (n = 8) reported high satisfaction and acceptability of the program components, but some expressed concerns about the length of the surveys. Overall mental health scores increased, and burden decreased in both groups from baseline to 24 weeks. CONCLUSION: The support program adapted for care partners of patients after stroke was acceptable and feasible and has potential for benefit to physical and mental well-being and burden, though this pilot was not powered to detect significance of outcomes for participants. Scaling out may promote efficient use of limited care partner services in a health system.

Background: Stroke is a leading cause of death and disability worldwide, with timely intervention being critical to minimizing long-term disability. Delays in hospital arrival frequently result in patients missing the therapeutic window for effective treatment. This study aimed to explore the factors contributing to delayed hospital arrival in acute stroke patients. METHODS: This cross-sectional study was conducted at a tertiary care hospital in the Arabian Gulf region, from February to November 2024. It included adults with computed tomography/magnetic resonance imaging-confirmed stroke, classified as early or late arrivers. Data collected included demographics, socioeconomic status, stroke symptoms and onset, risk factors, transportation method, post-stroke destination, and awareness of the emergency number and Alteplase (ALT). The National Institutes of Health Stroke Scale score at onset was recorded. RESULTS: Among 195 stroke patients, 46.15% arrived late. Significant differences between early and late arrivers were observed in employment, income, and stroke symptoms. Early arrivers had higher rates of limb weakness, facial weakness, and dysarthria/aphasia, whereas headache and vertigo were more common in late arrivers. Early arrivers were more likely to live with family or friends, be aware of ALT, and know the emergency number (P = 0.001, <0.001, <0.001, respectively). Knowledge of ALT [odds ratio (OR) = 5.63, 95% CI = 2.1-13.81] predicted early arrival, while headache (OR = 0.21, 95% CI = 0.04-0.97) and vertigo (OR = 0.17, 95% CI = 0.03-0.80) predicted delays. CONCLUSION: Lack of knowledge about ALT and unusual stroke symptoms is a potential barrier to early arrival within the therapeutic window. Strenuous efforts must be directed towards such barriers to achieve optimal care for patients with acute stroke.

BACKGROUND: Parkinson disease (PD) is the second most prevalent neurodegenerative condition and has a profound impact on patients' quality of life. Effective management requires active self-care, in which health literacy (HL) plays a critical role by enabling patients to acquire, interpret, and apply knowledge about their condition. This review aimed to map the existing literature on HL in PD and assess its impact on disease management. METHODS: A scoping review was conducted in accordance with Joanna Briggs Institute guidelines and reported following Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Review. Relevant studies were identified through systematic searches of 7 major databases. Eligibility criteria were structured using the Population-Concept-Context framework. RESULTS: Sixteen studies were included, most published between 2016 and 2024 and predominantly from high-income countries. The studies investigated key HL dimensions, including knowledge of motor and nonmotor symptoms, medication management, and patient-provider communication. Findings revealed substantial gaps in functional HL, particularly in recognizing nonmotor symptoms and understanding pharmacological regimens, while interactive and critical HL were rarely assessed. Across studies, age, education level, and disease duration consistently influenced HL levels. Importantly, no standardized or personalized HL interventions for PD were identified. CONCLUSIONS: HL in PD remains underdeveloped, with current research largely focused on functional HL and limited exploration of interactive or critical domains. Integrating HL assessment into routine care and developing nursing-led, personalized interventions may improve self-care, treatment adherence, and long-term outcomes for people with PD. Future research should prioritize validated measurement tools, multimodal interventions, and studies in diverse populations to address existing gaps.

Abstract: BACKGROUND: Frequent neurological assessments (neuro-checks) are critical for early detection of neurological deterioration in patients with acquired brain injuries. However, extended use of hourly neuro-checks may negatively impact patient outcomes by contributing to sleep deprivation, intensive care unit (ICU) delirium, and staff burden. PURPOSE: This quality improvement initiative aimed to evaluate the implementation of a nurse-driven protocol to reduce unnecessary hourly neuro-checks in stable Neurocritical Care Unit (NCCU) patients after 48 hours of admission. METHODS: This project involved adult NCCU patients and staff at an academic medical center. A stepwise nurse-driven protocol, based on patient stability criteria, guided neuro-check frequency. Preimplementation and postimplementation data from electronic health records included hourly neuro-check order volumes, Confusion Assessment Method for the ICU (CAM-ICU) scores, and length of stay. Staff perceptions of the nurse-driven protocol were gathered using a survey. RESULTS: During the 3-month implementation period, the number of hourly neuro-check orders on the NCCU decreased by 19% (from 372 to 301). The proportion of patients with at least 1 positive CAM-ICU score decreased from 90 to 58 (39.8% to 31.7%), and the length of stay distribution showed fewer very short (<2 d) and/or prolonged admissions (>9 d). Staff survey responses indicated increased confidence in patient safety and improved workflow following education and protocol use. CONCLUSIONS: A nurse-led protocol to individualize neuro-check frequency was implemented successfully in the NCCU, with observed trends in patient outcomes, staff workflow efficiency, and nursing confidence. Continued evaluation is warranted to assess sustainability and generalizability across other critical care units.

Background: There are 2 mainstays of therapy for malignant or aggressive brain tumors that are effective in controlling growth: systemic treatments such as immunotherapy and chemotherapy and radiation including brachytherapy. Prior versions of brain brachytherapy have proven challenging to use due to adverse effects, resulting in limited application of this therapy. The most recent development in brain brachytherapy is a tile-based radioactive device, GammaTile®, that is implanted at the time of tumor removal. GammaTile is FDA-approved for malignant brain tumors as well as recurrent brain tumors and addresses all the nuances of prior versions. This literature review provides neuroscience nurses with a working understanding of tile-based brain brachytherapy. METHODS: Searches were conducted across multiple medical databases including PubMed, CINAHL, and EBSCO, using combinations of keywords related to brachytherapy, GammaTile, and brain tumors to identify relevant background and descriptive literature, and using combinations of keywords, nursing care, brachytherapy, brain, head, and malignancies, to identify relevant nursing care literature. RESULTS: Fifteen recently published articles were deemed relevant to provide neuroscience nurses with a working knowledge of tile-based brain brachytherapy. Literature on the nursing care of patients receiving tile-based brain brachytherapy is scarce, and only 2 articles published within the past 40 years specific to nursing care of patients receiving brain brachytherapy were discoverable. CONCLUSION: As the number of GammaTile cases and centers across the country continue to mount, neuroscience nurses need to have a working knowledge of this type of tile-based brain brachytherapy. There are significant differences in the care of patients after implantation of tile-based radiation therapy like GammaTile compared with prior brachytherapy products. These differences have implications for nurse and patient safety and patient/family education.

Background: Central poststroke pain (CPSP) is a chronic neurological condition that results from damage to the brain's pain-processing pathways and causes hypersensitivity to pain. Despite its clinical importance, yet remains underrecognized, its estimated prevalence ranges from 8% to 35%. OBJECTIVE:This study examines the prevalence of CPSP and explores demographic and comorbidity differences among stroke survivors. METHODS: This retrospective, cross-sectional study used de-identified data from electronic health records from a large academic health center in the North Central Florida region (2014-2024). International Classification of Diseases-9 and International Classification of Diseases-10 codes were used to identify ischemic stroke, hemorrhagic stroke, and CPSP. Descriptive statistics, χ2, t test, and multivariable logistic regression were used for statistical analyses. RESULTS: Of 32,155 adult patients, only 99 (0.31%) were diagnosed with CPSP. The odds of being diagnosed with CPSP were higher in patients with ischemic stroke than hemorrhagic [adjusted odds ratio (AOR) = 2.00, 95% CI: 1.19-3.37, P = .009]. The mean age of CPSP patients was 59 years (SD = 13.1), significantly younger than those without CPSP (M = 64, P = .001), with no difference in sex distribution. Black patients (AOR = 0.47, 95% CI: 0.30-0.74, P = .001) and Hispanic patients (AOR = 3.31, 95% CI: 1.49-7.31, P = .003) both had significantly higher odds of a documented CPSP diagnosis compared with white and non-Hispanic patients. Hypertension (74.8%) was the most common comorbidity among patients with CPSP, while only atrial fibrillation was significantly less prevalent (P = .006) in the CPSP group. CONCLUSION: Our findings indicate a low prevalence of CPSP in patients who have experienced stroke. The prevalence of documented poststroke pain was substantially lower than published estimates suggest. Further investigation is needed to understand the experience of CPSP in younger, black, Hispanic, and multimorbidity populations.

Abstract: Diabetes mellitus affects millions of people and is a significant public health concern. Neurologically, hearing occurs with intact outer, middle, and inner ear functioning, with brain recognition and decoding. Hearing impairments are underrecognized and contribute to safety issues and poor quality of life. CONTENT: This article identifies how diabetes contributes to neurological changes that manifest as impaired hearing and balance. A pathophysiological review of the auditory pathway and ongoing theories of diabetes-related changes in the auditory nerves and blood vessels results in impaired hearing and balance. SUMMARY: Neuroscience nurses benefit from understanding how uncontrolled diabetes and nerve destruction impact communication, quality of life, and safety. Diabetic neuropathy does not exist in isolation and hearing loss often goes unappreciated.