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

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.

Abstract: BACKGROUND: Neuroscience nurses generate new knowledge through research. Establishing research priorities is essential to support evidence-based nursing practice and direct research agendas. The purpose of this scoping review was to describe the nursing interventions and outcomes of adult 18 years of age or older nonintensive care or rehabilitation hospitalized patients with acute ischemic stroke (AIS) and identify gaps in the evidence. METHODS: Scoping review was followed, which included creation of a structured review protocol, a comprehensive librarian-assisted literature search of studies from 2010 to 2023, and the use of systematic review software. Reviewers performed title, abstract, and full-text review of studies meeting the inclusion criteria. A structured data extraction form was used to record characteristics of included studies, as well as nursing interventions and outcomes for hospitalized patients with AIS. RESULTS: Of the 797 studies identified from the literature search, 35 studies met the inclusion criteria. Nursing interventions included specific activities related to motor functioning (13), patient and family education (7), dysphagia (8), workflow (3), management of hyperglycemia (3) and fever (3), and discharge planning (1). Clinical outcomes included measures of disability (20), mortality (17), neurological deficits (15), adverse events and complications (14), and length of stay (14). Additional less frequently reported outcomes included time (9), patient satisfaction (6), and unplanned emergency department visits and readmissions (1). No studies reported metrics related to return on investment or costs related to nursing interventions. Across all interventions, motor functioning appears to have a positive impact on length of stay, neurological deficits, disability, and timing. CONCLUSION: This review provides a summary of nursing interventions and outcomes for adult hospitalized patients with AIS from a small sample of studies over 20 years. Gaps in the literature are noted to help inform the American Association of Neuroscience Nurses on the need for future research.

Abstarct: BACKGROUND: IRRAflow is a novel active cerebrospinal fluid (CSF) exchange system for the treatment of hemorrhagic strokes and intracranial infections. It is a closed system that irrigates various medications dissolved in irrigation solutions at a speed of up to 180 mL/h, expediting resolution. Disrupting this closed system to withdraw CSF samples or infuse medications is necessary in certain circumstances. We report our novel approach for maintaining the sterility of the closed IRRAflow system using a needleless extension and assess the compatibility and safety of this technology throughout treatment. METHODS: We used a needleless extension to withdraw CSF samples and deliver medications to 5 patients treated with the IRRAflow system. We used 1 stopcock with a 3-way valve, 2 neutral needleless connectors, and 2 antiseptic caps. The stopcock was connected between the irrigation and drainage ports of the catheter. The needleless connectors were mounted at the 12 o'clock position of the attached stopcock and the irrigation port with antiseptic caps covering the distal ends. To initiate fluid exchange, the 2 needleless connectors were separated. The extra stopcock valve was connected between the drainage arm, the cassette, and the irrigation arm. The needleless connectors remained mounted at the 12 o'clock position of the stopcock and irrigation port throughout treatment. RESULTS: The needleless connectors mounted on the 12 o'clock position of the stopcock and irrigation port on the drainage and irrigation arms, respectively, provided efficient management of fluid exchange, CSF fluid sampling, and medication delivery. Our needleless extension was compatible with the IRRAflow device and prevented secondary infections despite repeated CSF sampling and medication delivery. CONCLUSION: The needleless extension facilitated a simple and safe interaction with the closed IRRAflow system without compromising the sterile environment during CSF sampling and medication delivery.

Abstract: INTRODUCTION: For patients undergoing endoscopic pituitary surgery, the most common complications are epistaxis, diabetes insipidus, cerebrospinal fluid leak, and other general postoperative complications. Members of the department of neurological surgery identified gaps in patient education regarding postsurgical complication management after pituitary surgery. This quality improvement project aims to develop a comprehensive digital educational tool that empowers patients and caregivers with the knowledge to better recognize and manage common postoperative complications. METHODS: This project used a pretest-posttest design and was underpinned by the Ottawa Model of Research Use. A digital educational material (Adobe Spark) was created by an interprofessional clinical team and was distributed to 17 patients through QR code or text message who were scheduled to undergo pituitary surgery. RESULTS: The Adobe webpage was scanned and viewed a total of 161 times in 4 months. Of 12 patients who completed both pretest and posttest, mean knowledge scores increased from 3.17 out of 5 (1.03) to 4.25 (0.97) out of 5 (P = 0.009). CONCLUSION: The development of a webpage for pituitary surgery education is a low-cost and efficient means to better standardize and improve the quality of the presurgical education provided to patients and families.

Abstract: BACKGROUND: Neuroscience nurses play a pivotal role in identifying nutritional risk factors, monitoring patients, and initiating interventions to optimize recovery outcomes. Patients with moderate to severe acquired brain injury (ABI) are at risk of undernutrition during subacute rehabilitation, yet prevalence is rarely described using recent diagnostic criteria. This study aimed to explore the Global Leadership Initiative on Malnutrition (GLIM) criteria in routinely collected clinical data and to describe undernutrition in patients with ABI at admission and discharge from in-hospital rehabilitation. METHODS: A quantitative descriptive study was conducted using nutritional data extracted from electronic health records stored in a clinical database. The analysis focused on GLIM criteria, including low body mass index (BMI), disease-related inflammation, and the risk of reduced food intake. RESULTS: A total of 2,645 patients were included. A low BMI was observed in 10% of 2,465 patients at admission and in 8% of 2,147 patients at discharge. Inflammation was present in 82% of 912 patients at admission and 71% of 420 at discharge. Reduced intake was noted in 61% of 1,745 patients at admission and 26% of 1,550 at discharge. Many patients did not meet the required combination of phenotypic and etiologic criteria for GLIM-defined malnutrition. CONCLUSION: Potential undernutrition, according to individual GLIM criteria, varied significantly at admission, with "low BMI" showing the lowest prevalence. This may indicate a substantial long-term nutritional risk among patients who appear well-nourished based on BMI. Furthermore, the lack of comprehensive data on individual criteria suggests that routinely collected clinical data may be insufficient for accurately assessing malnutrition.

Introduction: A global aging population seeking resolution of pain and functional decline from degenerative spine conditions is leading to an increasing number of spine surgeries. The recovery process is complex with many cognitive and physical actions performed by the patient, which can be conceptualized as patient work. Shaped by the dynamic patient work system (PWS), patient work is the time and effort patients complete at home and across health settings to meet their health goals. Our aim was to define factors in the PWS that influence the patient work of older adults' recovery during the hospital and posthospitalization phases as well as by discharge location after spine surgery.METHODS: Secondary data analysis (28 interviews) using deductive and inductive qualitative content analysis methods was used to describe PWS influencing factors. The Systems Engineering Initiative for Patient Safety 2.0 human factors framework (person, organization, task, tools and technology, and internal and external environments) guided independent (3 members) coding, codebook evolution, and team deductive analysis. Care phase and discharge location were further analyzed using team inductive analysis.RESULTS: In nearly all components, factor differences were present between discharge to home or skilled nursing facility or inpatient rehabilitation. These differences included pain severity, mobility, unexpected experiences, education not meeting their needs, the level of problem-solving required, and types of benchmarks to their goal of recovery.CONCLUSIONS: Our findings show that regardless of discharge disposition, older adults experience uncertainty and different needs during recovery that often generate invisible work in navigating the recovery process. Participants describe significant work to clarify any uncertainty and meet their recovery needs. Nursing has a pivotal role to further investigate strategies to help patients achieve their recovery goals.