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

Abstract: INTRODUCTION: In pediatric epilepsy monitoring units (EMU), nurses are essential in assessing seizure activity and neurological status. One critical element of neurological evaluation is the pupillary light reflex (PLR), traditionally assessed manually with low interrater reliability. Quantitative pupillometry offers a more accurate and reliable method for evaluating PLR, yet its use in EMUs has not been well described. The objective is to describe the implementation of quantitative pupillometry in a pediatric EMU through a nurse-led initiative. METHODS: A collaborative effort between nursing and physician leadership introduced the NPi-200 pupillometer in a pediatric EMU. Nurses received hands-on training, and a standardized electronic order was developed to integrate the tool into clinical workflows. Accessibility issues were addressed by relocating the device to a central nursing station. RESULTS: Over the pilot period, 40 patients underwent pupillometry assessments, with 88% yielding complete data. No adverse events occurred. Nurses reported the device was easy to use and successfully incorporated it into their routine care, even for children with developmental delay. CONCLUSION: Pupillometry can be effectively and safely implemented in the pediatric EMU setting through a nurse-driven process. This initiative demonstrated high usability, safety, and integration into clinical practice, supporting its broader use for neurological monitoring in epilepsy care.

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.

Abstract: BACKGROUND: Mental health literacy (MHL) is a key factor influencing mental health outcomes and may affect quality of life (QoL) in people with multiple sclerosis (pwMS), who often experience psychiatric comorbidities. However, research on MHL in multiple sclerosis remains limited. Therefore, this study aims to investigate levels of MHL in pwMS and the relationship with their QoL and sociodemographic factors. METHODS: A multicenter, cross-sectional study was conducted between March and August 2024. Data were collected through an anonymous online survey consisting of a questionnaire divided into 4 sections: sociodemographic and clinical characteristics; patient experience with nursing care; the Mental Health Literacy Questionnaire-Short Version for adults (MHLq-SVa) assessing MHL across 4 domains; and the Multiple Sclerosis Quality of Life Questionnaire to assess QoL. Statistical analyses included psychometric validation procedures. RESULTS: A total of 170 adult pwMS participated. Participants showed moderate MHL levels, with better knowledge of mental health problems than in other domains. Higher MHL was significantly associated with female gender and higher educational attainment. Weak correlations were found between MHL and QoL, with only 1 domain: knowledge of mental health problems, which showed a significant association. The MHLq-SVa demonstrated good internal consistency (α=0.816) and construct validity. CONCLUSION: While MHL appears to be influenced by gender and education, its direct impact on QoL in pwMS remains limited. These findings indicate that improving MHL alone may be insufficient to enhance well-being, and that additional factors must also be addressed. Nurses are strategically positioned to assess and support MHL, and validated tools like the MHLq-SVa can guide targeted educational strategies within multidisciplinary care.

Background: Measuring intracranial pressure with an external ventricular drain (EVD) if blood is present in the system may alter the rate at which cerebrospinal fluid drains. This study explored the differences in EVD drainage rate between 0.9% NaCl (saline) and blood. METHODS: This preclinical study used an acrylic chamber to represent the skull and EVD tubing. Four conditions were simulated by alternately filling the chamber, EVD tubing, or both, with saline or blood. The EVD was opened to drain at a pressure of 15 mm Hg with the column set for 10 mm Hg. The volume of drainage in the first minute after the drain opening determined the rate. RESULTS: There were significant differences in drainage rates among the 4 conditions (P<0.0001). A Tukey post hoc test showed that when the system contained only saline, the drainage rate was significantly higher than that with blood in the tubing, the chamber, or both (P<0.05). There was no significant difference in drainage rate with blood in the EVD tubing (P=0.424).

Conclusions: The physical properties of the cerebrospinal fluid drainage are key factors in determining drainage efficiency. The high viscosity of blood significantly inhibits drainage, and the low resistance properties of saline optimize drainage dynamics. These data provide an important direction for improving clinical EVD management.

Background: Stroke survivors often rely on informal care partners (ICPs), who commonly experience caregiver burden (CB) across multiple domains. Although CB has been widely studied, many interventions remain ineffective, potentially due to a limited understanding of how social needs shape ICP experiences. Health-related social needs (HRSNs), such as food insecurity, transportation barriers, and lack of support, may contribute significantly to CB but remain largely unexamined in stroke care partnership research. METHODS: This exploratory cross-sectional study examined the relationship between 12 HRSN domains and both total and domain-specific CB among ICPs of stroke survivors. A sample of 81 ICPs from the United States was recruited through social media and stroke support groups. Participants completed a demographic survey, the Accountable Health Communities HRSN Screening Tool, and the Caregiver Burden Inventory (CBI). Descriptive statistics, independent-samples t-tests, and stepwise multiple linear regressions were conducted using SPSS v29. RESULTS: Nearly all HRSNs domains were associated with significantly higher CB scores. Stepwise regression identified 3 significant predictors of total CB: transportation needs, family and community support needs, and education (adjusted R2=0.374, P<0.001). Additional HRSNs emerged as predictors of specific CB domains. Mental health needs predicted both physical and developmental burden, while utility needs predicted emotional burden, for example. Race did not significantly moderate any observed relationships. Reliability of the CBI and its subscales was strong (α=0.822 to 0.952).

Conclusion: Findings demonstrate that HRSNs significantly contribute to the CB experienced by ICPs of stroke survivors, highlighting actionable HRSNs. Incorporating structured HRSN screening into stroke aftercare may inform more responsive, equitable approaches to CB reduction and support the development of socially informed clinical pathways.

Background: The frequency and nature of neurological exams (neuro-checks) in patients with severe acquired brain injury resulting in coma or disorders of consciousness (DoC) remain variable, with limited evidence guiding practice and poor understanding of their role in predicting and preventing neurological deterioration, functional recovery and adverse effects such as delirium. This scoping review aims to explore the frequency of bedside neurological exams within the first 7 days of injury impact on clinical outcomes in adult patients with severe acquired brain injury including mortality, neurological deterioration, long-term function, and delirium. METHODS: A comprehensive literature search was conducted using the PubMed, CINAHL, Medline and EMBASE databases from 2003 to 2023. Search terms captured a range of acute brain injuries and neuro-assessment tools. Eligible studies included adult patients with severe traumatic or non-traumatic brain injury or stroke that addressed frequency of bedside neurological exams within the first 7 days of admission. RESULTS: Of 1327 studies screened, 20 met inclusion criteria, representing over 16,000 patients across 14 countries. Assessment tools varied, but use of the Glasgow Coma Scale was prevalent. Frequency of neuro-checks ranged from hourly to daily. Multiple outcome measures were utilized. Some studies found that continuing hourly neuro-checks beyond the first 48 hours did not provide additional clinical benefit. Others associated excessive assessment with increased stress or delirium. CONCLUSION: There is very low evidence supporting an association between the frequency of neuro-checks and functional outcomes, mortality, length of stay, or delirium. Although early assessments may aid prognostication, excessive exams may not improve outcomes and may contribute to harm. The heterogeneity, lack of evidence, and limited standardization of neuro-check frequency highlight the need for clinical research to guide future practice.

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: 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.