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

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.

Background: Despite more than 30 years of public health campaigns, critical gaps persist in community stroke symptom recognition and awareness of the importance of calling 9-1-1. Underserved communities experience disproportionately higher risk of stroke and poorer outcomes, and they have lower reported knowledge of stroke symptoms and are less likely to receive acute time-sensitive treatments. This quality improvement initiative outlines a pathway for stroke centers to address these disparities through reproducible and customizable pop-up health awareness events that also fulfill regulatory requirements.

Methods: The nurse leaders of 2 hospital stroke programs serving the same city in California developed a collaborative stroke awareness event at an urban farmers' market in a high-risk, underserved neighborhood. Volunteers conducted a brief intervention in the form of a survey to engage participants and share information.

Results: The event successfully engaged a diverse audience and fostered partnerships at a pop-up offering on one Sunday morning in May. A total of 128 community members participated, and 113 surveys were included in the final analysis. Pre-intervention, 42% of participants confidently recognized stroke symptoms, which increased to 88% postintervention ( P <0.0001). Participants' confidence in recognizing the importance of calling 9-1-1 increased from 22% preintervention to 93% postintervention ( P <0.0001).

Conclusion: An event plan for offering stroke awareness information enabled the facilitating hospitals to effectively share critical health information and gain insights into the communities served. The survey responses suggested significant improvement in stroke awareness within a limited timeframe. The collaborative event also succeeded in fostering relationships across organizations, departments, and between health care and the community.

Abstract: BACKGROUND: Multiple sclerosis (MS) is a neurological disease that manifests differently in men and women, including variations in clinical progression and symptoms. Despite the relevance of these differences, research exploring disparities in sexuality and relationships remains limited. Therefore, this study aimed to identify differences between men and women in alterations in sexual function and relationship adjustment in a Spanish sample of people with MS.METHODS: A descriptive cross-sectional study was conducted involving 208 adults recruited through 13 Spanish MS associations. An electronic form was used to collect sociodemographic and sexuality-related variables. The Multiple Sclerosis Intimacy and Sexuality Questionnaire-15 and the Dyadic Adjustment Scale-13 were also included in the data collection process.RESULTS: Men with MS reported greater concerns about sexually satisfying their partner ( P < 0.001) and more frequent feelings of sexual insecurity ( P = 0.001) than women. Differences in sexual function were also observed in physiological aspects, with erectile dysfunction being more prevalent in men than vaginal lubrication difficulties in women ( P = 0.031). Regarding relationship adjustment, no significant differences were identified ( P = 0.816). However, a significant correlation was found between relationship adjustment and alterations in sexual function in men ( P = 0.038).CONCLUSIONS: The results of this study point to meaningful differences between men and women with MS in how sexual function is experienced, with men reporting greater concerns related to both physiological (erectile dysfunction) and psychological (worries about satisfying their partner and insecurity) difficulties. Regarding relationship adjustment, overall levels were similar between groups; however, poorer sexual function was significantly associated with worse adjustment only among men. These specific differences should be taken into account when addressing sexuality in clinical care, as considering these disparities may contribute to more comprehensive, personalized, and effective interventions for people with MS.