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

Background: Patients with a brain injury (BI) frequently experience agitation during their initial postinjury hospitalization. Nurses at one hospital struggled to characterize, quantify, and trend the agitation experienced by patients with a BI and sought to incorporate a tool to assist them in their everyday practice.

Methods: Nurses and providers selected the Agitated Behavior Scale (ABS) as the tool they would implement. A multiyear educational project ensued using various teaching strategies, and eventually, a toolkit was created to aid other units and hospitals with implementation of the ABS.

Results: The education project led to neuroscience nurses using the ABS to effectively characterize, quantify, and intervene for agitation among patients with a BI. Furthermore, the neuroscience nurses recommended the expansion of this project to include all hospitalized patients experiencing agitation. They hypothesized that utilizing the ABS for other patients may positively impact patient outcomes and potentially reduce the length of stay for patients exhibiting agitated behaviors.

Conclusion: The ABS is a valuable tool for the management of agitation among patients with BI. The multiyear, tiered implementation of this project utilizing various education strategies was essential for its success. To enculturate change in nursing practice, educators should prepare and implement long-term education strategies.

Background: Guidelines recommend the use of enteral nimodipine for 21 days after aneurysmal subarachnoid hemorrhage (aSAH). The recommended duration (21 d) and frequency of administration (every 4 h) may lead to noncompliance. Nurses play a critical role in medication administration, monitoring adverse reactions, and ensuring patient compliance with prescribed regimens. The aim of this study is to assess the degree of compliance with nimodipine use, causes of noncompliance and explore if adherence to nimodipine in clinical practice correlates with improved neurological outcomes as indicated by modified Rankin Scale (mRS) scores.

Methods: A retrospective study of consecutive aSAH admissions to a comprehensive stroke center over a 67-month period. Compliance was defined as receiving at least 80% of the recommended doses of nimodipine over 21 days. A chart review was performed to explore the reasons for noncompliance. We examined hospital disposition at discharge and 90-day mRS, adjusted for severity of aSAH. Compliance rates before and after a pharmacist-guided intervention were also examined.

Results: Among 141 patients, the overall compliance rate was just 30%. The leading reasons for missed doses included hypotension (68.1%) and patients being off the unit (56%). Compliance was not associated with improvement in 90-day mRS scores for low-grade aSAH ( P =0.3638) and high-grade aSAH ( P =0.227). After pharmacist-guided intervention, compliance improved from 18.2% to 43.8%.

Conclusion: There is a high rate of noncompliance with nimodipine use in aSAH, but it did not significantly impact patient outcomes. Although pharmacist interventions improved compliance, full compliance remains challenging.

Abstract: BACKGROUND: Sleep-disordered breathing (SDB) occurs in 70% of stroke patients and is a risk factor for secondary stroke and poor outcomes. Discretionary nursing care provided to stroke patients with SDB is unexplored. This review examines nursing care for SDB after stroke. METHODS: We used Arksey and O'Malley's 5-stage framework. We systematically searched the PubMed and CINAHL databases through December 2023 for studies of interventions for SDB after stroke that could be implemented by nursing staff. Data on intervention characteristics, stroke and SDB types, timing, and outcomes were extracted. RESULTS: From 2866 screened articles, 10 studies met inclusion criteria. From these, we identified 5 distinct interventions: positional therapy, oropharyngeal muscle exercises, physical exercise, compression devices, and education. As confirmed by polysomnography or home sleep testing, 9 studies targeted obstructive sleep apnea. CONCLUSION: This review provides the first analysis of nurse-implementable interventions for poststroke SDB. The identified interventions appear promising for improving SDB parameters, particularly when adapted for stroke-specific care. Future research on developing standardized protocols that integrate these interventions into comprehensive care pathways will enhance the role of nurses in the early detection and management of poststroke SDB.

Abstract: BACKGROUND: Pupil examination, a fundamental part of the neurologic examination, is essential to detect problems after intracranial surgery. However, this examination may be worrying to patients because it requires close physical proximity and a light source directed at the patient's eyes. This study aimed to describe patient perspectives on pupil examination after intracranial surgery. METHODS: This is a qualitative descriptive study. Semistructured face-to-face, individual interviews were conducted with 12 patients after intracranial surgery. RESULTS: Three main themes, namely, "what I know about pupil examination," "what I felt during the pupillary examination," and "my expectations," were identified through thematic analysis. CONCLUSION: Pupil examination, a routine practice for nurses, may result in worry and uncertainty for patients. This study revealed the importance of nurses using practical communication skills during pupil examinations.