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

Abstract: BACKGROUND: Persons diagnosed with multiple sclerosis (PwMS) may experience uncertainty regarding the etiology, symptoms, treatment, and course of the disease. In these patients, intolerance of uncertainty may also make disease management difficult. METHODS: This study used a descriptive and correlational design to explore the relationship between intolerance of uncertainty, symptom severity, and disease self-management in MS patients. A total of 105 MS patients followed in the neurology clinic were included in the study. RESULTS: A positive moderate correlation was found between the participants' mean scores on the Intolerance of Uncertainty Scale and the mean scores on the Monitoring My Multiple Sclerosis Scale ( r =0.429; P <0.01), while a negative moderate correlation was found between the participants' mean scores on the Intolerance of Uncertainty Scale and the mean scores on the Multiple Sclerosis Self-Management Scale ( r =-0.558; P <0.01). CONCLUSIONS: Intolerance of uncertainty explained 18% of the total variance in symptom severity and 30% of the total variance in self-management of PwMS patients ( P <0.01). Intolerance of uncertainty increased symptom severity and decreased self-management level in PwMS and was an important predictor of both symptom severity and self-management. Nurses should address intolerance of uncertainty and take initiatives to reduce uncertainty in the care and treatment process of PwMS.

Abstract: BACKGROUND: Epilepsy should be approached in a multidimensional manner, considering its biological, psychological, and social aspects. The aim of this study is to examine the impact of epilepsy education on people with epilepsy regarding knowledge level, self-management, and stigma. METHODS: An online survey, including an epilepsy information form, epilepsy self-management scale, and stigma scale was sent to registered patients in our epilepsy clinic. After the survey, patients were invited to a 1.5-hour epilepsy education program, conducted by 2 instructors on different days, followed by a question-and-answer session. Participants were retested posttraining. RESULTS: Of 265 patients who filled out the pretraining survey, 69 (26%) attended the education program. Those who participated were generally more knowledgeable at the baseline. University graduates and those using the internet as a source of information were more inclined to attend, whereas unmarried individuals attended less. The participant age was 39.1 years (9.2 years), with 61% female, 65% having a university degree, and 61% actively working. Seizure types included focal (45%), generalized (22%), and both (33%), with 70% experiencing less than 1 seizure per month. Posteducation, participants answered more knowledge questions correctly ( P < .001, before: 37.0 [6.0], after: 40.7 [6.1]). Awareness about swimming risks increased in the self-management scale, along with the tendency to carry informative cards, join support groups, and educate relatives. There was no change in the stigma scale. CONCLUSION: Epilepsy education has a positive impact on raising awareness about the disease and promoting self-management in people with epilepsy. The fight against stigma needs to involve broader segments of society.

Abstract: BACKGROUND: Historically, patients in an academic tertiary care center were admitted to the intensive care unit (ICU) after Deep brain stimulation (DBS) placement. DBS patients progressed quickly through the ICU and did not require traditional ICU management. We identified an opportunity to shift DBS postoperative care from the ICU to the floor. METHODS: Key stakeholders were engaged to create a protocol to transition postoperative DBS patients from ICU to medical-surgical care. Forty-one DBS patients were admitted postoperatively to the ICU in the 6 months before implementation of the new process, and 22 patients were admitted postoperatively to a medical-surgical level of care in the 6 months of the study. A retrospective chart review of patient outcomes and metrics was completed at the end of the study period. RESULTS: A reduction in ICU use was noted. Only 3 of 22 (14%) patients required ICU care postoperatively because of medical comorbidities in the postimplementation group ( P < .0001). CONCLUSION: We were able to manage patients postoperatively on a medical-surgical unit without transfer to a higher level of care. Length of stay was lower without an increase in readmission. Implementation of this pathway resulted in a safe transition of care. Further research could explore financial benefits, a larger sample size, and review of patient demographics.

Abstract: INTRODUCTION: Neuromonitoring enhances patient assessment in neuroscience nursing, yet its integration varies globally. At the 2025 International Neuroscience Nursing Research Symposium, nurses from 16 countries discussed the adoption of neuromonitoring devices. This proceedings article explores international perspectives on neuromonitoring use, barriers, and facilitators. METHODS: Participants summarized their country's neuromonitoring technology level, key facilitators and barriers to adoption, and devices with the greatest potential impact. RESULTS: Significant disparities exist in neuromonitoring accessibility. Developed countries frequently use continuous electroencephalography, intracranial pressure monitoring, and pupillometry, whereas lower-resource settings face financial and training limitations. Key facilitators include policy support, funding, and interdisciplinary training, whereas barriers include cost, limited resources, and competency gaps. CONCLUSION: Nurses worldwide recognize how neuromonitoring may improve outcomes. International collaboration, standardization of training, and technological advancements could help bridge disparities in access and implementation. Addressing systemic barriers and investing in education and policy support will enhance equitable neuromonitoring integration, ultimately improving neurological patient care across diverse healthcare settings.

Abstract: BACKGROUND: Acute ischemic stroke (AIS) is a leading cause of mortality and disability. Patients who receive thrombolytic therapy promptly tend to have better outcomes. Although alteplase (tPA) is the standard Food and Drug Administration-approved thrombolytic for AIS treatment, recent American Heart Association guidelines suggest that tenecteplase (TNK) can be used as an alternative. This project compares the cost-effectiveness and clinical outcomes of TNK versus tPA in AIS treatment. Key outcomes include door-to-needle time, length of stay, National Institutes of Health Stroke Scale scores, and the incidence of hemorrhagic conversion events. METHODS: The project involved retrospective analysis through medical chart reviews at a thrombectomy-capable stroke center in a Pacific Northwest community hospital. Data were collected from 175 AIS patients treated with either tPA (82) or TNK (93) between March 2022 and December 2023. Patients eligible for thrombolytic therapy received tPA before March 15, 2023, with TNK used thereafter. Selection criteria adhered to American Heart Association guidelines and clinicians' judgment. RESULTS: Although door-to-needle times were similar ( P = .20), excluding outliers revealed a significant difference favoring TNK ( P = .04). No significant group differences were observed for demographics, National Institutes of Health Stroke Scale scores, length of stay, or post-intracerebral hemorrhage rates. Tenecteplase use resulted in over $40 000 in medication savings during the project period. CONCLUSION: Tenecteplase offers comparable safety and efficacy to tPA for treating AIS, with the added benefit of cost savings. Although clinical outcomes did not significantly differ between the 2 drugs, TNK's reduced cost and ease of administration make it an attractive option, particularly in resource-limited settings. These results support the current organizational treatment protocol favoring TNK.

Abstract: BACKGROUND: Nurses play a crucial role in the care of stroke patients improving health outcomes. However, stroke nursing care is complex, and an instrument available to monitor the patient dependence over time and an efficient management of care would be beneficial for the stroke care units. The purpose of this study is to develop and psychometrically test an instrument to measure nursing care intensity for patients admitted to stroke units. METHODS: A 3-step process was implemented. First, item generation was performed based on an established theory. Second, content validity was assessed on the generated pool of items, and finally, the instrument was tested on a sample of 1200 stroke patients at admission and discharge time points, to test its psychometric properties. RESULTS : Item generation was driven by the theory of Roper-Logan-Tierney, and a total of 13 items were derived. Content validity led to the elimination of 5 items. The final instrument, the Chart of Nursing Assessment in Stroke (STROKE-CNA), was made of 8 items. Confirmatory factor analysis had a supportive fit (root mean square error of approximation = 0.077, comparative fit index = 0.99), indicating structural validity. Scores of the instrument at admission were significantly lower than at discharge ( P < .001, Cohen d = 1.42), indicating longitudinal validity. The changes in STROKE-CNA scores between admission and discharge were positively correlated with the corresponding changes in scores on the Scandinavia Stroke Scale ( r = 0.57, P < .001), confirming adequate responsiveness. The STROKE-CNA scores were negatively correlated with age (admission: r = -0.22, P < .001; discharge: r = -0.28, P < .001), indicating convergent validity. Internal consistency was adequate at 0.93, and interrater reliability was optimal, with Cohen kappa ranging between 0.61 and 0.99. CONCLUSIONS : The STROKE-CNA has promising validity and reliability when used for assessing nursing care complexity of patients admitted to stroke units.