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

Abstract: Background: Over 795 000 US people per year experience a stroke, and 10% are younger than 50 years. After a stroke, posttraumatic stress disorder (PTSD) affects 10% to 30% of those patients and may compromise a survivor's secondary prevention compliance. At an inner-city clinic in Maryland where up to 300 young adult stroke survivors are followed, zero patients were screened for PTSD. A quality improvement project was implemented to screen for PTSD in a young adult stroke survivor clinic and to provide them with psychotherapy referrals and follow-up. Methods: Over 15 weeks in the fall of 2023, all patients presenting to the young adult stroke survivor clinic were screened for PTSD using the Posttraumatic Stress Disorder Checklist-5 validated screening tool. Providers and medical staff were all educated on the tool before implementation. Results: During the 15-week implementation period, 72 patients presented to the clinic. Posttraumatic stress disorder screening was completed for 88.9% (64/72). Of those, 32.8% (21/64) completed the Posttraumatic Stress Disorder Checklist-5 via the electronic health record, and 67.2% (43/64) completed it by in-person screening. Of the 64 patients screened, 12 patients screened positive for PTSD (18.8%, 12/64). Among those screening positive, 75% (9/12) were given a referral for psychotherapy. Conclusions: Literature reports that PTSD compromises stroke survivors' ability to optimize their health after a stroke. Screening identifies those experiencing symptoms of PTSD, providing an opportunity for referral and treatment. Results show that routine care of young stroke survivors can effectively include screening for PTSD.

Abstract: BACKGROUND: The epilepsy monitoring unit (EMU) is an independent unit for video electroencephalogram monitoring of epilepsy patients, with the aim of capturing typical seizure events. Because of the uncontrolled seizure frequency, there may be safety risks for patients, such as falling, trauma, aspiration, status epilepticus, and sudden unexpected death in epilepsy. This study aims to evaluate the application effect of comprehensive safety projects on safety management in a pediatric EMU. METHODS: From June 2022 to May 2024, a preevaluation and postevaluation study was conducted at the EMU of a tertiary grade A children's specialized hospital in China. The intervention group carried out a unit-based comprehensive safety project, including nurse safety culture training, establishing a normalized mechanism for safety improvement, and developing evidence-based safety prevention strategies. RESULTS: The response time of paroxysmal events in the intervention group was shorter than that in the control group ( P < .05). The scores of implementation of safety precautions and emergency measures in the intervention group were higher than those in the control group ( P < .05). The nursing-related complications in the intervention group were lower than those in the control group ( P < .05). CONCLUSION: The comprehensive unit-based safety project management mode can effectively improve the quality of EMU nursing care for children and reduce nursing-related complications.

Abstract: BACKGROUND: Tourette syndrome (TS) is a chronic neurodevelopmental disorder that begins in school-age children. Although TS is not life-threatening, the tics and comorbidities can impact a child's physical and mental health, as well as interpersonal interactions. Understanding the care needs of parents of children with TS is essential for providing healthcare services that effectively support these children. The aim of the study was to develop and evaluate the psychometric properties of the care needs scale for parents of children with TS (CNS-PCTS) in Taiwan. METHODS: This study used a methodological design. The scale was developed by preliminarily identifying relevant items and dimensions through a systematic review of the literature. A pilot test with 30 participants and exploratory factor analysis (EFA) confirmed the subscales and items pertaining to the care needs of the parents. Data analysis included content validity, item analysis, internal consistency, test-retest reliability, and EFA. The Chinese version of the Pittsburgh Sleep Quality Index was adopted to assess the discriminant validity of the CNS-PCTS. RESULTS: Two hundred fifty-six parents of children with TS completed the scale. The scale-level content validity index was 0.92. The EFA revealed that the CNS-PCTS consisted of 13 items, with the factor loadings ranging from 0.656 to 0.83, and covered 3 factors: getting information about TS, assisting children in social engagement, and obtaining parenting support. The discriminant validity showed a positive correlation between the Chinese version of the Pittsburgh Sleep Quality Index and the CNS-PCTS. Cronbach's α coefficients of the subscales ranged from 0.89 to 0.94, and the intraclass correlation coefficient was 0.94. CONCLUSION: The CNS-PCTS demonstrated satisfactory psychometric properties. It helps health professionals understand parents' care needs and assess the effectiveness of interventions. Confirmatory factor analysis can be performed in future studies to provide more rigorous validity.

Abstract: BACKGROUND: The impact of stroke is a global concern for health policymakers. A large proportion of survivors require long-term support from family members who are typically unprepared for their caregiving duties. This study determined the effect of different interventions on quality of life (QoL), depression, and the burden of care of stroke patients and their caregivers. METHODS: A systematic review was conducted from 2000 up to May 2023. Study inclusion criteria were as follows: individuals serving as informal caregivers for stroke survivors 18 years and older, devoting a significant portion of their time to the care of such survivors; involvement in psychoeducational, informational, supportive, psychosocial, or combined interventions; exposure to standard or conventional care practices; evaluation of outcomes relating to the QoL for stroke caregivers, depression, caregiver burden, and levels of stroke survivors; and consideration of randomized controlled trials and quasi-experimental studies. RESULTS: Thirty-seven studies met the inclusion criteria and were synthesized in this systematic review. Details of intervention were divided into 3 groups: educational and psychoeducational programs, multidisciplinary approaches, and support and caregiver skill-building programs; 12 studies focused on different interventions affecting the QoL, 23 studies focused on the burden of stroke caregivers, and 20 studies focused on depression of stroke patients and their caregivers. CONCLUSION: The desired effectiveness of particular interventions was evident in the results, although conflicting findings have emerged. The study emphasizes the need for well-structured preliminary studies for each intervention type. More studies on interventions and outcomes might lead secondary researchers to conduct analyses to ensure the certainty of results.

Abstract: BACKGROUND: Critical care neuroscience nursing is a specialized field requiring a complex knowledge base and unique clinical orientation. A comprehensive orientation for nurses new to this specialty can improve retention, performance, and satisfaction. Critical care neuroscience orientations are often hospital based and regionally specific, and lack a systematic approach. The aim of this research was to obtain expert consensus on the essential components of a 12- to 18-week critical care neuroscience nursing orientation. METHODS: A Delphi methodology was used to collect expert consensus on the components of a critical care neuroscience nursing orientation. Electronic surveys were distributed to 161 neuroscience critical care orientation experts in 2 Delphi rounds. Participant demographic data and a Likert rating scale (1-5) of literature-based components of a critical care neuroscience orientation were collected. Participants identified additional critical care neuroscience orientation components that were not included in the listed components in round 1 or round 2 of the survey. RESULTS: Round 1 of the survey had 38 responses (23.6%), and round 2 had 23 responses (14.2%). The round 1 survey included 47 elements, and 36 of 47 met the a priori threshold of ≥75% consensus of being important or very important. Two additional elements resulted from write-in recommendations. In round 2, 38 elements were included in the survey, and 37 of 38 elements met consensus. Expert consensus on the essential components of a critical care neuroscience orientation included 37 elements divided among 5 major components. CONCLUSION: Expert consensus was achieved on the essential components of a 12- to 18-week adult critical care neuroscience nursing orientation. Five components and 37 elements were agreed upon by expert consensus.

Abstract: BACKGROUND: Hospitalized patients who have had neurological trauma often require interventions to reduce agitation. Weighted blankets deliver deep pressure touch stimulation, which influences parasympathetic activity through increased vagal tone, to induce calmness and reduce sympathetic activation and reduction of the stress response. The purpose of this study was to investigate the effect of weighted blankets as an intervention on agitation scores in hospitalized adults who have experienced neurologic trauma. METHOD: This was a quasi-experimental design, pilot study with a convenience sample of patients who experienced neurological trauma. Participants who met the inclusion criteria received a weighted blanket that remained in place for 30 minutes. The Agitated Behavior Scale was used to measure the effect of the weighted blanket before and after the intervention with each participant serving as their own control. RESULTS: Twelve participants were included in the study. Related-samples Wilcoxon signed rank test indicated a significant difference for heart rate ( P = .05) and Agitated Behavior Scale scores ( P = .005). There were no significant differences with blood pressure or oxygen saturation levels. CONCLUSION: This pilot study demonstrated a reduction in agitation scores with the use of a weighted blanket. The deep pressure touch stimulation provided by a weighted blanket may provide a low-risk intervention to decrease agitation and prevent escalation. Future studies with larger sample sizes may demonstrate weighted blankets to decrease agitation and provide an adjunct therapy for patients.

Abstract: BACKGROUND : Blood loss from phlebotomy is a significant cause of hospital-acquired anemia. Use of small-volume (Pedi) tubes in adult patients reduces blood loss by 40% and does not increase need for repeated labs. Although this practice is evidencebased, it has not been widely implemented. Using Pedi tubes for phlebotomy is a key component of blood management programs to decrease the incidence of hospital-acquired anemia and blood transfusions in the intensive care unit (ICU). Our aim was to implement the use of Pedi tubes for labs in the adult neurocritical care unit to demonstrate feasibility in this population. METHODS : This was a pre-/postintervention quality improvement project. All consecutive patients admitted to the neurocritical care unit from April 10, 2023, to October 10, 2023, aged 18-99 years, were included in the project. During the intervention period from July 10, 2023, to October 10, 2023, Pedi tubes were used for all laboratory draws except admission and crisis labs. A retrospective chart review from April 10 to July 9, 2024, established standard practice for comparison. We recorded hospital and ICU admission, nadir, and discharge hemoglobin, length of stay, number of rejected specimens, number of blood transfusions, discharge disposition, and 30-day readmission for all subjects. RESULTS : Pedi tube use was successfully implemented with significantly less need for repeat laboratory collections in the postintervention cohort ( P = .001). Although no difference was noted in hemoglobin levels, there was a decrease in both ICU and hospital length of stay by 1 day in the intervention arm. Fewer transfusions were required in the intervention cohort. CONCLUSIONS : Small-volume tube use for phlebotomy in adult neurocritical care patients is feasible and can lead to decreased blood transfusion need in the ICU.