The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses
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The purpose of this article is to explore the management of coexisting brain insult and acute lung injury to help guide clinicians in balancing what may appear to be competing goals. First, contemporary management of mechanically ventilated patients with either brain or lung injury diagnoses is reviewed, followed by a review of intracranial pressure and acute lung injury/acute respiratory distress syndrome. The article ends with a discussion of a literature review regarding possible treatment balance when the two conditions coexist.
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The Full Outline of UnResponsiveness (FOUR) Score is a coma scale that consists of four components (eye and motor response, brainstem reflexes, and respiration). It was originally validated among the adult population and recently in a pediatric population. To enhance clinical assessment of pediatric intensive care unit patients, including those intubated and/or sedated, at our children's hospital, we modified the FOUR Score Scale for this population. ⋯ Our hypothesis was that the PFSS and PCPC should highly correlate and the GCS and PCPC should correlate lower. Study results show that the PFSS is excellent for interrater reliability for trained nurse-rater pairs and prediction of poor outcome and in-hospital mortality, under various situations, but there were no statistically significant differences between the PFSS and the GCS. However, the PFSS does have the potential to provide greater neurological assessment in the intubated and/or sedated patient based on the outcomes of our study.
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Observational Study
Assessment of satisfaction with care among family members of survivors in a neuroscience intensive care unit.
Many prior nursing studies regarding family members specifically of neuroscience intensive care unit (neuro-ICU) patients have focused on identifying their primary needs. A concept related to identifying these needs and assessing whether they have been met is determining whether families explicitly report satisfaction with the care that both they and their loved ones have received. The objective of this study was to explore family satisfaction with care in an academic neuro-ICU and compare results with concurrent data from the same hospital's medical ICU (MICU). ⋯ Parents of patients were more likely than other relatives to feel very included and supported in the decision-making process. Future studies may focus on evaluating strategies for neuro-ICU nurses and physicians to provide better decision-making support and to implement more frequent family meetings even for those patients who may not seem medically or socially complicated to the team. Determining satisfaction with care for those families whose loved ones passed away during their neuro-ICU admission is another potential avenue for future investigation.
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Clinical Trial
Effects of different musical stimuli in vital signs and facial expressions in patients with cerebral damage: a pilot study.
Along history, music has been used in a variety of ways for therapeutic purposes and has long been recognized for its physiological and psychological effects. Music listening can be an effective nursing intervention, to enhance relaxation, provide distraction, and reduce pain. ⋯ The results of the study suggest that the application of musical stimuli such as CRM and RMNS can be used to provide a state of relaxation in patients with severe cerebral damage.
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The advanced registered nurse practitioner (ARNP) began in the 1960s as an alternative provider to meet the demands of an escalating healthcare resource deficit. As the role evolved and ARNPs demonstrated safe and effective care, these providers began to appear in critical care settings. It is believed that in the specialty of Neurocritical Care, about half the providers are ARNPs. ⋯ The program contains a roadmap for knowledge base and skill acquisition as well as competency training and maintenance. Experience with appropriate hiring and screening standards, internally developed training tools, and identification of necessary advanced classes are discussed. This model may be used as a guideline for Neurocritical Care ARNP training as well as adapted for all other critical care settings.