The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses
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Multicenter Study Comparative Study
Monitoring and sedation differences in the management of severe head injury and subarachnoid hemorrhage among neurocritical care centers.
The emergence of specialized neurocritical care (NCC) centers has been associated with an improved survival of patients with severe traumatic brain injury or subarachnoid hemorrhage. However, there are no established guidelines on sedation strategy or the frequency of evaluating the level of consciousness using the neurological wake-up test (NWT) in sedated NCC patients. ⋯ Although Scandinavian countries have similar healthcare systems, there were marked differences among the participating NCC centers in the choice of monitoring tools and sedatives and the routine use of the NWT. These differences likely reflect different clinical management traditions and a lack of evidence-based guidelines in routine NCC.
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Review Case Reports
The impact of restless legs syndrome: a familial case study.
Restless legs syndrome (RLS) is a common neurological disorder characterized by an irresistible urge to move. RLS has a general population incidence of between 5% and 10% and a familial rate as high as 77%. This case study examines the pathophysiology, diagnosis, and treatment along with the presentation of RLS in two members of a family with near-identical onset and treatment. Cases of familial RLS may be best directed toward similar treatment regimens.
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The Glasgow Coma Scale (GCS) is a neurological instrument, which measures the "depth and duration of impaired consciousness." The appeal of the GCS lies in its applicability in a wide variety of clinical situations as well as its ease of use by a range of healthcare staff. However, the GCS is not without its weaknesses and limitations. Its ease of use opens it up to misinterpretation and misapplication. Despite the propensity for incorrect assessment, the GCS remains in use in the clinical setting and enjoys an "unwarranted and privileged position." This creates an issue to patient care as the GCS is an important instrument in communicating an accurate assessment of the patient's condition between clinical staff. ⋯ Educational interventions and guidelines in performing GCS assessment are suggested to maintain and improve knowledge in performing the GCS.
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Delirium is a widespread complication of hospitalization and is frequently unrecognized by nurses and other healthcare professionals. Patients with neuroscience diagnoses are at increased risk for delirium as compared with other patients. The aims of this quality improvement project were to (1) increase neuroscience nurses' knowledge of delirium, (2) integrate coaching into evidence-based practice, and (3) evaluate the effectiveness of this combined approach to improve nurses' recognition of delirium on a neuroscience unit. ⋯ Findings reveal that neuroscience nurses recognize the absence of delirium 94.4% of the time and the presence of delirium 100% of the time after a didactic session and coaching. The postintervention chart review showed a statistically significant increase (p = .000) in the documentation of delirium screening results. Expert coaching at the bedside may be a reliable method for teaching nurses to use evidence-based screening tools to detect delirium in patients with neuroscience diagnoses.
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Multicenter Study Observational Study
Significant practice pattern variations associated with intracranial pressure monitoring.
The purpose of this study was to describe nursing practice in the care of patients with intracranial pressure monitoring. Although standards for care of such patients have been established, there continue to be variations in the nursing practice. ⋯ For more insights from the authors, see Supplemental Digital Content 1, at http://links.lww.com/JNN/A7.