Nurses' self-confidence and attitudes in using the Glasgow Coma Scale: a primary study.

AIMS: The aim of this study was to examine nurses' self-confidence and attitudes towards the Glasgow Coma Scale (GCS). BACKGROUND: The GCS measures the depth and duration of impaired consciousness. However, there is an increasing evidence that problems are encountered in completing some aspects of the GCS. DESIGN: This descriptive correlational study recruited 114 Registered Nurses (RNs) in one acute care hospital in Singapore. METHODS: A set of questionnaires were given to the participants. The questionnaire had three parts, which collected data on demographics, attitudes and self-confidence. RESULTS: Data analysis showed the type of clinical discipline (B=0.19), seniority in nursing (Staff Grade) (B=0.28) and higher attitude scores towards the GCS (B=0.41) were significant factors determining a nurse's confidence in using the GCS. A longer length of time working in a Neuroscience setting (B=0.21) and higher self-confidence scores (B=0.41) were significant factors determining a nurse's attitude towards the GCS. CONCLUSION: To ensure patient safety, the GCS has to be performed accurately. This study has shown there are differences in attitudes and self-confidence in using the GCS between nurses of different demographics, and that there are a variety of factors influencing their attitudes and confidence. RELEVANCE TO CLINICAL PRACTICE: Mentoring and educational interventions are suggested in order to reduce safety risks resulting from lower proficiency in using the GCS.

A study to explore nurses' knowledge in using the Glasgow Coma Scale in an acute care hospital.

BACKGROUND: 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. OBJECTIVES: The aim of this study was to investigate nurses' knowledge in using the GCS and the demographic factors influencing knowledge of the GCS. METHODOLOGY: This is a correlational observational study conducted in one acute care hospital in Singapore. The participants were registered nurses involving in bedside nursing care. A self-administered questionnaire was provided to the participants via ward managers. The quantitative responses were collated and analyzed using SPSS 16.0. RESULTS: Type of clinical discipline (i.e., neuroscience, general medicine, and neurointensive care unit; beta = 0.51, p < .001) and the length of experience in a neuroscience setting (beta = 0.22, p = .005) were significant in determining a nurses' knowledge of the GCS. Nurses in the neonatal intensive care unit scored the highest mean scores (12.7), whereas nurses from the general medicine wards scored the lowest mean scores (9.7). Nurses who worked in a neuroscience setting for 6 years or more scored higher mean scores (11.9) on the knowledge scale, whereas nurses who worked in a neuroscience setting for less than a year scored lower mean scores (10.0). CONCLUSION: Educational interventions and guidelines in performing GCS assessment are suggested to maintain and improve knowledge in performing the GCS.

Investigating factors that have an impact on nurses' performance of patients' conscious level assessment: a systematic review.

AIM: To identify factors that have an impact on nurses' performance of patients' conscious level assessment. BACKGROUND: There is a need for nurses to accurately assess a patient's conscious level to detect neurological changes and initiate prompt action. METHODS: Nine databases were systematically searched (1990-February 2010) to review experimental, cohort, case control, cross-sectional and descriptive studies that addressed factors which affected nurses' performance of patient conscious level assessment. Participants in the studies reviewed were nursing staff. The Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument was used for quality assessment. RESULTS: Eleven studies were analysed in this review. Knowledge and experience were found to be the most significant factors in determining nurses' performance of patient conscious level assessment. Formal training was found to be effective in improving assessment skills and experience greatly affected the accuracy of assessment. CONCLUSION: Knowledge and experience are the most significant factors on nurses' performance of consciousness level assessment. Implications for nursing management Formal training is needed on a continual basis to maintain skills in consciousness level assessment, and nurses who are more experienced in the use of assessment should mentor those that are less experienced.

Factors causing acute delirium in critically ill adult patients: a systematic review.

BACKGROUND: Delirium, also known as acute confusional state, is a clinical syndrome that is typified by a disturbance of consciousness, attention, cognition and perception. It is estimated that the incidence of delirium varies between 28.3% to 80% in intensive care patients. Delirium is most likely to affect older patients above the age of 65 years. OBJECTIVES: The primary focus of this systematic review was to synthesise the best available evidence to identify the factors which are associated with acute delirium in critically ill adult patients. SEARCH STRATEGY: A three-step search strategy was utilised in this review. An initial limited search of MEDLINE and CINAHL was undertaken. A search strategy was then developed using identified keywords and MeSH headings. Lastly, the reference lists of all identified studies were examined. All searches were limited to English language studies published between 1990 and 2010. INCLUSION CRITERIA: The participants of this review were adult patients in a critical care setting who present with acute delirium in the intensive care unit.The review considered studies which examine the factors causing delirium in critically ill adult patients, such as fever, hypoxia and sepsis.This review considered studies that included the incidence of acute delirium as related to the individual factors as an outcome measure.This review considered any high quality quantitative papers that addressed factors causing acute delirium in intensive care unit patients. This review included data from cohort and case control studies. ASSESSMENT OF METHODOLOGICAL QUALITY: The Joanna Briggs Institute Critical Appraisal Checklist for Cohort / Case Control Studies was used to assess methodological quality. DATA EXTRACTION/SYNTHESIS: Data were extracted using a standardised Data Extraction Tool from the Joanna Briggs Institute. Due to the heterogeneous nature of the study methods, the findings of this systematic review are presented in a narrative summary. MAIN RESULTS: Twenty-four papers were included in this review. Some factors were common; however certain factors were exclusive to the type of setting. With regards to pharmacological factors, benzodiazepines were the most likely medications to be associated with delirium as compared to other drugs used in the intensive care unit. With regards to biomarkers, a variety were implicated in causing delirium, such as apolipoprotein 4 genotype, plasma tryptophan, interleukin-6, cortisol and C-reactive protein. Older age was also found to be a common risk factor. CONCLUSION: With regards to the medical and surgical intensive care units, relatively similar risk factors of older age and co-morbidity are significant. In the cardiac intensive care unit, a variety of risk factors were significant. Benzodiazepines have been singled out as the most likely drug to cause delirium. The biomarkers cortisol and hypoalbuminemia were also shown to be significant risk factors of delirium. IMPLICATIONS FOR RESEARCH: Future research should use increased sample sizes, recruited from more than one hospital, assessing diverse factors. Future studies could examine the effects of specific biomarkers on delirium. IMPLICATIONS FOR PRACTICE: By creating a regression model for delirium prediction, clinicians may be able to create a checklist to identify patients at risk of developing delirium. This checklist could assist in monitoring patients at higher risk for developing delirium, allowing measures to be implemented for preventing the incidence or reducing the severity of delirium. The use of benzodiazepines should also be avoided if possible, as they are seen to have a significant association with the incidence of delirium.

A systematic review of the factors that impact nurses' performance of conscious level assessment.

EXECUTIVE SUMMARY: Background The ability to perform a conscious level assessment forms a vital part of a nurse's skill base. By accurately assessing a patient's conscious level, the nurse is able to detect neurological changes and initiate prompt action. The clinical implications of this are grave and assessment errors are serious and have potentially important clinical consequences. OBJECTIVES: INCLUSION CRITERIA: This review considered any high quality quantitative papers that addressed factors which impacted nurses' performance of conscious level assessment. This review included data from cohort, case control, cross-sectional, and descriptive studies.The participants of this review were nursing staff working in acute hospitals, specifically working in settings, such as intensive care.Studies which examined knowledge, attitudes and demographic factors and their impact on nurses' performance of conscious level assessment were considered.Search strategy A three-step search strategy was utilised in this review. An initial limited search of MEDLINE and CINAHL was undertaken. A search strategy was then developed using identified keywords and MeSH headings. Lastly, the reference lists of all identified studies were examined. All searches were limited to English Language studies published between 1990 and 2010.Assessment of methodological quality The reviewers used the JBI Critical Appraisal Checklist for Cohort / Case Control Studies and the JBI Critical Appraisal Checklist for Descriptive / Case Series Studies to assess methodological quality.Data extraction Data were extracted using The JBI Data Extraction Form for Comparative Cohort / Case Control studies and the JBI Data Extraction Form for Descriptive/Case Series studies.Data synthesis Due to the heterogeneous nature of the study methods, the findings of this systematic review are presented in a narrative summary.Results Fifty papers were identified through the various database searches and review of reference list and bibliographies, based on their titles and abstracts. Thirteen studies were included in this review. Knowledge and experience were found to be the most significant factors in determining nurses' performance for conscious level assessment. Formal training was found to be effective in improving assessment skills and experience greatly affected the accuracy of conscious level assessment The agreement rates between healthcare staff were moderate to high, however there were still instances of disagreement.Conclusion This review demonstrated that knowledge and experience are the most significant factors to impact nurses' performance of conscious level assessment. There was variability between results of the studies found. This may have been due to differences in the setting, the target population as well as study methodology. However, these findings suggest that the factors impacting a nurses' performance of conscious level assessment may be more complex than what was initially assumed.Implications for practice It is suggested that formal training be on a continual basis to maintain skills in conscious level assessment. Secondly, nurses who are more experienced in the use of the conscious level assessment should mentor those less experienced.Implications for research The effect of training courses has not been studied comprehensively. Further research should be conducted concerning the accuracy and reliability of nurses using other conscious level assessment instruments.