Sharing our story individualized and triadic nurse meetings support couples adjustment to living with deep brain stimulation for Parkinson's disease.

Treatment with deep brain stimulation for Parkinson's disease, leads to a rapid improvement in mobility, which may challenge patients and spouses when adjusting to everyday life. An intervention, developed to support the adjustment to everyday life with DBS, demonstrated that individualized meetings with a specialized nurse was experienced as important and fruitful by both patient and spouses. Purpose: The aim was to gain a deeper understanding of how the meetings contributed to the adjustment process. Method: 38 audio-recorded meetings and six written summaries from eight couples participating in the intervention, were analyzed in a hermeneutic process. Results: The analysis revealed four themes: A relational triad of co-creating personal knowing. Sharing and listening in an atmosphere of trust and openness. Unveiling the couple's everyday life, coping strategies and expectations. Supporting adjustment through knowing their personal story. Conclusion: The triadic dynamics in the meetings were quite particular. The main focus was the patients' and spouses' stories, individually and as a couple. The DBS nurse pursues solutions based on professional and specialized knowledge of Parkinson's disease and the couple's everyday life. Thus, the intervention meetings offered tailored, individualized and specialized care in supporting adjustment to DBS for PD both individually and as couples.

Perioperative Care During Deep Brain Stimulation Surgery.

Deep brain stimulation (DBS) is a life-changing surgical treatment. More than 150,000 patients worldwide have been treated with DBS, primarily for Parkinson disease and medically refractory tremor and dystonia. However, the use of DBS has recently expanded beyond traditional movement disorders to include the treatment of obsessive compulsive disorder, epilepsy, and other neurological and psychological diseases. Considering this expanded use of DBS, it is essential to understand the role that each member of the multidisciplinary health care team plays and how to avoid possible complications during this procedure. Proper patient selection, precise anatomical placement of the electrode, and proper programming of the implanted device are key aspects of DBS treatment. It also is valuable to understand how the deep brain stimulator is implanted and functions. Accurate lead placement that results in positive outcomes for patients relies on collaboration from an experienced perioperative team led by the neurosurgeon.

"It Is Hard Work, But It Is Worth It": Patients and Spouses' Experiences of a Nursing Intervention to Promote Adjustment to Deep Brain Stimulation for Parkinson's Disease-A Feasibility Study.

This article evaluates the feasibility of a nursing intervention when adjusting to deep brain stimulation for Parkinson disease. Eight couples were included in the study. Main activities of the intervention were a diary and individualized meetings between nurses, patients, and spouses with a focus on everyday life and expectations to deep brain stimulation. All meetings were audio recorded and analyzed together with the content of the diary. The intervention was evaluated as feasible and experienced as meaningful. It supports the need for individualized care involving both patients and spouses and contributes to the development of an evidence-based nursing practice.

Infusion treatments and deep brain stimulation in Parkinson's Disease: The role of nursing.

Parkinson's Disease (PD) represents one of the most common neurodegenerative disorders in the elderly. PD is caused by a loss of dopaminergic cells in the substantia nigra pars compacta. The motor cardinal signs include a resting tremor, bradykinesia, rigidity and postural reflex impairment. Although levodopa represents the gold standard also in the advanced stage of the disease, over the years most patients develop disabling motor fluctuations, dyskinesias, and non-motor complications, which are difficult to manage. At this stage, more complex treatment approaches, such as infusion therapies (subcutaneous apomorphine and intraduodenal levodopa) and deep brain stimulation of the subthalamic nucleus or the globus pallidus internus should be considered. All three procedures require careful selection and good compliance of candidate patients. In particular, infusional therapies need adequate training both of caregivers and nursing staff in order to assist clinicians in the management of patients in the complicated stages of disease.

Update on deep brain stimulation.

Deep brain stimulation (DBS) is a commonly used neurosurgical form of therapeutic brain stimulation that has been demonstrated to be safe, well tolerated, and effective for the treatment of essential tremor, Parkinson's disease, and primary dystonia. These particular uses have been approved by the U.S. Food and Drug Administration (FDA). Investigational studies using DBS have been conducted for refractory epilepsy, obesity, chronic pain, tardive dyskinesia, Tourette syndrome, and other movement disorders, but none of these studies has led to FDA approval for these indications. Although the use of DBS has been approved by the FDA under a Humanitarian Device Exemption for the treatment of treatment-resistant obsessive-compulsive disorder, studies systematically investigating the potential use of DBS for various severe chronic psychiatric disorders are in their earliest stages, and further studies are warranted.

Perceptions of living with a device-based treatment: an account of patients treated with deep brain stimulation for Parkinson's disease.

OBJECTIVES: Deep brain stimulation (DBS) is an established treatment for Parkinson's disease. Little is known about patients' own perceptions of living with the implanted hardware. We aimed to explore patients' own perceptions of living with an implanted device. MATERIALS AND METHODS: Semistructured interviews with open-ended questions were conducted with 42 patients (11 women) who had been on DBS for a mean of three years. The questions focused on patients' experiences of living with and managing the DBS device. The interviews were transcribed verbatim and analyzed according to the difference and similarity technique in grounded theory. RESULTS: From the patients' narratives concerning living with and managing the DBS device, the following four categories emerged: 1) The device-not a big issue: although the hardware was felt inside the body and also visible from outside, the device as such was not a big issue. 2) Necessary carefulness: Patients expressed the need to be careful when performing certain daily activities in order not to dislocate or harm the device. 3) Continuous need for professional support: Most patients relied solely on professionals for fine-tuning the stimulation rather than using their handheld controller, even if this entailed numerous visits to a remote hospital. 4) Balancing symptom relief and side-effects: Patients expressed difficulties in finding the optimal match between decrease of symptoms and stimulation-induced side-effects. CONCLUSIONS: The in-depth interviews of patients on chronic DBS about their perceptions of living with an implanted device provided useful insights that would be difficult to capture by quantitative evaluations.

Clinical and ethical dimensions of an innovative approach for treating mental illness: a qualitative study of health care trainee perspectives on deep brain stimulation.

BACKGROUND: The acquisition of knowledge and application of critical thinking skills are required to tackle the clinical and ethical dimensions of new approaches and technologies. Health care trainees rely partly on their training to manage, reason and reflect on the ethical uncertainties of innovations and new technologies. Deep brain stimulation (DBS) is neurosurgery involving the implantation of electrodes into deep brain nuclei and is approved for Parkinson's disease and other motor disorders. Experimental uses of DBS are emerging in refractory obsessive compulsive disorder and depression. METHODS: We conducted a qualitative interview-based study to gather the perspectives of health care trainees from different disciplines on the clinical and ethical issues associated with DBS in psychiatric disorders. RESULTS: First impressions about the use of DBS in mental illness were mixed. We identified factors influencing impressions about DBS and information missing that compounded uncertainty about long-term outcomes and effects on other physical or psychological systems. Participants revealed nascent exploration of the ethical issues of DBS. They emphasized the obligations of health care providers to manage ethical problems and supported patient autonomy in guiding choice, even when choosing innovative approaches. DISCUSSION: We discuss trainee expectations about evidence in decision making and the role of ethics education.

Exciting the senses.

Deep brain stimulation can be a useful treatment for some patients with Parkinson's disease.

Neurosurgical approaches to therapeutic brain stimulation for treatment-resistant depression.

During the 1940s and 1950s, psychosurgery was used for the treatment of severe mental disorders but was associated with significant complications. These problems and the advent of psychotropic drugs led to a decline in the use of psychosurgery. Neuroanatomical and brain imaging studies have revealed distinct brain regions and the pathways that connect them, which may underlie depression and other mental disorders. On the basis of this knowledge, modern stereotactic neurosurgical methods have been used to implant electrodes in the brain to provide therapeutic stimulation. Electrical stimulation by these electrodes with pacemaker-like devices can be used to modulate brain function by stimulating or inhibiting the activity of specific brain regions, without causing permanent or destructive lesions that cannot be reversed. Deep brain stimulation and cortical brain stimulation are two such neurosurgical approaches to therapeutic brain stimulation for treatment-resistant depression.

Nursing time to program and assess deep brain stimulators in movement disorder patients.

The use of deep brain stimulation (DBS) to treat movement disorders such as Parkinson's disease, essential tremor, and dystonia is increasing. Although some published literature describes the methods for DBS programming, the time and nursing requirements to run a DBS surgical program have not been examined previously. For this study, we prospectively recorded the time required for both assessments and programming of the DBS from the preoperative period to 1 year after surgery in a variety of patients. Results showed that the mean total time spent programming the stimulator and assessing these patients ranged from 18.0-36.2 hours per patient. It took twice as long to program the stimulator in patients with Parkinson's disease as it did in patients with essential tremor or dystonia. When setting up a program for movement disorders surgery, nursing time spent on patient assessment and programming should be considered in the workload.

Stimulation of the subthalamic nucleus for the treatment of Parkinson's disease: postoperative management, programming, and rehabilitation.

High-frequency stimulation of the subthalamic nucleus is a neurosurgical procedure for the alleviation of motor symptoms of Parkinson's disease and debilitating medication-induced dyskinesias. Stimulation is achieved with electrodes implanted stereotactically in the subthalamic nucleus by a neurosurgeon specializing in stereotactic surgery and a team composed of an anesthesiologist, a neurophysiologist, certified nurses and nurse practitioners and, at some centers, a neurologist. The teamwork continues in the recovery room and the intensive care unit, where the patient may experience transient adverse behavioral effects. Two weeks after surgery, the neurostimulator is activated and programmed. The medications also are adjusted to complement stimulation to maximize the therapeutic effects and minimize the stimulation-induced side effects. For those patients who are deconditioned or have major speech, gait, or balance problems, rehabilitation therapy is employed.

High-frequency stimulation of the subthalamic nucleus for the treatment of Parkinson's disease--a team perspective.

Parkinson's disease (PD) is a debilitating neurodegenerative disorder affecting more than 1.2 million people in the United States. Genetic and environmental toxins are believed to be risk factors in acquiring the disease. PD is characterized by tremors, rigidity, bradykinesia, poor gait, and postural instability. These cardinal symptoms improve with medication such a levo-dopa (L-dopa). However, over time, as the disease progresses, the patient becomes refractory to medication, or medication produces debilitating side effects. When this occurs or when there are worsening of symptoms, neurosurgical treatment is recommended, particularly deep brain stimulating (DBS) electrodes implanted in the subcortical subthalamic nucleus (STN). Over the last 5 years STN DBS has gained acceptance and become the neurosurgical treatment of choice for PD. To achieve maximum beneficial effects with minimum adverse effects from the surgery, the expertise of an integrated team of physicians and nurses is essential. A clear understanding of the different aspects of the procedure, including the risks and benefits of the treatment, assists neuroscience nurses in communicating with the PD patient, and providing the most appropriate, knowledge-based pre- and postoperative care.