Assessment of motor limb strength by neuroscience nurses: variations in practice and associated challenges.

BACKGROUND: Limb strength is a central component of neurological assessment and monitoring in nursing practice, yet there is a lack of research examining the tools used by nurses or challenges nurses encounter when using these tools. The evidence base is lacking to inform effective practice and the underpinning educational approaches. AIM: To determine which tools are used by UK and Irish neuroscience nurses in the assessment of limb strength and the associated challenges and variations in practice. METHODS: This study used an online self-reported survey design to ascertain which tools neuroscience nurses used and their experience of using these (n=160). FINDINGS: Practices varied, with a dominance of two tools being used in practice: the Medical Research Council scale and the 'normal power' to 'no movement' scale found on the neurological observation chart. Most respondents used the same tool across all conditions. CONCLUSION: This study highlights variations in assessment practice and the absence of a sound evidence base behind choice of motor limb strength assessment tools used.

The Glasgow Coma Scale: A European and Global Perspective on Enhancing Practice.

Although the Glasgow Coma Scale has made a positive contribution to the care of people with neurologic orders, variance exists in its understanding and application secondary to inconsistency in guidelines, their interpretation, and the educational approach to the use of the tool. This fragmentation has been evidenced to result in variances in practice, some potentially harmful. Also, recent evidence demonstrates human factors, such as distress, have not been addressed within such education and guidelines for use. An opportunity now exists to take a new, unified approach to education and standards for use of the tool, framed within a person-centered context.

Nurses' understanding and experience of applying painful stimuli when assessing components of the Glasgow Coma Scale.

AIMS AND OBJECTIVES: To evaluate nurses' application, understanding and experience of applying painful stimuli when assessing components of the Glasgow Coma Scale. BACKGROUND: The Glasgow Coma Scale has been subjected to much scrutiny and debate since its publication in 1974. However, criticism, confusion and misunderstandings in relation to the use of painful stimuli and its application remain. An absence of evidence-informed guidance on the use and duration of application of painful stimuli remains, with the potential to negatively impact on decision-making, delay responsiveness to neurological deterioration and result in adverse incidents. DESIGN AND METHODS: This international study used an online self-reported survey design to ascertain neuroscience nurses' perceptions and experiences around the application of painful stimuli as part of a GCS assessment (n = 273). The STROBE checklist was used. RESULTS: Data revealed varied practices and a sense of confusion from participants. Anatomical sites for the assessment of pain varied, but most respondents identified the trapezius grip/pinch in assessing eye-opening and motor responses. Most respondents identified they assess eye-opening and motor responses together and apply pain for <6 s to elicit a response. Witnessed complications secondary to applying a painful stimulus were varied and of concern. CONCLUSION: Neuroscience nurses in this study clearly required evidence-informed guidelines to underpin practice both in applying painful stimuli and in managing the experience of the person in their care and the family response. A standardised approach to education is necessary to ensure greater interrater reliability of assessment not only within nursing but across professions. RELEVANCE TO PRACTICE: Results of this study illustrate inconsistency and confusion when using the Glasgow Coma Scale in practice; this has the potential to compromise care. Clarity around the issues highlighted is necessary. Moreover, these results can inform future guidelines and education required for supporting nurses in practice.

Perceived caring attributes and priorities of preregistration nursing students throughout a nursing curriculum underpinned by person-centredness.

AIM AND OBJECTIVE: To explore preregistration nursing students' caring attributes development through a person-centred focused curriculum. BACKGROUND: Developing caring attributes in student nurses to the point of registration has historically been challenging. Globally, curricula have not yet demonstrated the ability to sustain and develop caring attributes in this population, despite its centrality to practice. DESIGN AND METHODS: This longitudinal cohort study tracked how University preregistration nursing students (N = 212) developed their caring attributes over the 3 years of their programme using repeated measures at the end of each year with the same cohort. The Caring Dimensions Inventory (35 item version with 25 caring items under three constructs (technical, intimacy and supporting) and 10 inappropriate or unnecessary construct items) was used and data analysed using Mokken scale analysis to create a hierarchy of actions that students deemed as caring. Repeated measures of analysis of variance enabled evaluation of changes in responses over time. RESULTS: Students developed their caring attributes throughout their programme, ranking 22 of 25 items as caring (with statistical significance) at the end of year 1, 18 at the end of year 2 and all 25 caring items at the end of their final year. No unnecessary or inappropriate construct items were ranked as caring at any data collection point. Participants consistently ranked assisting a person with an activity of living, listening to a patient and involving them in their care as the most caring actions. CONCLUSION: This study found caring attributes can not only be sustained, but can also be developed throughout a preregistration nursing education programme grounded in person-centredness. RELEVANCE TO CLINICAL PRACTICE: Internationally, caring attributes are challenging to develop and sustain throughout preregistration education, largely being diminished over time. Little published evidence evidences how person-centred frameworks are successfully integrated into preregistration nursing curricula to develop person-centred nurses.

Impact of a web based interactive simulation game (PULSE) on nursing students' experience and performance in life support training--a pilot study.

The delivery of effective life support measures is highly associated with the quality, design and implementation of the education that underpins it. Effectively responding to a critical event is a requirement for all nurses illustrating the need for effective educational approaches from pre-registration training through to enhancing and maintaining life support skills after qualification. This paper reports the findings of utilising a web-based multimedia simulation game PULSE (Platform for Undergraduate Life Support Education). The platform was developed to enhance the student experience of life support education, to motivate on-going learning and engagement and to improve psychomotor skills associated with the provision of Intermediate Life Support (ILS) training. Pre training participants played PULSE and during life support training data was collected from an intervention and a control group of final year undergraduate nursing students (N=34). Quantitative analysis of performance took place and qualitative data was generated from a questionnaire assessing the learning experience. A statistically significant difference was found between the competence the groups displayed in the three skills sets of checking equipment, airway assessment and the safe/effective use of defibrillator at ILS level, and PULSE was positively evaluated as an educational tool when used alongside traditional life support training.

Emergency care of the patient with subarachnoid haemorrhage.

Subarachnoid haemorrhage (SAH) is a devastating neurological disorder which frequently leads to serious neurological impairment and is associated with high mortality and morbidity. One in twenty patients who present to emergency care environments with SAH are misdiagnosed. The emergency care environment presents as a challenging setting for the management of the needs of those following SAH, requiring proactive, knowledgeable and holistic care to work effectively within a multidisciplinary context to achieve positive patient outcomes. This article highlights the key aspects of the nurse's role in caring of a patient with a subarachnoid haemorrhage.

Effectiveness and value of massage skills training during pre-registration nurse education.

BACKGROUND: The integration of Complementary and alternative medicine (CAM) interventions into healthcare practices is becoming more popular and frequently accessed by patients. Various disciplines have integrated CAM techniques education into the preparation of their practitioners in response to this, but this varies widely, as does its success. Students'experiences of such education in pre-registration is largely unknown in the UK, and methods by which to successful achieve effective learning within this arena are largely unreported within the literature. AIMS AND OBJECTIVES: This study highlighted three specifics aims; to examine the perspectives of pre-registration nursing students on being taught massage skills during pre-registration nurse education; to identify the learning and development that occurs during massage skills training; and to identify methods of enhancing the provision of such skills training and its experience. CONCLUSION: This paper demonstrates the value of integrating complementary therapies into nurse education, developing the holistic approach of student nurses and their concept of caring. In addition it contributes significantly to the knowledge base of the effectiveness of the value of CAM education in nurse preparation, highlighting the high value students place on CAM education and demonstrating notable development in the preparation of holistic practitioners. The method utilised also yielded ways to improve the delivery of such education, and demonstrates how creative teaching methods can motivate and enhance effective learning.

Management of fluid and hydration in patients with acute subarachnoid haemorrhage - an action research project.

BACKGROUND: The contemporary role of the nurse in managing fluid and hydration in patients is currently ill-defined. Considering the pivotal function nurses have in the delivery of fluid therapies, and the high priority such therapies have in the successful treatment and prevention of secondary brain injury in subarachnoid haemorrhage, the clarification of this role is essential. AIMS AND OBJECTIVES: This research aims to clarify the nurse's role in fluid therapies in relation to subarachnoid haemorrhage. The objectives were to determine how nurses presently see their role in relation to fluid management in patients with subarachnoid haemorrhage, to determine the cues to guide their practice, and how this role corresponds to current patient care. A final objective was to identify how the nurse's role can be maximized to provide optimal patient care. METHODOLOGICAL DESIGN: This project takes an action research approach to examining the nurse's role in the care of patients with subarachnoid haemorrhage. A combination of focus groups, physiological data, nursing and medical documentation and a review of recent literature were used to meet the aims and objectives of the project. RESULTS: The results illustrate that, while nurses involved in the study are knowledgeable about fluid and hydration in subarachnoid haemorrhage, they have an ambiguity surrounding their role. Improvements can be made in the quality of patient care through educational sessions for staff and clarification of medical and nursing interdisciplinary roles. CONCLUSION: This action research project has gone a considerable distance towards begin clarifying this role, and has illustrated clearly that the nurse's role is pivotal to the successful implementation of such treatments. With further education and collaboration with the interdisciplinary team the nurses' role can be expanded to provide optimal, and dynamic patient-centred care. RELEVANCE TO CLINICAL PRACTICE: The results of this study highlight gaps within contemporary nursing and medical approaches to patients with subarachnoid haemorrhage, highlighting areas for improvement. It also begins to clarify the role of the nurse, with evidence of the cues they use to guide their practice.

Subarachnoid haemorrhage and vasospasm: using physiological theory to generate nursing interventions.

Caring for critically ill patients with a subarachnoid haemorrhage and preventing its most prevalent and devastating complication, vasospasm, requires an in-depth understanding of the mechanisms which underpin the physiology of SAH. This is essential to provide appropriate nursing practice derived from theory. All too often practitioners are asked to follow unsubstantiated regimes without question of the origins of practices. This paper approaches the physiological theory underpinning the mechanisms surrounding subarachnoid haemorrhage and the altered cerebral and extracerebral dysfunction which can occur. Physiological theory is analysed to generate nursing interventions which may be individually tailored to provide comprehensive nursing care with a sound underpinning to its practice. The foundations of effective management of SAH lies within prevention, early diagnosis, and correction of complications [Neurosurg. Clin. North Am. 9 (3) (1998) 595]. In order for such identification to take place, it is essential to have an understanding of the physiological theory that underpins the basis of care interventions. These interventions should compliment all other theoretical input that influences patient care and nursing practice, contributing to a holistic, dynamically formulated plan of care.