Coordinated care for the neuroscience patient: future directions.

A coordinated care model was developed on a neuroscience unit to achieve positive outcomes in a cost-effective environment. This included the development of a patient care coordinator (PCC) role, critical paths and a system for variance tracking. The PCC was responsible for coordinating care of patients and ensuring that patients progressed toward expected outcomes. Multidisciplinary critical paths were developed for four medical diagnoses. To evaluate the effectiveness of the program, an analysis of length of stay data, cost comparison, patient and staff satisfaction, and variance reports of one critical path, the microvascular decompression for trigeminal neuralgia were completed. Results from the pilot project were positive and provided valuable information for the use of coordinated care as a hospital-wide patient care delivery model.

A pilot program to promote professional growth for neuroscience nurses.

A pilot program was developed as a strategy to increase professional growth on a neuroscience unit. The primary objective of the program was to allow staff nurses to participate in activities that interface with the neuroscience patient population. Nurses could choose an area of interest that related to their unit responsibilities. This experience provided the participants with the unique opportunity to participate in patient care from the perspective of another discipline. The staff were enthusiastic about the experience and shared it eagerly with their peers. Participants' evaluation of the program was overwhelmingly favorable. The data suggest that this program was an effective means of increasing professional growth and staff development.

The elderly neuroscience patient: implications for the critical care nurse.

The elderly patient may present to the critical care unit with neurologic deficits such as acute confusion, loss of consciousness, or signs of a cerebrovascular accident. Recognizing the normal age-related changes that occur in the nervous system enables the critical care nurse to evaluate the patient's response to neurologic disorders. The normal neurologic changes associated with aging provide implications for assessment, response to the critical care environment, and the time needed for education and rehabilitation. Other changes, especially decreased immunity, malnutrition, and pulmonary and cardiac pathology, significantly increase the risk for morbidity and mortality after an acute neurologic event. Changes in pharmacokinetics and the likelihood of polypharmacy in the older patient greatly increase the risk for complications and side effects of the commonly used treatments. Important elements of nursing management for the elderly neuroscience patient include performing an accurate neurologic assessment, including noting changes in cognition, observing for adverse drug reactions, optimizing ventilation, and maximizing mobility and nutritional status. This article focuses on these aspects of nursing care for the elderly neuroscience patient.

Arnold-Chiari malformation--a closer look.

Arnold-Chiari malformation (ACM) is a malformation of the cervico-medullary junction characterized by displacement of the cerebellar tonsils, the brainstem and the fourth ventricle into the upper cervical canal. The clinical presentation of this anomaly is largely dependent upon age at onset, associated pathology, and the presence of hydromyelia. Considerable controversy exists within the literature concerning pathogenesis, signs and symptoms, diagnosis, and successful treatment of Arnold-Chiari malformation. This article will examine these issues and discuss the nursing management of patients with this syndrome.