Comfort nursing theory on the postoperative rehabilitation quality and nursing satisfaction of patients with intracranial aneurysm.

To explore the influence of comfort nursing theory on the postoperative rehabilitation quality of patients with intracranial aneurysms. From October 2017 to December 2022, 315 patients with intracranial aneurysms underwent interventional surgery in our hospital were included in this retrospective study and divided into the routine group (n = 105) and comfort nursing group (n = 210) based on different nursing methods. The Glasgow Outcome Scale (GOS) was used to assess patient rehabilitation outcomes. Patients' anxiety, pain, quality of life, and their satisfaction with treatment were compared. Compared with the patients receiving routine nursing, the time for comfortable nursing patients to resume normal diet, get out of bed and exercise, and the total hospital stay were significantly shortened. And the GOS score of patients receiving comfort nursing was significantly higher than that of patients receiving routine nursing. After nursing, self-rating anxiety scale and visual analog scale scores of comfortable nursing patients were significantly lower than those of routine nursing, and Karnofsky performance status scores were significantly higher than those of routine nursing. This showed that receiving comfortable nursing was beneficial to improve perioperative anxiety and depression in patients with intracranial aneurysm, and significantly improve the quality of life of patients. The total satisfaction of comfortable nursing patients was 95.24%, while that of routine nursing patients was 76.19%. Complications occurred in 30 patients receiving routine nursing, while only 15 patients received comfort nursing. The immune indexes such as CD3+, CD4+, and CD23+ of comfortable nursing patients were significantly higher than the routine nursing patients within 1 and 5 days after operation, while the immune indexes of CD8+ were lower than the routine nursing patients 5 days after operation. Comfortable nursing from the perspective of quality nursing can significantly improve the physiological indicators of patients with intracranial aneurysms, accelerate the progress of postoperative rehabilitation, improve the anxiety, pain and quality of life of patients, and improve the satisfaction of patients with nursing. Comfort nursing from the perspective of quality nursing can reduce the occurrence of postoperative complications, which may be achieved by improving the patient's immune function.

Noise Reduction Nursing in a Noisy Ward Environment Effectively Improves the Mental and Physical Health of Patients Who Underwent Intracranial Aneurysm Embolization: A Retrospective Study.

OBJECTIVE: This study aims to investigate the impact of noise reduction nursing in ward on patients who underwent intracranial aneurysm embolization. METHODS: Between April 2020 and March 2021, Funan County People's Hospital implemented standard nursing care for patients who underwent intracranial aneurysm embolization, comprising 55 patients admitted during this period, constituting the control group. Subsequently, from April 2021 to March 2022, the hospital introduced noise reduction nursing measures in wards. A total of 65 patients admitted during this period were included in the study group. Data on noise levels, emotional states, and sleep statuses were collected from both groups. The comprehensive impact of noise reduction nursing on the mental and physical health of patients who underwent intracranial aneurysm embolization was evaluated. RESULTS: Before propensity score matching (PSM), significant differences were observed in age and intracranial aneurysm diameter between the two groups (P < 0.05). However, following PSM, a total of 102 patients were included in the analysis, and no significant differences in baseline data were observed between the two groups (P > 0.05). The noise level in the study group's ward was significantly lower than that in the control group (P < 0.05). In addition, post-management, the study group exhibited lower Self-rating Anxiety Scale scores and total scores of Pittsburgh Sleep Quality Index compared with the control group. Moreover, the Glasgow Coma Scale score was higher in the study group, demonstrating statistical significance (P < 0.05). CONCLUSION: The implementation of noise reduction nursing in wards effectively controls ward noise levels and improves negative mood and sleep quality among patients who underwent intracranial aneurysm embolization. These findings indicate that noise reduction nursing facilitates postoperative rehabilitation and enhances patient outcomes.

Application of inter-professional care model in patients with aneurysmal subarachnoid haemorrhage.

OBJECTIVE: To explore the feasibility and effect of the inter-professional care model in patients with aneurysmal subarachnoid haemorrhage. METHODS: A convenient sampling method was used to recruit inpatients of a hospital as subjects from July 2016 to July 2018. According to the even/odd attribute of admission number, subjects were divided into a control group and an observation group. The number of recruited subjects was 311: the control group comprised 135 participants and the observation group 176. The average length of hospital stay, hospital fees, quality of life, and satisfaction with the quality of nursing were compared between the two groups. SPIRIT checklist was completed (see File S1). RESULTS: After intervention, patients in the observation group had shorter average hospital stay (15.98 ± 2.7), lower hospital fees (81,018 ± 1.3), higher satisfaction with the quality of nursing (98.3%), lower incidence of complications (19.89%), improved ability to perform activities of daily living, and lower rate of disease outcome and re-admission, with statistically significant differences from the control group (p < .05). CONCLUSION: The application of inter-professional care model in single disease patients with aneurysmal subarachnoid haemorrhage can shorten the average hospital stay, reduce hospital fees, improve the quality of life of patients, and increase patients' satisfaction with the quality of nursing, which is worthy of clinical promotion and application. IMPLICATIONS FOR NURSING MANAGEMENT SECTION: Nursing managers can use this model to improve the ability to ensure coordination between medical professionals and integrate the ability of nursing problems, the ability to make rational distribution of nursing human resources, and the ability of critical thinking. It can be used as reference to improve the nursing management of all kinds of single diseases.

Cerebral Mycotic Aneurysm and Infective Endocarditis: A Case Study.

Neurologic complications occur in 20%-40% of patients with infective endocarditis. Mycotic aneurysms are one example of these complications, and although rare, they can confound a patient's recovery and increase morbidity and mortality. This article will examine one patient's experience and the devastating effects that this complication had on his life. The information in this article will help to support neurological nurses in refining care and facilitating the best possible recovery for patients who develop this condition.

Health-Related Quality-of-Life Outcomes: Comparing Patients With Aneurysmal and Nonaneurysmal Subarachnoid Hemorrhage.

Subarachnoid hemorrhage (SAH) is divided into two major types (aneurysmal [ASAH] and nonaneurysmal [NASAH]) because, in approximately 15% of the patients who experience SAH, no source of hemorrhage can be identified. Anecdotal evidence and contradictory research suggest that patients with NASAH experience some of the same health-related quality of life (HRQOL) issues as patients with ASAH. This quantitative survey design study compared 1-3 years after hemorrhage the HRQOL in patients who had experienced an NASAH with those who had experienced an ASAH. This is the first U.S. study to specifically investigate HRQOL in NASAH and the second to compare HRQOL outcomes between patients with ASAH and NASAH. These study results corroborate those of the first-that the two groups are much more similar than different. It confirms that the impact on employment for both hemorrhage groups is significant, and it also finds an even greater inability to return to work for the patients with NASAH. Physical symptom complaints were more common in the group with NASAH, whereas the group with ASAH experienced more emotional symptoms. Both groups had low levels of posttraumatic stress disorder (PTSD), with those levels not differing significantly between groups. However, PTSD and social support were shown to impact HRQOL for both groups. The authors recommend that clinicians assess all patients with SAH for PTSD and institute treatment early. This may include offering psychological services or social work early in the hospital course. Further research and policy changes are needed to assist in interventions that improve vocational reintegration after SAH. Patients with NASAH should no longer be described as having experienced a "benign hemorrhage." They have had a life-changing hemorrhage that may forever change their lives and impact their HRQOL.

Elective endovascular treatment of unruptured intracranial aneurysms: a management case series of patient outcomes after institutional change to admit patients principally to postanesthesia care unit rather than to intensive care.

BACKGROUND: Our intention in this case series was to review the postoperative care and neurologic outcomes of patients who had undergone elective endovascular treatment of unruptured intracranial aneurysms. The case series is unique managerially in that a progressively increasing percentage of patients were admitted to the postanesthesia care unit (PACU; 1:2 nurse-to-patient ratio) and subsequently to the neurosurgical ward (1:3 nurse-to-patient ratio) instead of directly to the intensive care unit (ICU; 1:1 nurse-to-patient ratio). METHODS: A retrospective review was performed of 170 consecutive elective endovascular procedures to treat unruptured intracranial aneurysms between July 2009 and September 2012. Data included patient, aneurysm, procedural characteristics, and adverse events within 96 hours after the procedure. Rates of ICU admission and perioperative neurologic adverse events were compared over time. RESULTS: Although direct ICU admission rates decreased over time (P < 0.0001) from 100% to 15%, perioperative neurologic event rates did not change (P = 0.79). Sixteen of 170 patients experienced perioperative neurologic events. The percentages of patients with neurologic events who died or had deficits that did not resolve before discharge were 38% (3 of 8) among patients directly admitted to the ICU versus 38% (3 of 8) among those first admitted to the PACU. Although the duration of anesthesia was greater among patients admitted to the ICU, duration was not useful in predicting decisions on the day of surgery for individual patients. The duration of anesthesia also was not meaningfully associated with information available preoperatively (i.e., for use when scheduling the case). CONCLUSIONS: In centers in which PACU and ward care are comparable to those in this case series, in the absence of intraoperative events with the potential for ongoing cerebral ischemia, most patients undergoing elective endovascular treatment of unruptured cerebral aneurysms can be managed without direct ICU admission. Scheduling all these procedures by using the mean historical anesthesia duration is reasonable.

[Standardized impartial assessment of pain in unconscious patients with the Zurich Observation Pain Assessment on a neurosurgical intensive care unit - a case report]. / Die standardisierte Fremdeinschätzung von Schmerzen bei bewusstseinsbeeinträchtigten Patienten mit dem Zurich Observation Pain Assessment (ZOPA©) auf einer neurochirurgischen Intensivstation - Eine Fallstudie.

BACKGROUND: International studies show that the majority of patients undergoing treatment in ICUs report moderate to strong levels of pain. It has been established that undetected or insufficiently treated pain can cause severe physical and emotional distress. Therefore, early and effective pain assessment is a primary treatment goal of intensive care, which is a challenge with patients having cognitive impairment. AIM: This article shows how using the Zurich Observation Pain Assessment (ZOPA(©)) as part of a standardized assessment can close this gap. METHOD: An interpretive single case study evaluates the use of ZOPA(©) in nursing practice and its influence on pain management. RESULTS: The study case involved an intensive care patient with a severe subarachnoid haemorrhage for whom a total of 126 single ZOPA(©) assessments were analyzed. A total of 19 assessments showed behavioral characteristics indicative of pain. Immediate interventions to alleviate pain were taken in three quarters of these assessments. The study ICU has used ZOPA(©) for the past five years. This unit has a standard medication procedure, so nurses can administer analgesics on an "as needed" basis and take their responsibility in implementing pain management. CONCLUSION: This study supports the finding that ZOPA(©) can contribute to early and effective detection of pain in cognitively impaired patients, resulting in improved pain treatment.

Cerebral aneurysm and aneurysmal subarachnoid haemorrhage.

A cerebral aneurysm is a weak or thin spot on a blood vessel in the brain that swells and fills with blood. Rupture of a cerebral aneurysm, known as aneurysmal subarachnoid haemorrhage, is a medical emergency and is associated with increased mortality. This article explores the anatomy and physiology of the brain and blood vessels. Current research and guidelines are used to highlight risk factors for cerebral aneurysms and their rupture and to discuss best practice for treating both. The article provides information on the management and complications of the condition, alongside nursing considerations, long-term care, discharge and rehabilitation.

Functional capacity scale in assessment of patients with intracranial aneurysms: reliability and validity.

The aim of the study was to investigate the use of the Functional Capacity Scale (FCS) to measure functional outcome of patients who had undergone surgical removal of an intracranial aneurysm in the early postoperative period. Reliability and validity of the tool were tested as well as its utility in nursing practice. The study included 120 patients, operated on for intracranial aneurysm. Phase I included 23 patients. Reliability of FCS and the amount of time used for the assessment were tested using observation and direct measurement methods. Phase II included 97 patients, and the tool was administered along with standard outcome assessment tools (Barthel Index, Functional Index "Repty," Glasgow Outcome Score, and Rankin Scale) to determine concurrent validity. Kendall's coefficients of concordance (W) between particular care markers of FCS ranged from 0.910 to 1.000. Mean amount of time used for assessment was 90 seconds. Differences between time used for measurements by individual examiners were insignificant (p > .05). Correlation of FCS with the following scales was statistically significant: Functional Index "Repty" (p < .001), Glasgow Outcome Score (p < .01), Rankin Scale (p < .01), and Barthel Index (p < .001). The FCS appears to be a reliable, valid, and practical assessment tool for neuroscience nurses to use with patients who have undergone surgical removal of an intracranial aneurysm.

Recovery and quality of life in patients with ruptured cerebral aneurysms.

PURPOSE: Subarachnoid hemorrhage (SAH) secondary to ruptured cerebral aneurysm is a common and frequently devastating condition with a high mortality and morbidity among survivors. The purpose of this study was to conduct a long-term follow-up of SAH patients, assess the changes in functional outcomes, describe quality of life (QOL), and determine its predictors 3.6 years after the hemorrhage. DESIGN: The study design is an exploratory, descriptive correlational design. METHODS: Results were collected from a sample of 113 SAH survivors treated in our institution over a 2-year period (January 2006 until December 2007). We collected data on early and long-term functional outcomes and compared the differences. The health-related QOL was measured using the Polish version of The Short Form - 36 Health Survey Questionnaire (SF-36v2). Multivariable logistic regression was derived to define independent predictors of the QOL. FINDINGS: The mean follow-up time was 3.6 years. Sixty-six percent of patients had improvement in functional outcomes and among previously employed people 56% returned to work. QOL deteriorated in 24% of patients with the most affected dimension of Physical Role. Factors that predict good QOL are male gender, younger age, good economic/professional status, lack of physical handicaps, rehabilitation in a professional center, subjective improvement in health status, and absence of headaches or physical decline. CONCLUSIONS AND CLINICAL RELEVANCE: Recovery process in SAH patients is dynamic and progresses over time. Since physical handicaps and low economic status significantly reduce the quality of life, an effort should be made to provide intensive rehabilitation and to encourage SAH survivors to return to work.

Management for the case of twice ruptured anterior communicating artery aneurysm: from nursing perspective.

The anterior communicating artery (ACoA) is the most common site of cerebral aneurysms, accounting for as much as 36% of aneurysms. Microsurgical clipping and coil embolization are treatment modalities for ruptured and nonruptured cerebral aneurysms. Compared with surgical clipping, coil embolization has a relatively lower mortality and incidence of cognitive impairment in patients. However, successful management of the patient with twice ruptured ACoA aneurysm is facing critical challenges.This article has described a case of twice ruptured aneurysm with the first rupture occurring when the patient was admitted and the second rupture occurring during coil embolization. Perioperative nursing assessment, monitoring, intervention, patient teaching, and the nurse's role are discussed from a nursing perspective.

Development and validation of a disease-specific scale to assess psychosocial well-being of patients living with unruptured intracranial aneurysm.

Although the detection rate for unruptured intracranial aneurysm (UIA) has improved since the 1990s, the quality of life and psychosocial status of patients living with UIA have been negatively affected. However, a comprehensive assessment tool for UIA patients is still awaited. This study aimed to develop and validate a disease-specific scale to assess UIA patients' psychosocial well-being in their daily lives. On the basis of previous qualitative research, 52 items on a six-dimension scale were generated. After a pilot study, statistical analysis was conducted to examine construct validity-including convergent validity, discriminant and known-group validity, and internal reliability. Between 2010 and 2011, 124 patients across three hospitals in Japan were tested using a tentative scale. As a result of exploratory factor analysis, we identified 25 items based on five conceptually derived dimensions (psychological stability, trust in healthcare resources, satisfaction with the decision-making process, positive perception of self-management, and confidence in UIA knowledge) as a final psychosocial well-being scale for UIA patients (UIA-PW scale). Cronbach's alpha coefficients for each subscale ranged between .76 and .90, with .83 for the total score, which indicated satisfactory internal consistency. The total score for the UIA-PW scale correlated significantly with the existing quality of life and mental health scales, but it is important to note that psychological stability and positive perception of self-management were negatively correlated. Although additional investigation is needed, the UIA-PW scale shows reasonable validity and reliability in assessing psychosocial well-being of patients living with UIA.

Functional capacity of patients in the early period after the embolization of cerebrovascular malformations: preliminary findings.

Research into outcomes of endovascular intervention for cerebral blood vessel malformations has previously focused on the clinical picture of the disease, death rate, comparison of surgical methods, and the most common postoperative and postbleeding complications. From the nursing standpoint, the crucial elements in assessing postoperative patients are functional outcome defining patients' ability to function in life and recognition of impairments in which patients will be dependent on the nursing staff. The aim of the study was to assess functional capacity of patients before and after the embolization of cerebral blood vessel malformations in the aspect of nursing care. The study included 38 patients after embolization of cerebral blood vessels. The assessment of their condition using the Functional Capacity Scale was performed twice: before and after the surgical procedure. The research shows that on the day of admission to hospital, patients had greatest difficulty performing hygienic activities (p < .0001), satisfying physiological needs (p < .0001), and consuming their meals (p < .004). Headache (p < .002) and poor psychological state (p < .0001) manifesting itself through mild depression constituted other serious problems. After the surgery, vast majority of patients were independent in terms of self-care (p ≤ .03). Headache occurred in the case of 21% of patients, and psychological state improved in 34% of patients, which shows that there is a major demand for care in this sphere.

Drug name alert: potential for confusion between pradax and plavix.

In this article, the authors highlight an incident that involved a mix-up between the oral anticoagulant medication Pradax (dabigatran etexilate) and the antiplatelet medication Plavix (clopidogrel). Because critical care nurses may admit or care for patients who are receiving (or have received) one of these medications, it is important that they be aware of the potential for confusion between these two drug names throughout the medication-use process.

Infectious intracranial aneurysms: triage and management.

Infectious intracranial aneurysms are a rare but serious potential complication of subacute endocarditis. Early diagnosis and treatment is essential to prevent devastating neurological deficits and mortality. Because nurse practitioners' roles expand into acute care as well as urgent care settings, they are frequently involved in the care of this population. Identifying the patients at risk, ordering appropriate studies, and initiating goal directed therapy are vital to outcomes. For nurse practitioners who are involved in care of neuroscience populations, it is important to be familiar with disease processes. This article provides a literature review of the topic, explores diagnostic methods, discusses management strategies, and presents an illustrative case.

Length of stay and total hospital charges of clipping versus coiling for ruptured and unruptured adult cerebral aneurysms in the Nationwide Inpatient Sample database 2002 to 2006.

BACKGROUND AND PURPOSE: We have previously reported the difference in length of stay and hospital charges for patients with cerebral aneurysms treated with either clipping or coiling at our institution. We now report an analysis of the same comparison at a national level conducted using the Nationwide Inpatient Sample database. METHODS: We obtained the Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project, Agency for Healthcare Quality and Research. The Nationwide Inpatient Sample is the largest all-payer inpatient care database in the US and represents approximately 20% of all inpatient admissions to US nonfederal hospitals. Hospitalizations for clipping or coiling of ruptured and unruptured cerebral aneurysms from 2002 to 2006 were identified by cross-matching International Classification of Diseases-9 codes for diagnoses of subarachnoid hemorrhage (430) or unruptured cerebral aneurysm (437.3) with procedure codes for clipping (39.51) or coiling (39.79, 39.72, or 39.52) of cerebral aneurysms. Length of hospital stay and total hospital charges for clipping and coiling were compared using linear mixed models adjusted for the following patient and hospital-specific factors: gender, age, race/ethnicity, admission source and type, median income level in patient's postal code of residence, payer for care, comorbidities, and hospital cerebral aneurysm case volume, bed size, teaching status, rural/urban location, and geographic region. RESULTS: There were 9635 hospitalizations for ruptured aneurysm treatments (6019 clipping, 3616 coiling) and 9399 hospitalizations for unruptured aneurysm treatments (4700 clipping, 4699 coiling). For ruptured aneurysm patients, after adjusting for the effects of patient-specific and hospital-specific factors, clipping compared to coiling was associated with significantly longer length of stay (P<0.0001) and significantly higher total hospital charges (P<0.0001). For unruptured aneurysm patients, clipping compared to coiling was associated with significantly longer length of stay (P<0.0001) and significantly higher total hospital charges (P<0.0001). After adjusting for the effects of hospital-level and patient-level characteristics, clipping as compared to coiling was associated with an average of 1.2-times more days in hospitalization for ruptured patients and was associated with an average of 1.8-times more days in hospitalization for unruptured patients. On average, clipping resulted in $15,325 more in total charge for ruptured patients and resulted in $11,263 more in total charge for unruptured patients after considering all relevant hospital and patient characteristics. CONCLUSIONS: The results of this nationwide analysis differed from the findings of our single institution study. Clipping compared to coiling was associated with significantly longer lengths of stay and significantly higher total hospital charges for both ruptured and unruptured aneurysm patients.

[Nursing care in patients undergoing interventional neuroendovascular procedures]. / Cuidados de enfermería al paciente sometido a técnicas de neurointervencionismo endovascular.

Vascular interventional radiology (VIR) procedures have increased markedly, partly due to the current healthcare context, which encourages the use of less invasive procedures that reduce pressure on surgery departments and decrease hospital stays. In most patients, these techniques can be carried out in a single intervention. VIR procedures are based on the possibility of gaining access to vascular structures through a catheter inserted percutaneously without the need for open surgery. Due to the complexity of these procedures, hospitalization is required before and after the technique is performed but length of stay is short compared with that associated with surgery. As the health workers closest to patients, nurses must respond to their information needs. The provision of comprehensive nursing care should include all the care required before, during and after the procedure and all aspects related to the quality of the healthcare process. Knowledge of how diagnostic and therapeutic VIR techniques are performed in the neurovascular section is essential. Based on the authors' experience, the present article aims to provide nurses with knowledge of some neurointerventional procedures (cerebral angiography and embolization of intracranial aneurysms) and of the care provided in RVI rooms.

The impact of a highly visible display of cerebral perfusion pressure on outcome in individuals with cerebral aneurysms.

BACKGROUND: Nurses' ability to rapidly detect decreases in cerebral perfusion pressure (CPP), which may contribute to secondary brain injury, may be limited by poor visibility of CPP displays. OBJECTIVE: To evaluate the impact of a highly visible CPP display on the functional outcome in individuals with cerebral aneurysms. METHODS: Patients with cerebral aneurysms (n = 100) who underwent continuous CPP monitoring were enrolled and randomized to beds with or without the additional CPP display. Six-month outcome was assessed. RESULTS: Functional outcome was not significantly different between control and intervention groups after controlling for initial neurologic condition (odds ratio .904, 95% confidence interval 0.317 to 2.573). However, greater time below CPP thresholds (55 to 70 mm Hg) was significantly associated with poorer outcome (P = .005 to .010). CONCLUSIONS: Although the enhanced CPP display was not associated with significantly better outcome, longer periods of CPP below set levels were associated with poorer outcome.