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.

Neurological patient and informal caregiver quality of life, and caregiver burden: A cross-sectional study of postdischarge community neurological nursing recipients

BACKGROUND

Neurological conditions produce considerable disease burden.

AIMS

To describe quality of life in patients with neurological conditions and informal caregivers receiving postdischarge generic community neurological nursing services, and caregiver burden.

METHOD

A descriptive cross-sectional design was used with researchers administering the WHOQOL-BREF Australian Version questionnaire and Zarit Burden Interview.

RESULTS

Most patients and caregivers rated quality of life as 'Good'. The patients' physical, psychological and environment domain scores, and caregivers' physical domain scores, were below norms. Half of the caregivers experienced burden and 42% had risk for depression.

CONCLUSION

A heterogeneous group of patients with neurological conditions had considerable care and support needs for fundamental functioning postdischarge. Quality of life and caregiver burden measures highlight the impact of their circumstances on their health and wellbeing. Research is warranted to determine a comprehensive set of generic needs to guide integrated community nursing services for building patient and caregiver self-management capacity.

Caring for Traumatic Brain Injury Patients: Australian Nursing Perspectives

Each year, millions of people suffer traumatic brain injury (TBI). It is not inherent to any country or group of people. It occurs as a result of falls, combat situations, sports injury, schoolyard playgrounds, and car accidents. It does not discriminate with age or status. Cost implications for health care settings and individuals are substantial. Management requires prompt neurologic assessment by a highly specialized multidisciplinary team of neuroscience practitioners. It is important to understand normal brain anatomy and physiology to identify what is unusual or abnormal. Keen observational skills and constant questioning aid in early detection of neurologic deterioration.

Care of the Patient with Acquired Brain Injury in Latin America and the Caribbean

Traumatic brain injury and stroke are the leading causes of death and disability in Latin American and Caribbean countries. Specific characteristics, models of health care systems, and risk factors may influence the patient's outcome in this region. Relevant literature suggest that important delay problems exist in seeking care, reaching care, and receiving care in patients with acute neurologic injuries. Minimizing the time lost before care can be provided are vital to reduce the morbidity, long-term disability, and improved survival.

Delirium prevalence and prevention in patients with acute brain injury: A prospective before-and-after intervention study

OBJECTIVES

Knowledge regarding delirium prevention in patients with acute brain injury remains limited. We tested the hypothesis that an intervention bundle which targeted sedation, sleep, pain, and mobilisation would reduce delirium in patients with acute brain injury.

DESIGN

A prospective before-after intervention study: a five-month phase of standard care was followed by a six-month intervention phase.

SETTING

The neuro-intensive care unit, University Hospital of Copenhagen, Denmark.

MAIN OUTCOME MEASURES

The Intensive Care Delirium Screening Checklist was used to detect delirium. Primary outcome was delirium duration; secondary outcomes were delirium prevalence, ICU length of stay and one year mortality.

RESULTS

Forty-four patients were included during the standard care phase, and 50 during the intervention phase. Delirium was present in 90% of patients in the standard care group and 88% in the intervention group (p = 1.0), and time with delirium was 4 days vs 3.5 days (p = 0.26), respectively. Also, ICU length of stay (13 vs. 10.5 days (p = 0.4)) and the one year mortality (21% vs 12% (p = 0.38))) were similar between groups.

CONCLUSION

We found a high prevalence of delirium in patients with acute brain injury. The intervention bundle did not significantly reduce prevalence or duration of delirium, ICU length of stay or one year mortality.

The Projected Care Trajectory for Persons with Epilepsy

Epilepsy is a complex neurologic disease that requires both medical management and self-management. People with epilepsy and their families complete many transitions throughout the health care system in managing this disease. This article reviews key transitions for people with epilepsy and discusses strategies for improving these transitions.

[External lumbar drainage with volumetric continuing infusion pump in patients with cerebrospinal fluid leak. A case series]

OBJECTIVE

To describe the incidence and complications arising in a number of cases of patients with cerebrospinal fluid leak treated by external lumbar drainage with infusion pump (IP) volumetric continuous from 2001 to 2014. Quantify cerebrospinal fluid leak closed by lumbar drainage with IP.

METHODS

Retrospective descriptive case series study.

POPULATION

patients undergoing transsphenoidal pituitary surgery, Chiari surgery and laminectomy, that developed postoperative cerebrospinal fluid leak treated with continuous external lumbar drainage by IP.

VARIABLES

age, sex, type of intervention, variables related to the practice of the pump and complications. Average and medians were calculated for quantitative variables, frequencies and percentages for qualitative.

RESULTS

Sample: 11 subjects. Incidence in running IP: disconnection, occlusion and acoustic alarm activation. Most frequently complication is headache; a case of pneumocephalus.

DISCUSSION

The small number of subjects and the heterogeneity of these do not allow for comparison or establishing associations between variables. The resolution of the cerebrospinal fluid leak with continuous IP is lower in this study than others, and may be influenced by the small number of subjects. It should be noted the frequent activation of the pump alarm for no apparent cause.

IMPLICATIONS FOR PRACTICE

Protocol would be developed for preparing the IP team to reduce the acoustic alarm activation, and would make a prospective multicenter study.