Given the brain's capacity to recover from injury, plasticity may be enhanced following cerebral ischemia through environmental manipulation. Thus, the purpose of this study was to (1) determine the effects of early exposure to an enriched environment following ischemia on functional plasticity and (2) examine the relationship between morphological and behavioral plasticity. Adult female rats (n = 38) were divided into ischemia and control groups. Each group was further randomized to either standard (SC) or enriched conditions (EC). After 4 days of environmental exposure, rats were tested for 6 days in the water maze. Control and ischemia rats exposed to EC have increased total dendritic length (P < 0.05) as well as increased number of dendritic segments in the apical (P < 0.05) region of the hippocampal area compared to those housed in SC; furthermore, increased dendritic spine density in the apical (P < 0.05) region was also seen. Behavioral testing showed that ischemia rats exposed to SC have longer swim latencies (P < 0.05) and greater directional heading errors (P < 0.05) than ischemic rats exposed to EC; the latter group performed similar to controls. It is concluded that EC may be a potentially useful therapy in the recovery of spatial memory impairments seen after ischemia.

CA1 neurons in the hippocampus, a brain structure involved in learning and memory, are selectively vulnerable to ischemic effects. In this study, the authors examined if duration of ischemia is directly related to extent of CA1 damage and degree of spatial learning deficit. Adult female Wistar rats received either 5-min or 10-min ischemia or sham surgery. Following recovery, rats were tested in the Morris water maze. Histological analysis showed moderate cell loss in CA1 (31%) and CA3 (12%) and minimal cell loss in CA2 (4%) with 5-min ischemia. Increased cell loss was seen in CA1 (68%), CA2 (16%), and CA3 (23%) with 10-min ischemia. Behavioral testing revealed that animals with 10-min ischemia have greater spatial learning deficits and they remain impaired across the test days compared to the 5-min ischemic group. Furthermore, degree of CA1 cell loss accounted for approximately 45% of the variance in spatial learning deficits in the ischemic group. The authors conclude that cell loss is largely confined to CA1 region in rats who received 5 and 10 min of ischemia and that increased ischemic duration results in persistent learning deficits in female rats; also, the degree of behavioral impairment is related to extent of CA1 cell loss.

Hospitalization in a critical care setting has multiple effects on patients and their families. For patients, it can be a frightening and dehumanizing experience, while families are confronted with stressors that can disrupt normal family functioning. The nurse is the pivotal figure in the health care system who can positively affect family coping through the support offered. With family needs met, they are then strengthened and able to support their family member. This article examines the roles and relationships of families, social support systems, and nurses. Through the framework of social support, nurses provide emotional, instrumental, spiritual, and appraisal assistances to families. This can potentially positively affect the family’s adaptation to a stressful situation, and thus the family’s ability to provide support to the patient. A case study analysis is described to illustrate the interactions and interventions through a model of family support

Although care of the family has long been a focus of nursing, there has been an increased emphasis in recent years to provide opportunities for families to be an integral part of the hospitalization experience. This has been difficult for many nurses who perceive themselves as competent to care for a patient in “medical crisis” but feel unqualified to provide family care. This article will address issues related to implementing a family-centered philosophy of care in a critical care unit. Implementation strategies that will be discussed include: formulating a staff-led family support group and family committee, instituting a family visitation contract within open visitation parameters, and developing clinicians with expertise in family care. Tools such as a performance plan for a Clinical Nurse II specializing in family care and the family visitation contract will be shared

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