Routine Neurological Assessments by Nurses in the Pediatric Intensive Care Unit

Kirschen, Matthew; Lourie, Kristen; Snyder, Megan; Agarwal, Kenya; DiDonato, Pamela; Kraus, Blair; Madu, Chinonyerem; Geddes, Kylie; Davis, Daniela; Wolfe, Heather; Topjian, Alexis

doi:10.4037/ccn2019198

Cited by 8 publications

(10 citation statements)

References 36 publications

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“…These standardised pre-illness Glasgow Coma Scale values are then compared with Glasgow Coma Scale scores obtained during the hospitalisation to assess for deviations from the patient's neurologic baseline. 37 This study had limitations. Surveys were self-reported and represent what providers say they do, but may not accurately reflect actual institutional practice.…”

Section: Discussionmentioning

confidence: 92%

Bedside clinical neurologic assessment utilisation in paediatric cardiac intensive care units

et al. 2018

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IntroductionNeurodevelopmental disabilities in children with CHD can result from neurologic injury sustained in the cardiac ICU when children are at high risk of acute neurologic injury. Physicians typically order and specify frequency for serial bedside nursing clinical neurologic assessments to evaluate patients’ neurologic status.Materials and methodsWe surveyed cardiac ICU physicians to understand how these assessments are performed, and the attitudes of physicians on the utility of these assessments. The survey contained questions regarding assessment elements, assessment frequency, communication of neurologic status changes, and optimisation of assessments.ResultsSurveys were received from 50 institutions, with a response rate of 86%. Routine clinical neurologic assessments were reported to be performed in 94% of institutions and standardised in 56%. Pupillary reflex was the most commonly reported assessment. In all, 77% of institutions used a coma scale, with Glasgow Coma Scale being most common. For patients with acute brain injury, 82% of institutions reported performing assessments hourly, whereas assessment frequency was more variable for low-risk and high-risk patients without overt brain injury. In all, 84% of respondents thought their current practice for assessing and monitoring neurologic status was suboptimal. Only 41% felt that the Glasgow Coma Scale was a valuable tool for assessing neurologic function in the cardiac ICU, and 91% felt that a standardised approach to assessing pre-illness neurologic function would be valuable.ConclusionsRoutine nursing neurologic assessments are conducted in most surveyed paediatric cardiac ICUs, although assessment characteristics vary greatly between institutions. Most clinicians rated current neurologic assessment practices as suboptimal.

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Section: Discussionmentioning

confidence: 92%

Bedside clinical neurologic assessment utilisation in paediatric cardiac intensive care units

et al. 2018

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“…Some previous studies have also highlighted the suboptimal neurological assessment competency in assessing the consciousness level (Brunker & Harris, 2015), cerebellar function (Kim et al, 2016), application of the Glasgow Coma Scale (Waterhouse, 2008), pupil size interpretation (Brunker & Harris, 2015;Kerr et al, 2016), and bedside nursing neurological assessment practice (Kirschen et al, 2018). Standardized practice in the use of assessment scales is needed, because the greatest variation existed in training methods for the use of the instruments (Kirschen et al, 2019;Vink et al, 2018). Nurses have shown low neurological assessment competency because of fragmented curriculum allocations for neurological assessment and neurological disorders (Shin et al, 2017;Zarandona, Hoyos Cillero, & Arrue, 2019 (Dancer, Brown, & Yanase, 2017).…”

Section: Discussionmentioning

confidence: 99%

“…Nurses might find neurological assessment challenging. The reasons for the difficulties in performing neurological assessments include lack of training (Chan et al, Jones, 2018;Zasler, 2015), burden of mastery in performing the complex neurological assessment process (Nye et al, 2012;Rank, 2013), insufficient time and too much documentation (Curley, 2016), unfamiliarity with assessment tools (Iacono et al, 2014;Livesay, 2016;Nye et al, 2012), length of experience in a neuroscience setting and type of clinical discipline (Mattar, Liaw, & Chan, 2013), and unstandardized neurological nursing assessment protocol (Kirschen et al, 2019). Accordingly, it is imperative to develop a continuing education program reflecting the improvement of these barriers.…”

Section: Nurses' Neurological Assessment Competencymentioning

confidence: 99%

“…Training approaches that have been found to be effective in improving nurses' performance of neurological assessment include lectures (Curley, ; Jones, ), e‐learning (Chiu et al, ; Shin, Issenberg, & Roh, ), hospital projects (da P Oliveira, Pereira, & da P Freitas, ; Gocan & Fisher, ; Iacono, Wells, & Mann‐Finnerty, ; Kirschen et al, ), and patient simulations (Garside, Rudd, & Price, ; Mahaffey & Robertson, ; Ross et al, ). The analysis of training needs provides the basis for continuing professional development (Holloway, Arcus, & Orsborn, ).…”

Section: Introductionmentioning

confidence: 99%

“…The protocol includes oxygenation, hyperventilation, circulation, prophylactic therapy for thrombosis, thermoregulation, seizure prophylaxis, and neurological assessment (da P Oliveira et al, ). Kirschen et al () implemented a quality improvement, 1 year intervention that involved a mandatory online learning program, skills fair on neurological assessments, and one‐on‐one bedside education. The results showed that compliance with documentation of neurological assessments significantly increased after intervention among nurses in the pediatric intensive care unit.…”

Section: Introductionmentioning

confidence: 99%

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Training needs analysis of Korean nurses' neurological assessment competency

Bae

Roh

2019

Nursing & Health Sciences

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Despite the importance of neurological assessment, there is a lack of research directed at nurses' competency in performing these assessments. We aimed to identify nurses' competency levels in performing neurological assessments and prioritize their related training needs using importance–performance analysis. This survey research was conducted and reported based on the enhancing the quality and transparency of health research (EQUATOR) guidelines. A total of 213 nurses participated in a descriptive, cross‐sectional survey study. Exploratory factor analysis identified seven factors that together accounted for 70.34% of the variance: cerebral function, signs and symptoms, pathologic reflexes, motor strength, assessment of an unconscious patient, reporting and documentation, and neurological assessment scales. [Correction added on 10 February 2020, after first online publication: the value of the variance has been corrected from ‘7.34%’ to ‘70.34%’ in the preceding sentence.] There were significant gaps between importance and performance for all seven factors. The importance–performance matrix identified the neurological assessment scales factor as a high priority for continuing education. Emergency department nurses reported lower neurological assessment competency when compared with ward and intensive care unit nurses. The analysis of training needs is beneficial for developing programs to enhance neurological assessment competency. Training in neurological assessment scales is a priority for nurses, and they prefer simulation‐ and practicum‐based methods.

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