The Glasgow Coma Scale and evidence‐informed practice: a critical review of where we are and where we need to be

Braine, Mary E; Cook, Neal F.

doi:10.1111/jocn.13390

Cited by 30 publications

(34 citation statements)

References 84 publications

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“…Several respondents cited the rationale for their practice as stemming from being taught to practise in this way or because of local policy/guidelines. Given that Braine and Cook (2016) highlighted the ambiguity in guidelines and education, the disparity of practices found in this study is unsurprising. Combined, the lack of education, or indeed evidence-informed education, alongside the absence of clear, unambiguous, evidence-informed guidelines for use of the GCS has contributed to the current situation.…”

Section: Discussionmentioning

confidence: 84%

“…In descending order of worsening function, one of five responses is recorded on the GCS: • No movement at all. Heron, Davie, Gillies, and Courtney (2001), Barlow (2012) and Braine and Cook (2016) argue that the application of a noxious stimulus is the most controversial issue in using the GCS. The most appropriate method to apply a noxious or painful stimulus is not only controversial but is often the cause of much confusion for clinicians in terms of interpreting the response.…”

Section: Liter Ature Re Vie W/backg Roundmentioning

confidence: 99%

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Nurses' understanding and experience of applying painful stimuli when assessing components of the Glasgow Coma Scale

Cook

Braine

Trout

2019

Journal of Clinical Nursing

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Aims and objectives To evaluate nurses' application, understanding and experience of applying painful stimuli when assessing components of the Glasgow Coma Scale. Background The Glasgow Coma Scale has been subjected to much scrutiny and debate since its publication in 1974. However, criticism, confusion and misunderstandings in relation to the use of painful stimuli and its application remain. An absence of evidence‐informed guidance on the use and duration of application of painful stimuli remains, with the potential to negatively impact on decision‐making, delay responsiveness to neurological deterioration and result in adverse incidents. Design and Methods This international study used an online self‐reported survey design to ascertain neuroscience nurses' perceptions and experiences around the application of painful stimuli as part of a GCS assessment (n = 273). The STROBE checklist was used. Results Data revealed varied practices and a sense of confusion from participants. Anatomical sites for the assessment of pain varied, but most respondents identified the trapezius grip/pinch in assessing eye‐opening and motor responses. Most respondents identified they assess eye‐opening and motor responses together and apply pain for <6 s to elicit a response. Witnessed complications secondary to applying a painful stimulus were varied and of concern. Conclusion Neuroscience nurses in this study clearly required evidence‐informed guidelines to underpin practice both in applying painful stimuli and in managing the experience of the person in their care and the family response. A standardised approach to education is necessary to ensure greater interrater reliability of assessment not only within nursing but across professions. Relevance to practice Results of this study illustrate inconsistency and confusion when using the Glasgow Coma Scale in practice; this has the potential to compromise care. Clarity around the issues highlighted is necessary. Moreover, these results can inform future guidelines and education required for supporting nurses in practice.

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Section: Discussionmentioning

confidence: 84%

Section: Liter Ature Re Vie W/backg Roundmentioning

confidence: 99%

Nurses' understanding and experience of applying painful stimuli when assessing components of the Glasgow Coma Scale

Cook

Braine

Trout

2019

Journal of Clinical Nursing

View full text Add to dashboard Cite

show abstract

“…I undersøkelsen ble pasienter med intoksikasjon forårsaket av ulike substanser og varierende grad av bevissthet inkludert. Det advares mot å sette for mye lit til GCS på intoksikasjonspasienter fordi alkohol og narkotiske substanser påvirker bevissthetsnivået til pasienten (17).…”

Section: Resultaterunclassified

“…Lav GCS kan ta oppmerksomheten bort fra symptomer på hypoksi, sepsis og septisk sjokk fordi man antar at GCS-en er lav på grunn av intoksikasjonen (17). Sedasjon og smertestillende påvirker pasientens bevissthetsnivå og vanskeliggjør bruken av GCS som verktøy (8).…”

Section: Diskusjonunclassified

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Glasgow Coma Scale: Sykepleieres vurdering av bevissthetsnivå etter akutt forgiftning varierer

Helme¹

2018

Sykepleien

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BrainGain: A Technological Approach for Increasing Consciousness in Coma Patients

Pinto,

Gouveia

2024

Lecture Notes of the Institute for Computer Sciences, Social Informatics and Telecommunications Engineering

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The Glasgow Coma Scale and evidence‐informed practice: a critical review of where we are and where we need to be

Abstract: The evidence illustrates inconsistency and confusion in the use of the Glasgow Coma Scale in practice; this has the potential to compromise care and clarity around the issues is therefore necessary.

Cited by 30 publications

References 84 publications

Nurses' understanding and experience of applying painful stimuli when assessing components of the Glasgow Coma Scale

Nurses' understanding and experience of applying painful stimuli when assessing components of the Glasgow Coma Scale

Glasgow Coma Scale: Sykepleieres vurdering av bevissthetsnivå etter akutt forgiftning varierer

BrainGain: A Technological Approach for Increasing Consciousness in Coma Patients

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