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The changing health care environment has challenged nurses to develop creative care delivery systems that provide for quality, comprehensive, cost-effective care in a time of restricted reimbursement and diminishing human and material resources. Nursing case management has been identified as one such approach to health care delivery that has resulted in quality, patient-centered care and improved resource utilization. The case management plan, critical path and discharge planning sheet are primary tools in this care delivery model. Because of the diverse case types and variety of patient care settings, neuroscience nursing is an ideal arena for implementing a nursing case management model of care.
Neurological illness often influences the patient's behavior either as a direct result of trauma or due to pathophysiological changes to the brain. Neurological patients also experience psychological responses to their illness resulting in a heightened potential for a dual impact on behavior. The neuropsychiatric nurse provides care to patients with severe or unusually persistent behavioral manifestations of illness. Neurologic, psychiatric, cognitive and functional assessments are completed by the neuropsychiatric nurse to obtain an accurate picture of the behavioral problem. Nursing interventions are then developed to improve functional ability and promote independence. If a neuropsychiatric nurse is not available many of these assessment skills can be employed by neuroscience nurses and implemented on neurological and neurosurgical units.
Nurse case managers are becoming more visible within the nursing profession. Practice settings range from acute care to independent companies developed for the purpose of case management. In each area, the development of a more autonomous nurse is emphasized. Neuroscience nurses are particularly suited for the role of case manager since their patients often require extensive rehabilitation and nursing care. As patients face earlier discharges, neuroscience case managers will be the link to vital resources in what is now an often fragmented system of care.
This study examined trends in neuroscience nursing research from 1960 to 1988. The review was an extension of a study analyzing trends in cardiovascular nursing from 1960 to 1985. Four questions (similar to those developed by Yarcheski regarding elements essential to development of a scientific base) framed the present analysis of neuroscience nursing research studies. The sampling frame for the study consisted of four journals: Nursing Research, 1960-1988; Western Journal of Nursing Research, 1979-1988; Research in Nursing and Health, 1978-1988; Journal of Neurosurgical Nursing, 1969-1985; and Journal of Neuroscience Nursing, 1986-1988. These journals were canvassed for studies meeting specified criteria as neuroscience nursing research studies. A total of 71 studies meeting the stated criteria were included in the final sample and reviewed in a systematic manner to identify such characteristics as variables measured, type of approach to theory development, type of research design, number and type of subjects, data analysis procedures, interpretation and conclusions of the study. Findings of the study indicate there has been a substantial increase in the number of neuroscience studies conducted and reported by nurses and an increase in the number of principal authors with advanced degrees. The orientation of studies has shifted from chronic care or rehabilitation to acute care research. An absence of studies about prevention of head and spinal cord injury was noted. Although a trend toward the theory-then-research approach was detected, the research-then-theory approach has been and continues to be the primary strategy for the development of a body of scientific knowledge. It is possible that clinical nurses are using research more frequently to solve problems. Finally, the scientific methods employed in this group of studies have become more complex and varied over time.
Patients with neuroscience problems offer a wealth of data that can be collected as part of a research study. However, these patients are vulnerable to misunderstanding research purposes and procedures. They are also at risk for feeling pressured to participate in a study if they think it will make them recover or survive. In many instances, these neuroscience problems are devastating and even life-threatening. Because of the vulnerability of these patients, it is the responsibility of the neuroscience nurse to care for and also protect these patients. Therefore, it is incumbent upon nursing personnel to protect these vulnerable patients when they participate in nursing research studies.
This survey identified and described the characteristics and perceptions of neuroscience nurses as well as the basic and master's level curriculum relating to neuroscience theory and clinical components. The major sources of stress as perceived by neuroscience nurses were identified, categorized and prioritized in accordance with their present roles. The information in this survey can be used to guide future studies on neuroscience nurses. More must be learned about the neuroscience nurse so that nurse educators and administrators can provide the necessary resources to facilitate learning and coping. This is essential to insure the provision of high standards of patient care.
A task force appointed by the American Board of Neuroscience Nursing conducted a role delineation study to define current practice in neuroscience nursing. The results were used to validate the content matrix for future Certified Neuroscience Registered Nurse (CNRN) examinations. The study employed a survey design for which the Nursing Intervention Classification taxonomy was the guiding theoretical framework. The eligible sample included all current CNRNs and all members of the American Association of Neuroscience Nursing. An invitation to participate in an online survey was successfully emailed to 2,462 neuroscience nurses; the survey was completed by 477 respondents. They rated the performance and importance of 175 neuroscience nursing activities. On the basis of data analysis conducted by Schroeder Measurement Technologies, Inc., the task force recommended revisions to the CNRN examination matrix to reflect current practice in neuroscience nursing.
On the pediatric neurosciences unit of British Columbia's Children's Hospital we are in the throes of a nursing staff crisis. In the last year alone we hired ten new graduates to work as casuals on our unit. With a two and a half day hospital orientation, five preceptor shifts, and a Competency Based Education Plan in hand, we send them off to the trenches. We know these nurses have little nursing experience and even less Neuroscience nursing experience. Yet, we expect them to care for patients and families whose problems they may not understand. For a preceptor, and senior colleague, this is a disturbing situation. We recognize that in their orientation shifts they have not even begun to experience the challenges of a Neuroscience unit. Have they cared for a child who has had a postoperative laminectomy? Do they recognize subtle seizures? Have they sat with a family who have just learned that their child has a brain tumor? No. We expect them to care for patients and families with minimal support. This is the reality of nursing today. Many of us pride ourselves on being committed pediatric Neuroscience nurses. Our physicians rely upon our assessment skills and they trust our intuition! We believe we have earned that trust. How can we convey our enthusiasm and excitement to our perceptees so they are motivated to stay and become experienced pediatric Neuroscience nurses? In this presentation we outline our paper to remedy this situation.
Neuroscience nursing practice in the 21st century is considered from two perspectives: 1) scope of care and roles within a collaborative interdisciplinary model of care; and 2) patient-focused care within the challenging health care system. The implications of illness trends for neuroscience nursing practice are discussed, as are the developing changes in the health care delivery system driven by economics. The article focuses on the futuristic role of disease management in shaping practice and the models for practice which will prevail in this new health care environment.
This article describes the evaluation of the Neuroscience Nurse Internship Program (NNIP). The NNIP was initiated in 1988 by the National Institutes of Health Clinical Center to meet the demand for highly skilled nurses to care for persons with nervous system disorders. To determine whether the program was meeting its goals, an evaluation component was incorporated into the program. The evaluation process was based on the RSA Model of Continuing Education for nursing. The RSA model consists of four basic components, three of which were included in the assessment of the NNIP--process, content, and outcome. The evaluation revealed that the nurse-interns were satisfied with the lectures and clinical content of the program. Moreover, the nurse-interns improved their knowledge of neuroscience nursing and their confidence in performing neuroscience nursing skills. Information from the evaluation was used to modify the structure of the program and to refine lecture content and clinical requirements.
An instrument for assessing nurses' perceived self-efficacy in implementing a variety of neuroscience nursing tasks was developed. Self-efficacy theory served as the guiding framework. From 1988 to 1998, the instrument was used to assess changes in the perceived self-efficacy of 54 nurses who attended a neuroscience nurse-internship program. Self-efficacy was assessed during clinical orientation, prior to the beginning of the program, and at the end of the program. The results showed that the nurses' confidence in performing a variety of neuroscience nursing skills increased during the 6- to 10-month program. The instrument was also useful in helping program directors identify areas in which nurses could benefit most from the program and refine the program to meet the educational needs of the nurses.
The role of neuroscience nurses in relation to ethical issues has become increasingly complex. Knowledge of ethical principles and theories assists the nurse in the development of a theoretical basis for resolution of ethical issues or concerns. Additionally, the nurse must possess information regarding practice codes or standards as well as legislative requirements. The nurse must act as an advocate for the patient and society through active participation in institutional ethics committees and legislative forums.
Research-related activities in neuroscience nursing have increased. Clinical nursing research studies initiated and conducted by the practicing professional, however, have been limited. This paper explores potential areas for research, identifies cues to researchable problems, and describes the criteria by which researchable problems in neuroscience nursing are assessed.
The purpose of this study was to extend a previous evaluation of neuroscience nursing research to an assessment of the research published during the 1990s--the Decade of the Brain. The evaluation was conducted to assess the focus of neuroscience nursing research and to identify research strategies and scientific methods. The Journal of Neuroscience Nursing, Nursing Research, Research in Nursing & Health, and Western Journal of Nursing Research were canvassed. An assessment form developed by the authors was used to evaluate selected articles published between January 1989 and December 2000. The number of neuroscience research studies published in nursing journals increased substantially during the 1990s. The studies focused more on individuals with neurological disorders and less on neurological trauma. The findings demonstrated major changes in subspecialty area, care orientation, and nature of study variables from that observed in the previous evaluation in which acute care and physiological variables were most representative of the pre-1989 studies. As noted in the previous evaluation, the trend toward theory-then-research studies continued and the scientific methods grew more complex.
Writing a research proposal for a neuroscience nursing research project is much the same as writing a proposal for any other kind of research project. The same information is included in all proposals. Differences for the neuroscience nurse researcher include the nature of problems investigated (effects of various nursing care strategies on intracranial pressure, for example) and the nature of the target population, many of whom are cognitively impaired, very ill or both. More time may be involved in the collection of data from neurologically impaired persons than from normal persons.
Participation in clinical drug trials is becoming a common expectation of many neuroscience nurses. Prior to assuming responsibilities associated with a research study, the roles, rights and responsibilities involved must be thoroughly understood. The effective neuroscience nurse brings to the research arena a thorough knowledge of the drug under study, outstanding skills as a clinician and a commitment to ensure the safety and comfort of the participant as the search is made for better and more effective drug regimens.
To fulfill social contracts to those suffering from neurological disease or trauma and to thrive as professionals, neuroscience nurses must enter the political arena. To do so requires an understanding of policy, politics, and policymaking in our society. Social changes affecting neuroscience nursing, including increases in the aged and in minority populations and changes in state and local health care policies are discussed. Ways for neuroscience nurses to become politically active are presented.