Showing papers in "Journal of Neuroscience Nursing in 2004"

Time and difficulty of tasks provided by family caregivers of stroke survivors.

Abstract: Family caregivers of stroke survivors are at risk for negative health outcomes such as depression, psychosocial impairments, and even mortality as a result of providing care. Shortened hospital stays have contributed to the urgent need for caregivers to manage difficult and time-consuming tasks required for the care of stroke survivors in the home setting. The purposes of this study were to (a) identify which tasks were perceived as most time-consuming and difficult, (b) determine which of these tasks were most predictive of mood and other negative caregiver outcomes, and (c) evaluate the psychometric properties of the Oberst Caregiving Burden Scale (OCBS) as a measure of tasks in stroke caregivers. A cross-sectional design was employed using mailed questionnaires from 116 family caregivers of stroke survivors featuring the OCBS, the Profile of Mood States Short Form, and the Bakas Caregiving Outcomes Scale. The tasks perceived as most time-consuming and difficult, which also were predictive of mood and other negative caregiver outcomes, were managing finances, managing behaviors, and providing emotional support. Strong psychometric properties of the OCBS were found at both item and subscale levels. Developing an individual profile using the OCBS items may help to target individual support interventions for caregivers. Suggested interventions include referring caregivers to resources for tasks that fall outside the scope of nursing practice, supporting caregivers with tasks such as providing emotional support or managing behavioral problems, and encouraging caregivers to seek care for their own physical, emotional, or social needs.

Comparison of brain temperature to core temperature: a review of the literature.

Abstract: In both animal models and human studies examining acute neurological injury, elevated core temperatures have been shown to exacerbate the degree of neuronal injury. There is an assumption that core temperature and brain temperature are the same. With the introduction of brain temperature monitoring technology, it has become possible to examine the difference between core and brain temperatures. The purpose of this integrated review was to examine the published literature comparing core temperatures (blood, rectal, bladder, and esophageal) with brain temperatures (measured by direct contact with the brain or measured in any of the spaces surrounding the brain, excluding intraoperative measurements). Fifteen studies from 1990 and 2002 were found. All 15 studies found that brain temperature was higher than all measures of core temperature with mean differences of 0.39 to 2.5 degrees C reported. Only three studies employed a t test to examine the differences; all found statistical significance. Temperatures greater than 38 degrees C were found in 11 studies. This review demonstrates that brain temperatures have been found to be higher than core temperatures; however, existing studies are limited by low sample sizes, limited statistical analysis, and inconsistent measures of brain and core temperatures. Because fever is prevalent in acutely injured neurological patients, its detection and treatment are essential interventions. In the absence of brain temperature monitoring, detection of a 'brain fever' may be limited. Future research is needed to further examine the relationship between brain and core temperatures and their impact on intracranial dynamics.

Pain in children with cerebral palsy: a review.

Abstract: Children with cerebral palsy (CP) face many challenges including impaired motor control and coordination, functional impairment, sensory disturbances, and, sometimes, communication difficulties and cognitive deficits. Pain also may be a problem for children with CP due in part to the inherent deficits associated with the disease, as well as the invasive medical and surgical procedures and rehabilitative activities children with CP undergo on a regular basis. A review of current literature indicates pain is a common experience for children with CP and has been understudied in this population. Further emphasis and research on appropriate assessment and management strategies sensitive to the unique characteristics and limitations of children with CP are warranted.

Experiences of families in the neurological ICU: a "bedside phenomenon".

Abstract: This study explores the experiences of family members of patients with an emergent admission into a neurological intensive care unit. A descriptive, exploratory, multiple-case design was used. Participant observation and semistructured interviews were used to capture the experiences of families. Analysis revealed the "bedside phenomenon," which offers insight into families' desire to be at the bedside. The phenomenon is twofold, in that families are motivated by two goals to be at the bedside: They want to ensure their loved one is receiving the best care possible, and they want to maintain a connection with the person. Nurses who understand and recognize this phenomenon may be better positioned to work with families to achieve these goals.

Effect of backrest position on intracranial pressure and cerebral perfusion pressure in individuals with brain injury: a systematic review.

Abstract: Head elevation is a conventional nursing procedure for brain-injured individuals with intracranial hypertension; it is performed with the intent of reducing intracranial pressure (ICP) by means of a noninvasive physical intervention. However, in certain circumstances, head elevation puts the brain-injured individual at risk for secondary cerebral injury because of impaired arterial blood pressure and compromised cerebral perfusion pressure (CPP). A systematic literature search was conducted to evaluate existing evidence regarding the effect of changing the backrest position on ICP and CPP in brain-injured individuals. Eleven articles were retrieved. In nine articles it was concluded that ICP significantly decreased at 30 degrees of head elevation compared with a flat position. Five of the nine articles showed no statistical significance in the magnitude of change in CPP from a flat position to 30 degrees of head elevation. Major limitations in the 11 articles were small sample sizes and unclear study protocols, which may have caused a failure to detect the effect of head elevation. In clinical practice, intensive care unit staff members need to cautiously perform head elevation with a thorough understanding of its physiologic effect and potential hazard. Future research should investigate the effects of therapeutic positions on different neurological and neurosurgical populations and explore the combination of head elevation and lateral side-lying positions.

Focus groups: the lived experience of participants with multiple sclerosis.

Abstract: Multiple sclerosis (MS) is a chronic disease affecting young adults. The presence of the sometimes-invisible symptoms (loss of vision, fatigue, incontinence) and the episodic nature and uncertainty of symptoms can create a constant sense of vigilance or support the use of denial. Indeed, family, friends, and even nursing support may be elusive, leaving one feeling lonely, frightened, and insecure. The purposes of this research were to investigate the lived experiences of people with MS and examine their needs from their perspectives. Two focus groups included 4 men diagnosed with MS from 2 to 15 years and 6 women diagnosed with MS from 1.5 to 15 years. Four themes were identified. The first theme resonated around feelings that "nobody listened." The second theme, symptom devastation, described the overwhelming presence of symptoms and the difficulty they caused. The third theme was "picking and choosing," or making choices to maintain some control. "Fight your own fight" with self-advocacy and taking charge was the final theme. Even though MS continuously caused challenges and changes interfering with goals, participants described creative solutions. They learned to deal with the denial, refocus their priorities, plan their activities, and choose carefully. They described a litany of being unheard, unimportant, and confused, which led to feelings of dejection, desperation, and depression. Their most poignant need was someone to listen and teach since they identified knowledge as power. The data gathered contribute to knowledge and understanding of people living with MS. Findings support nursing interventions that empower and teach self-management techniques.

Riding out the storm: sympathetic storming after traumatic brain injury

Abstract: Following acute multiple trauma, hypothalamic stimulation of the sympathetic nervous system and adrenal glands causes an increase in circulating corticoids and catecholamines, or a stress response. In individuals with severe traumatic brain injury or a Glasgow Coma Scale score of 3-8, this response can be exaggerated and episodic. A term commonly used by nurses caring for these individuals to describe this phenomenon is storming. Symptoms can include alterations in level of consciousness, increased posturing, dystonia, hypertension, hyperthermia, tachycardia, tachypnea, diaphoresis, and agitation. These individuals generally are at a low level of neurological activity with minimal alertness, minimal awareness, and reflexive motor response to stimulation, and the storming can take a seemingly peaceful individual into a state of chaos. Diagnosis is commonly made solely on clinical assessment, and treatment is aimed at controlling the duration and severity of the symptoms and preventing additional brain injury. Storming can pose a challenge for the nurse, from providing daily care for the individual in the height of the storming episode and treating the symptoms, to educating the family. Careful assessment of the individual leads the nurse to the diagnosis and places the nurse in the role of moderator of the storming episode, including providing treatment and evaluating outcomes.

A prospective study of adherence to glatiramer acetate in individuals with multiple sclerosis.

Abstract: The purpose of this prospective study was to investigate whether self-efficacy, hope, level of disability, perceived support, and previous use of an immunomodulatory therapy when measured at the initiation of a therapy can accurately predict adherence. A convenience sample included 108 individuals with multiple sclerosis who initiated therapy with glatiramer acetate (Copaxone), plus or minus 21 days, and completed instruments online that included the Multiple Sclerosis Self-Efficacy Scale (MSSE), the Herth Hope Index, Performance Scales, and a sociodemographic data sheet that included questions about previous use of immunomodulators and individuals considered most supportive of glatiramer acetate therapy. Logistic regression analysis revealed that the MSSE total (Control and Function subscales combined) was the only significant predictor of adherence. The higher the score, the more likely the individual was to adhere to glatiramer acetate. Those in the adherent group had a significantly greater level of self-efficacy. The MSSE measured at the initiation of glatiramer acetate therapy correctly classified 98.8% of those who were adherent at the 6-month follow-up. For each unit of increase in score, the likelihood of adherence increased. This prospective study revealed that the MSSE, when measured at the initiation of therapy, seems useful in predicting adherence category at the 6-month follow-up.

Chronic sorrow and depression in parents of children with neural tube defects.

Abstract: Chronic sorrow has been described in the caregivers of individuals with myelomeningocele, multiple sclerosis, Parkinson's disease, cancer, and premature infants. Most studies have reported small numbers of fathers for comparison with mothers. One unpublished study compared chronic sorrow and depression. The purpose of the current study was to describe parental chronic sorrow following the birth of a child with neural tube defect and to explore the relationship between chronic sorrow and depression. One hundred and thirty-two parents (63 mother/father pairs and 6 single parents) responded to 3 measures of chronic sorrow and 1 measure of depression. Multivariate analysis of variance demonstrated significant differences between mothers and fathers in chronic sorrow. In addition, a relationship between chronic sorrow and depression was demonstrated. Chronic sorrow is a potential barrier to parental understanding of their child's care and diagnosis. Based on these findings, separate assessments of each parent and timely interventions are warranted. Further research should include more than 1 measure of chronic sorrow and delineate the dimensions being measured.

Aging with multiple sclerosis.

Abstract: Although multiple sclerosis (MS) does not typically reduce life expectancy, there has been relatively little systematic investigation of the experiences and health-related concerns of people aging with this disease. A current search of the database CINAHL produced no articles when the search terms "multiple sclerosis," "nursing" and "aging" were used. To initiate more dialogue about the role of nurses in addressing the issues and concerns of people aging with MS, a cross-sectional descriptive study was conducted using both qualitative interviews and the administration of standardized instruments to elicit information about the health concerns and service needs of 27 people with MS 55 years of age and older. Qualitatively, participants perceived that they had less freedom and required more assistance than same age peers who do not have MS. Scores from standardized instruments support these perceptions. Participants expressed unmet needs in the areas of housework, physical therapy, MS support groups, religious service attendance, information and referral, check-in services, assistive technology use, social activities, personal care, and care coordination. To address these perceptions and needs, neuroscience nurses need to be aware of and sensitive to the challenges of aging with MS. In addition, nurses must be prepared to discuss and provide information, resources, and referrals on a wide range of health, social, and wellness-related services.

Intrathecal baclofen therapy over 10 years.

Abstract: :Intrathecal baclofen (ITB) therapy has evolved into a standard treatment for severe spasticity. After this therapy had been provided for 10 years, a retrospective chart review on 50 patients, representing a total 2,922 patient months of ITB service, was done. These patients suffered severe

Caregivers dealing with stroke pull together and feel connected.

Abstract: Changes that can accompany stroke may create considerable stress for individuals caring for the affected person. This study explored the coping process for nine rural-dwelling caregivers of persons with stroke and the responses of these caregivers to a Web-based support program. The qualitative data management program QSR N 5 was used to analyze quotes from telephone interviews and computer entries. Stories of how caregivers came together and supported one another emerged from the data collected as part of a larger study that examined the experience of caring. Friedemann's framework of systemic organization guided data analysis and interpretation. Actions demonstrated by the caregivers illustrated the process of crisis resolution through family togetherness in which nurses were included. The findings of this study aided in understanding this process and gave direction for nurses working with such clients.

Dexamethasone therapy in patients with brain tumors--a focus on tapering.

Abstract: Administration of corticosteriods in brain tumor patients requires an understanding of the physiology of the adrenal system and desired patient response. Close attention to other concomitant medications will ensure adequate amounts of all drugs, including dexamethasone. Nurses need to assess patients' tolerance of dexamethasone, discuss these findings with physicians and pharmacists, and educate both patients and family members on doses and tapering schedules tailored to individual patient needs.

Multimodal monitoring: head injury management using SjvO2 and LICOX.

Abstract: Monitoring methods following severe head injury currently use indirect measurements of cerebral oxygenation and perfusion defined as intracranial pressure (ICP) and cerebral perfusion pressure (CPP) monitoring. Adequate information regarding cerebral blood flow and oxygenation is necessary to guide treatment and prevent secondary cerebral ischemia. Because of the ineffectiveness of ICP and CPP monitoring in detecting early ischemic changes in healthy, as well as compromised, brain tissue, patients' neurological outcome and recovery may be less than optimal. New technology has been recently developed to provide early detection of poor cerebral oxygenation and perfusion. The LICOX brain tissue oxygenation and jugular venous bulb catheters are two types of monitors currently available. Patients can benefit from a unique combination of multimodal monitoring when cerebral oxygenation and consumption measurements are quantified on both a local and global level. This unique combination helps reflect early changes in brain tissue viability. As with any new monitoring device, there are associated advantages and disadvantages as well as cost issues, to consider. Patients with head injuries can benefit from technology that guides decisions and prevents treatment delays.

Factors associated with hospital arrival time for stroke patients.

Abstract: Patients who experience a sudden ischemic stroke can benefit from administration of intravenous tissue plasminogen activator (tPA) to reduce the resulting disability, yet few arrive in time to be eligible for tPA administration. The purpose of this study was to determine (a) the stroke warning signs that most commonly result in the decision to seek hospital care, (b) who makes the decision to seek hospital care, (c) the most common mode of transportation to the hospital, (d) hospital arrival time in relation to the onset of the first warning sign, and (e) factors most associated with hospital arrival time for stroke survivors. Using a descriptive, cross-sectional design, data from a convenience sample of 50 stroke survivors and/or their companions (family, friends, or others seeking hospital care for the patient) were obtained by face-to-face interview during the patient's hospital stay using a structured interview guide developed by the investigator. The most common stroke warning sign resulting in the decision to seek medical care was sudden confusion and trouble speaking or understanding speech, followed by sudden numbness or weakness on one side of the body. Patients themselves were the most common initiators of care, followed by spouses, other relatives, and others. A majority of patients arrived by ambulance, followed by private car or taxi. Only 28.9% of patients arrived at the hospital within 3 hours of the first warning sign, with the mean arrival time for the group being 330.4 minutes (5.5 hours). Mode of transportation and perceived adequacy of income were the only significant factors associated with hospital arrival time, with no significant interaction effects. Patients arriving by private car or taxi and those perceiving their incomes as comfortable had the longest arrival times, suggesting public education efforts also should target people from higher socioeconomic groups. The nonsignificant associations between hospital arrival time, warning signs, and other demographic characteristics of initiators suggest there may be other unmeasured behavioral factors that play a more important role in reducing hospital arrival time for stroke patients. Further study of additional factors associated with early hospital arrival time is recommended to support educational efforts for early stroke treatment and prevention.

Love and load--the lived experience of the mother-child relationship among young adult traumatic brain-injured survivors.

Abstract: This study aims to describe the meaning of the experience of the relationship between young adult traumatic brain injury (TBI) survivors and their mothers using a phenomenological approach. Informants included 9 males and 3 females who were at least 2 years post-TBI, and their mothers, who were their primary caregivers after the injury. TBI informants were 18 to 25 years of age, had motor vehicle accident-induced injury, experienced post-traumatic amnesia longer than 24 hours, and were able to participate in a verbal interview. In addition, all informants currently were living with their mothers, who also participated in this study. Survivors acquired the sense of being abnormal from various sources, including social pressures, dynamics within the family, and intrapersonal changes. Mothers adopted both positive and negative actions during the period of uncertainty and often struggled to balance protecting their children and letting them become independent. They also struggled to maintain harmonious relationships with people both inside and outside of the family. Sometimes, survivors' parents marital relationships were at risk. Health professionals should design more appropriate long-term community interventions to help TBI survivors and their families decrease the burden of injury and the resulting stress, increase survivors' self-esteem, and improve quality of life of both survivors and their families, serving as a foundation for further TBI care.

Practice on an acute stroke unit after implementation of a decision-making algorithm for dietary management of dysphagia.

Abstract: Dysphagia is a common disability seen in stroke survivors that has been associated with high morbidity and mortality. Research has indicated that implementing clinical guidelines and algorithms improves dysphagia management and patient outcomes. A decision-making algorithm designed to enhance the assessment and dietary treatment of swallowing difficulties in the acute stroke patient was implemented on a dedicated neuroscience unit in January 2002. Following implementation, the medical records of 30 acute stroke patients consecutively admitted to the unit between February and May 2002 were reviewed for stroke and dysphagia characteristics, dysphagia-related complications, discharge dispositions, interdisciplinary baseline assessments, and nursing evaluations throughout the hospitalization. Of those patients admitted with stroke, 56.7% were dysphagic. As compared with the nondysphagic patients, the dysphagic patients had three times' longer inpatient stay, an increased incidence of complications, higher morbidity, and increased need for inpatient rehabilitation services and institutionalized care following discharge. Twenty percent of patients did not receive aformal evaluation of swallowing function within the first 48 hours of admission. In 10% of the patients, diets were changed following the formal evaluation of swallowing to change an unsafe, prescribed diet. More than 70% of patients showed clinical improvement in swallowing function during their hospitalization. Nurses tended to document assessments of general neurological factors (e.g., level of consciousness) related to swallowing function more frequently than factors felt to be more specific to swallowing (e.g., choking) and nutrition (e.g., tolerates diet). The results support the important role of the neuroscience nurse in the early and ongoing assessment of swallowing function and in providing directions to further improve the quality of care delivered to stroke patients with various degrees of swallowing dysfunction.

Long-Term Treatment Optimization in Individuals with Multiple Sclerosis Using Disease-Modifying Therapies: A Nursing Approach

Abstract: The introduction of disease-modifying therapies (DMTs) for multiple sclerosis (MS) over the last 7 years has had a significant effect on the management of those living with this disease. Initially, the focus of improving treatment outcomes was on ensuring adherence to therapy by managing drug-related adverse events. However, treatment adherence is only one facet of ensuring optimal health outcomes for patients using DMTs. Therefore, a group of 80 nurses from Canada and the United States (The North American MS Nurses' Treatment Optimization Group) developed an evidence-based nursing approach to address the various factors involved in obtaining optimal patient outcomes. The goal of this nursing approach is to ensure the best possible clinical, subclinical, psychosocial, and quality-of-life outcomes for patients with MS using DMTs.

Reducing discrepancies between MS patients' needs and use of healthcare services by applying a transmural care model.

Abstract: The Dutch healthcare system is effective for patients with acute, uncomplicated health problems but ineffective for patients with complex, chronic health problems such as multiple sclerosis (MS). To tackle these deficits, special working parties and the Dutch Ministry of Health concluded that healthcare professionals from primary and hospital settings should, by mutual agreement, cooperation, and shared responsibility, better coordinate their care and tailor care to meet patients' individual needs. In the Netherlands this approach is called transmural care. A transmural care model for MS (TCMMS) was developed to assist healthcare professionals in different settings cooperate with one another, comprehensively assess the needs of MS patients, and define an integrated care plan for each patient. The overall aim of the TCMMS was to reduce the discrepancies between the patients' needs and use of healthcare services and to test whether the TCMMS is applicable in practice. Outcomes using the TCMMS were measured using Kurtzke's Expanded Disability Status Scale (EDSS), Incapacity Status Scale (ISS), Environmental Status Scale (ESS), and RAND 36-Item Health Survey (RAND-36). In the study period, many different expressed needs were reported. For the total group the expressed needs decreased significantly from 57 needs 5 months before the implementation of the TCMMS to 19 needs at the end of the study. There were no significant changes over time in EDSS, ISS, ESS, and RAND-36. Overall, the TCMMS was applicable to practice and decreased the discrepancies between needs and services.

High-frequency stimulation of the subthalamic nucleus for the treatment of Parkinson's disease--a team perspective.

Abstract: Parkinson's disease (PD) is a debilitating neurodegenerative disorder affecting more than 1.2 million people in the United States. Genetic and environmental toxins are believed to be risk factors in acquiring the disease. PD is characterized by tremors, rigidity, bradykinesia, poor gait, and postural instability. These cardinal symptoms improve with medication such a levo-dopa (L-dopa). However, over time, as the disease progresses, the patient becomes refractory to medication, or medication produces debilitating side effects. When this occurs or when there are worsening of symptoms, neurosurgical treatment is recommended, particularly deep brain stimulating (DBS) electrodes implanted in the subcortical subthalamic nucleus (STN). Over the last 5 years STN DBS has gained acceptance and become the neurosurgical treatment of choice for PD. To achieve maximum beneficial effects with minimum adverse effects from the surgery, the expertise of an integrated team of physicians and nurses is essential. A clear understanding of the different aspects of the procedure, including the risks and benefits of the treatment, assists neuroscience nurses in communicating with the PD patient, and providing the most appropriate, knowledge-based pre- and postoperative care.

Preliminary psychometric testing of the Fox Simple Quality-of-Life Scale.

Abstract: Although quality of life is extensively defined as subjective and multidimensional with both affective and cognitive components, few instruments capture important dimensions of the construct, and few are both conceptually congruent and user friendly for the clinical setting. The aim of this study was to develop and test a measure that would be easy to use clinically and capture both cognitive and affective components of quality of life. Initial item sources for the Fox Simple Quality-of-Life Scale (FSQOLS) were literature-based. Thirty items were compiled for content validity assessment by a panel of expert healthcare clinicians from various disciplines, predominantly nursing. Five items were removed as a result of the review because they reflected negatively worded or redundant items. The 25-item scale was mailed to 177 people with lung, colon, and ovarian cancer in various stages. Cancer types were selected theoretically, based on similarity in prognosis, degree of symptom burden, and possible meaning and experience. Of the 145 participants, all provided complete data on the FSQOLS. Psychometric evaluation of the FSQOLS included item-total correlations, principal components analysis with varimax rotation revealing two factors explaining 50% variance, reliability estimation using alpha estimates, and item-factor correlations. The FSQOLS exhibited significant convergent validity with four popular quality-of-life instruments: the Ferrans and Powers Quality of Life Index, the Functional Assessment of Cancer Therapy Scale, the Short-Form-36 Health Survey, and the General Well-Being Scale. Content validity of the scale was explored and supported using qualitative interviews of 14 participants with lung, colon and ovarian cancer, who were a subgroup of the sample for the initial instrument testing.

The Influence of Resources on Perceived Functional Limitations Among Women with Multiple Sclerosis

Abstract: The purpose of this longitudinal investigation was to identify the effects of external resources (i.e., education, marriage, employment, social support, economic status) on the trajectory of perceived functional limitation among women with multiple sclerosis (MS). We hypothesized that these resources would have a long-term influence upon MS-related functional limitation. As part of a longitudinal study of health promotion and quality of life among persons with MS, we tested hypothesized relationships using data obtained at five time points, using repeated-measures MANOVA. We found that functional limitation scores increased over time for all participants. In general, women who were unemployed as a result of MS consistently had higher functional limitation scores, and employed women consistently had lower functional limitation scores. Women with lower social support scores consistently perceived greater functional limitation than those with higher social support scores. Women with lower perceived-economic-adequacy scores consistently had higher functional limitation scores than women with higher perceived-economic-adequacy scores. Nurses and other healthcare professionals are in an optimum position to observe and assess the resources of women with MS. They can use presence, listening, and observational skills to identify verbal and nonverbal cues of resource depletion. In addition, they can act as advocates for women with MS and speak out on policy issues and legislation at the local and national levels. Healthcare professionals can thus influence the presence of resources for those who are particularly vulnerable to resource loss, so they can participate successfully in work, recreational, and home environments.

Hyponatremia in the patient with subarachnoid hemorrhage

Abstract: Hyponatremia commonly occurs in patients with aneurysmal subarachnoid hemorrhage. Two mechanisms have been proposed as causes: syndrome of inappropriate anti-diuretic hormone and cerebral salt wasting. Physical examination and laboratory results can assist a clinician in identifying which mechanism is responsible and thus determine proper treatment. When hyponatremia is treated promptly and appropriately, patients' sodium levels return to normal without detrimental effects.

Intrapulmonary administration of medications.

Abstract: An increasing number of medications are being administered by inhalation. However, proper dosing, frequency, formulation, and the optimal delivery device remain to be determined for many of these agents. Inhalation therapy has many advantages compared with other routes of administration including achieving a high drug concentration in the lung, lack of systemic adverse effects, ease of administration, and patient convenience. A broad range of patients may benefit from this type of drug delivery. Practitioners must keep abreast of emerging drug administration strategies and new formulations in order to continually improve care for their patients.

Glomus jugulare tumor presentation and management: a case study.

Abstract: Glomus jugulare tumors are rare, normally benign, paragangliomas located in and around the jugular foramen at the base of the skull. They may cause significant lower cranial nerve deficits due to mass effect, and as part of the chromaffin cell system (including pheochromocytomas), they may also actively secrete catecholamines. Resection, while frequently difficult, is the treatment of choice. Nurses caring for patients with glomus jugulare tumors need to be skilled in recognizing lower cranial nerve deficits and complications that may arise related to inappropriate catecholamine release or due to disruption of cerebral venous return by tumor or surgery.

Perceptions of women with multiple sclerosis about osteoporosis follow-up.

Abstract: Research has demonstrated that women with multiple sclerosis (MS) do not make maximum use of information about osteoporosis prevention and management, even when they are well-informed. Focus-group methodology and telephone interviews were used to study how women with MS use or could use information about osteoporosis prevention and management to influence their healthcare providers to attend to osteoporosis-related needs. Twenty-two participants were asked to discuss their own and their peers' experience of sharing osteoporosis screening results with healthcare providers, as well as factors they think might influence healthcare providers to attend to osteoporosis risk reduction. Using comparative content analysis, the transcribed data were clustered into seven thematic areas: women's need to educate themselves about osteoporosis; women's need to educate their healthcare providers about osteoporosis as well as other women's health issues; the need to case manage oneself; advocacy for self and others; skills and characteristics required to negotiate the system; strategies for health researchers and advocates to inform healthcare providers about health issues and health promotion of women with MS; and strategies for healthcare providers to inform women with disabilities about health issues and health promotion of women with MS. These themes suggest directions for the development of strategies to enable women with MS to influence their healthcare providers in osteoporosis prevention and management.

An evaluation of neuroscience nursing research published during the Decade of the Brain.

Abstract: 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.

NDT competence of nurses caring for patients with stroke

Abstract: Neurodevelopmental treatment (NDT) is the most used rehabilitation approach in the treatment of patients with stroke in the Western world today, despite the lack of evidence for its efficacy. The aim of this study was to conduct an intervention check and measure the nurses' competence, in positioning stroke patients according to the NDT approach. The sample consisted of 144 nurses in six neurological wards who were observed while positioning stroke patients according to the NDT approach. The nurses' combined mean competence scores within the wards was 195 (70%) of 280 (100%) possible, and for each ward the mean score varied between 181 (65%) and 206 (74%). This study indicates that nurses working in hospitals where the NDT approach has been implemented have the knowledge and skills to provide NDT nursing.