Patients with neurologic disorders have been some of the most challenging and rewarding patients I have cared for throughout my career. As a nursing assistant, I recall caring for a patient recovering after weeks of being on a ventilator due to Guillain-Barre syndrome. The challenges this patient presented sparked my interest to learn more about patients with neurologic disorders.
Fast forward a few years when I was an RN working in a mixed ICU and, for the first time in my career, I was caring for patients with head trauma, spinal cord injuries and strokes. To be perfectly honest, these patients scared me. They were so unpredictable. What if they developed neuro storming or they extended their stroke? What was the best course of action? What if their neuro assessment changed, but I didn't catch the change?
What do I do when I’m afraid of something? I read and study. That is what I did then, and what I continue to do now.
Recently, I discovered that some of the most searched content on www.aacn.org is neuro or neurologic topics. I bet many of you are like me — searching for content to learn more so you can continue to take the very best care of your patients.
When I had a patient who could have developed neurostorming, I wish this journal article was available. Lucky for you, “Pharmacologic Treatment for Paroxysmal Sympathetic Hyperactivity” is available. This literature review describes what is known about managing patients with neurostorming. It also calls for more research into appropriate clinical pathways.
Have you ever taken care of a patient receiving neuromuscular blockade (NMB) who stops responding to train-of-four (TOF) testing? I once had a patient who took 18 hours after NMB was stopped to start responding to the TOF assessment. If you take care of patients on NMB, then “Residual Neuromuscular Blockade in the Critical Care Setting” is for you. The article was published in AACN Advanced Critical Care (ACC). ACC is a quarterly journal that requires a subscription. Also, Neuromuscular Blockade in the ICU: A Review of Practice is an NTI recording that offers 1.0 hour of CE. APRNs can earn 1.0 pharmacology hour.
Are you a nurse in an ER, ICU or PCU who doesn’t routinely care for patients with neurologic disorders? “Essentials of Critical Care Orientation Modules Caring for Neurologic Disorders,” Part 1 and Part 2 are also available for self-study for ICU or PCU. These modules will work well if you want to improve your neuro knowledge or are considering transitioning to neuro critical or neuro progressive care. Part 1 covers information on neurologic assessment and diagnostic testing, and topics such as increased intracranial pressure (ICP), herniation, death by neurologic criteria, and ICP monitoring and management including cerebral spinal fluid drainage. Part 2 covers assessment and management of ischemic and hemorrhagic stroke, seizures, central nervous system infections, and traumatic brain and spinal cord injuries.
Nurses are at the forefront of patient safety and fall prevention, and are always looking for ways to improve their practice. The team leading an AACN Clinical Scene Investigation (CSI) project improved day- and night-shift relationships and reduced falls on their neuro telemetry and neurosurgery unit by 40%. They accomplished this goal by improving their bedside shift handoff and hourly rounding processes. Access the project’s toolkits, presentation and project summary to see if you can adapt their improvements for your patients.
Mobility is another issue that’s sometimes difficult to tackle in the neuroscience ICU. “Don’t Be a Bedhead: Help Your Head, Get Out of Bed!” is a project a Washington state CSI team tackled. The team noted a 100% reduction in hospital-acquired pressure injuries and a 30% reduction in ventilator-associated pneumonia. Consider adapting the project to make improvements for your patients.
If you are looking to see the full variety of neurologic content, the AACN Clinical Resources for Neurology page is full of resources on different assessment, management, research and quality outcomes on neuro topics. For example, pediatric nurses could access “Critical Updates on the Third Edition of the Guidelines for Managing Severe Traumatic Brain Injury in Children.” Adult ICU nurses looking to improve patient safety might benefit from information in the following articles: “Toothbrushing for Dependent Neurological Patients in the Intensive Care Unit” and “Protecting Patient Safety and Preventing Modifiable Complications After Acute Ischemic Stroke.”
I wish I could list every great AACN resource on the care of patients with stroke, brain injury and neurological disorders. The best idea is for you to explore what resources will be meaningful to your practice. Once you’ve explored, stop back and, in the following comment section, share the top three neuro items that you found to be the most helpful for improving patient care!