A Study to Explore Nurses' Knowledge in Using the Glasgow Coma Scale in an Acute Care Hospital

Questions or comments about this article may be directed to Ihsan Mattar, RN BSc. (Hons), at . He is a PhD Candidate, Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore. Sok Ying Liaw, PhD RN MHSc, is an Assistant Professor, Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore. Moon Fai Chan, PhD CStat, is an Associate Professor, Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore.
The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses 10/2013; 45(5):272-280. DOI: 10.1097/JNN.0b013e31829db970
Source: PubMed


The Glasgow Coma Scale (GCS) is a neurological instrument, which measures the "depth and duration of impaired consciousness." The appeal of the GCS lies in its applicability in a wide variety of clinical situations as well as its ease of use by a range of healthcare staff. However, the GCS is not without its weaknesses and limitations. Its ease of use opens it up to misinterpretation and misapplication. Despite the propensity for incorrect assessment, the GCS remains in use in the clinical setting and enjoys an "unwarranted and privileged position." This creates an issue to patient care as the GCS is an important instrument in communicating an accurate assessment of the patient's condition between clinical staff.
The aim of this study was to investigate nurses' knowledge in using the GCS and the demographic factors influencing knowledge of the GCS.
This is a correlational observational study conducted in one acute care hospital in Singapore. The participants were registered nurses involving in bedside nursing care. A self-administered questionnaire was provided to the participants via ward managers. The quantitative responses were collated and analyzed using SPSS 16.0.
Type of clinical discipline (i.e., neuroscience, general medicine, and neurointensive care unit; beta = 0.51, p < .001) and the length of experience in a neuroscience setting (beta = 0.22, p = .005) were significant in determining a nurses' knowledge of the GCS. Nurses in the neonatal intensive care unit scored the highest mean scores (12.7), whereas nurses from the general medicine wards scored the lowest mean scores (9.7). Nurses who worked in a neuroscience setting for 6 years or more scored higher mean scores (11.9) on the knowledge scale, whereas nurses who worked in a neuroscience setting for less than a year scored lower mean scores (10.0).
Educational interventions and guidelines in performing GCS assessment are suggested to maintain and improve knowledge in performing the GCS.

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    ABSTRACT: The Glasgow Coma Scale (GCS) was introduced 40 years ago and has received worldwide acceptance. The GCS rates eye, motor and verbal responses to assess the level of consciousness. Concerns have been expressed with regard to reliability and consistency of assessments. We considered that lack of standardization in application techniques and reporting of the GCS may have contributed to these concerns, and aimed to assess current procedures in its use. Questionnaire-based assessments were conducted via an on-line survey and during neurosurgical training courses. Overall, 616 participants were recruited, representing 48 countries and including physicians and nurses from different disciplines. Use of the GCS was reported by nearly all participants for assessment of patients with traumatic brain injury, but not for all patients with a reduced level of consciousness from other causes (78%). Major differences were found regarding the type of stimulus applied when patients do not obey commands: nail bed pressure, supra-orbital pressure, trapezius or pectoralis pinch and sternal rub were all frequently used. 25% percent of responders reported to never use a peripheral stimulus. Strategies for reporting the GCS varied greatly and 35% of participants limited the reporting to a summary score. Moreover, different approaches were used when one of the components could not be assessed. Overall, the surveys have identified a general lack of standardization in assessment and reporting of the GCS. The results illustrate the need for continued education to improve reliability of assessments through guidance to a standard approach. Key words: Consciousness, Glasgow Coma Scale, Humans, Questionnaires, Reproducibility of results.
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