Content uploaded by Jeanne Barr
Author content
All content in this area was uploaded by Jeanne Barr on Nov 13, 2014
Content may be subject to copyright.
Volume 17 Number 2 2006
pain in community hospitals. Joumal of Advanced Nursing
Vol.
13,
No. 3: 183-6.
Palladino, M, and Laskowski-Jones, L. 1993 Managing the
crisis of AVM. Nursing Vol. 23, No. 3: pp 54-8.
Peterson, A.M 1997. Analgesics. RN Vol 60, No. 4:
45-51.
Qizilbash N., Lewington S.L., and Lopez-Arrieta J.M. 2004
Corticosteroids for acute ischaemic stroke The Cochrane
Library, (Oxford.) Available URL
http://gatewavl.ovid.com/ovidweb.cgi <Accessed 2004 May
03>.
Rafferty-Mitcheli C, Scanlon JP.Laskowski-Jones L. 1999
Gamma knife radiosurgery. American Joumal of Nursing
Vol.
99,
No.
10:
pp 52, 54-5, 57.
Romsing, J. 1996. Assessment of nurses' judgement for
analgesic requirements of postoperative children. Joumal of
Clinical Pharmacy & Therapeutics Vol.
21,
No. 3: 159-63.
Shannon, C, Gillespie, S., and Lancero, A. (1992) Elective
Craniotomy Care Plan Map. Tucson Medical Center 5301
East Grant Road PO Box 42195, Tucson, AZ.
Sherman, I.W., and Sherman, V.G. 1989 Biology: a human
approach. 4th edn. Oxford University Press, Oxford.
Society of Hospital Pharmacists of Australia 1995
Pharmacology and drug information for nurses. W. B.
Saunders, Sydney.
Sydney Children's Hospital 2003 Medication policy 2003/12.
Sydney Children's Hospital, Sydney.
Tessman, C. 1999 Exploring frameless stereotactic image
guided surgery. AORN Joumal Vol. 69, No. 3: 498, 500,
503-5.
Thelan, L.A., Davie, J.K., Urden, L.D., and Lough 1994
Critical Care Nursing. 2"'' edn. Mosby, St. Louis.
The New South Wales College of Nursing 2003 Section 2.
Neurological disorders. In Acute illness in children:
implications for practice. (Distance education materials) The
New South Wales College of Nursing, Burwood.
Thomson, K.R. 1997 Interventional radiology. Lancet
(August). Available URL:
http://gatewavl.ovid.com/ovidweb.cgi <Accessed 2004 April
29>.
Tortora, G.J., and Grabowski, S.R. 2000 Principles of
anatomy and physiology. HarperCollins, New York.
Touboul, E., Al Halabi, A., Buffat, L., Merienne, L., Huart,
J., Schlienger, M., Lefkopoulos, D., Mammar, H., Missir, O.,
Meder, J., Laurent, A. and Housset, M. 1998 Single-fraction
stereotactic radiotherapy: a dose-response analysis of
arteriovenous malformation obliteration. Intematlonal
Joumal of Radiation Oncology*Biology*Physics. Available
URL: http://www.sciencedirect.com/science <Accessed 2004
May 03
Tseng, E.Y., Narducci, C.A., Willing, S.J., and Sillers, M.J.
Angiographic embolization for epistaxis: a review of 114
cases.
Laryngoscope Vol. 108, No. 4: 615-9.
Williams, A. 2000 Severe head injury in children: A case
study. Emergency Nursing vol. 8,
No.
1:
16-19.
Willock, J. and Jewkes, F. 2000 Making sense of fluid
balance in children. Paediatric Nursing Vol. 12, No. 7: 37-
42.
Wong, D. L. & Whaley, 1999.Whaley & Wong's nursing
care of infants and children
(6""
ed.). Mosby, St. Louis.
Ziai, W., Varelas, P., Zeger, S., Mirski, M., and Ulatowski, J.
2003 Neurologic intensive care resource use after brain tumor
surgery: An analysis of indications and altemative strategies.
Critical Care Medicine Vol.
31,
No. 12: 2782-7,
2003.
Abstracts from the 2005 Scientific Meeting
The abstracts for the 2005 Scientific Meeting are presented
below. They provide you with a snapshot of the research and
practice that neuroscience nurses are engaged in, as well as
case study presentations.
Cerebral Metastases: An Update and an Overview
Rochelle Firth
Although much attention is given to primary central nervous
tumours, in particular gliomas, cerebral metastases are the
most common brain tumour identified clinically (Greenberg
2001).
Gerrard & Franks (2004) estimates that 10-50% of
patients with cancer will develop cerebral metastases.
Diagnosis, management and prognosis of cerebral metastases
differ from most brain tumours including a full system
review to assess for a primary lesion. Greenberg (2001)
suggests that 15% of patients present with no cancer history.
Due to the difference in nature of cerebral metastases it is
also important to consider support networks individually. The
presentation will highlight considerations given when setting
up support networks for this patient population.
Reference:
Gerrard, G.E. & Franks, K.N. (2004). Overview of the
diagnosis and management of brain, spine, and meningeal
metastases. Joumal of Neurology, Neurosurgery and
Psychiatry. 75: 37-42.
22
Volume 17 Number 2 2006
Greenberg.M. (2001). Handbook of Neurosurgery, fifth
edition. New York: Thieme.
Hereditary Schwannomatosis: A Family's Journey
Karen Morrison, Beryl Osman & Catherine Solley
Schwannomatosis is a recently defined rare and distinct
clinical entity. It is an autosomal dominant disorder whose
genetic background, although unclear, has a clinical picture
similar to that of neurofibromatosis type 2. Whereas the most
common manifestation of neurofibromatosis type 2 is
bilateral acoustic neuroma, in schwannomatosis there are
multiple schwannomas with no evidence of acoustic
neuroma. The appearance of multiple schwannomas usually
indicates hereditary disease.
Through a case study of an eighteen-year-old female and her
family this paper will discuss the pathophysiology and the
genetics of hereditary schwannomatosis. This case
demonstrates malignant transformation and the treatment of
this will be discussed.
By illustrating the complexity and the malignant
transformation in this case of hereditary schwannomatosis it
is hoped to heighten awareness of the effect on the family,
the amount of hospitalisation incurred, the need for genetic
counseling as well as the amount of energy and emotional
input that is required from nursing staff when caring for such
patients.
Supportive care needs of brain tumour patients and their
carers
Lucy Bailey, Jeff Dunn, Liz Eakin, Monika Janda, Suzanne
Steginga, Kate Troy, & David Walker
Primary brain tumours account for less than 2% of
all
cancers
but can carry significant burden for patients and carers.
Despite this, there is limited research about supportive care
service needs of patients with brain tumours and their carers.
A qualitative research approach was used to assess supportive
care needs and included in depth telephone interviews (6
patients and 8 carers) and focus groups (12 patients and 10
carers) with members of the Queensland Cancer Fund Brain
Tumour Support Service living in Queensland. All interviews
and focus groups were recorded and transcribed for analysis.
Six common themes emerged:
• Need for information and coping with uncertainty;
Support with finances and dealing with welfare
agencies;
• Retum to 'normal' life versus long term care;
• Social support / respite care;
• Stigma / discrimination;
• Death and dying.
Participants were frequently unable to define and request
helpfiil services, often due to limited awareness of these
services. Participants suggested strategies to overcome this:
• Assignment of a team or case manager to each
patient to provide infonnation and emotional
support;
• Proactive dissemination of information, education
and psychosocial support;
Referral to neuropsychological assessment' and
education of patients, carers, welfare agencies and
employers to improve understanding of restricted
working ability;
• Non bureaucratic access to welfare payments, home
visiting services and respite care for patients unable
to retum to previous roles;
Where tumours reduced life expectancy, services
facilitating communication about issues such as
treatment decisions, and death and dying early in
the treatment process.
PFO:
A 'Stroke' of Bad Luck
Kate Pradie & Sharon Eriksson
Cardiac disorders are acknowledged as a major source of
cerebral embolism. Patent foramen ovale (PFO) is one of
many structural heart diseases and its presence with or
without an atrial septal aneurysm (ASA) has been recognised
as a potential risk factor for ischaemic stroke. The relevance
of PFO in stroke and its subsequent management is still
controversial, but major developments have started to emerge
over the past decade.
PFO,
which is present in up to 30% of the population has
been increasingly implicated in the aetiology of stroke and is
more prevalent among young patients (<50 years of age) in
whom no other cause for their stroke is found or apparent
(cryptogenic). The management of stroke patients with PFO
is reliant on several factors. Along with the usual post -
stroke care and investigations, treatment involves secondary
prevention strategies to reduce risk of further stroke.
23
Volume 17 Number 2 2006
Caring for young stroke patients can be very challenging,
especially if permanent neurological deficit results. As
neuroscience nurses we need to be particularly sensitive to
the psychological needs of this group, in order to better help
the patient deal with their stroke and the impact on their life.
To gain further insight and understanding of PFO in stroke, a
case study of a young patient admitted to the Acute Stroke
Unit at Prince of Wales Hospital Sydney will be presented.
Showcasing the impact of Stroke Unit Service on patient
and service outcomes.
Lorinda Upton-Greer & Sam Saunders Battersby
In July 2000 a five bed Stroke Unit located within a general
medical ward was trialed at the Launceston General Hospital,
Tasmania. Today it has become an integral part of service
provision that has progressed to an 11 bed geographically
located Stroke Unit that meets criteria stated in the National
Stroke Strategy.
Management guidelines, policies and clinical pathways have
been developed and implemented. A stroke team has been
established since 2000 with care coordinated by the Clinical
Nurse Consultant. Key Liaison networks have also been
established with the Aged Care Transition Coordinator,
community health services and rehabilitation with nurse
initiated referrals.
Automatic referral and multidisciplinary team meetings have
resulted in a decrease in the average review time (day) range
froml.l to 5.2 days. This was previously up to 9.2 days.
Automatic reporting systems have been developed to enable
trend analysis of clinical indicators, key performance
indicators and patient and service outcomes. Average Length
of Stay for Stroke Unit patients has decreased from 37.3 days
to 24.88 days including rehabilitation. CT scanning time has
decreased from 11 hours and 19 minutes to 3 hours and 49
minutes. There has been a 6.9% increase in the number of
patients admitted to the acute rehabilitation ward, a 3.6%
decrease in mortality, a ll.8%decrease in the number of
patients requiring permanent residential care and a 6.7%
increase in the number of patients returning to their normal
place of residency.
Project Enhancing Patient care - An organisational
approach to improving care and access in a busy acute
ward with conflicting demands.
Lyn Wallace & Julie Faoro
In 2004, Southern Health undertook a review of patient flow
processes outside of our organisation in an attempt to
improve access and patient management across the
Organisation.
Previously projects undertaken in the organisation had
demonstrated improvements in care in set patient groups.
These included a group of general medical patients and
respiratory patients such as those with asthma. Patients,
families and treating teams surveyed at this time indicated
that overall satisfaction was enhanced with shorter more
efficient hospitalisations.
The next major step was to broaden the scope of these
projects to a ward, rather than a service. Ward 54S South, a
30-bed acute neurosciences ward was chosen.
In March 2005 a data collection marathon was undertaken
involving a patient journey approach looking at
approximately 100 admissions from varying entry points to
discharge. The data gathered encouraged us to review our
process in several areas.
These included:
1.
Implementing daily 0830 team meetings for each unit
including medical
staff,
allied health, nursing, and
rehabilitation assessors;
2.
A chart round each afternoon to enable feedback and
closure of
tasks;
3.Early identification of potential emergency department
patients soon after arrival to enable rapid acceptance to units
with only essential tests performed in ED. (reduce LOS in
ED);
4.
Review of demonstrated blockages to flow i.e. delays
waiting for MRI, NCS etc - where discharge was reliant on
test results.
A variety of changes have been made to our practice - these
are reviewed at monthly meetings and outcome measured.
This paper will describe the process, actions and outcomes of
the study. It will also demonstrate the frustrations along the
way.
24
Volume
17
Number
2
2006
What Standard
of
Professional Performance should
we
expect from
the
Postgraduate Certificate
or
Diploma
qualifled Neuroscience Nurse?
Jill Stow
With
the
increasing cost
of
postgraduate nursing education
there
is a
need
for
education providers
to
clearly articulate
the
educational
and
professional outcomes
of
both postgraduate
certificates
and
diplomas
in
neuroscience nursing.
The
recently published Professional Standards
for
Neuroscience
Nurses (ANNA, 2004) provides
a
fi-amework
for
neuroscience nursing practice based
on
eight domains
of
professional performance.
In its
introduction
the
authors
propose that
the
framework
may be
used
as a
tool
for
both
performance appraisal
and
curricula development. Whilst this
document clearly sets
out the
scope
of
neuroscience nursing
practice,
the
level
of
post graduate education
and
clinical
experience required
to
achieve each performance Standard
is
not defined. This paper will attempt
to
articulate, using
examples from
the
eight domains, what
the
specialty
can
expect from
a
certificate versus diploma qualified
neuroscience nurse.
Reference
Australasian Neuroscience Nurses' Association (2004).
Professional Standards
for
Neuroscience Nurses. Australia:
Australasian Neuroscience Nurses' Association.
The concept
of the
Expert Patient: Dream
or
Nightmare???
Tim O'Maley
An expert patient
has
been defined
as
"people
who
have
the
confidence, skills, information
and
knowledge
to
play
a
central role
in the
management
of
life with chronic diseases."
An observation often made
by
doctors, nurses
and
other
health professionals
who
undertake long-term follow-up
and
care
of
people with particular chronic diseases
is "my
patient
understands their disease better than
I do."
This knowledge
and experience held
by the
patent
has too
long been
an
untapped resource. Research
and
practical experience
in
North America
and the UK are
showing that patients with
chronic diseases need
not be
recipients
of
care: they should
become
key
decision-makers
in the
treatment process.
By
ensuring that knowledge
of
their condition
is
developed
to a
point where they
are
empowered
to
take some responsibility
for
its
management
and
work
in
partnership with their health
and social acre providers, patients
can be
given greater
control over their lives. Self-management programs
can be
specifically designed
to
reduce
the
severity
of
symptoms
and
improve confidence, resourcefulness
and
self-efficacy.
Maximising care through education
and
clinical support
in
the
Neuroscience Unit.
Natalie Deny
&
Janine Loader
In
our
current health care climate
it is
becoming increasingly
evident that organisations require innovative opportunities
for
clinical support
and
nursing environment.
In
2002
St
Vincent's
&
Mercy Private
as an
organisation
did not
embrace
the
culture
of
learning
and
development
and as a
consequence
we saw
both
low
numbers
of
graduate nurse
applications
and low
retention
of
graduates.
Expenditure rose
to
$9.6
million
a
year
on
agency staff
and
cross campus
departments such
as
Education struggled
to be
owned
in
this
structure.
Nursing
and
Nursing Education have taken
an
active role
in
the review
of the
organisation with
the key
initiative
of
retention
and
recruitment
of staff.
Such
a
focus requires
a
change
in
strategic direction
for the new
look Education
and
Development Unit
to
achieve desired outcomes.
The Neuroscience Department was chosen
as a
focus
for
such
an initiative.
The
position
of
'Clinical Coach'
was
created
in
the middle
of
2002 with
the aim of
instilling
in the
learner
motivation
to
improve performance
and
strive
for
excellence
in patient care. Prior
to
this there
was no
clinical support
within
the
unit,
no
post graduate education,
no
division two's
and minimal undergraduates that rotated through
the
unit
and
very
few
permanent
staff, all
of which were grad
2
year
6 and
above.
Two years after
the
creation
of the
position there
has
been
widespread staff satisfaction both throughout
the
department
and also with
the
initiative. There have been
5
graduate
nurses taken
per
rotation with division
2
graduates
and
trainees prominent throughout
the
unit. Seven students have
been retained after completing post graduate studies
and
both
doctor
and
patient satisfaction along with clinical risk have
had marked improvements.
25
Volume 17 Number 2 2006
Future directions in the transition of paediatric neuro
developmental patients to adult services.
Rachel Coleman & Stephanie Moore
The authors will introduce the topic of paediatric transition to
adult services within the specific context of neuro
developmental patients. Through a literature review the
authors will identify the key themes including barriers to
transition and nursing considerations for practice and future
roles.
The authors will explore current intemational and local
practice in order to make recommendations for future
directions.
Complex Nursing Care of a Patient in a Halo Brace
Maria Moran
A case study of a patient with a cervical injury and who
received treatment by the use of the Halo Brace was
presented. The presentation will include discussion of the
anatomy and pathology of the spine, concentrating on the
cervical spine, the injuries sustained, the mechanism of the
injury, investigations required to make the diagnosis and
decide on the best treatment to stabilise the fracture. The
treatment method will concentrate on the use of the Halo
vest/brace and how it works in stabilising the cervical spine.
The role of the complex and comprehensive nursing care and
allied health management in planning discharge for a patient
in a Halo brace will be presented. The complexity of care and
the role that the case manager plays in insuring that early
discharge planning is started to ensure a safe and smooth
transition from the hospital environment to home that the
patient in a halo brace requires will be identified.
Emerging technology and its role in the management of
severe brain injury.
Sharryn Byers
Every day in intensive care units throughout Australia nurses
and medical clinicians manage patients with severe brain
injury. Management of these patients is dependant on expert
nursing care and assessment. For many years this assessment
has been limited to assessment of level of consciousness,
blood pressure, cerebral perfusion pressure and in some units
saturation of oxygen in jugular veins. In other words using
global methods to assist us estimate what is happening within
the brain. In this presentation how the modalities work, how
to interpret the information and modify treatment will be
discussed as well as the meaning of the information and how
it can be utilised by the nurse to improve patient outcomes.
Whilst major progress in management of severe brain injury
has been achieved with the use of these modalities questions
remain regarding what is actually happening within the brain
itself Recently in both research and clinical settings the use
of monitoring equipment has begun to answer those questions
and provide clinicians with additional infonnation to assist in
the management of these patients.
Brain tissue oxygen monitoring utilising a catheter in the
parenchyma of the brain and microdialysis of the brain tissue
are two such monitoring modalities. Clinical use of these
modalities has begun to be utilised in Australian Intensive
Care Units. The introduction of any new technology has
challenges for all staff involved including the challenge of
learning how the technology works, the situation in which it
should be used and limitations of the technology.
Nursing staff are intricately involved in the use of these
technologies and therefore need to be at the forefront when
introduction of these technologies is considered.
The Terror of Technology.
Danni Phillips
Since the dawn of neurological intensive care in the 196O's,
monitoring of patients with a traumatic brain injury (TBI) has
become increasingly complex. Initially, basic clinical
examinations, formalised Glasgow Coma Scale (GCS), were
used, but advances in technology lead to the introduction of
such monitoring modalities as intracranial pressure (ICP) and
cerebral perftision pressure (CPP) monitoring, jugular bulb
oxygen monitoring, and more recently brain tissue oxygen
(PbO2) monitoring and cerebral microdialysis. GCS, ICP and
CPP measurements are currently used to formulate nursing
therapies and medical management of these patients, and in
conjunction with CT and MRI scans, may be used to predict
outcomes.
One new and exciting advance in technology is PbO2
monitoring, which allows monitoring of the oxygen levels in
brain tissue. Although this technology is new in Australia,
research of this tool has lead to the development of some
26
Volume 17 Number 2 2006
outcome predictors, which in cohort studies can be correlated
to survival.
In a recent case, a young man who sustained a TBI had PbO2
levels in the range predictive of neuronal death and poor
outcomes. Nurses caring for this man were concerned about
continuing care due to the poor prognosis predicted by the
guidelines. In fact the patient improved and was discharged
without requiring rehabilitation. While nurses caring for these
complex patients need to interpret the data collected using
these new technologies assessment must incorporate
'traditional' methods. No, one assessment method currently
available will provide all the answers nurses and medical
staff need to manage these critically ill patients.
A drug free novel approach to facilitate memory and
attention.
Krishna Murthy
A new Neuro - acoustic design of music therapy involving
brain wave entertainment used in this project could provide a
cost effective non-drug altemative to augment treatment of
special population. Mainstream education could benefit from
this by making widely available a form of brain-wave
training, which makes the leaming environment more
enjoyable and productive.
Hypothesis one (HI) postulated a statistically significant
higher mean score for the experimental group over the
control group as measured by a 20 item memorising and
recalling of a list of words.
Hypothesis 2 (H2) postulated a statistically significant higher
mean score for the experimental group over the control group
as measured by a 10 item French to English word list
memorisation, recalling and recognition test.
The increase in performance ofthe experiment group over the
control group in memory related motor tasks in this project
demonstrates a secondary aspect of this task, which is
'ATTENTION'. Thus it also helps those populations who
have academic difficulty due to an impaired ability to
persevere at routine motor tasks, such as ADHD (Attention
Deficit/Hyperactive Disorder) and LD (Leaming Disability)
affected children.
By using only audio stimulation the financial access to the
benefit of this new therapy is also improved. This also helps
the Neuroscience nurses to care for their patients easily as it
increases their attention and memory capacity as indicated in
the results of this study. Hence it could prove a boon for such
patients to recover easily as it is also designed on the basis of
music therapy, which has proven records of increasing
recovery times.
Case Study review of Vasospasm as a complication in
Subarachnoid Haemorrhages.
Carley Mills & Sue Day
This paper reviewed the case and literature associated with
the presentation Mrs. C, a 28 year old who first presented
with a Grade 2 SAH from an aneurysm, which was clipped
without incident. Six days later she presented with a Basal
Ganglia Infarct secondary to vasospasm.
The Neurological Nurse Specialist Service South West
Western Australia.
Penny Hughes
The Home and Community Care Branch of the Westem
Australian Health Department fimd the Neurological Nurse
Specialist Service of South West Westem Australia. It started
as a pilot program being the brainchild of the Neurological
Council of Westem Australia. The South West region now
has 2 nurse specialists and the Great Southern region 1 nurse
specialist. The service is community based and is well
networked with other care providers so outcomes are
improved for people with neurological conditions with the
aim of keeping people well and in their own homes for as
long as possible.
The principle activities of the Neurological Nurse Specialist
Service are:
1.
Provide advice relevant to nursing and allied care services
for clients and their families, carers. Medical and nursing
staff generally. This occurs in the home, office, community
health centres, medical practices, clinics, hospitals, nursing
homes and service provider centres.
2.
Education and information on Neurological conditions
likely to cause admission to hospital and techniques for the
specific care of clients to all areas of the health community,
advocacy for neurological clients and their families and
carers in matters relevant to nursing and medical care.
3.
Community education - promote community awareness of
neurological conditions
27
Volume 17 Number 2 2006
4.
Linking people into local services is a major role in the
position.
The service is utilised by the health community and service
providers. Interestingly the greatest source of referral is from
specialists. I have been involved in the care of 80 different
neurological conditions with a population from babies to the
elderly.
New Surgical Options for the Management of Chronic
Back Pain.
Suzy Goodman
To update those attending on current options for chronic back
pain patients who would traditionally only be offered a spinal
fusion.
Patients with chronic back pain now have more options
available to them than traditional spinal fusion surgery. The
new options have fewer complications and reduced recovery
rates with improved patient satisfaction and physical
functioning in the community in shorter time frames.
The new options that are available are the "Wallis Implant"
and the "Artificial Disc" which are "Stabilisation Procedures"
ofthe spine.
This presentation discusses the clinical outcomes between the
traditional surgery and newer options availahle to the "Right"
patient type from a nursing perspective of the current
Melboume experience. There will be a focus on the physical,
emotional and social recovery of the patient from a
debilitating chronic condition which prevents them
undertaking normal lifestyle activities.
Immunology in MS: Important Consideration for
Nursing.
Tim O'Maley
Multiple Sclerosis (MS) is a chronic, demyelinating and
degenerative disease of the central nervous system, and
research has suggested strong links to an autoimmune
process. Symptoms of this disorder include impairment of
vision, sensation, muscle strength and coordination, and
cognitive processes. Each patient is affected differently by
the disorder, and the physical and emotional progression of
MS is unpredictable.
Understanding the POSSIBLE immunological processes that
may be occurring is becoming an important issue for Nurses
concerned in the care of people with MS. The treatments that
we use are based on immunological theories of the disease,
and with more and more people turning to complementary
medicines, understanding the implications of these is an
essential component to building a successful long-term
patient management relationship.
Unusual Neurosurgical Presentation 12 Days Post Partum
- A Case Study
Simon Latham & Jane Raftesath
'Julie'
is a 38yr old woman who presents to the emergency
department with a seven-day history of thoracic and lower
hack pain, complicated in the last 24hrs by severe bilateral
lower limb weakness, urinary retention and constipation. Pre
hospital treatment had been provided by her local GP and
chiropractor. Interestingly to her case is that 'Julie' is 12 days
post partum, who had a normal vaginal delivery with no
epidural analgesia.
This case presentation will discuss the unusual disease
process and subsequent diagnosis. The pathophysiology,
treatment and prognosis of the patient and the challenges of
looking after a paraplegic patient within a non-spinal unit
setting will be discussed. The detailed involvement of the
multidisciplinary team and the psychological impact this
disease process had on the patient and her family will also he
addressed.
Neurosurgical Step-down Unit Model of
Care:
An
alternative to intensive eare.
Jeanne Barr, Vicki Evans & Jeff Ramos.
Patients undergoing neurosurgery or neurointerventional
procedures require constant ohservation and assessment by
nurses with specialised skills in neuroscience nursing. While
many patients require intensive care admission there are
certain groups of patients that may be safely managed within
a neurosurgical step-down unit.
Our institution is unique within NSW having for many years
maintained a specialised neurosurgical intensive care unit
with its own staff of neurosurgical ICU nurses. Over the
years,
the complexity of patients admitted to that unit
continued to increase along with the demand for the service.
28
Volume 17 Number 2 2006
After a proposal for a neurosurgical step-down unit was
accepted by the health service executive we began planning
for that unit. This involved nursing, medical, and allied health
staff from both the neurosurgical intensive care unit and
ward. This paper will outline the development process and
describe the step-down unit model of care including the types
of patients admitted, their length of
stay,
the pros and cons of
the model and plans for the future.
Hot, Wet, Rigid & Numb: A case study
Joanne McLoughlin
McKinley (Denali), there are extra precautions and a
realisation of the fine line between life and death.
Cerebral syndromes usually develop at altitudes above
2,500m (8,000ft), Cerebral oedema, hypoxia, hypothermia
and frostbite can claim even the most experienced climber,
"Falling Head over Heels" Reducing Falls in
Neurosurgical Inpatients with the infiplementation of a
'High Risi( Falls Room'.
Kylie Wright, Jason Selmon, Kendall Neilson & The Team
CB 4 West Liverpool Hospital NSW
A 57-year-old man (Mr, X) presented to the Emergency
Department with back pain and spasms. He had become
unwell at home for the past three weeks and previously had a
perforated eardrum a few weeks earlier and was taking
amoxil. He was admitted to the medical ward but during the
night he was given IMI Pethidine and half-Hour later he was
desaturating, extremely agitated and diaphoretic. The signs
and symptoms were atypical of a number of disease processes
and this baffled the medical
staff.
What was wrong with Mr.
X? The suggestions were Meningitis? Encephalitis? Tetanus?
Multiple Sclerosis? Epileptic seizures?
On CT scan he had a right mastoiditis and the next day he
was sent to theatre for a right mastiodectomy. His condition
initially improved and was extubated but later that day there
was reappearance of the previous symptoms and he required
reintubation. He was transferred to St George Hospital for
MRI, EEG and neurological opinion, as the diagnosis was
still unclear. While at St George hospital a diagnosis was
confirmed and the patient was treated accordingly and later
transferred back to Wollongong, Today Mr, X hasn't been
able to retum to work he still has muscle spasms, muscular
weakness and tires easily,
POSTER ABSTRACTS
Everest & Denali: Cerebral Syndromes
Vicki Evans
It's been over 50 years since Hillary conquered Everest.
Since 1975, Mt, Everest has been climbed more than 1,600
times by over 1,200 individuals, including approx, 175
fatalities. There are many factors that the avid climber must
research before any climb. Yet to climb Mt. Everest or Mt,
Fall related injury in acute care facilities is a major safety
concern. Our quality processes identified a high number of
falls with adverse consequences were occurring on the
neurosurgical ward, A multidisciplinary team was formed
and brainstormed ideas to decrease the incidence of falls in
high-risk patients. The team suggested cohorting high-risk
patients together into a 'High Risk Falls Room' with the aim
of preventing falls, A target was set of 50% reduction in 6
months and eventually to zero. Falls incidence data was
collected and analysed and results reviewed after 6 months.
Results showed the incidence of falls decreased from 6,5 falls
per month to just 1, and within 9 months the team had
achieved a zero falls incidence rate. Using this model,
standards for falls prevention and benchmarking between
facilities can further help decrease the incidence of fall
related injury.
Neuroscience Nurses making a difference in the lives of
people living with Advanced Parkinson's Disease.
Karen O'Maley
People living with advanced Parkinson's Disease (PD) face
complex issues, which must be dealt with using health care
professionals' assistance. Medication doses become complex
and therapeutic regimens confusing. Surgery is also an option
for symptom control, however many people are unable to
access this option in Queensland due to financial constraints
(no public funding for the procedure) or because they are
poor surgical candidates. Medication side effects can often
become more disabling and problematic than the sjonptoms
ofPD,
One way Neuroscience nurses are making a difference in the
lives of people living with advanced PD is in education,
initiation and maintenance of a novel injectable dopamine
29
Volume 17 Number 2 2006
agonist. The Dl, D2 agonist can improve PD symptom
control in select PD patients. The treatment, however,
requires intense education and strong nurse - patient
relationships. The treatment is prescribed by Movement
Disorder specialist neurologists but assessment, initiation and
ongoing evaluation is carried out by Movement Disorder, PD
Nurse Specialists.
Educating and relationship formation with the person with
PD,
their families, carers and other involved health care
professionals is intrinsic to successful outcomes of this
therapy. This poster describes the process of patient selection,
trialling of apomorphine to assess appropriateness and the
patient education required. Anecdotal evidence of patients
currently using the treatment is described. The potential for
multi-cenn-e nursing driven research into the use of
apomorphine in PD symptom control is also discussed.
Back to 'BASICS': BuUding A Stroke Inpatient Care
Strategy: Key Performance Indicators in Stroke Nursing.
Karen Tuqiri, & Sharon Eriksson
Monitoring of the standard of health care delivered to patients
is essential in the current quality-focused health care system.
The need for objective key performance indicator data
collection is evident as health care environments focus on
improved quality of care and greater accountability. More
recently the quality of nursing care received by patients and
its impact on patient outcomes has received great attention.
The development of key performance indicators (KPI's)
sensitive to patients' nursing needs is of great importance in
this indicator-oriented health care system.
This poster outlines the strategy the Acute Stroke Unit at the
Prince of Wales Hospital, Sydney used to facilitate the
introduction of KPI's in stroke nursing.
The aim of this strategy is to optimise patient safety and
outcome by monitoring and reviewing nursing care delivery.
The entire process promotes the continuation of existing good
nursing practice and allows the identification of key areas
requiring improvement.
This strategy included:
1.
The identification of five relevant and measurable
core stroke nursing indicators,
2.
The development and implementation of clinical
audit tools, and
3.
Determining the process for collating results
and providing timely feedback to the nursing
staff.
The implementation of stroke nursing KPIs has been well
received by the nursing team in our Acute Stroke Unit. They
have recognised the importance their care has on patient
outcomes and are demonstrating greater accountability for
their nursing care.
Sharing the Expertise of a potential Learning
Organization
Anne Macleod
A learning organization is a workplace where learning takes
place at an individual and organizational level. It needs to be
adaptive in its learning processes to bring about
organizational change.
The Neurosurgical ward at Royal North Shore Hospital
places a strong emphasis upon nursing education. The aim is
to achieve the best possible care for the neurosurgical patients
based upon the stafTs clinical and theoretical knowledge and
in doing so seek to reach the objectives of a learning
organization. With the development of new technology,
procedures and research there is a need to continually leam in
order to provide optimal patient care.
30
