Management of fluid and hydration in patients with acute subarachnoid haemorrhage - an action research project

Nursing interventions for critically ill traumatic brain injury patients

Neuroscience intensive care unit (ICU) nurses deliver a number of interventions when caring for critically ill traumatic brain injury (TBI) patients. Yet, there is little research evidence documenting specific nursing interventions performed. As part of a larger study investigating ICU nurse judgments about secondary brain injury, ICU nurses were asked to identify interventions routinely performed when caring for TBI patients. Quantitative and qualitative analyses indicate that all nurses routinely monitored hemodynamic parameters such as oxygen saturation, blood pressure, and temperature. Nurses were responsible for monitoring intracranial pressure and cerebral perfusion pressure approximately 50% of the time. Qualitative analyses revealed that additional nursing interventions could be categorized as neurophysiological interventions, psychosocial interventions, injury prevention interventions, and interventions to maintain a therapeutic milieu. Findings from this study provide evidence of the multifaceted role of the neuroscience ICU nurse caring for TBI patients and can be used in future research investigating the impact of nursing interventions on patient outcomes.

From monitoring physiological functions to using psychological strategies. Nurses' view of caring for the aneurysmal subarachnoid haemorrhage patient

AIMS

The aims of this study were: (1) to describe nurses' views of the physical and supportive needs of patients who have suffered a subarachnoid haemorrhage (SAH), (2) to describe nurses' views of changes in social circumstances and (3) changes in the mental condition of patients after SAH.

BACKGROUND

As patients with SAH are generally younger and predominantly female compared with other stroke groups they may have different needs of nursing support to facilitate adaptation. Caring for persons surviving stroke involves advanced nursing skills such as monitoring neurological functions in neurointensive care and providing physical care during rehabilitation.

DESIGN

Explorative descriptive design.

METHOD

Semi-structured interviews were performed with 18 nurses in neurointensive and rehabilitation care. A qualitative latent content analysis was conducted.

RESULTS

Nurses viewed patients' need for support as a process ranging from highly advanced technological care to 'softer' more emotional care. However, shortages in the communication between neurointesive and rehabilitation nurses regarding this support were acknowledged. Changes in social circumstances and mental conditions were viewed both as obstacles and advantages regarding return to everyday life. Nurses also viewed that the characteristics of the group with SAH was not particularly different from the group with other types of stroke.

CONCLUSIONS

Support to patients with SAH is viewed as a process carried out by nurses at neurointensive care units and rehabilitation units. Shortages in communication, regarding this support, were acknowledged. Obstacles and advantages with respect to returning to everyday life could apply to any stroke group, which could make it more difficult for nurses to detect the specific needs of patients with SAH.

RELEVANCE TO CLINICAL PRACTICE

The communication between neurointensive nurses and rehabilitation nurses regarding support to patients with SAH is not satisfactory. Occasionally the specific needs of patients with SAH are not recognized.