Essentials of Neurological & Neurosurgical Nursing TP Prema, KF Graicy
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Unit One

Overview of Neuronursing and its New Challenges1

Nursing or caring the sick is as old as the world itself. Family members, servants, friends, neighbors and religious groups cared the ill individuals as and when required. Then few people took up the job of nursing for their livelihood. Florence Nightingale provided a light to these group of women, a different dimension of their work, and therefore Florence Nightingale is known as the mother of modern nursing. Nursing has taken many other shapes as it started having a written curriculum to follow, has a definite period for practical experience and also the need to appear for an examination, before a certificate is issued.
The present-day nursing is an encounter with a client and his or her family wherein the nurse observes, supports, communicates, administers and teaches. The nurse also has the duty of her own independent diagnosis, intervention and evaluation of what she carries out for patients. She is also involved in research to improve the nursing management by forming nursing theory.
Other changes happened in nursing are according to the changes occurred in the medical and surgical services. These two basic concepts branched out enormously to its minute dimension. Among these developments, one of the important event is the invasion of neurology from medical science and neurosurgery from surgical science. Faster developments happened in neuroscience and 1990s was called as the decade of brain.
If the literature of the neuronursing is reviewed for last hundred years, it can be divided into three periods, i.e. early, transitional, and modern. In the early period, the neuronursing textbooks were written by neurophysicians. Those books were based on medical and surgical nursing and the literature reflected the dependent 2nature of nursing. In the second period, namely the transitional period, physicians and nurses were co-authors reflecting a trend towards interdependency of nursing practice. In the third, i.e. the modern period the nurses became independent authors of books written on neurological and neurosurgical nursing.
If one reviews the practice of neuronursing started out from the merely carrying out the doctors' orders. In 1970, the textbook written by Brunner and Sudharths placed emphasis on the nurses' role in assessment of the neurological patients by nurses. This also stated the plan of care including the nursing management of unconscious patient with objectives, principles and rationale for care. Here the nursing intervention were directed by data obtained from assessment of the patient and family and less by intuition and physicians' direction.
In 1975, Smith and Germain wrote about the clinical management by nurses for the patients with increased intracranial pressure. It listed the actions which the nurses can take during the management of patients with increased intracranial pressure. They are:
  • Check vital signs every 30 minutes.
  • Check the level of consciousness and pupillary reaction.
  • Check for paralysis.
  • Give breathing by mouth.
  • Elevate the head end of the bed 30° angle.
  • Maintain patients' head to the side.
Later, the different editions of textbook written by Joanne V. Hickay included the individual chapters on different neurological conditions, e.g. chapter on increased intracranial pressure, chapter on unconscious patient, etc.
Problems Faced by Nurses
Though the texts are available about the responsibilities of nurses, nurses do not use these texts to practice independently. They go for the old routine of carrying out the physicians' orders. Nursing text whether it is written by physicians or nurses, do not generally mention about the nursing management. Exception to this style are worthy of mentioning. Roger Bannister's revision of Brain's Clinical Neurology (1978) contained a very small section on nursing management of unconscious patient. Another example is, literature written by James R Howe, titled “Patient Care in Neurosurgery”. 3Observations regarding nursing care were extensive and spread in the text rather than clustered in a small section at the end of the each chapter. So now enough literature is available for neuronurses to take care of patients with different neurological or neurosurgical conditions. In practice, the nurse has few changes in her side such as preparing and assisting in the procedures like CT scan, MRI and Interventional radiology. In her neurosurgical operation theater, the nurse has different new equipments which she has to get acquainted. Laser and gamma knife are two such equipments which are not available in many neurosurgical operation theatres. So nurses have no or less knowledge about these equipments and their usage.
Future Challenges in Neuronursing
Current literatures in neuroscience is available in every corner of the world. But the neuronursing is lacking behind in its knowledge. So the leaders in nursing profession has to take up the responsibility of giving current trends to their fellow nurses by:
  1. Writing articles in national journals.
  2. Writing articles in international journals.
  3. Conducting continuing education program and ISE program for nurses.
  4. Doing research to form nursing theories in neuroscience nursing.
  5. Publishing manuals or handouts according to the changes happening in neuroscience.