INTRODUCTION
A neuroscience nurse assists patients with brain and nervous system disorders. Some of their duties include monitoring neurological exams, administering medication and consulting physicians on patient progress. Neuroscience nurses work in diverse, challenging and rewarding environments, such as hospitals, healthcare clinics, brain injury units and intensive rehabilitation units. Neuroscience nursing is both rewarding and challenging and encompasses neurosurgical and neurological nursing.
The ‘neuro’ nurse must be astute and observant as effective, rapid change management can ensure better patient outcomes. Conditions treated may be acute in nature, such as head injuries, brain hemorrhages, stroke or spinal tumors or chronic and debilitating such as multiple sclerosis, motor neuron disease and Parkinson disease.
Skills acquired as a ‘neuro’ nurse include airway management, seizure management, identifying and managing raised intracranial pressure and neurological assessment skills. Applying the skills and knowledge of a ‘neuro nurse’ will make a difference to the outcome of the client. Developments in stem cell research, pharmacology, computer monitoring and others make neuroscience an evolving specialization.
HISTORICAL PERSPECTIVES OF NEUROSCIENCE NURSING
Although women have always been considered caretakers of the sick and injured, they were rarely trained to provide specialized care. During the Crimean War in the mid-1850s, Florence Nightingale established the first standardized training for nurses. Neuroscience nursing began to emerge as a specialty in response to advances in the fields of neurosurgery and neurology as ell as iin response to the need to care for individuals injured during World Wars I and II and the Korean War.
During the Vietnam War, Margarethe Cammermeyer, served as the head nurse in the neurosurgical unit in the 24th Evacuation Hospital during the Tet Offensive in 1968. Heavy casualties were sustained during this battle and Cammermeyer was faced with caring for patients with devastating head injuries. Despite limited resources, limited staff and the overwhelming need to care for an increasing number of critically ill patients, Cammermeyer remained committed in providing care, the human touch and a sense of compassion to patients. No neurosurgical patient was allowed to be removed from life support unless she was at the bedside so that ‘no one would die alone’ (Cammermeyer M, personal communication, 1995).
The simultaneous provision of expert nursing care combined with a sense of compassion began to lay the foundation for neuroscience nursing care as it is known today. This article traces the growth in the profession of neuroscience nursing as it developed at Barrow Neurological Institute and within the greater context of neuroscience nursing.
DEFINITION
Nursing is defined as, “the protection, promotion and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response and advocacy in the care of individuals, families, communities and populations.”
Neuroscience nursing is a unique area within the nursing discipline, which specializes in the care of individuals who have biological, psychological, social and spiritual alterations due to nervous system dysfunction. This encompasses all levels of human existence, from4 basic bodily functions to advanced processes of the human mind. Neuroscience nurses identify and treat human responses to actual or potential health problems related to phenomena affected by nervous system dysfunction. Neuroscience nursing care is provided across the lifespan, from birth to death.
Major categories of disease that produce alterations of concern to neuroscience nurses include degenerative diseases, tumors of the nervous system, neuromuscular diseases, traumatic injury to the nervous system, cerebrovascular disease, seizures, pain, diseases of the spine, movement disorders and developmental problems of the nervous system. Potential recipients of neuroscience nursing care are individuals with nervous system dysfunction, their families and significant others and the society in which they live. Neuroscience nursing also includes prevention of neuroscience dysfunction through health promotion, community education and research.
NEUROSCIENCE NURSING ORGANIZATIONS
The important neuroscience nursing organizations and their contributions are listed in Table 1.1.
HISTORY OF NEURONURSING IN SOME IMPORTANT NATIONS
History of AmericanNeuroscience Nursing
In the mid 20th century and beyond, advances in medical treatment and healthcare technology led to the evolution of nursing specialties. Specialized education, training and certification ensued in both traditional and newer areas of clinical practice, including neuroscience nursing.
Neuroscience nursing was formally recognized as a specialty in 1968 with the formation of the American Association of Neurosurgical Nurses (AANN). In 1985, the organization name was changed to the American Association of Neuroscience Nurses to reflect the practice diversity of its members. A statement of the standards of neurological and neurosurgical nursing practice was first completed in 1977 and was approved by the executive committee of the American Nurses Association’s (ANA’s) division of medical-surgical nursing practice and AANN. A statement of neuroscience nursing scope of practice was first completed in 1986 by the AANN Nursing Practice Committee. This document served to describe the parameters of nursing practice for the specialty, identify the population served and practice setings and distinguish qqualifications of nurses in the specialty and the type of care rendered to patients. This description was useful to the neuroscience nurse in defining goals and to the public for clarifying expectations.
In 1993, the standards and scope of practice statements were combined into a single document and updated, addressing the expanded options for neuroscience nursing in the 1990s. The third revision in 2002 reflected practice evolutions at the beginning of the new millennium. The borders of nursing practice have grown in recent years with potential for continued change as healthcare reforms take shape. A renewed emphasis is placed on care of patients across the lifespan and a spectrum of health states rather than focusing on episodes of illness.
As neuroscience nursing evolved as a specialty, so did opportunities for advanced practice. The nursing shortage, need to improve quality of care, restricted residency hours and promotion of cost-effective care have led to increasing use of advanced practice nurses. The number of advanced practice nurses in neuroscience nursing has grown in recent decades, reflecting the complexity and diversity of the field.
In 2009, work began on a scope of practice and standards document for advanced neuroscience nursing, which was published in 2010. This document reflects an update to the 2002 revision as well as incorporation of the advanced neuroscience nursing scope and standards and represents collaboration between AANN and ANA.
History of Canadian Neuronursing
In June of 1969, Miss Jessie Young and a small group of neuroscience nurses held an organizational meeting in Montreal. At the end of their meeting, the Canadian Association of Neurological and Neurosurgical Nurses and its first executive had been formed. From these early beginnings, the association has continued to grow and develop. Since 1970, Canadian Neuronursing (CANN) hosted its Annual General Meeting and Scientific Sessions bringing together neuroscience nurses from across the country to network and share knowledge. Highlights of CANN’s accomplishments include the first interest group to be awarded affiliate membership in the Canadian Association of Nurses (CNA) and the first nursing specialty accepted for certification under CNA’s program.
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In 1979, CANN published the first edition of the journal AXON. Over the years, the journal evolved in format and content including most recently a name change to the Canadian Journal of Neuroscience Nursing, but always remains dedicated in providing content of interest to the community of neuroscience nurses in CCanaa. The 80s saw CANN’s involvement in advancing the practice of neuroscience nursing by publishing the first standards of practice for neurological and neurosurgical nursing, becoming a member of the World Federation of Neuroscience Nurses and offering bursaries and awards to support members for continuing education.
In the 1990s, the administrative side of the organization solidified leading to the creation of a mission statement and strategic plan. By the mid 90s CANN had its own website opening the door for better dissemination of knowledge across the country and internationally.
National Neuroscience Nurses Day
Launched during the 2007 Annual General Meeting and Scientific Sessions held in Edmonton, Alberta. This celebratory day was created to recognize the ongoing dedication and achievements of neuroscience nurses across Canada.
The CANN members are encouraged to use this day to help spread the word of the contributions neuroscience nurses make each and every day to promote the health of all those affected by neurological disorders. National Neuroscience Nurses Day occurs annually June 20th commemorating the anniversary of the creation of CANN in 1969.
History of Australasian Neuroscience Association
In 1968, Agnes Marshall-Walker, cofounder of the American Association of Neurosurgical Nurses established the World Federation of Neurosurgical Nurses (WFNN). The WFNN is in the unique position of being 6affiliated with its medical counterpart, the World Federation of Neurosurgical Societies. In 1973, the first Australians (Tonnie Koenen and Marita Pigden) were admitted as members of the WFNN and Tonnie Koenen was given the task of establishing a national society of neuroscience nurses in Australia. Tonnie Koenen also served as the WFNN editor of publications.
In 1974, on the 4th of May, Tonnie Koenen organized the first meeting of Australasian Neuroscience Nurses in Canberra, during the Neurosurgical Society of Australasia’s annual meeting. Thirty nurses from the Australian Capital Territory, New South Wales, Tasmania, Victoria and Western Australia met to formally establish the Australasian Neurosurgical Nurses’ Association. In 1975, the second meeting of the Australasian Neurosurgical Nurses’ Association saw the constitution ratified and the association’s emblem launched (Fig. 1.1). The association’s membership numbered 42. The emblem was designed as a neuron with the Southern Cross superimposed with the association’s initials inserted inside the neuronal body. Blue background, silver stars, white inscription.
The Australasian Neurosurgical Nurses’ Association was formally accepted as a member of the WFNN in October 1977. Tonnie Koenen, the association’s founder, stood down as president. She retains the lifelong position of Honorary President. In 1980 Brainstem, the association’s first newsletter was launched, with Narelle Glass and Jan Davis serving as editors. In 1981, Valda Jones became the first association member to be elected to the WFNN office of Vice President.
The resignation of the WFNN President saw the promotion of Valda Jones to that office, the first association member to hold that position. The first nursing paper was presented at the Neurosurgical Society of Australasia’s (NSA’s) meeting in Queenstown, New Zealand in 1986. Leandra Ingram presented a paper on ‘Nursing Diagnosis’. At this meeting, the society awarded the inaugural NSA Prize for the best nursing paper presented during the association’s educational program. The prize was won by Alice Grote, from South Australia.
In 1987, the association’s name was changed to the Australasian Neuroscience Nurses’ Association. Membership numbered 108. In 1988, the Australasian Journal of Neuroscience was launched with Veronica Roach as editor. The first full day association meeting was conducted preceding the Neurosurgical Society of Australaaia’s meeting in Sydney. The inaugural Tonnie Koenen Prize was awarded for the paper judged as making a significant contribution to or comment on the practice of neuroscience nursing. The prize was awarded to Rhonda Atkinson, Tasmania and presented by Tonnie Koenen. The Association’s Operational Manual was launched. In 1989, the association conducted its first 2 day annual meeting, including a workshop on ‘Standards of Neuroscience Nursing Practice’.
The Australasian Journal of Neuroscience achieved its first medical index listing on the Australasian Medical Index (1990). Incorporation of the Australasian Neuroscience Nurses’ Association was finalized. Membership numbered 224. In 1994, 20th Anniversary Meeting Gold Coast, Queensland. In 1997, association member Barbara Lester was elected Vice President to the World Federation of Neuroscience Nurses. Association member Vicki Evans was elected as Secretary to the World Federation of Neuroscience Nurses.
In 1999 the founder, Tonnie Koenen passed away in September (2001), Australia hosted its first World Federation Neuroscience Nurses Congress in Sydney, NSW, with Barbara Lester and Vicki Evans serving as scientific chairs. Association member Rochelle Firth was elected Secretary to the World Federation of Neuroscience Nurses.
Review of the Standards of Neuroscience Nursing was undertaken by the Western Australian branch and accepted at the Annual General Meeting; Queenstown (2003) Vicki Evans, association member, was elected to the WFNN office as Vice President at the World Congress in Barcelona, Spain (2005).
History of Neuroscience in India
The important events and contributions in neuroscience in India are listed in Table 1.2.
CLINICAL ROLE OF NEUROSCIENCE NURSE
The daily routine of a neuroscience nurse consists of providing high-quality medical care to those patients that are suffering from nervous system conditions. Some of these conditions are, but not limited to: seizures, spinal cord injuries, brain and head injuries, brain tumors, multiple sclerosis and many other nervous system diseases and conditions.
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The nurses provide postoperative and immediate care to those patients that are recovering from any neurosurgery that they have had performed. They can also provide specialized care to patients that have had any ltterations in consciousness and those patients that are either quadriplegic or paraplegic. These nurses not only do all of this but also take medical histories, perform routine exams, interpret and administer tests and plan a variety of treatments and interventions to help the patient and then implement them. They are the ones that focus on the treatments that will help improve and even support functions of the body, promote early recovery and encourage all patients to adapt to any neurological difficulties that they might have and are becoming persistent.
SCOPE OF NEUROSCIENCE NURSING
The career outlook for neuroscience nurses is expected to grow at a fast rate, increasing over 20% within the next 5 years. This is because of the growing and aging population that we live in, which causes an increase in demand for neuroscience care on these people. This is what is going to increase the need for neuroscience nurses, as well as many other specialized nurses. The job prospects for this field are expected to be and stay excellent for those nurses that have certification and experience in the field already over the next few years. A lot of job openings will provide neuroscience nurses with a chance to become part of many different diverse medical teams.
Choosing to become a neuroscience nurse might be one of the best things that someone can do when the time comes. This is because, for anyone with a strong interest in neuroscience and a clear understanding of helping out people, this would be the perfect career path to choose. Not only can the nurse focus on neuroscience but also they can help patients along the way and provide support to them. The nurses that choose this specialty should have an understanding of the treatment and care that is needed for many different neurological diseases and conditions.
Patience, physical stamina, tact, critical thinking and even detail orientation are all needed to become successful in this type of nursing specialty. Neuroscience nurses also have to be able to communicate efficiently and effectively with everyone that they work with, including their patients and their coworkers. They have to be inviting and allow their patients to feel comfortable,8 while working with them. They have to be able to make the best decisions, even in emergency situations and be quick on their feet at all times.
CHARACTERISTICS OF NEUROSCIENCE NURSING
Distinguishing Characteristics of Neuroscience Nursing
The ANA identifies the following essential features of nursing practice:
- A caring relationship that facilitates health and healing.
- Attention to a range of human experiences and responses to health, disease and illness in the physical and social environments.
- Integration of objective data with knowledge gained from an appreciation of the healthcare consumer’s or group’s subjective experience.
- Application of scientific knowledge to diagnosis and treatment through the use of judgment and critical thinking.
- Advancement of professional nursing knowledge through scholarly inquiry.
- Influence on social and public policy to promote social justice.
- Assurance of safe, quality and evidence-based practice.
Essential Featuresof Neuroscience Nursing
These essential features are applied in neuroscience nursing practice to address the phenomena unique to the specialty. Specific phenomena defined by the American Association of Neuroscience Nurses (AANN) that comprise the unique domain of neuroscience nursing include:
- Consciousness and cognition: The awareness of and interaction with the surrounding environment as well as the higher thought processes; alterations include problems such as coma, memory impairment and seizures.
- Communication: The language interaction with others; alterations include language impairments secondary to aphasia or dysarthria.
- Mobility: The ability to move freely within the environment; alterations include various forms of paralysis.
- Affiliate relationships: The ability to form and maintain social support relationships; alterations include social isolation and role changes secondary to nervous system disease.
- Rest and sleep: Phenomena necessary for restorative function; alterations include the spectrum of sleep disorders.
- Sensation: The ability to sense and distinguish internal and external stimuli; alterations include decreased sensation and pain.
- Elimination: Bodily excretion of waste products; alterations include bowel and bladder dysfunction secondary to nervous system disease.
- Sexuality: The ability to interact and maintain a sexual relationship; alterations include sexual dysfunction secondary to nervous system disease.
- Self-care: The ability to provide for one’s basic needs; alterations include the inability to care for one’s self.
- Integrated regulation: The inter-relationship between the nervous system and other body systems; alterations include loss of regulatory control (Stewart-Amidei and Kunkel, 2000).
NURSING PROCESS APPLICATION IN NEUROSCIENCE NURSING
Neuroscience nurses use the nursing process to deliver care. The nursing process is often conceptualized as having linear direction from assessment to diagnosis, outcomes identification, planning, implementation and evaluation. However, these steps are often necessarily inter-related, as one step may inform another.
The Neuroscience Nursing Standards of Practice coincide with the steps of the nursing process. The nursing process begins with assessment, with specific attention focused on neurologic assessment. Data gathered from the neurologic assessment is used to plan and implement nursing interventions specific to the patient’s neurologic dysfunction. Interventions may support bodily functions and promote healing and recovery of the acutely ill; enhance adaptation to persistent neurologic deficits for the chronically ill; facilitate patient, family and significant other coping; and teach patients, families and significant others about disease processes, adaptation techniques and therapies.
The neuroscience nurse evaluates the outcomes of nursing care on an ongoing basis and revises the plan9 s nnecessary. Further, application of clinically relevant research promotes evidence-based care and development of creative therapeutic nursing interventions to improve outcomes for patients with neurologic dysfunction.
Ethical principles are applied in any care rendered. Similarly, the Neuroscience Nursing Standards of Professional Performance relate to how the professional nurse adheres to the Neuroscience Nursing Standards of Practice, completes the nursing process and addresses other practice issues and concerns.
Tenets of NeuroscienceNursing Practice
Five tenets characterize contemporary neuroscience nursing practice and are reflective of nursing practice as a whole:
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Neuroscience nursing practice is individualized: Neuroscience nursing practice respects diversity and is individualized to meet the unique needs of the healthcare consumer. The healthcare consumer is defined as the individual with or at risk for neurologic dysfunction, their family, group, community or population who is the focus of attention and to whom the neuroscience nurse is providing services as sanctioned by the state regulatory bodies.
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Neuroscience nurses coordinate care by establishing partnerships: The neuroscience nurse establishes partnerships with persons, families, communities, support systems and other providers, utilizing in-person and electronic communication methods to reach a shared goal of delivering health care.Health care is defined as the attempt “to address the health needs of the patient and the public.” Collaborative, interprofessional team planning is based on recognition of each discipline’s value and contributions, mutual trust, respect, open discussion and shared decision-making.
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Caring is central to the practice of the neuroscience nurse: Professional nursing promotes healing and health in a way that builds a relationship between the neuroscience nurse and healthcare consumers (adapted from Watson, 1999, 2008). ‘Caring is a conscious judgment that manifests itself in concrete acts, interpersonally, verbally and non-verbally’ (Gallagher-Lepak and Kubsch, 2009). While caring for individuals, families and populations as the key focus of neuroscience nursing, the neuroscience nurse additionally promotes self-care, as well as care of the environment and society (Hagerty, Lynch-Sauer, Patusky and Bouwsema, 1993).
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Neuroscience and advanced practice neuroscience nurses use the nursing process to plan and provide individualized care to their patients. Neuroscience nurses use theoretical and evidence-based knowledge of human experiences and responses to advocate for and collaborate with healthcare consumers in assessing, diagnosing, identifying outcomes, planning, implementing and evaluating care. Nursing interventions are intended to produce beneficial effects, contribute to quality outcomes, 14 and above all, do no harm.Nurses evaluate the effectiveness of their care in relation to identified outcomes and use evidence-based practice to improve care. Critical thinking underlies each step of the nursing, problem-solving and decision-making processes. The nursing process is cyclical and dynamic, with each step informing both the previous step and the succeeding step. The nursing process is also client centered, interpersonal and collaborative and universally applicable.
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A strong link exists between the professional work environment and the neuroscience registered and advanced practice nurse’s ability to provide quality patient care and achieve optimal patient outcomes.Professional neuroscience nurses have an ethical obligation to maintain and improve healthcare environments conducive to the provision of quality health care (ANA, 2001). Elements of a healthy work environment have been extensively studied and document the relationship between effective practice and quality of the work environment. The neuroscience nurse must maintain and improve the healthcare environment for both nurses and healthcare consumers in order to prevent injury and illness as well as promote health.
CONCLUSION
The neuroscience nursing team cares for patients with a wide range of neurological conditions, including chronic,medically complex cases. They benefit from the broad array of treatments offered by the Department of Neurology and Neurosurgery. Some of the most advanced treatments available to resolve or manage conditions ranging from neurovascular disease, neurotumors, neurospine disorders, brain attack, multiple sclerosis (MS) and Alzheimer’s disease, to chronic pain, sleep disord10 ers and migraines are also offered. The neuroscience nursing division provides a continuum of care including intensive care, intermediate care and acute care units, as well as an area for specialty epilepsy monitoring.