Han Jung-Hee, Han Claire, Park Sunmae, Kim Young-Joo, Kim Bum Joon
Asan Medical Center, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea.
The Ohio State University, College of Nursing, Columbus, OH, USA.
Heliyon. 2024 Jun 5;10(12):e32175. doi: 10.1016/j.heliyon.2024.e32175. eCollection 2024 Jun 30.
There is little evidence about the factors related to the detection of neurological deterioration by nurses. We examined the related factors and therapeutic outcomes of nurses' detections of patient's neurological deterioration.
This was a descriptive retrospective study. We included 549 adult stroke patients who were admitted to the acute stroke unit of a tertiary hospital between May 2018 and December 2019 and had changes in neurological symptoms that were detected by stroke nurses. We measured the following outcomes: stroke lesion progression, early neurological deterioration (increase in the total national institutes of health stroke scale score of 2 points or more, increase in the limb weakness score of 1 point or more, or decrease in the alertness score of 1 point or more), and additional clinical management (increasing intravenous fluids, diagnostic imaging, or neuro-intervention). Data was analyzed by logistic regression.
A total of 651 new or aggravating symptoms were detected by nurses. The most detected symptom was motor aggravations (49.2 %). Symptoms were commonly detected during the day shift (51.0 %) and by scheduled neurochecks (71.3 %). Of 132 patients who underwent diagnostic imaging by nurses' detection, 63.6 % cases had stroke lesion progression. Nursing experience over 4 years was positively associated with finding stroke lesion progression (OR: 2.49, 95 % CI = 1.09-5.67). Early neurological deterioration was found in 70.7 %, and it was significantly higher during scheduled neurochecks (OR:2.65, 95 % CI = 1.04-6.72) and in the group of large artery atherosclerosis (OR: 2.19, 95 % CI = 1.06-4.49) Additional clinical management was provided to 49.9 % of detection, and scheduled neurocheks (OR: 4.76, 95 % CI = 2.18-10.39) and changes of alertness (OR: 2.89, 96 % CI = 1.51-5.26) were the significant factors.
Stroke nurses were able to detect a large number of stroke lesion progression and early neurological deterioration as well as to provide additional clinical management. Systematic guidelines for qualification of stroke nurses may be beneficial.
关于护士发现神经功能恶化相关因素的证据很少。我们研究了护士发现患者神经功能恶化的相关因素及治疗结果。
这是一项描述性回顾性研究。我们纳入了2018年5月至2019年12月期间入住一家三级医院急性卒中单元的549例成年卒中患者，这些患者出现了卒中护士检测到的神经症状变化。我们测量了以下结果：卒中病灶进展、早期神经功能恶化（美国国立卫生研究院卒中量表总分增加2分或更多、肢体无力评分增加1分或更多、或警觉性评分降低1分或更多）以及额外的临床管理（增加静脉输液、诊断性影像学检查或神经介入）。数据通过逻辑回归进行分析。
护士共检测到651个新的或加重的症状。最常检测到的症状是运动功能加重（49.2%）。症状通常在白班（51.0%）和定期神经检查时（71.3%）被检测到。在因护士检测而接受诊断性影像学检查的132例患者中，63.6%的病例有卒中病灶进展。4年以上的护理经验与发现卒中病灶进展呈正相关（比值比：2.49，95%置信区间=1.09 - 5.67）。70.7%的患者出现早期神经功能恶化，在定期神经检查期间（比值比：2.65，95%置信区间=1.04 - 6.72）以及大动脉粥样硬化组（比值比：2.19，95%置信区间=1.06 - 4.49）中显著更高。49.9%的检测病例接受了额外的临床管理，定期神经检查（比值比：4.76，95%置信区间=2.18 - 10.39）和警觉性变化（比值比：2.89，96%置信区间=1.51 - 5.26）是显著因素。
卒中护士能够检测到大量的卒中病灶进展和早期神经功能恶化，并提供额外的临床管理。制定卒中护士资质的系统指南可能会有所帮助。
