Informing the World About the Hidden Role of Neurology Nurses

What is Nursing?

The ANA (American Nurses Association) describes nursing as a highly specialized profession that is the adhesive that supports the entire healthcare journey of an individual, as a science which employs critical thinking, and as an art that demonstrates intuition for patient’s needs and respect for human dignity (nursingworld.org, n.d.). This definition attempts to broadly classify nursing in the midst of the other healthcare professions and is certainly not meant to encompass 100% of what nurses do. The profession of nursing is ever-evolving and what is true of the roles of nurses today may no longer be true a decade from now. What will likely never change is the nursing process. Nurses will always assess physiological, economic, social, and spiritual factors, attentively and cautiously form a diagnosis, plan for patient outcomes by setting realistic goals, implement care plans, and evaluate or analyze patient outcomes (nursingworld.org, n.d.). The definition of nursing is a multifaceted description that has various interpretations based on individual experience; it involves considering the evolving nature of the profession, and the space that it occupies in healthcare.

What is a Neurology Nurse’s Role?

Neurology nursing is a specialty of nursing that incorporates all the established nursing responsibilities, but additionally incorporates a new subset of functions that impact patient outcomes. The following is a list that attempts to broadly categorize the roles of neurology nurses in order that the public can better understand the complexity and indispensability of their role.

1. As the very foundation of neurological nursing, nurses must understand physiology behind all neurological conditions and diseases. Only with this background do the physical signs and symptoms begin to be understood within the greater context of what is occurring internally. (Lewis et al., 2017).
2. Neurological nurses indirectly assist neurologists in diagnosing conditions based on their assessments. For this reason, it is so important for nurses to provide accurate assessments and reports to physicians when they round. (Lewis et al., 2017).
3. Neurological nurses provide the patient with the therapeutic interventions laid out in the care plan. (Lewis et al., 2017).
4. Neurological nurses provide information to the family about the interventions, disease process and signs and symptoms. Physicians explain to family what is transpiring; however, nurses are often the ones that are asked clarifying questions once the physician has left. For this reason, it is important for nurses to identify themselves as educators and be prepared to speak to patients and family with confidence about disease process, progression, and teach about different treatment modalities.
5. Through the interview process, nurses could uncover a piece of history about the patient that could explain or direct a course of treatment. (Walleck, 1982).
6. Neurological nurses must be attentive to vital signs, and neurological changes through the use of critical thinking and assessment tools. To provide an in-depth analysis of all the assessments carried out could take an entire book.

The following briefly summarizes some of the most common assessment techniques that RNs carry out that go unnoticed by the general public.

Common Assessment Techniques that Go Unnoticed

1. Before anything else, the fundamental principal in neurological examinations is change. If a patient experiences a baseline change, no matter how subtle, it could be significant. This implies that there must be an excellent assessment to provide an accurate baseline. This is easier when a patient is alert and awake. However, when the patient is unconscious due to a head injury, alcohol, or drugs, a strong stimulus must be provided to bypass the effects of one or all three of those factors. The first test is to simply ask the patient in a soft voice to follow a command. After this you ask in a loud tone of voice. Subsequently, a strong stimulus must be created using one of the following: squeezing the trapezius muscle, applying supraorbital pressure, applying mandibular pressure, and lastly applying a sternal rub. If the patient responds to one of the painful stimuli forms, this means that their brain is responding, not a spinal or reflex response. If the patient doesn’t respond to any of the forms of painful stimuli within 15-30 seconds, it is time to desist. (Lower, 2002).
2. Level of consciousness is another key aspect a nurse is always attentive to. When the patient opens their eyes spontaneously in response to voice or pain, that is an indicator of a functional wakefulness center located in the brain stem. Awareness is also tested through the use of four components: orientation, memory, calculation, and fund of knowledge. In patients who begin to exhibit disorientation, the first level that noticed is time followed by place and then person. Short term memory can be tested with simple questions about remembering three separate words, long term by asking about date of birth. Simple mathematical calculations give an indicator about that portion of the brain. Fund of knowledge involves drawing on something current (president, current news). (Lower, 2002). When dealing with patients who are at risk for ICP there are more subtle signs that nurses look for that may not be obvious to the family. They are changes in LOC, losing details and disorientation, forgetfulness, restlessness, and sudden quietness. The nurse will also assess pupillary, motor, and vital signs changes.
3. The interview process is vital to determine if there are any peculiarities exhibited by the patient’s speech and thought processes. Sometimes this can be an indicator of an underlying process, especially if the family states this is a change from baseline (Walleck, 1982).
4. A description of every cranial nerve will not be provided; however, it must be conducted as it can be a vital indicator of brain cranial nerve function.

Conclusion

This small article’s goal was to inform the public of a few of the more subtle tasks neurology nurses carry out that are often not perceived by the public. A neurology nurse is always assessing for change from baseline. This is a foundational concept upon which rests a significant portion of the patient’s outcome. As the profession of nursing continues to evolve there will certainly be new tasks required of nurses. Some of those tasks will be visible to the public, some will not. What will remain constant is the need for nurses to continue to critically think and carry out the nursing process in order to provide the best outcome for the patient.

References

1. Lewis, S. M., Bucher, L., Heitkemper, M. M. L., Harding, M., Kwong, J., & Roberts, D. (2017). Medical surgical nursing: assessment and management of clinical problems. St. Louis: Elsevier.
2. Lower, J. (2002). Facing neuro assessment fearlessly. Nursing, 32(2), 58–65. doi: 10.1097/00152193-200202000-00054
3. What is Nursing? (n.d.). Retrieved from https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/
4. Walleck, C. A. (1982). A Neurologic Assessment Procedure That Wonʼt Make You Nervous. Nursing, 12(12), 50–59. doi: 10.1097/00152193-198212000-00023