Sara Temple

Every nurse has their specialty, an area of nursing with which they are most comfortable and have the most experience. One system that transcends all specialties is the neurologic system. Neurologic events occur in any patient population. Whether you work at the bedside or in an office, whether you care for adults or children, whether you work ER, ICU, psych, or any other specialty, it is vital that you know how to complete a basic neuro assessment. Understanding how to do a neuro assessment can seem overwhelming to a nurse who is unfamiliar with it. Many nurses feel that neurology is a difficult specialty to understand and that only specially trained nurses can complete this type of assessment. However, it is important not to allow these feelings to prevent providing thorough care to your patients. Neurologic events can happen anywhere, and the best way to recognize them is by including this type of assessment in your basic care. Early detection of neurologic changes can lead to the identification and treatment of stroke more quickly, allowing for the best possible recovery. The more time passes between the onset and treatment of stroke, the more brain is affected and the lower the chances of improvement in the stroke symptoms. The sooner symptoms are recognized, and treatment is initiated, the better the treatment can benefit the patient. The best way to recognize neurological changes in a patient is to have a good baseline assessment. This does not have to be complicated or take a long time. Many of these assessments can be done informally while you are conversing with the patient or engaging in your assessment of other body systems. Neuro Patient Assessment The first step is evaluating whether they are alert and oriented. Do they arouse or awaken easily? Do they answer simple questions correctly when you speak to them? The next step is examining their speech. Are their words clear and easy to understand? Do they seem to have difficulty finding the right words to say? Along with their speech, watch their face while they are talking and note if there seems to be symmetry or if one side of the face is drooping. Another step is assessing the patient's movement. If they are responsive, ask them to raise their arms, then their legs. Do they raise and lower them equally, or is one side weaker or unable to move at all? If they are ambulatory, you can observe their gait and see if one side appears to be stronger or if there is limited movement. If they are not responsive, a simple reflex test can be done by pressing on the patient's nailbeds and observing their movement. Does the patient respond to this painful stimulus equally on both sides of the body? A final basic assessment step is done by examining the patient's pupils' response to light. A small flashlight or the light on a smartphone can be used for this. Check to see if the pupils are the same size and if both react by constricting as the light is being shone into the eye. It may be helpful to do this in a dark room in order to see the light reaction more clearly. Once you have completed each of these steps, you now have a baseline neurologic assessment. As you continue to encounter the patient, you can consider if the patient's response is different than their baseline. Any change in alertness, confusion, difficulty speaking, inability to move one side of the body or pupils that are unequal or do not react to light is cause for concern. There are many more components to a complete neurological exam, some of which can be quite complex. However, these basic steps can be done by any nurse and can be pivotal in getting patients the care that they need. Your patients will thank you for it! References/Resources Simplifying neurologic assessment: Nursing Made Incredibly Easy! Neurologic Exam: National Library of Medicine Guidelines For The Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: American Stroke Association / American Heart Association, Inc.

Healthcare professionals are called to care for any and every patient in need. These patients cover a broad spectrum of humanity. Variety can be found in our patients across age, gender, religion, race, socioeconomic status, and a plethora of other characteristics. It is important and necessary that our care be inclusive of all of these various patient populations. One such group that has often been marginalized is the LGBTQ community. This group comprises those people who identify as any sexual orientation other than straight (lesbian, gay, bisexual, queer, and many others) as well as those who identify as transgender (a gender other than that which was assigned to them at birth). Members of the LGBTQ community have historically experienced extreme discrimination throughout society, often leaving them fearful to reveal their identities. Studies have shown that this population may be reluctant to seek healthcare related to their valid fears of being misunderstood, misgendered, or mistreated. Many healthcare providers report a lack of knowledge on issues specific to the LGBTQ community. Familiarizing yourself with terms describing gender identity, sexual orientation, and gender expression can be easily done by seeking out training materials or videos online. Individuals who identify as LGBTQ have unique needs when it comes to their healthcare. Statistically, members of this population have an increased risk for sexually transmitted infections and some cancers. Mental health needs are equally important; studies show that LGBTQ individuals are at higher risk for self-harm and suicidal thoughts or attempts. Often this increased risk is related to feelings of rejection by family or peers. Having at least one accepting adult in the life of an LGBTQ young person can significantly reduce suicide risk. As medical professionals, we may be one of the only allies in their lives, and it is important that we are capable and prepared to take on that role. Additionally, reproductive health is an important facet of LGBTQ healthcare that can be unmet. Specifically, in the transgender population, reproductive health needs often go overlooked. Patients who present as a gender other than that which they were assigned at birth still need gender-related reproductive screening, and they need a place where they feel safe to seek such care. Some transgender patients may choose to have gender-affirming surgery, but there are many who do not. Therefore, it is necessary to educate patients on the need for gynecological and urological exams regardless of the person's presenting gender. It is the responsibility of healthcare providers to become informed about these needs as well as to screen their patients for these healthcare conditions without judgment or prejudice. There are many simple interventions that can indicate to LGBTQ individuals that they are affirmed by their healthcare provider. One of the easiest ways to do this is by calling the patient by their specified name and pronouns. The patient's legal name and gender may not match the way they identify, so it is important to be sure they are recognized the way they request. Using gender-neutral language or inclusive statements is another way to help patients feel safe and comfortable. For example, ask about their spouse or partner instead of asking a patient about their husband or wife. Other practical strategies include using inclusive language on registration forms and other paperwork, displaying your own pronouns on your nametag or business card, and being intentional about educating yourself and others in your practice on the needs of this community. Make an effort to use the language and terms each patient uses. If you make a mistake, acknowledge that and apologize. Making your practice a place where LGBTQ individuals feel welcome will open the door to addressing their specific healthcare needs. References/Resources Improving pathways to primary health care among LGBTQ populations and health care providers: key findings from Nova Scotia, Canada: BioMed Central A Novel Curriculum for Medical Student Training in LGBTQ Healthcare: A Regional Pathway Experience: SAGE Publishing Providing Inclusive Services and Care for LGBT People: National LGBT Health Education Center Facts About LGBTQ Youth Suicide: The Trevor Project