objective of the present study was to discuss patients with disturbances in
consciousness by analyzing nursing records. Observations from clinical nurses
as well as patients’ responses about their care were selected from nursing
records. Nursing records from one week of patient care were examined for patients
who were unable to speak during hospitalization within a neuro-surgery ward of the hospital. Selected records
were classified into the following eight categories: results from monitoring;
results from observation; opening and moving the eyes to stimulus; movement
of the limbs to stimulus; vocalization to stimulus; facial expression to
stimulus; patient’s response to care; and miscellaneous. Patients comprised
two groups. One group encompassed eight patients with Japan Coma Scale (JCS) II
and the other was a group of eight patients with JCS III. When nurses use the
JCS to assess patients with disturbances in consciousness, patients who awaken
to stimulus are classified as JCS II, while those who do not are JCS III. The
total nursing records selected for JCS II were 1551 and 1160 for JCS III. The
category of “results from monitoring” was the most selected category within
nursing records and accounted for 42.8% of the JCS III group, while “results
from observation” accounted for 38.4% of the JCS II group. Furthermore,
results indicated that the categories of “results from monitoring”, “results
from observation”, and “movement of the limbs for stimulus” had peaked after
two to three days, and then abruptly decreased. There were only a few records
for the categories of “vocalization to stimulus” and “facial expression to
stimulus”, both for the JCS II and the JCS III groups. Even though patients
could not verbally indicate their intentions due to problems with consciousness,
it is essential for nurses to pay careful attention to the details of patients’
Cite this paper
Tsuchiya, R. , Mikami, K. , Aidu, K. and Nishizawa, Y. (2013) Patients with disturbances in consciousness as observed by clinical nurses: Analysis of nursing records. Open Journal of Nursing
, 467-471. doi: 10.4236/ojn.2013.37063
 Waterhouse, C. (2005) The Glasgow Coma Scale and other neurological observations. Nursing Standard, 19, 56-64. http://dx.doi.org/10.7748/ns2005.04.19.33.56.c3857
 Juarez, V.J. and Lyons, M. (1995) Interrater reliability of the Glasgow Coma Scale. Journal of Neuroscience Nursing, 27, 283-286. http://dx.doi.org/10.1097/01376517-199510000-00008
 Dewey, H.M., Donnan, G.A., Freeman, E.J., Sharples, C.M., Macdonell, R.A. and McNeil, J.J. (1999) Interrater reliability of the National Institutes of Health Stroke Scale: Rating by neurologists and nurses in a community-based stroke incidence study. Cerebrovascular Disorders, 9, 323-327. http://dx.doi.org/10.1159/000016006
 Joao, F.F., Simoes, L., Luis, M.T., Jesus, D.V., Sa-Couto, P., Fernandes, J. and Morgado, M. (2011) Assessment of comatose patients: A Portuguese instrument based on the coma recovery scale-revised and using nursing standard terminology. Journal of Advance Nursing, 65, 1129-1141.
 Cheung, R.T.F., Lyden, P.D., Tsoi, T.H., Huang, Y., Liu, M., Hon, S.F.K., Raman, R. and Liu, L. (2010) Production and validation of putonghua-and cantonese-Chinese Language National Institutes of Health Stroke Scale training and certification videos. World Stroke Organization International Journal of Stroke, 5, 74-79. http://dx.doi.org/10.1111/j.1747-4949.2010.00411.x
 Dawes, E., Lloyd, H. and Durham. L. (2007) Monitoring and recording patients’ neurological observations. Nursing Standard, 22, 40-45. http://dx.doi.org/10.7748/ns2007.11.22.10.40.c6237
 Formisano, R., Carlesimo, G.A., Sabbadini, M., Loasses, A., Penta, F., Vinicola, V. and Caltagirone, C. (2004) Clinical predictors and neuropsychological outcome in severe traumatic brain injury patients. Acta Neurochirurgica, 146, 457-462. http://dx.doi.org/10.1007/s00701-004-0225-4
 Phuping, A. (2009) Endorsement of the four Score for consiciousness assessment in neurosurgical patients. Neurologia Medico-Chirurgica, 49, 565-571. http://dx.doi.org/10.2176/nmc.49.565
 Hinoura, Y. and Watanabe, K. (2008) The methods and future tasks nursing intervention for patients in persistent vegetative state. Bulletin of School of Health Sciences Faculty of Medicine, Niigata University, 9, 189-197. (in Japanese).
 Kumiko, M. and Yuko, H. (2013) Review of nursing literature on patients with persistent disturbance of consciousness in Japan. Journal of comprehensive nursing research, 14, 3-16. (in Japanese).
 Mitsue, S., Kazuo, Y., Hiroshi, K. and Takeshi, K. (2011) Study on evaluation indices for care to the patients with persistent unconsciousness. 3rd Report, Eastern Medicine, 27, 39-49. (in Japanese).
 Takahashi, C., Okudera, H., et al. (2007) What is an excellent coma scale? Comparative study of the JCS and ECS-first report. Neurosurgical Emergency, 12, 129-135. (in Japanese).
 Yoshisaki, M. and Okudera, H. (2010) Current status of clinical evaluation on consciousness level in nursing practice. Journal of Regional Emergency and Disaster Medicine Research, 9, 23-27. (in Japanese).
 Shimomura, A. (2004) The indicators of nurses’ assessment for judging level of consciousness. Rehabilitation Nursing, 3, 17-25. (in Japanese).
 Okubo, N., Shiro, M., et al. (2002) Analysis of clinical nurses’ observations of patients with protracted consciousness disturbance-basis for determining improvement of their consciousness level. The Society for Treatment of Coma, 11, 27-32.
 Satoru, F., Nobukazu, N., Kuniaki, O., et al. (1993) Evaluation of the severity of prolonged consciousness disturbances after head injury: A scoring system developed in our department. The Society for Treatment of Coma, 2, 173-183.
 Satoru, F., Nobukazu, N. and Yoshihide, N. (1997) Reliability and factorial structure of a rating scale for persistent vegetative state. Brain and Nerve, 49, 1139-1145. (in Japanese)
 Sugimoto A., Horikosi M., et al. (2005) Clinical Decision-making by nursing staff according to their perceptions of patients’ abnormalities. The Kitakanto Medical Journal, 55, 123-131. (in Japanese). http://dx.doi.org/10.2974/kmj.55.123