Back
 OJN  Vol.3 No.7 , November 2013
Patients with disturbances in consciousness as observed by clinical nurses: Analysis of nursing records
Abstract: The 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’ reactions.
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, 3, 467-471. doi: 10.4236/ojn.2013.37063.
References

[1]   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

[2]   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

[3]   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

[4]   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.

[5]   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

[6]   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

[7]   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

[8]   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

[9]   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).

[10]   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).

[11]   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).

[12]   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).

[13]   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).

[14]   Shimomura, A. (2004) The indicators of nurses’ assessment for judging level of consciousness. Rehabilitation Nursing, 3, 17-25. (in Japanese).

[15]   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.

[16]   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.

[17]   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)

[18]   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

 
 
Top