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Nursing Interventions and Assessments for Aneurysmal Subarachnoid Hemorrhage Patients: A Mixed Methods Study Involving Practicing Nurses

Wuchner, Staci Sue; Bakas, Tamilyn; Adams, Georgann; Buelow, Janice; Cohn, Jennifer

Journal of Neuroscience Nursing: August 2012 - Volume 44 - Issue 4 - p 177–185
doi: 10.1097/JNN.0b013e318252763f
Article

ABSTRACT: Aneurysmal subarachnoid hemorrhage (aSAH) caused by a ruptured aneurysm is a devastating event that can lead to severe disability or death. Although published guidelines on the management of aSAH exist, research is limited regarding the role of nursing in the care of aSAH patients. The purpose of this study was to describe the interventions and assessments that nurses provide while caring for aSAH patients in the critical care setting. A mixed methods design was utilized for this study. Individual interview sessions with 10 neurocritical care nurses were completed and transcribed verbatim. The transcripts were analyzed and categorized using a predetermined code list based on a theoretical framework derived from the work of McNett and Giankis. The predetermined code list included four areas: (a) neurophysiological, (b) psychosocial, (c) injury prevention, and (d) maintaining therapeutic milieu. Frequencies were also computed based on an investigator-developed questionnaire to identify the most common interventions and assessments. The qualitative data supported the four main areas in the predetermined code list. The neurophysiological theme focused on blood pressure management and detailed neurological exams. The psychosocial theme addressed education, support, and communication. The injury prevention theme involved repositioning and reorienting/distracting the patients. The theme of maintaining a therapeutic milieu focused on decreasing the patients’ stimulation. An additional theme emerged and was labeled, “Giving the Patient a Chance.” Quantitative data revealed that neurophysiological and psychosocial interventions were most frequent. Nurses are responsible for the complex care of aSAH patients and their families and must implement a variety of nursing interventions and assessments. Further research is needed to identify the impact of these interventions and assessments on the outcome of aSAH patients while in the critical care setting.

Questions or comments about this article may be directed to Staci Sue Wuchner, MSN RN ACNS-BC CCRN CNRN, at swuchner@iupui.edu. In addition to being a PhD student, she is also a neuroscience clinical nurse specialist at Indiana University Health Methodist Hospital, Indianapolis, IN.

Tamilyn Bakas, PhD RN FAHA FAAN, is a professor and PhD program coordinator at the Department of Adult Health, School of Nursing, Indiana University, Indianapolis, IN.

Georgann Adams, MSN RN ACNS-BC CCRN CNRN, is a neurocritical care clinical nurse specialist at the Indiana University Health Methodist Hospital, Indianapolis, IN.

Janice Buelow, PhD RN FAAN, is an associate professor and Chair of Adult Health Nursing, School of Nursing, Indiana University, Indianapolis, IN.

Jennifer Cohn, MSN RN CNRN, is a clinical director at St. Vincent Neuroscience Institute, Indianapolis, IN.

Sources of financial support: This study was funded with a grant from the Graduate Student Nursing Research Fund of the School of Nursing, Indiana University.

Jennifer Cohn is a consultant for Codman and Shurtleff, Inc., as well as a speaker for Genetech. Otherwise, the authors declare no conflicts of interest.

© 2012 American Association of Neuroscience Nurses