Neuroscience Nursing

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Neuroscience Nursing at SBCH: Our Practice, Programs, Outcomes, and Future


by Laura Canfield, MSN, RN, ACNS-BC Clinical Nurse Specialist, Neurosciences


On the heels of Santa Barbara Cottage Hospital's move in February 2012 to our new, state-of-the-art hospital, the design of a neuro critical care unit (NCCU), slated for completion in 2014, is receiving its final touches.


The NCCU will be a 12-bed unit with larger rooms designed to promote better patient recovery through a private, quiet environment and the latest in technological advances.


The new NCCU is designed as a family-friendly environment.  The


Laura Canfield, MSN, RN, ACNS-BC

floor plan includes space for sofas that convert to beds so family members can stay with a patient around the clock. A patio will be built off the waiting room so loved ones can enjoy the outdoors without having to leave the unit. Other useful designs featured in the floor plan include a family consult room, a conference room and a private physician dictation space.




Looking up and looking forward to the future of neuroscience nursing at Santa Barbara Cottage Hospital


This photograph, featuring members of the neuroscience advanced practice nursing team, won the American Association of Neuroscience Nurses annual photo contest for best representing the spirit of neuroscience nursing in America. The photo reflects our vision and mission to provide superior health care to some of the most vulnerable patients and their families.

"The NCCU is being separated from the current Critical Care Units to provide peace and quiet for our neurological patients, which is consistent with their needs," says Herb Geary, RN, vice president of patient care services and chief nursing officer at Santa Barbara Cottage Hospital. "The isolated space will protect against overstimulation, which can raise intracranial pressure and hinder recovery. Being visitor- friendly will also be a significant draw, especially for loved ones of patients who require extended hospitalization."


It not just the bricks and mortar, or architectural advances, that make a new unit state-of-the-art; it's the nursing care of neuroscience patients.


As a Joint Commission-certified primary stroke center and Level II trauma center, Santa Barbara Cottage Hospital provides registered nurses in neuroscience nursing the opportunity to practice patient-focused, multidisciplinary, technologically advanced care for a spectrum of patients suffering from neurological diseases across the life span, at all levels of care.


Over the past five years, as the hospital's neuroscience service line has expanded to include complex endovascular interventions for stroke and neurocritical care, the development of specialized care units staffed by expert nurses became vital. This growth required a significant investment in both human and technological capital. Hospital administration, the Cottage Board of Directors and the Santa Barbara Neuroscience Institute (SBNI) have supported the investment in this highly specialized group of direct care nurses.


Nursing has risen to the challenge of caring for this new population by developing a comprehensive, evidence- based-practice educational program that is congruent with adult learning theory and that considers the needs of our multigenerational nursing staff.


Didactic and clinical training for our neuroscience nurses in the emergency department, critical care units and neuro step-down include the Hemispheres® Stroke Competency Series-where our impressive scores meet or exceed all other Joint Commission primary stroke centers as well as hospitals with Magnet® designation in the United States-as well as neuro assessment classes, web-based learning, one-on-one orientation to our critical neuro patients with competency sign off, skills labs and simulation learning.


Working with the newest technologies is a big part of neuroscience nursing. Critical care recently implemented the use of a portable computed tomography (CT) machine to reduce the risks associated with intrahospital transport and allow the care team the ability to assess images immediately and make treatment decisions at the point of care. Complex neurocritical care monitoring like brain tissue oxygenation, volume-derived hemodynamic monitoring, intracranial pressure monitoring, pharmacologic and ventilator management requires neuroscience nurses to maintain an extensive knowledge base.


Continuing educational opportunities are frequent and accessible. These include the annual Saving the Brain Neuroscience Symposium that features physician and nursing key opinion leaders, as well as the SBNI speaker's series and support for attendance at national conferences.


In addition to the excellent direct-care nursing staff, SBCH employs four full-time advanced practice registered nurses, a neuroscience clinical nurse specialist, and three acute care nurse practitioners dedicated to the care of neuroscience patients, their families and nursing staff.



Santa Barbara Cottage Hospital recently received the Get With the Guidelines Stroke Gold Plus Achievement Award. This award means that we have reached an aggressive goal of treating stroke patients with 85 percent or higher compliance to core standard levels of care, as outlined by the American Heart Association / American Stroke Association for 12 consecutive months. In addition, we have demonstrated 75 percent compliance on seven of 10 stroke quality measures during the 12-month period.


Achieving excellence in nurse-sensitive outcome measures and patient satisfaction takes a dedicated team of nurse leaders and direct care nurses committed to best practices. Nursing is empowered by a shared governance structure of decision-making, and evidence-based practice guidelines are used to promote quality care.


In 2012, SBCH achieved Gold Plus designation for stroke care from Get With The Guidelines® (GWTG), a program that helps ensure consistent application of the most recent American Heart Association/American Stroke Association scientific guidelines for patient treatment. The Gold award recognizes a 12-month period of 85 percent or greater compliance with the requirements in the GWTG program. These include aggressive use of medications such as tPA, antithrombotic, anticoagulation therapy, deep venous thrombosis prophylaxis, cholesterol- reducing drugs and smoking cessation. Nurse-sensitive measures like patient education on stroke risk factors and dysphagia screening upon admission are in the 98th percentile. Our stroke program's nursing satisfaction mean score is 88 percent, and Press Ganey scores for our neurology unit are 98 percent year-to-date.


An annual tradition was started this year with a series of events to celebrate Neuroscience Nurses Week, held the third week of May. Each day had an event; case studies were presented, the neuroscience nurse practitioners gave talks on neurological assessment and neurological anatomy. Past patients and families returned to SBCH to share stories of their acute and rehabilitation hospitalizations and show their gratitude for the nursing care that affected their recoveries and contributed to their quality of life.


The future is bright for neuroscience nursing at Cottage: a motivated group of neurology RNs are preparing for board certification. The Certified Neuroscience Registered Nurse® (CNRN) credential formally recognizes the attainment and demonstration of a unique body of knowledge necessary for the practice of neuroscience nursing. CNRN certification is a nationally accepted mark of excellence, and there is evidence that patient outcomes and nurse satisfaction are improved when a RN is nationally certified in his or her speciality. Encouraging national certification of direct care nurses also aligns with the Magnet model's foundations of transformational leadership and structural empowerment. As SBCH works to submit its Magnet application later this year, the commitment to nurses and nursing practice has never been greater.



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