Patients with disturbances in consciousness as observed by clinical nurses: Analysis of nursing records

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.

Thought Processes of Nurses in Nursing Assessment: Analysis of Nursing Problems and Patient Strengths, Patient Information

Aims: The purpose of this study was to clarify the thought processes of nurses in performing nursing assessment. Methods: The participants comprised 20 nurses working in a surgery ward. Patient information on a case, including presenting illness, vital signs, and other findings from admission until 09:00 on the day after surgery, was shown to the participants. After reading the case report, the nurses presented their assessments. Based on these assessments, nursing problems, patient strengths, and patient information were identified. Nursing problems and patient strengths were described by various words and sentences, and were classified according to similar content. Results: The number of nursing problems ranged from 1 to 8 and patient strengths from 0 to 6 for each nurse. The mean number of nursing problems was 4.7 ± 1.8, and the mean number of patient strengths was 2.2 ± 1.4. The main nursing problems were respiratory complications, postoperative wound pain, and anxiety, and the main patient strength was family cooperation. Patient information as evidence of respiratory complications included history of smoking, chest radiography results, postoperative vital signs, sputum color and properties. Patient information as evidence of postoperative wound pain included complaints of pain, epidural anesthesia, use of patient-controlled anesthesia and its effect. Patient information indicating family cooperation included family structure, preoperative visits by family, and presence of family while providing informed consent. Significant differences were seen in the number of nursing problems and patient strengths according to cognitive style. Conclusions: Postoperative complications were the nursing problems most commonly extracted by nurses. To clarify nursing problems and patient strengths, the nurses made assessments on the basis of information such as patient complaints, vital signs, and test results. However, extracted nursing problems and patient strengths were diverse, suggesting that nursing problems and patient strengths as determined by nurses differed between individual nurses.