title: Secondary insults related to nursing interventions in neurointensive care: a descriptive pilot study.
abstract: The patients at a neurointensive care unit are frequently cared for in many ways, day and night. The aim of this study was to investigate the amount of secondary insults related to oral care, repositioning, endotracheal suctioning, hygienic measures, and simultaneous interventions at a neurointensive care unit with standardized care and maximum attention on avoiding secondary insults. The definition of a secondary insult was intracranial pressure > 20 mm Hg, cerebral perfusion pressure < 60 mm Hg and systolic blood pressure < 100 mm Hg for 5 minutes or more in a 10-minute period starting from when the nursing intervention began. The insult minutes did not have to be consecutive. The study included 18 patients, seven women and 11 men, aged 36-76 years with different neurosurgical diagnoses. The total number of nursing interventions analyzed was 1,717. The most common kind of secondary insults after a nursing measure was high intracranial pressure (n = 93) followed by low cerebral perfusion pressure (n = 43) and low systolic blood pressure (n = 14). Repositioning (n = 39) and simultaneous interventions (n = 32) were the nursing interventions causing most secondary insults. There were substantial variations between the patients; only one patient had no secondary insult. There were, overall, a limited number of secondary insults related to nursing interventions when a standardized management protocol system was applied to reduce the occurrence of secondary insults. Patients with an increased risk of secondary insults should be recognized, and their care and treatment should be carefully planned and performed to avoid secondary insults.
authors.affiliation: Questions or comments about this article may be directed to Lena Nyholm, RN MSc, at lena.nyholm@neuro.uu.se. She is a PhD student and clinically active Neurointensive Care Nurse in the Department of Neuroscience/Neurosurgery, Uppsala University, Uppsala, Sweden. Erika Steffansson, RN, is a clinically active Neurointensive Care Nurse in the Department of Neuroscience/Neurosurgery, Uppsala University, Uppsala, Sweden. Camilla Fröjd, RN PhD, is a Senior Lecturer in the Department of Surgical Science, Uppsala University, Uppsala, Sweden. Per Enblad, MD PhD, is a Professor and Head of the Department of Neuroscience/Neurosurgery, Uppsala University, Uppsala, Sweden.
authors.forename: Lena
authors.initials: L
authors.lastname: Nyholm
authors.forename: Erika
authors.initials: E
authors.lastname: Steffansson
authors.forename: Camilla
authors.initials: C
authors.lastname: Fröjd
authors.forename: Per
authors.initials: P
authors.lastname: Enblad
mesh_terms: D000328:Adult; D000368:Aged; D001927:Brain Diseases / Q000175:diagnosis / Q000451:nursing* / Q000601:surgery*; D002545:Brain Ischemia / Q000175:diagnosis / Q000451:nursing* / Q000517:prevention & control; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007022:Hypotension / Q000175:diagnosis / Q000451:nursing* / Q000517:prevention & control; D007049:Iatrogenic Disease; D007362:Intensive Care Units; D019586:Intracranial Hypertension / Q000175:diagnosis / Q000451:nursing* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D065816:Neuroscience Nursing / Q000458:organization & administration*; D010865:Pilot Projects; D011182:Postoperative Care / Q000009:adverse effects* / Q000451:nursing*; D012307:Risk Factors; D013548:Sweden