Nursing interventions and assessments for aneurysmal subarachnoid hemorrhage patients: A mixed methods study involving practicing nurses

摘要

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.