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Volume 31, Issue 2, 2009

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Using the Human Response to Illness Model to assess altered level of consciousness in patients with subdural hematomas

Janice Nesbitt, RN, CNN(C), and Jo-Ann V. Sawatzky, RN, PhD

Abstract

Head injuries are the leading cause of trauma mortality and account for nearly half of all deaths related to head trauma injuries. Patients who present with subdural hematomas are at risk for initial damage to the brain, as well as for subsequent brain damage related to re-bleed, ischemia or cerebral edema. These injuries can be acute or chronic in nature, and may be manifested in the patient as an altered level of consciousness. Skilled nursing assessment of altered level of consciousness leads to early nursing and medical intervention, which, in turn, can improve patient outcomes.

In this paper, a critical review of the literature will focus on altered level of consciousness in patients presenting with a subdural hematoma. The Human Response to Illness Model will be utilized as a framework for this review. Accordingly, the physiological, pathophysiological, behavioural, and experiential perspectives of altered level of consciousness will be examined. Thus, a comprehensive understanding of this human response and rationale for evidence-based interventions will be established.

A pediatric experience with endoscopic third ventriculostomy for hydrocephalus

Kelly Bullivant, MN, NP, Walter Hader, MD, and Mark Hamilton, MD

Abstract

Pediatric neuroscience nurses deal with many children with hydrocephalus. This paper will provide a review of hydrocephalus with a specific focus on third ventriculostomy. Endoscopic third ventriculostomy (ETV) is an accepted treatment option for patients with obstructive hydrocephalus. At the Alberta Children’s Hospital in Calgary, Alberta, we have been performing ETV for 15 years. This experience has helped us better understand the complications and benefits of ETV. The author will provide data on the complications specific to ETV in pediatric patients at the Alberta Children’s Hospital. A case report comparing neurocognitive testing before and after ETV will be shared. An additional case report of a patient with a spontaneous third ventriculostomy will help illustrate our understanding of the natural history of hydrocephalus.

Back to life again—Patients’ experiences of hope three to four years after a spinal cord injury—A longitudinal study

Vibeke Lohne, RN, MScN, PhD

Abstract

This paper presents narratives that focus on experiences of hope, told by 10 participants three to four years after suffering spinal cord injury. Experiences of hope are understood as vital, essential and dynamic aspects of human life and human health. This is the first study addressing patients’ experiences of hope three to four years following spinal cord injury. This study has a descriptive, longitudinal design, and is part of a larger study on patients’ experiences of hope three to four years following spinal cord injury (Lohne, 2001, 2006, 2008a, 2008b; Lohne & severinsson, 2004a, 2004b, 2005, 2006). Data were collected at three points in time by personal interviews. A phenomenological approach inspired by Ricoeur (1976) was used to extract the meaningful content of the patients’ experiences. Findings revealed three main themes: Life-related hopes (I), Body-related hopes (II), and Creative and expanding hopes (III). Results indicated that three to four years following injury, participants were focusing on life more than on hope due to improvements and adaptation to a new life.

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