Volume 32, Issue 3 ,2010

Mary Glover Lecture presented at the CANN Conference, Quebec City, Quebec, June 2010: Working in neuro… The need for self-care
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By Linda Yetman, RN, ACNP (dip), PhD


Thank you for this honour of delivering The Mary Glover Lecture. Many of you may know who Mary Glover was; some of you may have worked with her. Mary Glover was a British nurse who came to Canada in 1968. She worked at St. Paul’s Hospital in Vancouver, British Columbia, and was an active member of the Canadian Association of Neuroscience Nurses (CANN). In preparation for this talk, I was able to ask colleagues who had worked withMary what she was like as a person, what she was like as a nurse. I had worked at St. Paul’s only a year or so after Mary had been a head nurse there and her memory was very much alive at that time with those who had worked with her, respected her and continued on with the standards that she set through her role modelling and mentorship. “She knew neuro… she knew her stuff” were themes that I heard when I asked those who had worked with her and knew her through CANN. Following her tragic death in a plane crash, her family generously donatedmoney to establish The Mary Glover Fund. The establishment of this lecture to recognize a nurse leader is a tribute to Mary, as well as to the Canadian Association of Neuroscience Nurses and recognizes the importance of maintaining a piece of our legacy, as a nursing specialty. This legacy is shared in this venue of a conference where neuro nurses come together to learn, to have fun together—did Imention to have lots of fun? However, perhaps the most important gift neuro nurses receive here is the nourishment to each other, as kindred souls on the journey of caring or patients and families in this specialty of “working in neuro”. Also, oftentimes, the connections made at CANN conferences extend into lifelong friendships.



Medtronic Award Paper presented at the CANN Conference, Quebec City, Quebec, June 2010: Selective dorsal rhizotomy in children: Comparison of outcomes after single-level versus multi-level laminectomy technique
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By Christine Ou, RN, BN, MSN(c), Sarah Kent, RN, BScN, CNN(C), Stacey Miller, PT, BSc, and Paul Steinbok, MBBS, FRCSC


Abstract

Children with cerebral palsy may experience spasticity, which may negatively impact their quality of life. One proven treatment for such spasticity is selective dorsal rhizotomy (SDR), whereby a partial sectioning of the dorsal roots from L2 to S1 is performed. SDR can be performed where the nerve root exits the intervertebral foramina via multi-level laminectomies, or at the level of the conus via a single-level laminectomy. At British Columbia Children’s Hospital (BCCH), SDRs were performed via multi-level laminectomies until 2005, when the single-level technique was adopted. The single-level procedure is technically more challenging and takes longer, but requires a smaller incision and involves lessmuscle dissection. Functional outcomes at one-year follow-up are similar for the two methods of surgery. It was hypothesized that post-operative pain would be less, mobilization faster and hospital stay shorter using the single-level technique. Using a retrospective case series analysis, we compared nine patients who had had single-level SDR to 18 matched controls who had undergone SDR using the multi-level technique. There were no significant differences in post-operative pain, duration of opioid infusion, or time to mobilization. Length of hospital stay was significantly decreased after the single level procedure: 3.4 versus 5.2 days (p=0.01).

Résumé

Les enfants avec une paralysie cérébrale peuvent avoir une spasticité qui peut avoir un impact négatif sur leur qualité de vie. Un traitement efficace pour cette spasticité est la rhizotomie dorsale sélective (RDS) où une partie des racines dorsales de L2 à S1 est sectionnée. La RDS peut être pratiquée à l’endroit où la racine des nerfs sort par le foramen intervertébral avec une laminectomie élargie (à plusieurs niveaux) ou au niveau du cône médullaire une laminectomie simple (à un seul niveau). Au British Columbia Children`s Hospital (BCCH), les RDS étaient pratiquées par des laminectomies élargies jusqu’en 2005, quand la technique à niveau simple fut adoptée. La procédure à niveau simple est techniquement plus difficile et plus longue à réaliser, mais requiert une plus petite incision et inclue moins de dissection de muscles. Les résultats fonctionnels un an après l’intervention sont similaires pour les deux méthodes chirurgicales. Les hypothèses posées étaient qu’il y auraitmoins de douleur postopératoire, que la mobilisation serait plus rapide, et que l’hospitalisation serait plus courte en utilisant la technique à niveau simple. En utilisant une analyse rétrospective d’une série de cas, neuf patients ayant subi une RDS avec laminectomie simple ont été comparés à 18 contrôles appareillés qui avaient subi une RDS avec laminectomie élargie. Il n’y a pas eu de différence dans la douleur postopératoire, la durée d’administration d’opioïdes, ou du temps de mobilisation. La durée d’hospitalisation a été significativement diminuée après la procédure simple: 3,4 versus 5,2 jours (p=0,01).



Codman Award Paper presented at the CANN Conference, Quebec City, Quebec, June 2010: The needs of family members of severe traumatic brain injured patients during critical and acute care: A qualitative study
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By Alanna Keenan, RN, MScN, and Lynn Joseph, RN, MScN, CNN(C)


Abstract

Traumatic brain injury (TBI) is a devastating injury for both patients and their family members. The goal of this study is to identify the needs expressed by family members, as patients with severe brain injury progress through their recovery. A qualitative study was undertaken with 25 family members who were associated with 15 injured relatives. Data are reported from 44 interviews conducted at two time periods: discharge from ICU (Time 1) and discharge from acute care facility to home or rehabilitation (Time 2). The findings are part of a larger mixed method study of both qualitative and quantitative data collected over three time periods.

Family members identified a variety of needs during the acute hospitalization period. Thematic analysis at Time 1 identified four main themes that described the trajectory of the families’ experiences: getting the news, uncertainty, making sense of the news and moving on. At Time 2, themes of the family experience included uncertainty, looking for progress, transition and letting go/building a new connection. Themes that identified the needs of families included managing life, involvement in care, and holding on to hope. Support required by the family included the need for information, professional support and community support. Families had intensive needs in the acute phase of the injury and their needs changed over time. Findings of the study will assist neuroscience nurses in understanding their role in providing for the needs of families of TBI patients.

Les besoins des familles de patients avec un traumatisme crânien sévère en phase critique et aigue : une étude qualitative

Résumé

Le traumatisme crânien est un évènement dévastateur pour les patients ainsi que pour les membres de leur famille. Le but de cette étude était d’identifier les besoins exprimés par les membres de la famille de patients présentant un traumatisme crânien sévère lors de leur hospitalisation. Une étude qualitative a été réalisée auprès de 25 membres de la famille de 15 personnes ayant subi un traumatisme crânien sévère. Les données sont été recueillies lors de 44 entrevues réalisées à deux occasions: lors du congé de l’unité de soins critiques (T1) puis lors du congé de l’établissement de soins aigus pour le retour au domicile ou vers un établissement de réadaptation (T2). Les résultats présentés font partie d’une étude mixte (qualitative et quantitative) plus large comportant trois temps de mesure.

Les membres de la famille ont identifié plusieurs besoins durant la période d’hospitalisation en soins aigus. L’analyse thématique à T1 a permis d’identifier quatre thèmes principaux décrivant la trajectoire de l’expérience des familles: Recevoir la nouvelle; l’incertitude; donner un sens à ces nouvelles; et aller au-delà. À T2, les thèmes ont inclus: l’incertitude; la recherche de progrès; la transition; et lâcher prise/reconstruire. Les besoins des familles identifiés ont été: gérer leur vie; être impliqués dans les soins; garder espoir; et recevoir de l’information, du soutien professionnel et du soutien dans la communauté. Les familles ont rapporté des besoins intenses lors de la phase aigue de l’évènement et que ces besoins ont changé avec le temps. Les résultats de cette étude aideront les infirmières en neuroscience à comprendre leur rôle au regard des besoins des familles lors de l’hospitalisation des patients avec un traumatisme crânien sévère.



Brain Tumour Foundation Award Paper presented at the CANN Conference, Quebec City, Quebec, June 2010: Truth-telling and an adolescent diagnosed with a malignant brain tumour: Who are we protecting?
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Arbelle Manicat-Emo, RN(EC), MS, NP-Paediatrics, Dzigbordi Bankas, RN, BScN, Laura Bradbury, RN, BScN, and Beverly Espedido, RN, BSc(Hons), BScN


Case report summary

A previously healthy 16-year-old female of Asian descent presented to a pediatric hospital with a three-month history of headaches, and having missed her menstrual cycles for approximately seven months. She was first seen by a family physician who ordered a brain CT scan, which showed a lesion in the right frontal area. She was taken to hospital after awaking with left-sided numbness and weakness, facial weakness, and slurred speech. On neurological exam, she had bilateral sixth cranial nerve palsies and bilateral disc edema. A brain MRI also confirmed the right frontal lesion.