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The Profession of the Neuroscience Nurse
-Introduction
Neurological problems are not uncommon. Approximately one in seven
consultations in primary care is for a nervous system symptom of some kind and
one in five emergency admissions to hospital are due to a neurological problem.
Also the PYLL index in many European Countries shows that neurological
problems causes premature mortality.1
Neurological diseases are disorders of the nervous system, including the brain,
spinal cord, peripheral nerves and muscle. These can be conditions managed almost
entirely in the community (epilepsy and migraine), acute neurological emergencies
(stroke and meningitis) or chronic disabling conditions (dementia, multiple
sclerosis and Parkinson’s disease). Many neurological diseases affect the young
and economically active including epilepsy, multiple sclerosis, traumatic brain
injury and many of the inherited disorders. The neurodegenerative conditions, such
as Parkinson’s disease, Alzheimer’s disease and motor neurone disease largely
affect older people. With an aging population their incidence is increasing. Trauma
is the most common cause of death in people under 40, and 50% of deaths in this
group are due to head injury.
People with neurological conditions may have complex needs that affect their
ability to function not only physically but also emotionally and mentally. The
condition may impact on different aspects of their lives including family and carers,
education, housing, finance and employment. A person centred service therefore
requires that all aspects of an individual’s life are taken into account when
assessing needs, often involving a number of different professionals and agencies
across health and social care. At present, patient education is often undertaken by
specialist nurses and others rather than neurologists, partly because of the scarcity
of neurological services. The pathway for people with head injuries in many cases
is extremely complex as there are often so many organisations and agencies
involved.
The care planning process for people with complex neurological conditions needs
to be well co-ordinated to ensure that the individual is receiving the right care at the
right time to enable them to live as independently as possible. This involves a
multi-disciplinary approach, ideally co-ordinated by the neuronurse at each stage of
the patient pathway.
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Effective multidisciplinary team working and good communication between
different professionals and agencies are the most essential prerequisites to
supporting people to live in the community, as health and social care needs are
inextricably linked. A multi-disciplinary, multi-agency team can make a significant
difference to the experience of people with long term neurological conditions by
ensuring that the right person is seeing the patient at the right time and in the most
appropriate setting.
This means that good communication between agencies and organisations is
essential as these neuro-patients are often transferred out of their local area for
specialist care and treatment and then return to their local community for
rehabilitation. The neuro-patients are thus treated in different care settings and
environments by a large amount of health professionals.
Good quality information is widely available from Associations of Neurologists,
Nurses and patient groups. Neurological patients are encouraged to develop
strategies for self-care. Those with chronic disorders (such as e.g. multiple sclerosis
are particularly adept at this). The role of the neuronurse is in this pathology
indisputable.
Nurses with specialist knowledge in neurological conditions can enhance a service
by supporting patients and their family from the phase of diagnosis toward
rehabilitation. The neuroblend project has focused on neuroscience nursing by
developing the learning paths from competent neuro-nurse toward an expertise in
neuroscience nursing.
- Neuroscience Nursing
Neuroscience nursing has been recognised as a specialisation area in nursing
science since 1980`s. This means that neuroscience nursing needs to define
specified role, skills and tasks areas as well as knowledge base, which is developed
by scientific research.
The challenges for neuroscience nursing are :
- Ensuring appropriate access to neurological care for all patients.
- Advance the art and science of neurology and nursing and thereby promote
the best possible care for patients with neurological disorders.
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- Supporting and advocating for an environment which ensures ethical, high
quality neurological care.
- Providing excellence in professional education by offering a variety of
programs in both the clinical and nursing aspects of neurology and the basic
neurosciences to other nurses and allied health professionals
- Supporting clinical and basic research in the neuroscience nursing and
related fields.
- Developing evidence based care for neuro-patients.
A Clinial Nurse Specialist in Neuroscience is an advanced practice nurse (APN)
with graduate-level preparation as a clinical expert in evidence-based nursing
practice within a neuroscience nursing. The CNS uses clinical expertise to
influence patients/clients, nurses and nursing practice, and the organization/system
with a focus on providing high quality and cost-effective care.
The professional expertise in neuroscience nursing goes through the steps from
novice to expert ( Benner ). To reach the level of expert in neuroscience nursing
requires an education that develops further the nurses´ competences.
The EANN has been the promoter to developed neuroscience nursing. The EANN
defined the European Function Profile of a neuroscience nurse in year 2005 and
based on that Neuroblend project developed European Competence Profile (ECP)
which defines the role, tasks and competences of neuroscience nursing.
References
• Kirrane C (2000) Evidence-based practice in neurology: a team approach to
development. Nursing Standard, 14, 52, 43-45.
1The PYLL is an indicator of premature mortality. It represents the total number of years NOT lived by an
individual who died before age 75. Source: Working Group on Community Health Information Systems,
Community Health Indicators – Definitions and Interpretations, Ottawa, Ontario: Canadian Institute for
Health Information.
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