뇌졸중의 신경학적 사정 도구인 NIHSS 적용을 위한 체계적인 간호사 교육 프로그램의 효과 = Effect of Systematic Educational Program for the Application of National Institutes of Health Stroke Scale (NIHSS) as a Neurologic Assessment Tool in Stroke Patients

다국어 초록 (Multilingual Abstract)

Purpose: In assessing patients' neurological status following a stroke it is very important to have a valid tool for early detection of neurological deterioration. NIHSS is considered the best tool to reflect neurological status in patients with ischemic stroke. An education program on use of NIHSS was planned for nurses caring for these patients and the effects of the program were evaluated.
Methods: The NIHSS education program (NEP) which
includes online and video lectures, and practical education was provided to the nurses from April to July, 2010. To examine the effect of NEP, nursing records of patients with ischemic stroke who were admitted to a stroke center were analyzed. Two groups, a historical control group (n=100) and the study group (n=115) were included.
Results: Nursing records for neurologic symptoms for each patient increased (41.0% versus 100.0%, p<.001), and especially, visual disturbance, facial palsy. limb paralysis and ataxia, language disturbance, dysarthria, and neglect symptoms significantly increased (all p<.001). Nurse notification to the doctor of patients with neurological changes increased (21.0% versus 39.1%, p=.004), and nurses' neurological deterioration detection rates also increased (37.5% versus 84.6%, p=.009).
Conclusion: NEP improved the quality of nursing records for neurological assessment and the detection rate of neurological deterioration.

참고문헌 (Reference)

1 이경무, "한글판 미국 국립 보건원 뇌졸중 척도의 신뢰도 및 타당도-다기관 연구-" 대한재활의학회 28 (28): 422-435, 2004

2 Schlegel, D., "Utility of the NIH Stroke Scale as a predictor of hospital disposition" 34 (34): 134-137, 2003

3 Richardson, J., "Successful implementation of the National Institutes of Health Stroke Scale on a stroke / neurovascular unit" 38 (38): 309-315, 2006

4 Korean Stoke Society, "Stroke scales, In Textbook of stroke" EPUBLIC 197-206, 2009

5 Asan Medical Center, "Stroke imaging protocol (Issue Brief No. II. 2)" Asan Medical Center 2011

6 Kim, J. S., "Stroke 119" Galim 2001

7 Criddle, L. M., "Standardizing stroke assessment using the National Institutes of Health Stroke Scale" 29 (29): 541-546, 2003

8 Goldstein, L.B., "Reliability of the National Institutes of Health Stroke Scale extension to non-neurologists in the context of a clinical trial" 28 (28): 307-310, 1997

9 Korean Stoke Society, "Prognosis of stroke, In Textbook of stroke" EPUBLIC 57-63, 2009

10 Park, K. H., "Nursing quality improvement for acute stroke patients through the use of NIHSS" 15 (15): 73-81, 2009

11 Darmer, M. R., "Nursing documentation audit-the effect of a VIPS implementation programme in Denmark" 15 (15): 525-534, 2006

12 Bae, C., "NIHSS predicts outcome better than GCS in intracerebral hemorrhage" 32 : 356-c, 2000

13 Clinical Research Center for Stroke, "NIH Stroke Scale"

14 Johnston, K. C., "Medical and neurological complications of ischemic stroke: Experience from the RANTTAS trial" 29 (29): 447-453, 1998

15 Brott, T., "Measurements of acute cerebral infarction: A clinical examination scale" 20 (20): 864-870, 1989

16 Kim, J. T., "MRI findings may predict early neurologic deterioration in acute minor stroke or transient ischemic attack due to intracranial atherosclerosis" 64 (64): 95-100, 2010

17 Goldstein, L. B., "Interrater reliability of the NIH stroke scale" 46 (46): 660-662, 1989

18 van Swieten, J C., "Interobserver agreement for the assessment of handicap in stroke patients" 19 (19): 604-607, 1988

19 Adams, H. P. Jr., "Guidelines for the early management of patients with ischemic stroke: A scientific statement from the Stroke Council of the American Stroke Association" 34 (34): 1056-1083, 2003

20 Kang, D. W., "Early recurrent ischemic lesions on diffusion-weighted imaging in symptomatic intracranical atherosclerosis" 64 (64): 50-54, 2007

21 Woo, D., "Does the National Institutes of Health Stroke Scale favor left hemisphere strokes?" 30 (30): 2355-2359, 1999

22 Muir, K. W., "Comparison of neurological scales and scoring systems for acute stroke prognosis" 27 (27): 1817-1820, 1996

23 Adams, H. P. Jr., "Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial or Org 10172 in acute stroke treatment" 24 (24): 35-41, 1993

24 Bessenyei, M., "Characteristics of 4 stroke scales for the detection of changes in clinical signs in the acute phase of stroke." 10 (10): 70-78, 2001

25 Powers, D. W., "Assessment of the stroke patient using the NIH stroke scale" 30 (30): 52-56, 2001

26 Song, S. L., "A study on the recognition for clinical nurse specialist's roles-focusing on the clinical nurse specialist, nurses and doctors." 7 (7): 23-32, 2003

27 Lyden, P. D., "A modified National Institutes of Health Stroke Scale for use in stroke clinical trials: Preliminary reliability and validity" 32 (32): 1310-1317, 2001