Authors (including presenting author) :
Chong KM, Chu HM
Affiliation :
Department of Anaesthesia, Pamela Youde Nethersole Eastern Hospital
Introduction :
The Glasgow Coma Scale (GCS) was first described in 1974 by Graham Teasdale and Bryan Jennett to describe the level of consciousness in patient with acute brain injury. The use of assessment tools for conscious level e.g. GCS and AVPU scale in PACU is required by the UK National Core Competencies for Post-anaesthesia Care. Early emergence and extubation are recommended for early assessment of patients’ neurological status postoperatively, especially in neurosurgical patients. It is therefore crucial to detect this change early so as to allow prompt clinical intervention. The knowledge and adeptness of GCS, however, was shown to be affected by multiple factors, including self-confidence and attitude. Therefore, various efforts and teaching strategies were trying to enhance nurses’ self-confidence and attitudes towards GCS. However, the evidence of their usefulness in improving nurses’ attitude and confidence in assessing GCS is limited.
Objectives :
To evaluate the effectiveness of continuous education in improving nurses’ attitude and confidence in performing Glasgow Coma Scale in Post Anaesthetic Care Unit.
Methodology :
This was an exploratory survey conducted in Pamela Youde Nethersole Eastern Hospital. The questionnaires consisted of three parts including demographic data, nurses’ attitudes and self-confidence respectively. Each question regarding attitude and self-confidence was delivered as a 5-point Likert scale. The questionnaires were distributed to nurses who worked in the operating theatre (student nurses will be excluded) from January to March 2018. This survey was followed by an educational program about GCS and its clinical application. Another set of questionnaires, containing the same set of questions about attitude and self-confidence, together with a few new questions evaluating the training program were distributed to the nurses again after they have gone through the educational program. Four identical tutorials were conducted in June. The tutorial was composed of 3 parts. First, a demonstrative video about structural assessment of GCS from https://www.glasgowcomascale.org was played to the attendants. This was followed by a short discussion about the importance of assessing GCS in PACU and case scenarios. The last part of the training was an evaluation by asking the attendants to assess the GCS of patients with different extents of neurological deficits showing in videos from https://www.nottingham.ac.uk/nmp/sonet/rlos/neuro/gcs/activity2.html. Each of the participants was given a GCS cue card to facilitate their future clinical application.
Mean and percentages were used for descriptive analysis of the pre- or post- tutorial demographic data. Mean and median were used for descriptions of the Likert scale score. SPSS version 24 was used for data analysis. Mann-Whitney U test was used for comparing results between pre- and post- questionnaires.
Result & Outcome :
The study has shown that a one-hour tutorial comprising of video, lecture and scenario discussion about GCS has positive impact on the attitude and self-confidence of nurses in PACU. We would recommend this to be provided regularly in the future for the potential enhancement of nursing practices and the quality of patient care.
