Learning Objective 1: The learner will be able to understand the difficulties with using the GCS in the non neurological areas.
Learning Objective 2: The learner will be able to understand some of the reasons why RNs have difficulty in using the GCS in the non neurological areas.
The Glasgow Coma Scale (GCS) was designed for use in a wide range of clinical environments with staff that had no special training (Teasdale and Jennett 1974). Evidence (Waterhouse 2007 and 2008) suggests however that there are ongoing problems with the use of the GCS assessment, and the impact that this might have on patient outcome is unknown. Variations in practice have been found in all areas, including the neurological specialties wards, however the skill level of nursing staff in non neurological areas is concerning with inconsistency in practice.
The purpose of this project was to explore the use of the GCS in the non neurological clinical areas – to determine whether registered nurses felt confident in using the scale to assess patients with neurologic deterioration.
A mixed methods methodology was used with two phases. Registered nurses from a metropolitan Sydney Hospital were recruited to the study. The first phase asked participants to complete an existing survey (Waterhouse 2008). Following analysis of the survey data, questions were developed and used in the phase two focus group.
The results demonstrated that the participants in the non neurological clinical areas had significant gaps in their education and training. Furthermore because the participants did not routinely assess patients using the GCS in the non neurological areas, a lack of skill refinement led to a knowledge and practice deficit. Incomplete skill development meant that the participants did not feel confident in using the GCS to assess patients with neurological dysfunction. In fact, participants were confused regarding the use of the GCS, and this affected how they made clinical decisions. This was significant because timely identification of neurological deterioration was crucial to patient survival.
Recommendations for practice include more attention to skill development and importantly opportunities for training, refinement and reinforcement of the GCS.
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