Implementation of the Canadian neurological scale on an acute care neuroscience unit: a program evaluation.

(n = 66) Perception of BPGs M (95% CI) p Value Is aware of BPGs 0.14 (-0.83-0.36) .21 Is aware of BPGs for stroke 0.30 (0.05-0.56) .02 Finds BPGs easy to access 0.58 (0.35-0.80) <.0001 Finds BPGs valuable in 0.20 (-0.002-0.40) .05 providing care for neuroscience patients Uses BPGs in practice 0.26 (0.04-0.48) .02 Uses or will use the Canadian 0.27 (0.07-0.47) .01 Neurological Scale to assess patients with stroke Note. Participants indicated their level of agreement with these statements on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). CI = confidence interval. (a) One participant completed only the postworkshop questionnaire, therefore the number of participants is not the same lot all three time periods. Table 2. Perception of Best-Practice Guidelines (BPGs) Immediately After and 3 Months After Workshop

Immediately

After 3 Months After

Workshop Workshop

(n = 23) (n = 23) Perception of BPGs M (SD) M (SD) Is aware of BPGs 4.43 (0.90) 4.78 (0.42) Is aware of BPGs for stroke 4.39 (0.84) 4.70 (0.63) Finds BPGs easy to access 3.52 (0.95) 3.86 (0.94) Finds BPGs valuable in 4.22 (1.00) 3.91 (0.73) providing care for neuroscience patients Uses BPGs in practice 4.00 (0.80) 3.87 (1.06) Uses or will use the Canadian 4.57 (0.84) 4.43 (0.73) Neurological Scale to assess patients with stroke

Change in Perception from

Immediately After to 3 Months

After Workshop

(n = 23) Perception of BPGs M (95% CI) p Value Is aware of BPGs 0.34 (-0.01-0.71) .06 Is aware of BPGs for stroke 0.30 (-0.03-0.64) .07 Finds BPGs easy to access 0.27 (-0.09-0.64) .14 Finds BPGs valuable in -0.30 (-0.73-0.11) .15 providing care for neuroscience patients Uses BPGs in practice -0.13 (-0.64-0.38) .60 Uses or will use the Canadian -0.13 (-0.57-0.31) .54 Neurological Scale to assess patients with stroke Note. Participants indicated their level of agreement with these statements on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). CI = confidence interval. Table 3. Perception of the Canadian Neurological Scale (CNS) Assessment Tool in Practice at 3 Months Postimplementation

3 Months

Postimplementation

of the CNS

Assessment on the

Neuroscience Unit

(n = 24) Statement M (SD) I find the CNS easy to use. 2.92 (1.28) I find the CNS useful to communicate the status 2.63 (1.24) of patients with stroke to other team members (e.g., other nurses, medical doctors). I find the CNS useful in identifying changes in 2.75 (1.29) awake patients with ischemic stroke or intracerebral hemorrhage. I find the CNS useful in identifying changes in 2.5 (1.18) awake patients with subarachnoid hemorrhage. I find I have to switch between the CNS and the 4.0 (0.88) Glasgow Coma Scale when assessing patients with subarachnoid hemorrhage because their level of consciousness changes. Note. Participants indicated their level of agreement with these statements on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Table 4. Confidence in Performing the Canadian Neurological Scale (CNS) Assessment Before and Immediately After Workshop

Immediately

After

Before Workshop Workshop

(n = 64) (n = 65) (a) Components of the CNS Assessment M (SD) M (SD) Level of consciousness 4.70 (0.68) 4.72 (0.53) Orientation 4.79 (0.63) 4.76 (0.52) Aphasia 4.10 (1.01) 4.59 (0.65) Motor function 4.18 (0.91) 4.68 (0.54) (patient with no comprehensive deficit) Motor function 3.99 (1.04) 4.64 (0.56) (patient with comprehensive deficit) Motor function 3.92 (0.90) 4.58 (0.61) (uncooperative patient) Overall performance of 3.36 (1.45) 4.38 (0.66) CNS assessment (c) (n = 47) (n = 61)

Change in Confidence from Before

to Immediately After Workshop

(n = 63) (b) Components of the CNS Assessment M (95% CI) p Value Level of consciousness 0.05 (-0.06-0.16) .37 Orientation 0.00 (-0.12-0.12) 1 Aphasia 0.48 (0.25-0.72) .0001 Motor function 0.51 (0.32-0.71) <.0001 (patient with no comprehensive deficit) Motor function 0.66 (0.40-0.92) <.0001 (patient with comprehensive deficit) Motor function 0.71 (0.48-0.94) <.0001 (uncooperative patient) Overall performance of 1.14 (0.70-1.57) <.0001 CNS assessment (c) (n = 44) Note. Participants indicated their level of agreement with these statements on a 5-point Likert-type scale ranging from 1 (not confident at alb to 5 (very confident). Cf = confidence interval. (a) One participant completed only the postworkshop questionnaire, therefore the number of participants is not the same as for "Before Workshop" data. (b) One participant's preworkshop questionnaire was incomplete. (c) Not all participants completed the pre- and postworkshop questionnaires. Table 5. Confidence in Performing Canadian Neurological Scale (CNS) Assessment Immediately--After and 3 Months After Workshop

Immediately 3 Months

After After

Workshop Workshop

(n = 23) (n = 23) Components of the CNS Assessment M (SD) M (SD) Level of consciousness 4.87 (0.34) 4.83 (0.39) Orientation 4.87 (0.34) 4.91 (0.29) Aphasia 4.80 (0.39) 4.37 (1.07) Motor function 4.85 (0.34) 4.59 (0.67)

(patient with no

comprehensive deficit) Motor function 4.80 (0.44) 4.41 (0.92)

(patient with

comprehensive deficit) Motor function 4.73 (0.46) 4.36 (0.85)

(uncooperative patient) Overall performance of 4.60 (0.59) 4.14 (0.96)

CNS assessment (a) (n = 20) (n = 21)

Change in Confidence from

Immediately After to

3 Months After Workshop

(n = 23) Components of the CNS Assessment M (95% CI) p Value Level of consciousness -0.04 (-0.20-0.12) .57 Orientation 0.04 (-0.12-0.20) .57 Aphasia -0.44 (-0.83- -0.04) .03 Motor function -0.26 (-0.52- -0.02) .05

(patient with no

comprehensive deficit) Motor function -0.38 (-0.72- -0.04) .03

(patient with

comprehensive deficit) Motor function -0.38 (-0.77-0.01) .053

(uncooperative patient) Overall performance of -0.47 (-0.99-0.04) .07

CNS assessment (a) (n = 19) Note. Participants indicated their level of agreement with these statements on a 5-point Likert-type scale ranging from 1 (not confident at all) to 5 (very confident). CI = confidence interval. (a) Not all participants completed the pre- and postworkshop questionnaires. Fig 1. The Canadian Neurological Scale (CNS)

Date

Time Mentation Level of Alert 3

Consciousness Drowsy 1.5

Orientation Oriented 1

Disoriented or 0

Nonapplicable

Speech Normal 1

Expressive Aphasia 0.5

Receptive Aphasia 0 Section A1 Motor Functions: