Article Review of “Interobserver Reliability of Glasgow Coma Scale Scores for Intensive Care Unit Patients”
The Glasgow Coma Scale (GCS) assesses patients’ consciousness levels after traumatic brain injuries. It is used in patient evaluation using the eye, motor, and verbal responses. The score’s reliability is critical in determining the degree of neurological impairment. The overall score is the summation of individual scores from the above three aspects and can reach a maximum of 15. The extent of trauma to the brain depends on the overall score registered with severe injuries having lower scores and mild injuries registering scores close to the maximum value. The article availed for review focuses on studying the interobserver accuracy in ICU patient GCS scoring. A comprehensive review will feature an article summary, new information acquired from the article, its significance to students, and its application in general practice.
This observational study evaluated the GCS scoring done by 21 intensive care unit (ICU) nurses and two independent researchers on 202 patients. The study targeted young nurses who had graduated at least six months before the study (Kebapci et al., 2020, p. 19). The results indicated a near-perfect agreement between the scores provided by the researchers. In contrast, the agreement of the scores availed by the nurses among themselves and the researchers was moderate and not near perfect. In essence, nurses should possess adequate knowledge and skills on GCS evaluation through appropriately designed continuous medical education and induction by preceptor nurses.
Therefore, accurate evaluation of patients’ GCS scores is valuable for effective patient care that yields desirable treatment outcomes, although this is not always the case in emergency departments and ICUs. Previous video-based research highlighted that the GCS score accuracy levels of 29% among nurses and 33.1% among other health care workers (Kebapci et al., 2020, p. 19). The above statistic is worrying since the role of GCS patient assessment is to prevent irreversible neurological damage. As such, ICU nurses must carry out an accurate evaluation of patients for timely management and intervention.
The study’s main objective was to compare different GCS scores among ICU nurses and establish interobserver reliability of such scores. Notably, in 2014, the wording of the GSC was updated (Kebapci et al., 2020, p. 19). Hence, this study is critically essential in pointing out the gaps of inappropriate GCS scoring among nurses as fewer similar studies have been conducted.
The total GCS score was derived from the summation of the eye, verbal, and motor subcomponent scores. Every observation was allocated a maximum of 5 minutes to prevent score variations by the same nurse (Kebapci et al., 2020, p. 20). The states of neurological patients change every minute, and significant changes in GCS score might occur with prolonged observation. The time restriction indicates the scoring data obtained from the study was fairly accurate.
The new information is the recommended use of the nail bed, trapezius, and suborbital sites of pain stimuli to acquire the best motor responses. However, other studies proposed that the trapezius pinch was the most preferred pain stimulation method (Kebapci et al., 2020, p. 24). Standardization is thus necessary since using different points to assess motor response has led to the questioning of GCS reliability. Moreover, important information gained elaborated that endotracheal intubation is a major hurdle to verbal response evaluation. The study discouraged assigning the value V (tube) for verbal response among intubated patients (Kebapci et al., 2020, p. 24). Patients need to be assigned numeric values to help in decision-making. Usually, increased accuracy and precision in scoring leads to positive treatment outcomes.
Lastly, the eye response was not considered an accurate marker of consciousness. A previous study established that 55% of neurosurgical nurses were unaware that the eye subcomponent score ranged from 1 to 4 (Kebapci et al., 2020, p. 23). It indicated the knowledge gap among nurses regarding GCS scoring. The significance of the accuracy of GCS scoring is seen in the direct proportionality between the scores and disease prognosis. There is a direct interrelationship between low scores and poor prognosis.
Significance of the Information to Students
This semester, I will learn how to best conduct and score the motor, eye, and verbal response subcomponents in the clinical area. Usually, nurses new to the clinical setting experience difficulty transferring knowledge to aid in patient care due to a lack of clinical experience (Lee & Sim, 2019, p. 449). However, the learning points gained from the study will increase my confidence to practice practicum acquired skills effectively. The guiding knowledge on the GCS from the study will make me out-perform my limits as a student.
Furthermore, this study has made me acknowledge the benefits of continuous medical education to improve my hands-on skills while in the clinical area. Hospital experience brings the pressure to begin relearning due to an apparent knowledge gap (Lee & Sim, 2019, p. 451). In turn, I will always take induction training by preceptors seriously and participate in multi-disciplinary ward rounds. I will also request my preceptor to allow me to attend all professional development training hosted by the hospital. Effectively, the study embraces skills development through novel simulation strategies that students can also request to participate in to be adequately resourceful in building competency.
General Practice Application
The future benefit of the study to my general practice is that I can be adapt its primary information to reduce mortality rates and improve the prognosis of neurosurgical patients. Rapid changes in patients with neurological conditions can result in irreversible outcomes, and so, nurses should be in a position to promptly perform tests and accurately carry out a patient’s evaluation under such states (Lee & Sim, 2019, p. 450). Accordingly, I will regularly take online nursing aptitude tests and read updated online resources on current nursing practices to perfect future skills. The GCS assessment standardization proposed by the study could potentially limit ICU mortalities. As a result, if the study recommendations are implemented in a healthcare setting, future nurse practitioners, including myself, will inherit safe ICU environments with improved prognoses for neurosurgical patients.
In conclusion, this study’s disparity in nurses’ GCS scores reveals that adequate standardization on evaluation criteria of neurosurgical patients and appropriate education for nurses is essential. Implementing such changes will enhance ICU patients’ treatment outcomes for head injuries. However, imparting special skills in nurses, especially critical care nurses, entails initiating competency programs in nursing schools and providing an elaborate procedure for transferring the classroom knowledge to hands-on experience.
Kebapci, A., Dikec, G., & Topcu, S. (2020). Interobserver reliability of Glasgow coma scale scores for intensive care unit patient. Critical Care Nurse Journal, 40(4), 18-26. https://doi.org/10.4037/ccn2020200
Lee, J. E., & Sim, I. O. (2019). Gap between college education and clinical practice: Experience of newly graduated nurses. Nursing Open Journal, 7(1), 449–456. https://doi.org/10.1002/nop2.409
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