The Article: Cheerio, Laddie! Bidding Farewell to the Glasgow Coma Scale

Green, S. M. (2011). Cheerio, Laddie! Bidding Farewell to the Glasgow Coma Scale. Annals of emergency medicine, 58(5), 427-430. Elsevier Inc. doi:10.1016/j.annemergmed.2011.06.009

Big Idea:

The Glasgow Coma Scale was not originally intended to be a ubiquitous neurological scoring system. There is evidence to demonstrate the GSC is confusing, unreliable, and unnecessarily complex, and its manner of common clinical use is statistically unsound. Therefore we should consider using Simplified Motor Scales (SMS) that provide the same information, are easier to remember, are statistically derived and externally valid (p. 428)

Evidence:

This article is an editorial, so it is not primary research. The article references a number of other primary sources of evidence including recently published peer-reviewed literature from well respected journals. Referenced studies indicate the GSC has poor inter-rater reliability, it is not consistently remembered, there are different versions (usually outdated 12-point evaluations), it is inconsistent which prevents prognostic value (p. 428 par 1)

Quotable:

"It is time to abandon the Glasgow Coma Scale (GCS). As discussed below, this ubiquitous neurologic scoring system is confusing, unreliable, and unnecessarily complex, and its manner of common clinical use is statistically unsound." p. 427

"Some traditionalists will no doubt object to the blasphemy of "dumbing down" the GCS, but why tolerate pointless complexity?" p. 428

"The GCS is intellectually appealing to health care providers in that it creates apparent order out of disorder. It ambitiously tackles the enormous complexity of human neurologic response and organizes (oversimplifies) it into a tangible, appealing yardstick that cannot fail to impress with its seeming accuracy and precision. We want to believe that medicine can be this objective, and thus we tolerate the delusion." p. 429

So What?

This article was fascinating to me for two reasons. First, as a student I remember trying very hard to memorize the GCS and found it difficult, but thought I was the problem. Second, working in a simulation lab now I find it interesting to see how students do tend to want black and white answers. It is fascinating to step back and see the dialogue that happens in the literature as evidence evolves and researchers have to push for change, not an easy thing to do. As an educator I wonder how we make this apparent to students, since we have to mark them on something and they want very defined and specific answers, yet their knowledge will hopefully and should always be changing (read: evolving) with new evidence.

Dr. Judith Shamian RN FAAN

Chief Executive Officer - Victoria of Nurses (VON)

Beginning her career as a clinical nurse Judith Shamian earned her way to the Chief Executive office at the Victoria Order of Nurses. Along the way she has learned many things and feels strongly about the importance of mentoring nurses in hopes of inspiring future nursing leaders. In our conversation how we discuss the inspiration for beginning her research and her advice for aspiring nursing students and nurses. Among her many words of wisdom Judith recommends nurses find their a purpose they feel strongly about and a passion to learn about how organizations work. Learning to make decisions based on available knowledge, learn from mistakes and constantly reflect on your work is another critical lesson she passes on to future leaders.

Resources Discussed

• Presentations given by Judith as CEO of VON
• Articles published by Judith
• Role responsibilities of head nurses in primary nursing and team nursing units. J Nurs Adm. 1988 May;18(5):7.
• Registered nurse and registered practical nurse evaluations of their hospital practice environments and their responses to these environments.
  Tourangeau AE, Coghlan AL, Shamian J, Evans S.
  Nurs Leadersh (Tor Ont). 2005 Dec;18(4):54-69

Question

Dr. Judith Shamian: Do you have a plan of how to gain different experiences in the next 12-15 months? What would you like to explore or do?

Joan E Mitchell MSN, EdD

jemitchell [at] cbahi.org

Nurse Consultant and Surveyor

Central Board of Accrediation for Healthcare Institutions - Jeddah [googleMap], Saudi Arabi

Sitting down with Joan Mitchell at the Sigma Theta Tau Conference in Indianapolis and discussing her work in patient safety and quality of care was very enlightening. After watching her presentation at the conference about her research on job satisfaction on foreign trained nurses in Saudi Arabia. It was a pleasure to learn about how and why she choose this topic to research.

Research

• Mitchell, JE (2009) Job satisfaction and burnout among foreign-trained nurses in Saudi Arabia: A mixed-method study. Ed.D. dissertation, University of Phoenix, United States -- Arizona. Retrieved January 20, 2010, from Dissertations & Theses: Full Text.(Publication No. AAT 3357443).

Resources

• Contact Helen Ziegler if you are interested in working in Saudi Arabia

Questions

• Joan Mitchell: Will this research be helpful to you, for personal or research reasons?
• Robert Fraser: Have you seen any advertisements recruiting nurses to international destinations? Have you thought about the factors that impact job satisfaction in those exotic destinations?

Peter Goossens RN PhD - email: p.j.j.goossens [at] saxion.nl

Nurse Expert - Dimence - Map

Professor in Mental Health - Saxion

Senior Researcher - Radboud University Nijmegen

Peter Goossens, a Dutch mental health nurse and researcher, and I sit down to discuss his research that helps bi-polar patients recognize on coming periods of mania and depression. We met at the Sigma Theta Tau 40th Biennial and discussed his fascinating research with mental health patients and their families. He has not only conducted excellent research he is allow a great ambassador for the profession of nursing, working to ensure the are able to fully able to support their patients and the nurses perspective is represented in national consortiums.

Research

• PubMed Search for Peter's Research
• Recognizing prodromes of manic or depressive recurrence in outpatients with bipolar disorder: A cross-sectional study (UPDATED SINCE ORIGINAL POST)

Peer reviewed articles

• Van der Voort T.Y., Goossens P.J.J., van der Bijl J.J. (2009) Alone together: a grounded theory study of experienced burden, coping, and support needs of spouses of persons with bipolar disorder. International Journal of Mental Health Nursing 18, 434-443
• Goossens, P.J.J., Hartong, E., Knoppert-van der Klein, E.A.M. & Van Achterberg T. (2008) Self-reported psychopathological symptoms and quality of life in outpatients with a bipolar disorder. Perspectives in Psychiatric Care, 44/4 275-284
• Goossens, P.J.J., Knoppert-van der Klein, E.A.M. & Van Achterberg T. Coping styles of outpatients with a bipolar disorder. (2008) Archives of Psychiatric Nursing, 22/5 245-253
• Goossens, P.J.J., Van Wijngaarden B., Knoppert-van der Klein, E.A.M. & Van Achterberg T. (2008) Family caregiving in bipolar disorder: caregiver consequences, caregiver coping styles, and caregiver distress. International Journal of Social Psychiatry, 54/4 303-316
• Jonker E., Goossens P.J.J., Steenhuis I.H.M. & Oud N.E., (2008) Patient aggression in clinical psychiatry: perceptions of mental health nurses. Journal of Psychiatric and Mental Health Nursing, 15, 492-499
• Goossens, P.J.J., Beentjes, T.A.A., de Leeuw, J.A.M., Knoppert-van der Klein, E.A.M. & Van Achterberg T. (2008) Nursing bipolar disorder outpatients: what nurses actually do. Archives of Psychiatric Nursing, 22/1, 3-11
• Van der Voort T.Y., Goossens P.J.J., van der Bijl J.J. (2007) Burden, coping and needs for support of caregivers for patients with a bipolar disorder: A systematic review. Journal of Psychiatric and Mental Health Nursing 14, 679-687
• Goossens, P.J.J., J.A.M., Knoppert-van der Klein, E.A.M, Kroon. H, & Van Achterberg T. (2007) Self- reported care needs of outpatients with a bipolar disorder in The Netherlands: Journal of Psychiatric and Mental Health Nursing. 14, 549-557
• Goossens, P. J. J., Van Achterberg T. & Knoppert van der Klein E.A.M. (2007) Nursing processes used in the treatment of patient with a bipolar disorder. International Journal of Mental Health Nursing. 16, 168-177

International presentations, both oral and posters

• Goossens P.J.J. Self management in Bipolar Disorder; recognizing prodromes of manic or depressive relapse STTI 20th biennial convention. Indianapolis; nov. 2009
• Goossens P.J.J., Van Achterberg T, Knoppert – Van der Klein E.A.M. Nursing processes used in the treatment of patients with bipolar disorder. ISPN conference. Greenville; April 2009.
• Van der Voort T.Y., Goossens P.J.J., Van der Bijl J.J. Together-and-still-alone: Qualitative research on burden, coping and needed support of spouses of patients with a bipolar disorder. ISBD conference. New Delhi; jan. 2008

Questions

• Peter Goossens:  Who is performing an assessment and teaching of a client's ability to recognize early warning signs of their bi-polar disorder? Are you able to do this as a nurse?
• Robert Fraser: For nurses outside of mental health, do you have tools to self manage mental health disorders and support patient's self-care?

Irmajean Bajnok RN PhD

Director of International Affairs and Best Practice Guidelines - Registered Nurses Association of Ontario

Sitting down with Irmajean Bajnok we discuss her experience and how she came to be Director of the IA-BPG. We talk about how the BPG came to be but also about how she hopes that they are able to support nurses in the workplace and create a health work environment for them to practice in.

Recently the RNAO won the an award from Sigma Theta Tau International, for Practice Academe Innovation Collaboration, below I posted a short video I took in Indianapolis of them accepting their award. Enjoy!

Links

• RNAO Best Practice Guidelines (BPG) Professionalism in Nursing
• Health Work Environments Best Practice Guidelines
• RNAO PhD Fellowships
• Condensed Guidelines for PDA's
• Video on Kingston General Hospital implementation of BPGs
• REISS Project
• Submit Idea for BPG & Sign up to be a BPG Stakeholder

Question

• Irmajean Bajnok: Do you have any ideas for BPG that you would find useful? How many of you have downloaded the PDA version of the guidelines?
• Robert Fraser: What format of information is best for you to use knowledge in practice (i.e print, video, audio, PDA, etc)?

Sioban Nelson PhD

Dean and Professor - Lawrence S Bloomberg Faculty of Nursing

After starting the MN at the University of Toronto, I have had a few readings from Sioban about understanding the history of Nursing. These articles really helped my understanding of nursing. Being young in the profession this historical analysis helps to ground and better understand nursing. During this episode we talked about Dr Nelson's background and how she integrated her understanding of historical analysis into her academic work.

Links

• Nursing (wikipedia) Timeline of Nursing
• Sioban's latest book: Complexities of Care

Research

• Nelson, S. & Gordon, S. (2004). The rhetoric of rupture: Nursing as a practice with a history? September/October Nursing Outlook, 52, 255-261.
• Nelson, S. (1997). Reading nursing history. Nursing Inquiry, 4: 229-236.
• Nelson, S. & McGillion, M. (2004) Expertise or performance? Questioning the rhetoric of contemporary narrative use in nursing, Journal of Advanced Nursing. 47(6).

Question

• Robert Fraser: How have you learned about nursing history? Do you understand how it might give you insight into the profession?

Chris Salgado RN, BN, MA

Program Leader - Children, Youth & Families Program

Vancouver Coastal Health

I really must apologize to Chris about this podcast. We had a great conversation in January last year (2009). We met at the Canadian Nursing Association - Nursing Leadership Conference. She had a very interesting idea about how to engage with nursing staff. She works in public health who have their fingers on the pulse of what familes, clients and communities partners need form nursing leadership. Using the World Cafe approach she was able to engage and pull ideas from key stakeholders of her nursing practice. Below are the pictures of what resulted from this approach.

Links

• The World Cafe

Research

• Standielf, R. B. (2000) The art of focused conversation: 100 ways to access group wisdom in the workplace. Gabriola Island, BC, Canada: New Society

Question

• Chris Salgado: What are your ideas that work for leading teams for changing practice?
• Robert Fraser: What was the last conference you were at that you had an opportunity to exchange ideas and share thoughts with others?

Dr Michael Gardam

Director of Infectious Disease Prevention and Control - Agency for Health Protection and Promotion

Director of Infection Prevention and Control - University Health Network

An experienced and passionate physician in the field of infection control, Dr Michael Gardam is now working with the Agency for Health Protection and Promotion on provincial issues of protection and control. After hearing him give a talk at Princess Margaret I knew I needed to speak with him. In this talk he shares major insights into how Ontario began to public reporting, what they are reporting, how that is perceived and the many issues around hand washing in hospitals.

Research

• Dr Gardam's publications (PubMed Search)
• Infection Prevention and Control in the Design of Healthcare Facilities
• The Changing Face of Critical Care
• Influence of Roles Models and Hospital Design on Hand Hygiene of Healthcare Workers

Links

• Ontario Public Reporting of MRSA and VRE
• Positive Deviance - The Basics
• Positive Deviance Article by Fast Company

Question:

• Dr Michael Gardam: What do you think about this (Positive Dieviance)? Are you interested in taking part?
• Robert Fraser RN: Did you know Ontario is reporting these infection rates? Do you know if your province or state is reporting any infection rates?

Dr Mary Jane Esplen RN

Clinician Scientist and Professor - University of Toronto

Area of expertise: Psychosocial Oncology

Dr Mary Jane Esplen has an extensive career in clinical oncology practice that has evolved over the years to include research as major part of her role. Her ability to drive research strongly tied to clinical practice and how she managed to stay in both academia and practice is part of what we talk about. More recently she has been appointed Director of the de Souza Institute for nursing oncology knowledge transfer for the province, and is planning to take this international. We discuss how her career evolved, why she loves psychosocial oncology and how others might learn from her experience.

Research

• Some of Mary Jane's research Search Results
• Quality of Life Tools for adult patients with cancer undergoing chemotherapy
• Literature Search: Body Image + Cancer
• Profile: Jimmie Holland MD - Pscyho Oncology
• Effects of psychological interventions on survival of patients with metastatic breast cancer

Other

• Definition of Nursing Intervention Model
• Research profile of Mary Jane
• Dr David Spiegel - Psychosocial Researcher
• de Souza Intitute
• Canadian Partnership Against Cancer
• Oncology Nursing Society

Questions:

Mary Jane Esplen: What is the impact of new technologies on practice? Who should be involved in helping families involve these technologies? How can they change clinical practice? What can my role be in this?

Rob Fraser: Are you seeing cancer starting to come into your area of practice? Are you aware of the research that is happening in oncology and how it might improve your practice?

Martha Schroder RN

St. Michael's Hospital - Toronto

Research Advancing Practice Participant

Martha Schroder was one of the first cohort of nurses participating in the RAP program. We cover her motivation for signing up and both the challenges and rewards of her experience of participating in this innovative program.

Questions

• Martha: Are you excited about working in healthcare? Are you considering research and lifelong learning?
• Rob: What is your research question? What information you want know but you don't have access too?

Lianne Jeffs RN, PhD(c)

Director Nursing & Clinical Research

Research Scientist - Li Ka Shing Knowledge Institute

In her current role at she contributes globally to evolving patient safety science as her program area of research is patient safety. Her work focuses on the generating knowledge on the design and delivery of safer health-care systems. In this interview we talk about the Research Advancing Practice initiative that was start at St Michael's Hospital to get clinical nurses to start generating research relevant to their areas of practice

Links

• Research and Reflection for RAP artists (2009) The Standard. College of Nurses of Ontario.
• The art and science of caring
• RNAO Leadership Award in Nursing Research - Lianne Jeffs Research Advancing Practice

Research

• Jeffs, L., Smith, O., Wilson, G., Kohn, M., Campbell, H., Maione, M.,
  Tregunno, D. & Ferris, E. (in press). Building Knowledge for Safer Care:
  Nursing Research Advancing Practice. Journal of Nursing Care Quality.
  24(3).
• Fineout-Overholt, E., Melnyk, B., Schultz, A. (2005) Transforming Health Care from the Inside Out: Advancing Evidence-Based Practice in the 21st Century, Journal of Professional Nursing, 21(6), 335-344.
  

Questions

• Lianne: Have you been involved in a similiar process or program? What are the difficulties, challenges and enablers where you are practicing and how do you bring research to your daily work?
• Rob: Do you see yourself as a researcher, and feel a need to contribute to nursing knowledge? If you hospital offered a program like this would you take part?

Cathy Crowe RN

Street Nurse

A Street Nurse in Toronto. She has worked in the area of homelessness since 1988. In January, 2004 she received the Atkinson Charitable Foundation’s Economic Justice Award which will last for up to three years. During this period of time she is “housed” at the Sherbourne Health Centre.

Links

• Toronto Disaster Relief Committee
• Get Involved in Canadian with TRDC
• Wellesley Institute - Housing and Homelessness
• Homeless Mermorial - Toronto
• Canadian Nursing Students' Position Statement on Health and Homelessness

Research

• TB or not to be
• Shelter Inspection Report

Question

• Cathy Crowe: How much information and course material do you get or have you gotten on Homelessness, the housing crisis, poverty, the recession?
• Rob Fraser: Have you had a community placement? Where was it? Are you fighting for one?

Dr. Judy Boychuck Duchscher RN, PhD

Executive Director  - Nursing the Future

Interview with Dr. Judy Boychuck Duchscher RN, PhD about her research on the transition of new graduate nurses into the profession and what has evolved from her research.

Links

Research

• Cowin, L. , Duchscher, J.E.B. (2007). Transitional programs. In E. Chang & J. Daly (Eds.). Transition in Nursing: Preparing for professional practice, 2nd ed. NSW, Australia: Elsevier Australia.
• Cowin, L. , Duchscher, J.E.B. (2006). The new graduates' professional inheritance. Nursing Outlook, 54(3), 152-158.
• Cowin, L. , Duchscher, J.E.B. (2006). The experience of marginalization in new nursing graduates. Nursing Outlook, 52(6), 289-296.
• Cowin, L. , Duchscher, J.E.B. (2004). Multigenerational Nurses in the Workplace. Journal of Nursing Administration, 34 (11), 1-9.
• Duchscher, J.E.B. (2008). Glimmer of hope, ripples of change: The lived experience of the new nursing graduate. Self-publication in press, July, 2008
• Duchscher, J.E.B. (2008). Transition shock: The initial stage of role adaptation for newly-graduated Registered Nurses. The Journal of Advanced Nursing, Accepted for publication, In Press, July, 2008
• Duchscher, J.E.B. (2008). A process of becoming: The stages of new graduate professional role transition. Journal of Continuing Nursing Education, 39 (10), 441-450.
• Duchscher, J.E.B. (2004). Transition to professional nursing practice: Emerging issues and initiatives In M.H. Oermann & K.T. Heinrich, Annual Review of Nursing Education (Vol 2). New York: Springer Publishing Company, Inc.
• Duchscher, J.E.B. (2003). Critical Thinking: Perceptions of Newly Graduated Female Baccalaureate Nurses. Journal of Nursing Education, 42(1), 14-27.
• Duchscher, J.E.B. (2001). Out in the Real World. Journal of Nursing Administration, 31(9), 426-439.
• Duchscher, J.E.B., Myrick, F. (2008). The prevailing winds of oppression: Understanding the new graduate experience in acute-care. Nursing Forum, 43 (4), 191-206.

Question

1. Judy: What strategies have you used to maintain that spirit that you left your educational program with? The feeling that you can change your world. Who supported you? How did they support you? What can organizations do to help you?
   
2. Rob: Nursing Students are you thinking about the transition period, and how are you preparing for it? Nurses who have gone through the transition, when did you transition and what was the experience like?
   

Hélène Sabourin, RN, BScN, MHA

Links

• The Canadian Nurses Foundation - La Fondation des infirmières et infirmiers du Canada

Question

1. Do you know of any technology that easily allows you to find what research has been done in a particular area, or grants are given out?
2. Have you ever applied for awards or grants? What resources do you feel you need in order to feel comfortable submitting for a research grant?