Emergency Department Glasgow Coma Scale - Health Assignment Help

Assignment Task:

Identifies an area of specialty within the health setting 

Emergency medicine is specialized services to deliver acute medical services from the Emergency Department (ED), and ED has a highly skillful clinician to provide emergency treatment (Cameron et al. 2014). However, during my recent placement at ED, I have noted that nurses working in ED have a variety of knowledge and practice on using the Glasgow coma scale (GCS) to assess the level of consciousness of the patient with a neurological problem. 

Criterion 2: 

Relevant research of a high level is used to identify an educational gap within this specialty area 

GCS is the neurological assessment tool that measures the depth and duration of impaired consciousness which is important to identify the early deterioration in the level of consciousness (Braine & Cook 2017). Nagalakshmi, Sagarkar & Sakharkar (2018) write that GCS is the 15-point scale to evaluate the consciousness on the basis of response to external stimuli; eye and verbal response and motor responsiveness. Nurse’s critical thinking skills, knowledge, and competence are the foundation of GCS applicability (Braine & Cook 2017). A quantitative descriptive cross-sectional study published in the MEDLINE Complete database, using GCS questionnaire methods has explored the knowledge and competency level of ED and outpatient department nurses in assessing GCS (Basauhra Singh et al. 2016). The result of this study shows that only 2.96% of nurses have good, 41.48% have satisfactory knowledge about the GCS and more than half 55.56% of participants have poor knowledge in assessing GCS. Therefore, further education and practice on GCS for nurses working in the ED to develop their knowledge are crucial. 

Correspondingly, a systematic review with a cohort study, case-control, cross-sectional, and descriptive studies published in The Joanna Briggs Institute (JBI) database has explored the demographic factors that affect nurse’s performance on assessing consciousness level (Matter & Chan 2011). The result of the study concludes that knowledge and experience are the significant factors that affect acute care settings nurses; such as ED and intensive care unit (ICU) nurse's ability to conduct the level of consciousness assessment (Matter & Chan 201). This systematic study also suggested the formal training and education session for nurses on a continual basis to maintain standard and uniformity in the level of consciousness assessment. Similarly, another cross-sectional analytical study conducted with 127 nurses working in ED and ICU with the aim of evaluating their knowledge about GCS published in BASE database indicates that despite number of years after graduation, experience and work in critical settings, nurses have restricted knowledge in using GCS, thus further education and training is required (Santos et al. 2016). 

Criterion 3:
Analysis of the impact of educational gap undertaken 

Recognizing and responding to clinical deterioration in acute health care is one of the National Safety and Quality Health Service Standard (NSQHSS) developed by Australian Commission on Safety and Quality in Health Care (ACSQHC) which requires all health professionals to ensure patient’s deterioration is recognized promptly, and action is taken immediately (ACSQHC 2012). Massey, Chaboyer & Anderson (2017) write that there are many studies and systematic reviews providing insights to the risk that hospitalized patients faced due to the lack of early detection and identification of deterioration. They further write that failure to recognize and respond to patient deterioration because of the limited knowledge in assessing patients such as; vital signs and GCS assessment has led to an increased risk of adverse events in hospitalized patients which might have been avoided if the deterioration was rectified and responded earlier. 

Chou et al. (2017) discuss that poor knowledge and skills of nurses in assessing consciousness of patients with traumatic brain injury, and neurological deficiency is associated with poorer prognosis and requiring more intensive care which increases mortality and morbidity and results in an adverse outcome. Ahamed & Ebraheim (2017) write that neurological assessment is one of the fundamental aspects of nursing care; hence nurses working in critical care should use GCS assessment as easily as other routine observations such as vital signs. They further write that despite, GCS being a universally accepted tool to assess the level of consciousness in nursing practice, many nurses are using it inaccurately without following the instruction. This might impact nurse’s ability to develop proper nursing care plans depending on the actual needs of the patients, compromise early detection of potential health issues and can affect the quality of nursing care which reflects on poor patient outcomes (Ahamed & Ebraheim 2017). Furthermore, misinterpretation and misapplication of GCS create an issue because it is an important mechanism of communication between the clinicians regarding the patient's condition (Mattar, Liaw & Chan 2013). 

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