Nurses' understanding and experience of applying painful stimuli when assessing components of the Glasgow Coma Scale

Braine, ME; Cook, NF; Trout, R

Abstract

Aims and Objectives
To evaluate nurses' application, understanding and experience of applying painful stimuli when assessing components of the Glasgow Coma Scale.

Background
The Glasgow Coma Scale has been subjected to much scrutiny and debate since its publication in 1974. However, criticism, confusion and misunderstandings in relation to the use of painful stimuli and its application remain. An absence of evidence informed guidance on the use and duration of application of painful stimuli remains, with the potential to negatively impact on decision‐making, delay responsiveness to neurological deterioration and result in adverse incidents.

Design and Methods
This international study used an online self‐reported survey design to ascertain neuroscience nurses' perceptions and experiences around the application of painful stimuli as part of a GCS assessment (n=273). STROBE checklist was used.

Results
Data revealed varied practices and a sense of confusion from participants. Anatomical sites for the assessment of pain varied, but most respondents identified the trapezius grip/pinch in assessing eye opening and motor response. Most respondents identified they assess eye opening and motor responses together and apply pain for less than 6 seconds to elicit a response. Witnessed complications secondary to applying a painful stimulus were varied and of concern.

Conclusion
Neuroscience nurses in this study clearly required evidence informed guidelines to underpin practice in both applying painful stimuli and in managing the experience of the person in their care and the family response. A standardised approach to education is necessary to ensure greater interrater reliability of assessment not only within nursing but across professions.

Relevance to Practice
Results of this study illustrate inconsistency and confusion when using the Glasgow Coma Scale in practice; this has the potential to compromise care. Clarity around the issues highlighted is necessary. Moreover, these results can inform future guidelines and education required for supporting nurses in practice.

Citation

Braine, M., Cook, N., & Trout, R. (2019). Nurses' understanding and experience of applying painful stimuli when assessing components of the Glasgow Coma Scale. Journal of Clinical Nursing, 28(21-22), 3827-3839. https://doi.org/10.1111/jocn.15011

• Journal Article Type: Article
• Acceptance Date: Jun 30, 2019
• Online Publication Date: Jul 25, 2019
• Publication Date: Oct 16, 2019
• Deposit Date: Oct 7, 2019
• Publicly Available Date: Jul 25, 2020
• Journal: Journal Of Clinical Nursing
• Print ISSN: 0962-1067
• Publisher: Wiley
• Volume: 28
• Issue: 21-22
• Pages: 3827-3839
• DOI: https://doi.org/10.1111/jocn.15011
• Publisher URL: https://doi-org.salford.idm.oclc.org/10.1111/JOCN.15011
• Related Public URLs: https://onlinelibrary-wiley-com.salford.idm.oclc.org/journal/13652702