CLINICAL PRACTICUM ANALYSIS

Clinical Practicum Analysis - of NIHSS (National Institute Of Health Stroke Scale)

Clinical Practicum Analysis - of NIHSS (National Institute Of Health Stroke Scale)

Introduction

The NIH Stroke Scale (NIHSS) International is an initiative by national and international government entities as well as private and scholastic organizations. These bodies are dedicated to promoting wellness and better patient care in the field of stroke. The National Institutes of Health Stroke Scale (NIHSS) is a systematic assessment tool that provides a quantitative measure of stroke-related neurologic deficit. The NIHSS was originally designed as a research tool to measure baseline data on patients in acute stroke clinical trials. Now, the scale is also widely used as a clinical assessment tool to evaluate acuity of stroke patients, determine appropriate treatment, and predict patient outcome.

The NIHSS can be used as a clinical stroke assessment tool to evaluate and document neurological status in acute stroke patients. The stroke scale is valid for predicting lesion size and can serve as a measure of stroke severity. The NIHSS has been shown to be a predictor of both short and long term outcome of stroke patients. Additionally, the stroke scale serves as a data collection tool for planning patient care and provides a common language for information exchanges among healthcare providers. The scale is designed to be a simple, valid, and reliable tool that can be administered at the bedside consistently by physicians, nurses or therapists.

The NIHSS is a 15-item neurologic examination stroke scale used to evaluate the effect of acute cerebral infarction on the levels of consciousness, language, neglect, visual-field loss, extraocular movement, motor strength, ataxia, dysarthria, and sensory loss. A trained observer rates the patent's ability to answer questions and perform activities. Ratings for each item are scored with 3 to 5 grades with 0 as normal, and there is an allowance for untestable items. The single patient assessment requires less than 10 minutes to complete.

The evaluation of stroke severity depends upon the ability of the observer to accurately and consistently assess the patient.

Nursing Practice

Much has been written about reflection and its potential to develop not only practitioners but an understanding of nursing practice through theory that is embedded in practice (Rolfe 1998, 22-29). A key skill needed by nurses is the ability to work in partnership with older people. To achieve this, it is important for nurses to be able to 'make sense' of their practice, and to understand their contribution in practice placement. Structured reflection can therefore be a tool to help nurses gain a greater insight not only into professional practice but into their working relationship with older people.

Acquiring greater knowledge and insight into practice through reflection is not new. Schön (1999, pp.45-47) describes 'reflection-in-action' as an approach taken by practitioners in the practice setting to immediately reshape and modify their practice. 'Reflection-on-action' is a term used to contemplate practice retrospectively, usually away from the setting in which the practice took place. Unstructured or 'chaotic' reflection will not generate theory or ...