Clinical nurses knowledge, skills and learning needs about glasgow coma scale for neurological patients’ assessment in tertiary hospitals in Edo state, Nigeria: A mixed method study

Abstract

BackgroundThe Glasgow Coma Scale (GCS) is a nurse’s/physician’s clinical tool for assessing patients’ level of consciousness. Evidence suggests that nurses’ show poor integration of GCS knowledge into clinical practice. GCS knowledge and use among nurses in Nigeria has been under studied. AimThis study assessed the knowledge, skills, and learning needs of clinical nurses in using the GCS for neurological patients’ assessment. MethodA convergent parallel mixed methods design was adopted. Quantitatively, 212 nurses working in purposively selected hospitals/wards/units were surveyed using a structured questionnaire and observational checklist; while qualitatively, using explorative descriptive design, an in-depth interview of 20 purposively selected nurse managers using an interview guide was conducted. Quantitative data were analysed using descriptive statistics and t-test at 5% level of significance. Qualitative data were content analysed using thematic approach following Creswell’s steps. ResultMost of the respondents had poor knowledge (169 = 79.71%) of the GCS, and demonstrated a poor level of skills (205 = 96.69%) with no significant differences between institutions in knowledge and skills (p greater than 0.05). Qualitatively, two major themes emerged with five subthemes: 1. Nurses reported negative experiences with neurological patients’ assessment (Lack basic knowledge, wrong interpretation/application of GCS skills, and non-usage of GCS in practice), and 2. Nurses identified learning needs (a. challenges in using GCS, and b; proffered solutions). ConclusionWith poor GCS knowledge and skills established in this mixed method study, there is need to develop and implement a self-instructional educational package embodying theoretical and practical demonstrations of GCS knowledge and skills for nurses’ use in clinical patient assessment.