Abstract:
Background: Neurological observations comprise of a combination of indicators and
are performed on patients who may be at risk of neurological deterioration. The
Glasgow Coma Scale (GCS), first presented by Teasdale and Jennet in 1974, is one of
the most effective and reliable tools to assess the depth and duration of impaired
consciousness, especially for the patient with head injuries. It can be used by nurses as
an indicator when there is a need for intervention or treatment in emergency conditions.
Aim: To assess the knowledge, practice and identify the factors associated with
assessment of the GCS among nurses working at Muhimbili National Hospital and
Muhimbili Orthopedic Institute, Dar es Salaam.
Methods: A quantitative cross-sectional design was used, where by a structured
questionnaire assessed 158 nurses about their knowledge and the factors associated with
utilizing the GCS, and a checklist was used for observation of practice. Nurses working
in EMD and ICU were conveniently recruited. Data was analyzed using SPSS computer
software version 21.
Results: More than half (55.1%) were aged between 25 to 34 years. Many of them
(69.6%) were females. Of the participants 62.7% had a diploma in general nursing and
only 4 (2.5%) had a Master‟s degree and above. Only 13.3% of participants had high
level of knowledge regarding GCS. More than half the nurses did not know the lowest
score. Around half (47.6%) of nurses had never attended any type of training. Several
factors were reported to deprive assessment using GCS such as lack of knowledge about
application of GCS (19.6%), work overload of nurses (19.6%), lack of resources
(14.6%), lack of skills (5.7%) and lack of training (5.1%).
Conclusion: Nurses have a low level of knowledge about the GCS assessment. More
than half the nurses did not know the lowest score for the GCS. They could not identify which GCS score indicated a patient was in a critical neurological condition. There was
a large discrepancy between the knowledge scores and the nurses‟ perception about their
current knowledge. There was less understanding of the neurological bases, and clinical
application of the GCS, with lack of continuing educational updates on the GCS. The
inadequate knowledge possibly will limit their capacity for clinical judgment and
decision making in managing unconscious or deteriorating patients.
Recommendation: There is need to implement a continuous professional education
program on GCS assessment with special focus on methods of assessment, guidelines,
how to use assessment tools, protocols and proper documentation for critically ill
patients.
