Nurses’ Knowledge and Practice in the Application of the Glasgow Coma Scale in the Intensive Care Units and Emergency Department at Muhimbili National Hospital and Muhimbili Orthopaedic Institute, In Dar Es Salaam.

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.