Barbara J. Boss

Adverse effects of pain on the nervous systems of newborns and young children: a review of the literature.

&NA; There are immediate and long‐lasting harmful consequences to the nervous system when infants experience severe or repetitive pain. These effects are especially significant in preterm infants, who are vulnerable to neurological damage during this critical time of neurodevelopment. Painful experiences may cause structural and physiological changes within the nervous system. Repeated painful procedures may result in decreased pain thresholds and hypersensitivity to pain. Immediate harmful effects of pain include physiologic instability and increased incidence of serious complications such as intraventricular hemorrhage. Painful stressors may lead to sleep disturbances, feeding problems, and inability to self‐regulate. Long‐term effects of pain may include altered pain perception, chronic pain syndromes, and somatic complaints. Repetitive pain in the preterm infant may be associated with attention deficit disorders, learning disorders, and behavioral problems in later childhood. Nursing involvement with pain management is crucial to achieve positive health outcomes for high‐risk infants and older children and adults who have experienced repetitive or severe pain as infants.

The Neuroanatomical and Neurophysiological Basis of Learning

&NA; The physiological basis of learning is memory The established facts about memory, the memory systems, and learning are presented along with relevant theories currently proposed. Additionally, current physiological theory about cognition is examined. Specifically, the functions of the memory systems in cognition and the function of the frontal lobes in goal orientation and elaboration of thought are addressed Implications for neuroscience nursing practice are drawn.

Syncope: neuroscience nursing assessment based on an understanding of underlying pathophysiological mechanisms.

&NA; To assist neuroscience nurses in their assessment of the client experiencing syncope, the authors propose use of models derived from the three underlying pathophysiological mechanisms of syncope to guide data collection and documentation. This approach is also useful in educating the client and family, as well as nurses and students about the phenomenon of syncope.

Memory impairments: forgetfulness versus amnesia.

&NA; Two varieties of memory disorders can be distinguished—those characterized by the phenomenon of forgetfulness and those characterized by the presence of an amnesic state. Although these two conditions may appear similar, they have different anatomical correlates and functional significance. States of forgetfulness and amnesia arise from different etiologies, have different prognoses and require different therapeutic regimes. The purpose of this article is to distinguish these two varieties of memory disorders and contrast them as to anatomical features, functional differences, etiologies, prognoses and therapeutic management regimes. This should assist the neuroscience nurse to better understand relevant nursing assessment features and plan appropriate therapeutic nursing interventions for the client. Teaching protocols for families and significant others as well as clients with memory impairments should also be enhanced.

Dysphasia, Dyspraxia, and Dysarthria: Distinguishing Features, Part II

&NA; Part I of this article appeared in the June issue of the Journal of Neurosurgical Nursing.

Barriers to Physical Activity and Healthy Diet Among Children Ages 6 Through 13 in a Mississippi Elementary School

The purpose of this study was to identify barriers to adequate physical activity and a healthy diet, investigate differences in the perceived barriers among subgroups, and determine predictors of high versus low total barrier scores in one inner-city elementary school. A mixed method design was used and included students ages 6 through 13 (n=110) and parents, teachers, and community leaders (n=20). Data were collected using questionnaires and focus groups. Quantitative findings revealed no differences in total barriers based on age, gender, number of parents, or household income; however, subscale differences among groups were noted. Qualitative findings indicated that perceived barriers to physical activity were knowledge-related, and barriers to healthy diet concerned access to healthy foods.

Severe brain injury rehabilitation. What's going to happen after critical care.

Treatment advances and technology will continue to decrease mortality in SBI in the future. A clearer line between lingering death and reasonable potential for recovery will only slowly reveal itself, and prediction will never be an exact science. Concerns about resource utilization and costs will continue to escalate. Critical care, acute care, and rehabilitation nurses will continue to live in this painful haze with the patients and their families. Nevertheless, critical care nurses can help by assisting families to understand the possible outcomes of SBI, the clinical state the patient is experiencing, how diagnosis and prognosis are related and how they are different, the indicators used to establish prognosis early on and then later in the course, and how prognosis is related to treatment decisions. Likewise, the critical care nurses can help the family begin to come to terms with the level of sophistication (or lack of precision, as the case may be) of prognostication, the agonizing time length factor involved, and the demanding prerequisites for level of consciousness assessment in the low functioning clinical states.

Cognitive Systems: Nursing Assessment and Management in the Critical Care Environment

In-depth knowledge of cognitive systems allows the critical care nurse to incorporate that information into an expanded assessment. This in-depth nursing assessment enables the nurse to identify intact and deficient cognitive systems and quantify the deficits. Astute assessment is fundamental to planning appropriate interventions and permits more specific deficit-related interventions by the critical care nurse.