Effect of training sessions about Full Outline of Un-Responsiveness scale compared to Glasgow Coma Scale on nurses’ performance, perception and its reliability

Document Type : Original Article

Authors

1 Assistant Professor of Critical Care and Emergency Nursing Department, Faculty of Nursing, Alexandria University, Egypt 2. Assistant Professor of Critical Care and Emergency Nursing, College of Nursing, King Saud bin Abdulaziz University for Health Sciences, Al-Ahsa, Saudi Arabia 3. King Abdullah International Medical Research Center, Al-Ahsa, Saudi Arabia

2 Assistant Professor of Critical Care and Emergency Nursing Department, Faculty of Nursing, Alexandria University, Egypt

Abstract

Background: Assessing patients’ level of consciousness in intensive care units
(ICUs) through Full Outline of Un-Responsiveness (FOUR) scale versus the Glasgow Coma
Scale (GCS) requires critical care nurses’ (CCNs) knowledge and skills to detect deterioration
of patients’ level of consciousness. Objectives: To evaluate the effect of implementing
training sessions on critical care nurses’ performance and perception regarding FOUR scale
compared to GCS and reliability of each one. Research hypotheses: Nurses who attend
training sessions will show a significant improvement in performance of FOUR scale
compared to GCS. Study design: A pretest posttest study design was used in this study.
Method: The study was conducted at seven ICUs at Alexandria Main University Hospital
including; Unit I, Unit II, Unit III, Medical, Respiratory, Neurosurgery, and Emergency
anesthesia ICUs. Subject: A convenient sampling technique of all CCNs (100) and a
purposive sample of adult critically ill patients equivalent to the number of nurses’ sample was
used to recruit the participants from previously mentioned CCUs. Results: The implemented
training sessions were significantly effective in increasing CCNs’ performance and positive
perception of FOUR scale compared to GCS. There was overall higher inter-rater reliability
regarding FOUR score than that of GCS score Cohen’s kappa (0.92 versus 0.81) and 83% of
nurses agreed that FOUR scale is a preferred scale to assess the depth of coma. Conclusion:
training sessions were significantly effective in increasing CCNs’ performance and positive
perception regarding FOUR scale compared to GCS. Recommendation: Nursing
administrators should provide continuous training sessions. Manual for procedures is advised
to be distributed to all CCNs including all methods for assessing patients’ level of
consciousness (LOC).

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