Neurological assessment by nurses using the National Institutes of Health Stroke Scale: implementation of best practice guidelines.

Assessment is an essential nursing skill that gathers clinical information to strengthen decisions about health interventions and priorities inpatient care delivery. Neurological assessment of the acute stroke survivor provides the cornerstone for early diagnosis, appropriate prognostic evaluation, and optimal management to obtain favourable patient outcomes. The nursing approach to neurological assessment has been enhanced in recent years through the development of new evidence-based assessment tools and the support of best practice guidelines. Based on gaps seen in clinical practice and current best practice guideline recommendations, neurological nurses from The Ottawa Hospital (TOH) identified the need to assess acute stroke survivors using a standardized neurological assessment tool. In 2004, a Registered Nurses of Ontario (RNAO) nursing advanced clinical practice fellowship provided the opportunity for the development of expertise in stroke assessment and establishment of recommendations for neurological nursing assessment at TOH. As a result, standards for nursing neurological assessment have been adopted at TOH using the National Institutes of Health Stroke Scale (NIHSS). This paper will review current evidence and best practice guidelines for neurological assessment. The significances of using the NIHSS for nurses in the context of the provision of acute stroke care will be presented. Knowledge transfer, application and evaluation of best practice guidelines (BPGs) in clinical nursing practice will also be discussed.