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The challenge of neuro nursing

Caring for patients with brain diseases takes specialized skills

National Nursing Week recognizes nurses across Canada who help others in need of care, compassion and understanding. These traits are exemplified in the work of 233 full-time and auxiliary nurses at The Neuro, where patients must cope with illnesses that can take years to develop in a long process of degeneration.

“It’s difficult for patients to lose the ability to be independent, so there are a lot of struggles to face. It makes me proud that our nurses are helping them through that process by focussing on whatever strengths the patients still have,” notes Georgia Niarchos, Associate Director of Neurosciences in charge of patient care and services. “I find that neuro nurses are a special group. They don’t focus on deficits. They focus on how they can help patients to have some quality of life and reach their goals as individuals.”

In contrast with other care missions where patients stay only long enough to have surgery, for example, and are then discharged, neurological patients characteristically have a lifelong disorder that requires regular follow ups.

“There’s a lot of patient engagement and connection with the staff,” says Niarchos, who joined The Neuro after 11 years as Nurse Manager of the Neurology/Neurosurgery Department, the Traumatology Program and the Orthopedics Department of the McGill University Health Centre. “Nurses here understand this and have a sense that they belong in the patient’s life.”

Communicating with patients over the long term becomes especially important, says Shannon Godin, who has been a nurse in the Stroke Unit for the past three years.

“A lot of patients have some trouble communicating. Sometimes the wrong word comes out, or their behaviour is out of the ordinary, or they communicate non-verbally. You have to be able to understand what they are saying.”

Dealing with patients whose conditions vary widely according to the stage of their illness means that neuro nurses also need to be adaptable.

“In one shift we’ll see patients who get up and go home with no consequences and also patients who must go into palliative care,” says Yasmin Khan, a ten-year veteran in the Stroke Unit, which has about 40 full- and part-time nurses. “Sometimes it’s difficult to switch gears, but we do it. We get through it by supporting each other.”

New nurses are immediately put on the support track.

“We have three nurse educators who follow new nurses during their integration period,” says Josée Lizotte, an MUHC nursing manager at The Neuro. “We teach a lot with role-play simulations. For example, an actor pretends to have an epileptic seizure. A few nurses intervene and the nurse educators give feedback on the spot, which is the best kind of feedback.”

Nurse managers encourage staff to develop their skills and knowledge continuously. One nurse who is taking her learning to a new level is Marianne Sofronas, a nurse clinician in the Intensive Care Unit for the past ten years. Before coming to The Neuro, she worked in neuroscience research at Sick Kids Hospital in Toronto. Having earned a masters’ degrees in both anthropology and in nursing, Sofronas is now studying for her doctorate in nursing.

“I always had an interest in research,” says Sofronas. “What was missing while I was doing research in Toronto was seeing where the knowledge was applied. I wanted to have a clinical aspect to my job. Nursing fit my vision of what excellent health care should look like.”

For her doctorate, Sofronas is preparing a study on neuro palliative care. The Neuro has a specialized Neuro Palliative Care program aimed at reducing the mental and physical suffering of neurological patients and their families in the journey from diagnosis of a terminal illness to end of life.

“Neuro palliative care is relatively new and not well understood, especially the nursing aspect,” Sofronas says. “Traditional palliative care models originated in cancer care and are not always a good fit for patients with neurological diseases. For example, you can be in the final stages of a neurological disease and not be actively dying — you can go on for a long time, as in the case of dementia. It’s a devastating experience for patients and their families. But to qualify for traditional palliative care, you must have a life expectancy of less than three months. Our patients are often falling through the cracks for a lot of services. We’re so well placed to investigate neuro palliative care at The Neuro because managing how patients think and communicate and behave is something that The Neuro’s nurses are exceptionally good at.”

The Montreal Neurological Institute & Hospital is a McGill University research and teaching institute; delivering the highest quality of care to patients, as part of the Neuroscience Mission of the McGill University Health Centre. The Neuro is proud to be a Killam Institution, supported by the Killam Trusts.