Implementation of the Canadian Neurological Scale on an acute care neuroscience unit: a program evaluation

The Canadian Neurological Scale (CNS), a validated stroke assessment tool, was implemented for the neurological assessment of patients with stroke. The purpose of this study was to explore nurses' values and perceptions of best-practice guidelines (BPGs) and the CNS assessment, to evaluate the effect of a workshop and implementation process on nurses' self-efficacy for CNS use, to determine whether the workshop and implementation process met the needs of the nurses, and to evaluate the accuracy and appropriateness of CNS assessment documentation. Nurses reported moderate-to-strong awareness and use of BPGs and expressed the belief that BPGs were valuable; however, they had some difficulty accessing BPGs. At 3 months after the workshop, nurses reported using the CNS assessment in practice but said that it was not easy to use and that it was not useful as a patient status communication tool or for documenting neurological changes. Nurses were moderately confident while performing the CNS assessment before the workshop. Confidence increased immediately afterward (p < .0001), and then decreased slightly at 3 months. The majority of nurses said the workshop met their learning needs. A chart audit demonstrated that only 69% of patients appropriate for the CNS assessment were assessed with this tool. Although nurses are aware of BPGs, translating these changes into practice takes time and may require BPG modification to best fit the needs of the areas in which they will be used. When choosing a validated stroke assessment tool, clinicians must consider how often the tool will be used for assessments, particularly in the acute phase.