Nursing neurological assessment in the intensive care unit: A scoping review

To describe the scope and nature of research examining nurse-performed neurological assessments in adult intensive care unit (ICU) settings and identify gaps for prioritisation in future research.

Scoping review conducted according to a prospectively registered protocol.

Systematic searches of CINAHL, MEDLINE and PsycINFO were conducted in June 2025. Studies published from 2014 were eligible if focusing on nursing neurological assessments in adult ICUs. Independent screening and selection were undertaken by at least two reviewers. Data extraction using a customised form was duplicated for 20% of studies. An inductive content analysis approach was used to identify predominant research themes.

Thirty-one studies were included, with the majority involving only patients with neurological conditions. Four research themes were identified: assessment of consciousness, pupil inspection, electroencephalography (EEG) monitoring, and clinical utility of hourly neurological assessments (neurochecks). Each theme was characterised by substantial clinical and methodological heterogeneity, limiting meaningful synthesis of study findings. Nevertheless, several broader findings emerged, each representing priority areas for future research. First, the reliability and validity of ICU nurses' assessment of consciousness and pupils remain uncertain. Second, nurse-led EEG monitoring appears technically feasible in expediting electrographic seizure detection and optimising therapeutic burst suppression. Finally, the clinical utility of sustained hourly neurochecks appears limited, given low diagnostic yield and potential risks.

Evidence regarding nurse-performed neurological assessment in ICU settings is low in volume, methodologically heterogeneous, and concentrated within neurocritical populations. This evidence lacks the coherence and empirical maturity required to substantiate the reliability, validity, and clinical significance of current practices. Progress in this field requires rigorous research to address the identified priority areas.

Without robust evidence, nursing neurological assessment practices remain convention-driven rather than outcome-oriented. Uncertainty surrounding the reliability and validity of neurological assessment practices raises questions regarding their utility in informing safe, high-quality care for critically ill adults in ICU settings.