Effectiveness of a clinical nurse specialist-led structured education program for consciousness assessment in the emergency department
Related Experiment Video
Updated: Nov 2, 2026
Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide
Published on: January 15, 2017
Nayoung Kim1, Miyeon Ju1, So Jeong Kim1
1Department of Nursing, Asan Medical Center, Seoul, Republic of Korea.
Background:
Accurate consciousness assessment is essential in emergency care, but existing education has focused on individual tools rather than integrated bedside performance and documentation. This study examined whether a Clinical Nurse Specialist (CNS)-led education program was associated with change in documented consciousness assessment.
Methods:
A quasi-experimental pre-post study was conducted in an adult emergency department. The program followed Miller's Clinical Competence Pyramid through theoretical learning, one-to-one coaching, bedside practice, and independent performance. Assessment completion and tool use were analyzed in repeated cross-sectional electronic medical record cohorts. Nurses' knowledge, perceptions, and concordance with CNS assessments were also assessed.
Results:
Documented assessment within 1 h of arrival increased from 78.1% to 97.3% (95% CI for the difference, 8.8 to 30.1 percentage points), and before disposition from 60.3% to 91.8% (18.0 to 43.8). Combined use of AVPU with at least one additional tool increased from 28.6% to 65.6% before disposition. Mean nurse-CNS concordance was higher at follow-up (4.38 vs 2.38; Cohen's d = 1.76); exploratory knowledge and perception outcomes were also higher.
Conclusions:
The CNS-led, practice-integrated education program was associated with more timely and comprehensive documentation and greater combined tool use. Controlled multicenter studies are needed to establish causality.
Related Concept Videos
01:15Nursing Implementation
The five steps to implementing effective nursing care include reassessing the patient, reviewing and revising the existing nursing care plan, organizing the resources and care delivery, anticipating and preventing complications, and implementing nursing interventions.
01:27Nursing Clinical Information System
A Nursing Clinical Information System (NCIS) is a specialized type of healthcare information system tailored to meet the unique needs of nursing practice. It incorporates the principles of nursing informatics to streamline information management and improve the quality of care delivery.
Critical attributes of NCIS include:
01:30National Nursing Organizations II
The AACN emphasizes a healthy work environment through six standards to achieve an optimal patient outcome. The standards are appropriate staffing, meaningful recognition, collaboration, authentic leadership, effective communication, and decision-making. In addition, AACN provides certification programs, webinars, journals, and...