From Evidence to Action: Nurse Decision-Making in Intracranial Pressure Management

Introduction: Despite the severity of outcomes associated with increased intracranial pressure (IICP), there is no ‘gold standard’ of treatment to dictate consistent evidence-based management. Neuro-critical care nurses play a pivotal role in evaluating and treating these patients, relying on both orders and their own clinical judgment. However, there is a lack of research that focuses on the critical decision-making process employed by nurses in this setting. This study aimed to identify the accepted evidence-based practices for IICP management, as well as to better understand the decision-making process for nurses in the selection of interventions. Methods: A descriptive qualitative methodology was employed to explore these central topics. After a literature review identified current practices for IICP management, semi-structured interviews were conducted with neuroscience ICU nurses. Results: Three primary themes were identified: (1) Knowledge and Utilization of Evidence-Based Interventions, (2) Decision-Making, and (3) Barriers to Evidence-Based Care. The nurses possessed a strong understanding of current evidence-based care for IICP management. Notably, their decision-making processes were significantly influenced by their level of clinical experience. Barriers to the implementation of evidence-based care included ineffective communication, changing of evidence, and the impact of the pandemic. Conclusions: These findings underscore the importance of enhancing communication and fostering greater involvement from nurses to optimize patient care. By addressing these barriers and leveraging nurses’ expertise, healthcare teams may be able to collectively improve IICP management.