An In-depth analysis of nurses’ knowledge, practice, and attitude towards neurological examination and the challenges: “bridging the gap”

The complexity of the neurological examination makes it more difficult than the other patient assessment components. Quick and accurate neurological evaluation can help identify deterioration early and support management and intervention efforts. Thus, to guarantee that nurses execute neurological assessments as well as possible, thorough training is required [1]. The neurological examination is one of the most complex skills to master. Research on nurses’ proficiency in doing neurological exams is lacking, despite the significance of this procedure [2]. Selecting which elements to incorporate in a neurological examination appears to be complicated, which makes it challenging to carry out. The absence of professional agreement over the proper terminology—neurological assessment, neurological examination, or neurological check—contributes to the misunderstanding. These are ideas that are interchangeable and have similar definitions. Nurses may have issues with appropriately documenting minor neurological modifications in the electronic health record (EHR) if there is disagreement over the components of a clinical assessment. Inconsistent EHR reporting can lead to communication errors and an inaccurate representation of the patient’s ongoing neurological condition [3].

The nervous system is a hugely keen system that regulates and integrates the body’s actions. Conducting neurological assessment depends on the professional’s knowledge as regards the structure of the nervous system and its function and very entirely the skills required to identify and interpret abnormalities. Neurological examination is not as similar as physical examination. This examination is very important, as it would study the activity of the nervous system and thereby provide information on the working of some of the parts of the body controlled by the nervous system. Neurological examination yields an important report about the functioning of the brain [4]. An important skill that all health professionals should possess in conducting a neurological examination is the proper use of GCS and other tools of neurological observations, plus accurate recording of the findings [5].

The process of evaluating sensory neurons and motor responses particularly reflexes to ascertain whether the nervous system is compromised is known as neurological assessment. This usually entails a physical examination as well as a review of the patient’s past medical records. The process of evaluating neurological function is intricate and nuanced involving numerous tests with extremely specific functions. However, the fundamental component of neurology is still the neurological examination. It makes growing difficulties due to the intrusion of diagnostic imaging, neurological examination skills have retained their therapeutic value [6].

Nurses are frequently the first to notice abnormalities and can sometimes stop something in time before it becomes too aggressive. The five-minute neurological nursing assessment can quickly identify any issues, preventing progression and providing intervention. Thus, it is important to understand that a neurological nursing assessment should be completed with accuracy, thoroughness, and complete understanding of the assessment. Since a patient’s neurological status can change suddenly and abruptly, making sure that “neuro checks” are performed and reported helps predict the patient’s outcomes [7].

Furthermore, the accuracy of the assessment data and the nurses’ critical thinking skills to identify the change, interpret its significance, and take appropriate action from the foundation of neuroscience nursing practice. So, one of the major challenges that nurses find during the assessment is neurological dysfunctions; especially in patients with coma [8]. Nurses play a critical role in this team as they assess patients’ needs and create individualized care plans that cater to their specific symptoms and concerns to reduce the risk of complications, enhance quality of life, and prolong life expectancy, a thorough assessment and efficient management of neurological disorders within an evidence-based practice approach are essential [9].

A descriptive cross-sectional research design was utilized for this research study.

Table (1) reveals a predominantly young workforce, with 53.7% aged 20–30 years and 35.1% aged 31–40 years. The majority are female (89.8%), and they are fairly evenly distributed across various departments, with the highest concentration in Intensive Care (35.6%). Most nurses hold the position of Nurse (77.6%), and a significant portion (40.0%) have less than one year of experience. Educational backgrounds vary, with 31.7% holding a Nursing Technician degree, 28.8% a Bachelor’s, and smaller percentages holding advanced degrees. Training in neurological examination is lacking for 44.9% of nurses, though 11.2% reported high benefits among those trained. Training durations also vary, with the largest group (18.5%) having training between 3 to less than 6 months.

Table (2): The data indicates that the nurses’ knowledge scores range from 1.0 to 36.0, with a mean score of 22.22 (SD = 5.22). The median score is 22.0, suggesting that the distribution of scores is relatively symmetrical around the mean. The average score per item is 0.53 (SD = 0.12), indicating moderate knowledge levels among the nurses. The attitudes of nurses towards neurological assessment show a total score range of 0.0 to 15.0, with a mean score of 8.78 (SD = 2.81) and a median of 9.0. The average score per item is 0.59 (SD = 0.19). The practice scores range from 0.0 to 4.0, with a mean score of 1.96 (SD = 1.36) and a median of 2.0. The average score per item is 0.49 (SD = 0.34).

Table (3): reveals significant reliance on others and technology (mean score: 28.47), time constraints and interruptions (mean score: 15.29), and the influence of ward culture (mean score: 15.38). Additionally, nurses report a lack of confidence (mean score: 11.52), absence of role models (mean score: 12.79), limited influence on patient care (mean score: 12.87), and challenges specific to their specialty area (mean score: 16.01).

Table (4): The correlation analysis between knowledge, practice, and attitudes among nurses regarding neurological assessments reveals several significant relationships. Which, Knowledge is positively correlated with attitudes (r = 0.284, p < 0.001) and practice (r = 0.143, p = 0.041), indicating that higher knowledge levels are associated with more positive attitudes and better practices. Additionally, attitudes are positively correlated with practice (r = 0.186, p = 0.008).

Table (5): The correlation analysis between challenges faced by nurses and their knowledge, attitudes, and practices in conducting neurological assessments reveals several significant relationships. Notably, the subscale “lack of time and interruptions” shows a positive correlation with knowledge (r = 0.298, p < 0.001), indicating that nurses who face more time constraints tend to have higher knowledge levels, possibly due to increased awareness of the need for efficiency. “Ward culture” also positively correlates with knowledge (r = 0.176, p = 0.011), suggesting that a supportive ward environment enhances knowledge acquisition. Conversely, “lack of confidence” negatively correlates with practice (r = -0.104, p = 0.138), though not significantly, indicating that confidence issues may hinder practical application.

Table (6): The association between demographic data and nurses’ knowledge, attitudes, practices, and challenges in conducting neurological assessments reveals several significant findings. Age significantly affects knowledge (p < 0.001), with nurses aged 21–40 years scoring highest. Gender impacts attitudes (p = 0.004), with female nurses showing more positive attitudes. Department influences attitudes (p = 0.035), with emergency and cardio-thoracic care nurses scoring higher. Job position affects practice (p = 0.028), with department supervisors scoring the highest. Years of experience significantly affect knowledge (p < 0.001) and attitudes (p = 0.011), with those having 10–20 years of experience scoring highest. Education level impacts knowledge (p = 0.011), attitudes (p = 0.028), practice (p = 0.011), and challenges (p = 0.018), with bachelor’s degree holders scoring the highest in knowledge. Training courses significantly affect attitudes (p < 0.001) and practice (p < 0.001), with those benefiting more from training scoring higher.

The neurological examination is an essential tool for the diagnosis of neurological conditions and guiding patient management, hence a cornerstone of clinical practice. However, the skill with which nurses perform and interpret neurological examinations greatly affects patient outcomes. Undeniably, nurses play a crucial role in this process; however, there is usually a lack of knowledge, practice, and attitude regarding the conduct of thorough neurological assessments. This disparity compromises the standard of care and makes the process of identifying neurological disorders well in time even more difficult [18].

The demographic profile of the nurses in this study offers insight into the composition of the workforce and points out those areas which need improvement through training and development. Most of the age groups are on the younger side, with over half being between 20 and 30 years of age, suggesting that the group is dynamic and adaptable. More importantly, most of the nurses are females, reflecting the normal gender distribution within the nursing profession. Departmental distribution shows a reasonable allocation; the highest proportion has been allotted to the intensive care units, followed by casualty and cardio-thoracic care, internal, surgical, dialysis, and burns departments. The spread would thus mean varied experience and specialization amongst the nurses, which is good for all-rounded patient care.

Most of the nurses held job positions as a nurse, while a few held supervisory or charge nurse positions, which is typical in a typical hospital setting where the majority of the staff are in direct patient care. The years of experience data show that a large number of nurses have less than one year of experience, indicating a high influx of new graduates or recently hired staff. This may suggest a need for strong on boarding and mentorship programs to support these less-experienced nurses. Educational backgrounds vary, with nearly one-third holding a nursing technician degree and more than one-quarter a bachelor’s degree. The presence of nurses with advanced degrees, although smaller in proportion, indicates opportunities for leadership and specialized roles within the workforce. Training in neurological examination appears to be an area that requires attention, as nearly half of the nurses reported not having received any training in this area. For those who had received training, only a small portion reported high benefits; this suggests that the quality or applicability of the training could be an issue.

Other durations of training also prevail, the largest category being a period ranging from three months to less than six months. This could be due to the varied depth or intensity of training programs. This overall data thus calls for specific training programs, particularly in neurological assessment, and also may indicate added benefits from increased availability and quality of such training in order to ensure that all nurses have the requisite skills and knowledge to deliver high-quality care. Also, the very high percentage of less than one year of experience for the nurses suggests providing transition support to new nurses while adjusting to the profession. The results of this study have also agreed with those of Smith et al. [19].

Furthermore, the results of this study provide a detailed overview of nurses’ knowledge, attitudes, and practices regarding neurological assessment. The knowledge scores, ranging from a minimum of one to a maximum of thirty-six with a mean of approximately twenty-two, indicate a moderate level of knowledge among the nurses. A median score of twenty-two is indicative of a rather symmetrical distribution of scores around the mean, with relatively consistent knowledge levels across the sample. This finding agrees with previous studies that have pointed out the necessity of improving neurological assessment training for nurses [20]. The findings also agree with Bell et al. [21], who observed that nurses find it challenging to perform neurological assessments because they perceive the task as complex and without an agreed approach.

The attitudes towards neurological assessment, with scores ranging from a minimum of zero to a maximum of fifteen and a mean of nearly nine, reflect a generally positive disposition among the nurses. The median score of nine supports this, indicating that more than half of the nurses have an attitude score above the midpoint of the scale. This optimistic view is hopeful, given it reflects the probability of nurses accepting further training and education on this subject. Smith et al. 19 reported similarly: “Nurses with positive attitudes towards neurological assessment were more likely to engage in continuous professional development”. These range in practice from a minimum score of zero to a maximum of four with the mean approximately at two, and the median at two. These scores illustrate a reasonable adherence to the best practices in conducting neurological assessment. This spread of practice scores that some nurses do neurological assessment at very high levels while other nurses do not follow the best practices at all. This is in line with AANN [22], which says that a standard method of neurological assessment is important to avoid inconsistencies in practice.

Consistent with this is that other studies have also established a dire need to have a better-designed training program in neurological assessment among nurses. To be specific, the study of Johnson et al., [23] in which standardized training on neurological assessment was provided to the nurses, showed that these nurses depicted significantly higher knowledge and practice scores compared with those nurses who were not subjected to standardized training in neurological assessment. The study’s findings underscore several critical factors affecting nurses’ work environments and their ability to deliver care. Notably, there is a significant reliance on others and technology, with a mean score of approximately twenty-eight and a half, reflecting the growing integration of digital tools in healthcare. This finding aligns with Booth et al. [24], who emphasize the need for nursing to transform into a digitally enabled profession to maximize the benefits of patient care.

Time constraints and interruptions, with a mean score of about fifteen and a third, are recognized challenges that can increase stress and the risk of errors. The influence of ward culture, scoring around fifteen and two-fifths, is pivotal in shaping nurses’ experiences, where a positive culture can enhance teamwork and support. A lack of confidence, with a mean score of nearly eleven and a half, suggests a need for additional training and mentorship. The shortage of role models, scoring twelve and four-fifths, is an indication that mentorship in nursing is needed. The concern of the nurses that they have little influence on the care of the patient with a mean score of approximately twelve and seven-eighths is worrying since they are usually the first caregivers and advocates for the patients. Lastly, challenges typical of their professional or clinical specialty area of practice averaged at about a mean score of sixteen; these are unique obstacles the nurses go through concerning their field of practice. Therefore, solving these problems involves many approaches, from investment in technology to better leadership and development of a work environment that will support the nurses and make them feel valued in the workforce. These points are further corroborated by the studies that reported the effects of digital technologies in nursing practice and education [25, 26].

Regarding nurses’ knowledge, practice, and attitudes toward neurological assessments, there are several significant relationships indicating that higher knowledge levels are associated with more positive attitudes and better practices. Attitudes are positively correlated with practice. Therefore, educational interventions and professional development opportunities that aim to increase knowledge and cultivate positive attitudes may be effective strategies for improving nursing practices in neurological assessments. Teixeira 9 points out the importance of detail in assessment and management of neurological disorders within an evidence-based practice framework. It is thus befitting to say that more knowledge will translate to better practices and ultimately better outcomes.

Furthermore, there are guidelines by the American Association of Neuroscience Nurses [22] on neurological assessment in older adults focusing on those nurses being informed and astute in their assessments for safe and effective care. The challenges faced by nurses and their knowledge, attitudes, and practices in conducting neurological assessments reveal several significant relationships. Notably, the subscale “lack of time and interruptions” shows a positive correlation with knowledge, indicating that nurses who face more time constraints tend to have higher knowledge levels, possibly due to increased awareness of the need for efficiency. “Ward culture” also positively correlates with knowledge, suggesting that a supportive ward environment enhances knowledge acquisition. Conversely, “lack of confidence” negatively correlates with practice, though not significantly, indicating that confidence issues may hinder practical application. The challenges faced by nurses in conducting neurological assessments and their impact on knowledge, attitudes, and practices are complex and multifaceted. As Busca et al. [27] summarize, cultural and organizational aspects are the most relevant determinants for the implementation of nursing roles, which coincides with the positive correlation found between “ward culture” and knowledge in this study. Similarly, Dickens et al. [28] stress that the knowledge and attitudes of nurses provide the basis for giving physical healthcare, supporting the assumption of a close connection between.

Al Thobaity et al. [29] discuss the challenges nurses face, including time constraints and confidence issues, which can impact their practice, similar to the findings in this study. Loke et al. [30] categorize barriers to patient-centered care, including personal and behaviour-related barriers, which can be related to the “lack of confidence” subscale in this study. Finally, Geng et al. [31] identify challenges related to skill development and their association with competency, which can be linked to the practice-related findings in this study. These references provide a broader context for the relationships observed in this study and can be used to support the discussion of these findings in research papers. They also highlight the complex interplay between knowledge, attitudes, and practices, and the role of organizational culture and personal factors in influencing these relationships.

There is also an association between demographic data and nurses’ knowledge, attitudes, practices, and challenges in conducting neurological assessments, revealing several significant findings. Age significantly affects knowledge, with nurses aged 21–40 years scoring the highest. Gender impacts attitudes, with female nurses showing more positive attitudes. Department influences attitudes, with emergency and cardio-thoracic care nurses scoring higher. Job position affects practice, with department supervisors scoring the highest. Years of experience significantly affect knowledge and attitudes, with those having 10–20 years of experience scoring the highest. Education level impacts knowledge, attitudes, practice, and challenges, with bachelor’s degree holders scoring the highest in knowledge. Training courses significantly affect attitudes and practice, with those benefiting more from training scoring higher. The association between demographic data and nurses’ knowledge, attitudes, practices, and challenges in conducting neurological assessments is well-supported by the literature.

Sedri et al. [32] found that demographic and occupational features significantly affect nurses’ knowledge and attitudes towards older adults, revealing a positive correlation between knowledge and general opinion, as well as between practice experiences and general opinion, which aligns with the idea that demographic factors can influence knowledge and attitudes. Arsat et al. [33] reported that demographic factors such as gender, age, education, economic status, position, and experience significantly affect caring behaviour among nurses, supporting the finding that demographic variables like age, gender, department, job position, years of experience, education level, and training courses impact nurses’ knowledge, attitudes, and practices. Moreover, Młynarska et al. [34] highlighted the influence of sociodemographic data and work-related variables on nurses’ knowledge, particularly in the context of evidence-based practice, which is in line with the observation that education level impacts knowledge, attitudes, practice, and challenges.

The present study has pointed out some demographic variables that may act to influence knowledge, attitude, practices, and challenges of the nurses on neurological assessment. The results indeed identified that younger nurses aged between 21 and 40 years have higher knowledge, probably due to fresher educational exposure. On the other hand, female nurses depicted a more positive attitude toward neurological assessment, probably related to ascribed gender roles in caregiving. Emergency and cardiothoracic care department nurses had the most positive attitude, probably because of the high-stake environment that they are working in. Moreover, the department supervisors scored the highest in practice with their added responsibilities, placing more emphasis on experience and leadership in further developing their skills. Similarly, those with 10–20 years of experience also showed significantly higher knowledge and attitudes, underlining the role of experience in enhancing professional competence.

Besides, it has pointed out that higher levels of education-a bachelor’s degree-would also strongly predict higher knowledge scores, indicating advanced educational preparation that is very significant for the assessment skill development in nurses. Finally, these training courses increased the attitude and practices that once more support the need for continuous professional development as necessary for keeping the highest possible care. These findings point to the serious need for targeted educational interventions and professional development programs in an effort to enhance the quality of neurological assessment by nurses. Health organizations will be able to improve the quality of care when the knowledge gaps are addressed, attitudes are improved, and practices are standardized, hence leading to more appropriate neurological assessments and the earlier identification of neurological disorders. Continuous education and training, especially for younger nurses, need to be emphasized more, and such training programs should be integrated into the hospital systems.

It is ultimately the responsibility of every nursing institution and healthcare organization to take up the mantle of continuously developing their workforce so that nurses feel equipped with the knowledge, skills, and confidence to deliver care at the highest level. This will assure not only improved outcomes for individual patients but also overall quality in care within healthcare settings to make sure neurological conditions are identified and treated on time and appropriately.