Assessment of nurse practitioners’ capacity of using the ABC/2 formula for intracranial lesion volume measurement

This study primarily aimed to assess the precision of intracranial lesion volume measurements conducted by NPs using the ABC/2 method, and our findings present some insightful observations. As the results indicate, the tumor volumes measured by nursing staff showed a statistically significant variation from those obtained via the automated ABC/2 method. However, it’s essential to contextualize this variation within clinical settings. Further analysis, which focused on the percentage difference and the effect size indicated by Cohen’s d, revealed that the measurements conducted by NPs tended to underestimate tumor volumes by approximately 6.59% (standard deviation = 1.91%), with a Cohen’s d value of only 0.08. These findings suggest that, although there is a statistical difference from the gold standard, the practical discrepancy in these measurements is relatively minor. In essence, this indicates that NPs can effectively use this method to quickly obtain reasonably accurate estimates of lesion volumes, providing valuable support in the diagnosis and treatment of neurosurgical diseases. The findings from the Bland-Altman and ICC analysis reinforce the clinical utility of NPs-derived measurements in estimating tumor volumes. Despite the inherent variability in manual measurements, the average values provided by the nursing staff were in good agreement with the gold standard method. This agreement is crucial for clinical settings where quick and reliable tumor volume estimations are needed.

The relationship between clinical expertise and years of work experience is an extensively-explored area, with several studies indicating a positive correlation. For instance, Takase et al. observed a substantial increase in nurses’ competence during their initial ten years of clinical practice, primarily due to an enhanced capacity for absorbing skills and knowledge [14]. Similarly, Faraji et al. reported that nurses with more extended work experience generally showed higher clinical competence than their less experienced peers [15]. In contrast to these findings, our study did not find a significant difference in lesion volume measurement accuracy among NPs with different lengths of work experience. This disparity might be due to the straightforward and intuitive nature of the ABC/2 method, which can be mastered with minimal clinical experience. This notion receives some support from the works of Bahreini et al. and Liu et al., who found a minimal correlation between clinical competence and years of experience [16, 17]. Consequently, our study highlights the practicality of the ABC/2 method for NPs, and also emphasizes the crucial role of targeted training sessions and hands-on experience in nursing education for effective specialized skill acquisition.

The global shortage of primary care physicians might be alleviated through the integration of NPs. Equipped to administer medical treatments, order diagnostic tests, and manage chronic diseases, NPs fulfill roles similar to those of physicians. This capability is particularly vital in underserved and rural areas, where the scarcity of physicians is more pronounced [7, 18]. Increasingly, NPs are becoming the usual source of care for many patients, offering a holistic approach to healthcare that emphasizes health education, preventive care, and disease management. Such an approach effectively supplements the care provided by physicians, proving crucial in managing patients especially with non-severe or chronic conditions [19, 20]. Moreover, the collaboration between NPs and physicians is fostering more comprehensive and coordinated care. NPs bring unique skills in patient education and common disease management, while physicians are more adept at handling acute or complex cases. This partnership is pivotal in addressing the increasing healthcare demands of aging populations and societies with prevalent chronic diseases [21]. Thus, their integration into the healthcare system is not only enhancing access to care but is also a crucial response to the declining number of physicians in certain regions.

In the specialized domain of neurosurgery care, the role of NPs is increasingly recognized as pivotal. NPs are key members of the neurosurgery team, performing essential tasks such as frequent neurologic assessments, rapid detection of neurologic deterioration, and effective communication with both the healthcare team and patients’ families. Their ability to promptly identify and act upon deterioration in neurologic status is crucial, particularly for patients with neurologic pathology, where such actions can be life-saving [22]. Moreover, NPs play instrumental roles in delivering care and are central to the stability and cohesion in intensive care settings, although the full impact of their involvement on patient care and satisfaction is still evolving [23, 24]. Their comprehensive training, focusing on neuroanatomy, neurologic assessment, and the management of neurologic deterioration, is critical for handling the complexities of neurosurgical conditions and postoperative care [22, 25]. The integration of skilled nursing staff in neurosurgery care not only enhances the quality of patient care but also addresses the complex management of neurologic conditions, underscoring the importance of ongoing professional development in this specialized area.

Our study addresses a question of practical clinical significance, primarily focusing on the estimation of intracranial lesion volumes using the ABC/2 method. This relevance is underscored by the fact that many intracranial pathologies, such as meningiomas, gliomas, cerebral hematomas, epidural hematomas, and infarcts, often present with ellipsoid shapes; hence, the ABC/2 method theoretically provides a relatively accurate estimation of their volumes. Moreover, this method is simple and user-friendly, with a minimal learning curve, making it accessible for clinical application. Significantly, NPs, who are at the forefront of patient management and often observe clinical changes, including assessments of imaging data like CT and MRI scans, can provide early insights into the patient’s condition. Their ability to perform preliminary assessments of lesion volumes and convey this critical information to physicians can undoubtedly aid in diagnosis and treatment, potentially improving patient outcomes. Furthermore, involving NPs in comprehensive patient care, including understanding lesion volumes, not only enhances their engagement and satisfaction in the therapeutic process but also indirectly improves overall nursing care quality. Our study not only preliminarily answers the question of the usability of the ABC/2 method by NPs but also aims to serve as a reference for further research in this area. We hope to explore in future studies whether other clinical diagnostic and therapeutic tasks could be partially undertaken by nursing staff. Through this research, we seek to explore the feasibility and extent of NPs involvement in clinical diagnosis and treatment, thus enhancing the role of nursing in patient care.

In addressing our study’s limitations, we note several key factors. Firstly, our focus on meningioma cases, dictated by data availability, narrows the scope of our conclusions. Including a wider range of intracranial pathologies in future studies could broaden our understanding of the ABC/2 method’s applicability. Efforts are underway to obtain access to a more diverse set of clinical and imaging data. Secondly, our study involved NPs with up to ten years of experience. Future research incorporating a larger, more varied group of NPs could provide deeper insights into how experience affects measurement accuracy. Thirdly, the use of the automated ABC/2 method as a gold standard, despite being theoretically less precise than planimetry, was a strategic choice to assess NPs’ measurement accuracy more effectively. Fourthly, conducting the study in a single tertiary hospital may limit the wider applicability of our results. Multi-center studies could yield richer, more diverse data, thereby enhancing the findings’ external validity. Lastly, the one-hour training for NPs, though useful, may not fully convey the ABC/2 method’s intricacies. Future research should explore varied training formats and durations to optimize education for healthcare professionals in this methodology.