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It's Not Brain Surgery.

Full disclosure; I would like to take credit for this idea, but it's not mine. In fact, it was a physician who shared this with me. To paraphrase him, "In reality, it's not brain surgery that makes the difference, it's nursing care."

Wait! At the risk of being tarred and feathered by my neurosurgery friends, I would like to refine this statement a bit. Brain surgery is important, it's a big deal, but patient outcomes are also heavily influenced by the care that happens before the first incision and the care that happens long after the procedure ends. In this realm, nursing care and nursing science drive outcomes, not only for neurosurgery but also for every aspect of neuroscience nursing.

A simplified example of this can be seen in almost every hospital on a daily basis. Some events (first seizure, car crash, or aneurysm rupture) are the catalyst to a healthcare encounter. The patient arrives in a clinic or emergency department where the first person they meet is very often a nurse. They are assessed and triaged, perhaps next encountering an advanced practice nurse before meeting their surgeon. Additional tests, more nursing care. Additional assessment and teaching, more nursing care. Surgery is planned for the next day, week, or month, during which time the patient will see the surgeon sporadically. Throughout most of each day, the task of patient assessment and monitoring is primarily delegated to nursing care.

Finally, the patient is prepped for O.R., more nursing care. Surgery happens. During the procedure, nursing, anesthesia, surgical teams, pharmacists, and collaborative professionals work together to ensure the success of the procedure. The patient is transferred from O.R. to postanesthesia or critical care, more nursing care. Over the next 24 hours, the patient will likely interact with the surgeon for less than 15 minutes. The remaining 23 hours and 45 minutes will be spent under the direct supervision of a nurse. Discharge orders are written and caried out, more nursing care.

The astute reader will note 2 things from the previously mentioned scenario. First, I am not diminishing the role of the surgeon but rather highlighting the role of the nurse. Second, an overwhelming proportion of the time before and after brain surgery is nursing care. This is an opportunity to influence outcomes. A great deal of time, money, and scientific discovery has been leveraged to understand surgical procedures. The opportunity exists for nursing care to be similarly studied with the expectation that improving the science of care will improve outcomes.

Nurses are involved in every aspect of patient care. In 2018, exactly zero patients will have brain surgery who will not be impacted by nursing care. What we do as nurses is fundamentally related to patient outcomes. The Journal of Neuroscience Nursing publishes groundbreaking research results in every issue. These findings are the key to improving care of the neurological and neurosurgical patient. Although these studies may not capture the same headlines as new neurosurgical procedures, they build the foundation upon which those procedures will depend for success. At the end of the day, it's not brain surgery, it's nursing care.

The Editor declares no conflicts of interest.

DOI: 10.1097/JNN.0000000000000392

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Title Annotation:EDITORIAL
Author:Olson, DaiWai M.
Publication:Journal of Neuroscience Nursing
Article Type:Editorial
Date:Oct 1, 2018
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