As new patients went about the process of making their cup of tea, many neurological functions could be assessed without formal testing.
The Glasgow Coma Scale (GCS) is one of the most widely used and best known neurological assessment tools. Introduced in 1974, GCS provides a simple and uniform assessment of a patient's level of consciousness. Aird and McIntosh (2004) cite Teasdale as stating the GCS is superior to technological monitoring. It measures three modes of behavior: verbal response, eye opening, and motor response, with each graded on a scale of increasing dysfunction. These scores are then combined to determine a consciousness level. However, Aird and McIntosh cite Segatore and Way as considering the psychometric properties of GCS to be weak, because it lacks the subtleties needed to appropriately detail patients who have discrete disturbances of intellectual function.
The MiniMental Status Examination (MMSE) is one of the most commonly referred to assessment tools. It was developed to assess psychiatric patients' cognitive abilities. It is used particularly in elderly care settings, according to Aird and McIntosh (2004). The MMSE measures attention, orientation, calculation, registration, recall, use of language, and the ability to follow a three-part command. Eleven open-ended questions are used to evaluate the person's recall, orientation and ability to follow simple visuospatial commands. Although it is not used to diagnose cognitive problems, the MMSE is used to confirm or rule out cognitive impairment.
Evaluation:
The article effectively describes several cognitive assessment tools. In addition to describing their features and benefits, the authors also point out some of the limitations of these tools. The ambiguous nature of the term "confused" is also discussed quite throughly, with some previous research briefly overviewed to...
However, despite these areas where the authors have done well, they missed the mark on several critical areas.
First, the abstract and introduction of the article leads the reader to believe the article is going to be focused on the differences between confusion and cognition. However, a majority of the article discusses different cognitive assessment tools. Although the ambiguity in the term "confusion" could be discussed as it relates to these tools, the authors never make this connection. Instead, it's as if they are having two different discussions within their article. This is what would have interested me far more, then the handling of them as two disparate topics.
The assessment strategies they described, however, were beneficial. I could utilize either the GCS or MMSE in my practice. Both were explained clearly enough to allow me to get a feel for whether or not they'd be appropriate for a specific patient. However, more research should be conducted regarding how the term "confusion" affects the interpretation of the results of these tools. The article applies to all populations, although the MMSE is most often used with the elderly.
Conclusion:
A patient's cognitive ability can negatively impact their quality of life. With this in mind, Aird and McIntosh (2004) effectively describe the ambiguous nature of the term "confusion." They also clearly discuss several cognitive assessment methods, their use, and some drawbacks to the most popular methods. However, the authors don't make the connection between these two topics, relating how the ambiguous nature of "confusion" could impact these assessment methods.
References
Aird, T. & McIntosh, M. (27 May -- 9 Jun, 2004). "Nursing tools and strategies to assess cognition and confusion." British Journal of Nursing, 13.10. p.…
