Patients who have acute neurologic conditions may have severe physical and cognitive impairments and are often at a high risk of death. Common acute neurologic impairments include acute ischemic stroke, traumatic brain injury, brain tumors, and intracerebral or subarachnoid hemorrhage. On admission to the neuroscience intensive care unit (NICU), these patients may be unable to participate in their own goals of care and/or treatment decisions. The unique needs of the patient in the NICU can include a prolonged and fluctuating course of neurologic disease with prognostic uncertainty. Patients and their families may need to contend with numerous losses such as communication deficits, impaired physical functions, and limited lifespans.

Patients with acute neurologic illness or injury have uniquely complex care needs, and the bedside nurse must have competency in managing these needs. Palliative care needs, including decision-making, advance care planning, emotional...

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