Nursing collaboration: A key element in debunking neurocritical care myths

PURPOSE OF REVIEW: To explore the origin of myths and their progression toward dogma. The process of debunking myths in the neurocritical care unit (NCCU) is facilitated if nurses are involved early during the process. RECENT FINDINGS: Current and past practices in the NCCU were reviewed through our personal experiences, followed by a literature review. Several myths and dogmas were identified, and the most prominent were explored regarding their origin and the work done to evaluate their validity or lack thereof. A cornerstone in the NCCU is intracranial pressure management, thus several of the myths revolve around this practice and cerebral perfusion pressure. Other myths and dogmas reviewed include the neurologic exam, perioperative scalp shaving, and nursing care. SUMMARY: Myth and dogma are problems confronted in all of medicine and here we provide specific examples from the NCCU. Nursing care, especially in the ICU, can help identify these myths and, in conjunction with physicians, tests these myths via the scientific method instead of accepting the null hypothesis. Even when myths are proven false, changing clinical practice, altering physician or nurse behavior, and fighting dogma remain a challenge.