Nursing is fundamental to the care of stroke patients. From the acute setting all the way to rehabilitation and community reintegration, nursing is there. Having well-educated and highly skilled nurses to monitor and care for stroke patients is crucial. Equally important is the collaboration of colleagues at a national level to facilitate and disseminate research and best practice guidelines across Canada. The National Stroke Nursing Council aims to fill this role. Stroke nurses from across Canada were invited to a national forum in 2005, hosted by the Canadian Stroke Network. The focus of this forum was to elucidate issues of concern to nurses across the stroke care continuum in relation to a Canadian Stroke Strategy. Subsequent to this forum, a cadre of nurses, after undergoing a rigorous screening process, were selected to form the inaugural National Stroke Nursing Council (NSNC). With ongoing support from the Canadian Stroke Network, the mandate of the NSNC is to promote leadership, communication, advocacy, education and nursing research in the field of stroke.

In this review paper, the prevalence and characteristics of central auditory processing disorder (CAPD) are reviewed. The causes, pathology and diagnosis of CAPD are also discussed. Recommendations are made for classroom interventions and a case study is presented. CAPDs are complex, heterogeneous disorders involving the process of auditory stimuli within the mechanisms of the central nervous system that can result in profound personal, social and academic consequences. Specificity in diagnosis, support by family members, neuroscience and allied health professionals and educators, and self-management and advocacy are required for children, adolescents and adults to have successful academic and work outcomes.

Stroke has a significant impact on personal, social and financial factors for individuals, families and the health care system. Stroke prevention clinics (SPCs) were developed in order to address the needs, identified through research, for improved recognition and reaction to TIA/stroke symptoms, as well as for expediting investigations and implementing early stroke prevention interventions. Along with the advent of SPCs came a new role for nurses. As part of an interdisciplinary team, the nursing role continues to evolve in the southeastern region of Ontario. SPC nurses play an important role in assisting to coordinate activities in and outside the clinic setting, and are instrumental in raising public and health care provider awareness of TIA, stroke, stroke prevention and risk factor management. In this article, the evolution of SPCs in Ontario is discussed. A case study is used to illustrate both the role of SPCs in expediting diagnosis and treatment for patients experiencing TIA or stroke symptoms, as well as the nursing role and how evidence is incorporated into practice. Results of some preliminary research and the issues involved in establishing an appropriate outcome evaluation process are explored. As well, the potential for nursing research within SPCs and future directions for the nursing role are appraised.

Although primary malignant brain tumours represent only 1.4% of all cancers, it is considered one of the most devastating types of cancers in adults. From the time of diagnosis, the patient and family embark on a "roller coaster" ride of uncertainty, fear and hope. Despite improved medical outcomes, patients often experience severe functional impairment, as well as behavioural and cognitive dysfunction. Subsequently, they suffer from greater dependency and hopelessness than other cancer patients. The family caregivers are faced with multiple demands such as taking on new roles within the family and caring for their loved one while grieving the loss of the person they knew. The role of the nurse is to support the patient and the family throughout the illness trajectory, identify and promote their strengths and mobilize the necessary resources to facilitate patient and family coping. The purpose of this paper is to present, via a detailed case study, the impact of a malignant brain tumour on the patient and the family. The nursing strategies used to help them make the necessary transitions throughout the illness trajectory are discussed.

Cerebral metastasis of cancers originating outside the brain has traditionally been treated with whole brain radiation therapy (WBRT). Gamma Knife Radiosurgery (GKS) provides safe and effective alternative treatment that is less invasive and has fewer side effects. Both WBRT and GKS are reviewed and discussed in terms of quality of life and health outcomes. The case studies of two individuals who underwent Gamma Knife surgery are presented.

In this study, the concept of hope in patients diagnosed with amyotrophic lateral sclerosis was explored. The researchers asked, "What does hope mean to you?" The final sample consisted of 13 patients at varying stages of illness and at differing times since diagnosis. Semi-structured interviews with open-ended questions were used to elicit views on hope, its sources and evolution. The findings were similar to a study done by Herth (1990) in which two themes emerged: hope fostering strategies and hope hindering barriers. The study process allowed the researchers to capture the participants' sources of hope. An unexpected finding was that participants described taking part in the interviews as "therapeutic." The findings support the notion that clinicians need to engage patients in discussions of hope, particularly the question of hope and its meaning, in order to adequately address their most important concerns and understand their point of view. Implications and suggestions for nursing practice include taking the time to explore hope-fostering approaches and discuss hope-hindering obstacles and our role in creating a hopeful environment.

The awake craniotomy procedure has become the gold standard for tumour resection in eligible patients. In this paper, the awake craniotomy procedure is reviewed, including the advantages of the procedure over the standard craniotomy procedure. The role of the neuroscience nurse in awake craniotomies is highlighted.

The scholarly literature related to quality of life (QoL) is reviewed. Specific contributions by neurosciences nursing related to quality of life for patients and family caregivers is presented in the areas of stroke, neuro-oncology, traumatic brain injury, multiple sclerosis, and epilepsy. QoL information is important, as it is used in decisions concerning treatment and interventions for patients and their family members who are living with neurological conditions and their consequences.

In this paper we described our approach to the development of the role of a nurse within a stroke and cognition ambulatory clinic at Baycrest. In developing this approach we integrated Baycrest's commitment to clients and family-focused care, our focus on interdisciplinary collaborative practice, the position of the post-rehabilitation clinic in the continuum of care, the clinical experience of the nurse and director, and the relevant scholarly literature. The role of the nurses in the stroke and cognition clinic includes assessment, interdisciplinary care planning, client/family support, and knowledge transfer.

Trillium Health Centre (THC) is one of Canada's largest community hospitals and a regional provider of tertiary-level cardiac, neuroscience, and orthopedic care. In 2001, it was named one of nine Regional Stroke Centres in Ontario, with a mandate to coordinate stroke services across the continuum of care in keeping with best practices in the west Greater Toronto Area (GTA). Within its role as a Regional Stroke Centre, THC has successfully implemented an innovative approach to the delivery of stroke prevention services in its regional catchment area. Building on best practices, it has introduced a specialized and interdisciplinary team to provide timely and effective primary and secondary prevention services. The rapid growth in utilization to more than 2000 patients in the last fiscal year (2004-2005), suggests that the clinic is meeting a real need in the community for stroke prevention services. Many of these patients now benefit from appropriate medical management, stroke awareness education, lifestyle counselling, and expedited referrals to other specialists. The Regional Stroke Prevention Clinic (RSPC) may be the first step in preventing a stroke, thus avoiding the social costs to people with strokes and their families, and the financial burden on the health care system.

Negotiating is the core variable or central concern of families who have a close relative in a state of post-comatose unawareness or minimal responsiveness following a severe traumatic brain injury. Family members negotiate with each other, with members of the health care team, and with others such as insurance agents, case managers, and representatives of the justice system on behalf of the injured individual. Family members also negotiate the intricacies of the health care system. These are the findings of a 16-month grounded theory study conducted on two acute neurosurgical units in Toronto, with 25 family members from 11 families who had a close family member who suffered a severe traumatic brain injury and who was in a state of post-comatose unawareness or minimal responsiveness. An extensive review of the scholarly literature related to family research methodology and family research related to families following the brain injury of a family member is also provided in this paper.

Approximately 84% of all stroke patients with hemiplegia will experience shoulder injury and pain. The importance of maintaining proper posture while positioning and transferring a stroke patient is key to decreasing risk for shoulder injury. Shoulder subluxation injury post-stroke is a consequence of sustained hemiplegia and spasticity. Current research evidence suggests that using therapies such as gentle range of motion and functional electrical stimulation may reduce and prevent shoulder subluxation and hemiplegic shoulder pain. However, physiotherapists are currently the only professionals who can implement such therapies. Considering that stroke care provided by neuroscience nurses includes transferring, positioning and assisting in activities of daily living, it is clear that nurses are an important part of the therapy process. Therefore, the question is: "What is the role of the neuroscience nurse in the reduction and prevention of shoulder pain post-stroke?" The purposes of this paper are to i) discuss the causes of shoulder subluxation and related pain post-stroke, ii) review current best practice in prevention and treatment of shoulder subluxation, and iii) explore ways in which the acute neuroscience nurse can prevent or reduce shoulder subluxation in the hemiplegic stroke patient.