Positioning as an Intervention for Vertigo in Neurological Patients

This article discusses the importance of positioning as an intervention for vertigo in neurological patients. It explores the potential life-threatening complications that can arise and the best evidence-based practices for implementing positioning interventions. The article also provides a detailed search strategy and identifies relevant research articles.

Running head: NURSING ASSIGNMENT
EVIDENCE BASED NURSING ASSIGNMENT
Name of the student
Name of the university
Author note

1NURSING ASSIGNMENT
Introduction
In high acuity clinical settings, it is important to implement several essential nursing
cares such as mouth care, eye care and repositioning and others as it may prevent life threatening
complications in patients who are unable to move or are dependent on nursing professionals
(Commiso et al., 2018). Patients with neurological complications are having constant threat of
paroxysmal positional vertigo as those patients spend majority of their time in healthcare wards
and require assistance to move or perform activity (Bhattacharyya et al., 2017). Hence, dizziness
becomes their quintessential symptom while receiving care in such healthcare facilities,
especially neurological wards.
Several researchers have identified the cause of dizziness among the patients receiving
neurological interventions in the healthcare facilities and have found that benign paroxysmal
positional vertigo could be the primary reason for this complication. The statistical data provided
by the reputed neurological organization Kleffelgaard et al. (2019) mentioned that 25% of
outpatients and 13% of total inpatients in the healthcare facilities complaints of dizziness in their
wards. Therefore, regular assessment and implementation of several interventions is required to
prevent the occurrence of such life threatening complication in patients requiring neurological
assistance in healthcare facilities. (Bhattacharyya et al., 2017)
The primary aim of this paper is to mention all the life threatening conditions, which
could arise in the neurological ward of the healthcare facilities and find out the severe
complication, which has the ability to affect patient’s life. Further, implementation of
interventions would be discussed so that using that best practice, identified life threatening risk
could be mitigated. Critical analysis and evidence based practice would be followed and to

2NURSING ASSIGNMENT
achieve that CINAHL and Pub Med would be used to locate useful resources and a detailed
search strategy, used keywords, Boolean operators, and prisma diagram of search strategy would
be provided in this paper. Finally, from the search strategy findings, few accurate research
articles would be used to identify the best evidence based practice to overcome the life
threatening risk of Vertigo among patients with neurological complications.
Discussion
Positioning as the intervention for vertigo
It is important to develop new and improved management strategies and guidelines in
healthcare facilities so that evidence based care and interventions could be included in the care
process (Rethorn, Barlow & Gavlick, 2017). In this paper, discussion about neurological patients
and their associated complications were identified and vertigo of dizziness was chosen as the
primal complication, which could increase the complication among patients due to its life
threatening effects. Positioning could be used as one intervention to overcome the harmful
effects of severe dizziness (Kleffelgaard et al., 2019). Several researches indicated to the fact that
repositioning patient within their ward and in short intervals, helps to increase the blood flow
rate and deceases the risk of severe complications. Further, several national and international
guideline for neurological patients treatment indicated to the fact that with repositioning of
patients, helps to relieve their stress and dizziness as well as decreases the chance of pressure
ulcers (Gillick et al., 2018). However, to understand the effectiveness of repositioning in the
neurological patients affected with vertigo, Pub Med and CINAHL would be discussed and
eventually the accurate research should be used to determine evidence based practice
(Kleffelgaard et al., 2019).

3NURSING ASSIGNMENT
PICO question
PICO question used for this research paper is as follows:
Patients intervention Complications Outcome
Patients affected
with neurological
complications
Application of
repositioning related
intervention to
overcome the
complications
Vertigo related
complications
associated with
dizziness and
impaired movement
Improved health,
mitigates the risk of
vertigo
The question: did the usage of repositioning helps to mitigate the risk of Vertigo in
patients affected with neurological complications and helps to improve patient condition?
Search strategy
Evidence based practice is a problem solving approach, conscientious and accurate
approach so that using these approach healthcare professionals in clinical settings could utilize
the well design interventions with their expertise in healthcare process to provide effective care
to the process (Sherman et al., 2016). This is the best and most effective research utilized by the
healthcare professionals in clinical settings so that by collecting, processing and implementing
the research findings, most effective care could be developed and improved outcome could be
obtained (Funtowicz & Ravetz, 2018).
In this research process, CINAHL and Pub Med would be used as the databases in which
with combination of several key terms, Boolean operators and with effective permutation and
combinations, research articles would be collected. Further, the search strategy would be refined
for the achievement of accurate research articles related to application of repositioning to

4NURSING ASSIGNMENT
overcome the risk of vertigo. Application of inclusion and exclusion criteria would help to sieve
the inaccurate research articles and hence, proper articles would be sieved through the process.
Search conducted in CINAHL

5NURSING ASSIGNMENT
Search conducted in Pub Med
The inclusion and exclusion criteria helped to refine accurate research articles from the
research articles collected from these above mentioned stress strategies. The inclusion criteria
included, Publication date within 2013 to 2019, presence of English language, peer reviewed
research article with proper research design, methodology, results and data analysis section.
Besides that research articles which provided peer reviewed systematic analysis were also
included in the research process. On the other hand, elimination of improper research articles

6NURSING ASSIGNMENT
was done depending upon several factors. These are published before the chosen time frame,
papers in languages other than English, descriptive paper with no research process, articles with
no data analysis and interpretation, no methodology and so on, that eliminated research articles
inaccurate for the care process.
The prisma diagram of search has been provided in the following section.

7NURSING ASSIGNMENT
Key terms were used with accurate permutation and combination and search was
conducted in Pub Med and CINAHL
Pub Med search result (total):
88935
CINAHL search result total:
32031
Total n=120966
Inclusion criteria:
Publication date within 2013 to 2019,
presence of English language, peer
reviewed research article with proper
research design, methodology, results
and data analysis section.
Exclusion criteria:
published before the chosen time
frame, papers in languages other
than English, descriptive paper
with no research process, articles
with no data analysis and
interpretation, no methodology
After application of these, only 3 research articles
appropriate to the PICO question were used for the
Evidence based practice
Created by Author

8NURSING ASSIGNMENT
Critical discussion about the collected evidence
The first research article collected from the extensive research strategy conducted
CINAHL and Pub Med was research conducted by Chimirri et al. (2013) in which the primary
aim of the research was to identify the adverse effects in patients after neurological disorder
interventions. For this process, the researchers included the data collected from the Pharmaco-
vigilance Regional Center of Italy and then analyzed their adverse drug reactions. Further the
research also provided details about the side effect of the drug that is provided to patients to treat
their neurological symptoms and the way it leads to vertigo or dizziness symptoms (Chimirri et
al., 2013). This research mentioned that patients suffering from vertigo conditions are unable to
define their complications properly hence, it is the role of the healthcare physicians to determine
the intensity and adverse condition of the vertigo symptoms. Besides this, the researchers also
collected evidences of neurological complications such as progressive hearing loss, risk of
cardiovascular diseases, altered level of consciousness and ataxia or weakness (Chimirri et al.,
2013). Hence, the research data collected from the Pharmaco-vigilance Regional Center
determined that due to use of epileptic drugs, anti-depressant drugs increased the chance of
vertigo and dizziness, hypotension and headache among patients with neurological conditions.
Therefore, the research suggested the change in the movement or position in every 2 hours so
that the blood flow could be normalized in the sections affected due to increased risk factor of
vertigo and effective care could be provided (Chimirri et al., 2013). Further, the patients should
also be included in several movement exercises within their ward so that relapse of vertigo
condition could be avoided. However, the research was unable to provide a detailed observation
and assessment of patients on whom the positioning intervention was applied, and the article was

9NURSING ASSIGNMENT
completely based on providing evidence of vertigo that caused due to healthcare facilities and its
lack of movement interventions (Chimirri et al., 2013).
Another research study by Koch (2017) could be included in this critical discussion as it
focuses on the application of positioning or repositioning as a primary intervention in treating
postural unsteadiness and find out the patients who are benefitted by application of these
interventions in the healthcare facilities. The researchers conducted a retrospective collection
method in which data from 15 patients who are affected with postural unsteadiness and have
undergone treatment with application of repositioning treatment were included (Koch, 2017).
The patients were asked to go through a DHI index test so that presence of dizziness and
disability could be assessed and also conducted assessment for cervical vertigo and upon
confirmation of no vertigo after intervention application, the 15 patients and their data were
included in the research. In all groups included in the study, before and after treatment, a balance
testing was conducted with the use of a petrography platform so that identification of vertigo in
patients could be done, but no such presence was identified (Koch, 2017). Therefore, through
this literature, it was seen that application of position change associated symptoms and it is
evident through their DHI scores, that assessed the patients disabilities and dizziness that occurs
due to the presence of vertigo. Further, it was also seen through research that positioning of the
utricular macula helped to reduce the positioning dysfunctioning situation and hence, healthcare
professionals around the world should implement this intervention and develop guidelines
associated with it to help the patients (Koch, 2017).
Another research article found from the search strategy provided details of the application
of positioning change and its relation to the successful management of benign paroxysmal and
positional vertigo (Burrows, 2018). The research identified the fact that 14.5% of patients

10NURSING ASSIGNMENT
suffering from neurological issues in healthcare facilities are suffering from vertigo or associated
health complications that could affect their by increasing their risk factors. In this research
researchers conducted their study on a 61 year patients who was admitted to the ICU section
after suffering from spinal injury (Burrows, 2018). Upon ventilation the patient mentioned of
several complications such as dizziness, weakness and others that indicated to the occurrence of
vertigo. Therefore, this was considered as one of the complication of patients suffering from
neurological conditions. However, upon implementation of positioning related intervention and
rolling helped to decrease their vertigo conditions and hence, application of this intervention
helped him to overcome his vertigo condition within one year of care process (Burrows, 2018).
Therefore, this research was able to provide complete details of the application of the
intervention for the treatment of the Resolution of dizziness.
Positioning in care process for patients affected with neurological interventions
Hence, through the above- mentioned study it was mentioned that healthcare
interventions for the patients affected with neurological disorders should be inclusive of
positioning changes so that their life threatening complication could be avoided (Castellan et al.,
2016). Researchers determined that it is important to implement motion and activity in patients
affected with neurological complications as their lack of movement and physical activity could
lead to severe physiological complications (van Bilsen et al., 2017). Mobility helps to maintain
blood circulation in the entire body and improper blood circulation could lead to sever
complication such as vertigo, weakness, and hence, it is important for the healthcare
professionals to implement neutral positioning of the patients (Golubnitschaja et al., 2016).
Besides vertigo, it was also seen that improper positioning of patients with neurological
complications could lead to increased heart rate, improper body temperature, digestive issues,

11NURSING ASSIGNMENT
sensational issues and autonomic dysfunctioning among patients. Hence, it is another major
complication which could affect the life of patients affected with neurological complications.
Hence, changing the positioning of the patients every two hours would help them to roll easily
around their bed sides and they would be able to maintain neutral blood circulation throughout
the body (Gulanick & Myers, 2016). Further as per Castellan et al. (2016), patients should also
be taken for a small walk on their wheel chair so that without putting stress on their
physiological conditions, they could be provided with healthcare interventions and mental relief
and their complications could also be avoided.
Besides that, as per van Bilsen et al. (2017), another intervention such as application of
changing the head position of the patient, providing them less salt diet, assessing their fluid
intake and output changing their positioning slowly and evenly and with accurate medication
administration could be applied on patients, These interventions are also effective in maintaining
activity or neutral blood circulation among patients suffering from neurological condition, and
hence, could benefit the condition of vertigo or autonomic dysfunctioning (Golubnitschaja et al.,
2016).
Evaluation of patients with positioning intervention
The evaluation of applied intervention related to position change would be achieved after
understanding the improvements the intervention brought in the health of patients (Rice et al.,
2018). For this, a specific time frame would be chosen and after that intervention, application
and its assessment would be carried out after specific time period so that continuous and
compatible assessment could be obtained (Ardıç et al., 2017). It was seen through researches that
DHI scale is the most appropriate assessment method through which application of positioning

12NURSING ASSIGNMENT
related intervention and its beneficial effect could be understood (McCaslin et al., 2015).
Therefore, after application of this intervention, three assessment would be carried out, one prior
to commencement, second after three months of the application of the intervention and the final
assessment using DHI scale after completion of the process so that improvement could be
understood through gradual process (Ardıç et al., 2017).
Conclusion
While undergoing healthcare treatment in healthcare facilities, the monotonous routines,
closed environment and restricted movement increases the health complications among patients.
Specifically patients with neurological conditions are unable to move on their win, due to which
their complications are of severe and life threatening level. Hence, they have the risk factors of
developing health complications associated to autonomic dysfunctioning, healthcare
complications related to vertigo and others. Hence, through this evidence based structured essay,
conduction of search for accurate research articles were done in which two reputed data bases
namely the CLNAHL and Pub Med were searches with combination of research terms. Further
using inclusion criteria, only three articles from the pool of research papers were selected and it
was assessed that application of position change intervention could improve the patient condition
within healthcare facilities. Further, it was also seen that positioning was able to maintain neutral
blood circulation among patients due to which, all the patients upon whom the interventions
were applied showed positive results. Hence, this research was able to provide effective evidence
for the chosen intervention.

13NURSING ASSIGNMENT
References
Ardıç, F. N., Tümkaya, F., Akdağ, B., & Şenol, H. (2017). The subscales and short forms of the
dizziness handicap inventory: are they useful for comparison of the patient
groups?. Disability and rehabilitation, 39(20), 2119-2122.
Bhattacharyya, N., Gubbels, S. P., Schwartz, S. R., Edlow, J. A., El-Kashlan, H., Fife, T., ... &
Seidman, M. D. (2017). Clinical practice guideline: benign paroxysmal positional vertigo
(update). Otolaryngology–Head and Neck Surgery, 156(3_suppl), S1-S47.
Burrows, L. (2018). Successful management of benign paroxysmal positional vertigo (BPPV) in
a patient who was ventilated with a C3 complete spinal injury on a regional spinal unit
intensive care. BMJ case reports, 2018, bcr-2017.
Castellan, C., Sluga, S., Spina, E., & Sanson, G. (2016). Nursing diagnoses, outcomes and
interventions as measures of patient complexity and nursing care requirement in Intensive
Care Unit. Journal of advanced nursing, 72(6), 1273-1286.
Chimirri, S., Aiello, R., Mazzitello, C., Mumoli, L., Palleria, C., Altomonte, M., ... & De Sarro,
G. (2013). Vertigo/dizziness as a Drugs’ adverse reaction. Journal of pharmacology &
pharmacotherapeutics, 4(Suppl1), S104.
Comisso, I., Lucchini, A., Bambi, S., Giusti, G. D., & Manici, M. (2018). Nursing in Critical
Care Setting: An Overview from Basic to Sensitive Outcomes. Springer.
Funtowicz, S., & Ravetz, J. K. (2018). Post-normal science. In Companion to Environmental
Studies (Vol. 443, No. 447, pp. 443-447). ROUTLEDGE in association with GSE
Research.

14NURSING ASSIGNMENT
Gillick, B., Rich, T., Nemanich, S., Chen, C. Y., Menk, J., Mueller, B., ... & Krach, L. (2018).
Transcranial direct current stimulation and constraint-induced therapy in cerebral palsy: a
randomized, blinded, sham-controlled clinical trial. European Journal of Paediatric
Neurology, 22(3), 358-368.
Golubnitschaja, O., Baban, B., Boniolo, G., Wang, W., Bubnov, R., Kapalla, M., ... &
Costigliola, V. (2016). Medicine in the early twenty-first century: paradigm and
anticipation-EPMA position paper 2016. EPMA Journal, 7(1), 23.
Gulanick, M., & Myers, J. L. (2016). Nursing care plans: diagnoses, interventions, and
outcomes. Elsevier Health Sciences.
Kleffelgaard, I., Soberg, H. L., Tamber, A. L., Bruusgaard, K. A., Pripp, A. H., Sandhaug, M., &
Langhammer, B. (2019). The effects of vestibular rehabilitation on dizziness and balance
problems in patients after traumatic brain injury: a randomized controlled trial. Clinical
rehabilitation, 33(1), 74-84.
Kleffelgaard, I., Soberg, H. L., Tamber, A. L., Bruusgaard, K. A., Pripp, A. H., Sandhaug, M., &
Langhammer, B. (2019). The effects of vestibular rehabilitation on dizziness and balance
problems in patients after traumatic brain injury: a randomized controlled trial. Clinical
rehabilitation, 33(1), 74-84.
Koch, E. (2017). A new positioning maneuver for treating a subtype of postural unsteadiness-
based on a modified model of the utricular macula. Laryngo-rhino-otologie, 96(10), 678-
684.

15NURSING ASSIGNMENT
Liepert, J. (2015). How evidence based is the positioning of patients with neurological
illness?. Deutsches Ärzteblatt International, 112(3), 33.
Macdonald, N. K., Kaski, D., Saman, Y., Al-Shaikh Sulaiman, A., Anwer, A., & Bamiou, D. E.
(2017). Central positional nystagmus: a systematic literature review. Frontiers in
neurology, 8, 141.
McCaslin, D. L., Jacobson, G. P., Lambert, W., English, L. N., & Kemph, A. J. (2015). The
development of the vanderbilt pediatric dizziness handicap inventory for patient
caregivers (DHI-PC). International journal of pediatric otorhinolaryngology, 79(10),
1662-1666.
Rethorn, Z., Barlow, S. J., & Gavlick, E. (2017). Differential diagnosis of a patient referred to
physical therapy for dizziness: a case report. Physiotherapy theory and practice, 33(3),
254-259.
Rice, T., Mancinelli, C., Utzman, R., Cassis, A., & Wetmore, S. (2018). Reliability of the
Numeric Dizziness Scale for the Quantification of Dizziness. West Virginia Medical
Journal, 114(3), 30-35.
Sherman, R. E., Anderson, S. A., Dal Pan, G. J., Gray, G. W., Gross, T., Hunter, N. L., ... &
Shuren, J. (2016). Real-world evidence—what is it and what can it tell us. N Engl J
Med, 375(23), 2293-2297.
van Bilsen, M., Patel, H. C., Bauersachs, J., Böhm, M., Borggrefe, M., Brutsaert, D., ... & Floras,
J. (2017). The autonomic nervous system as a therapeutic target in heart failure: a
scientific position statement from the Translational Research Committee of the Heart

16NURSING ASSIGNMENT
Failure Association of the European Society of Cardiology. European journal of heart
failure, 19(11), 1361-1378.

17NURSING ASSIGNMENT