1. DeLemos, Christi
  2. Evans, Vicki

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As mortality rates decline, the global burden of neurological disease is on the rise. Stroke affects 15 million people worldwide each year, contributing to 5 million deaths and another 5 million left with permanent disability.1 By 2050, the rate of dementia is expected to triple to 115 million worldwide.2 During the last 20 years, we have seen dramatic advances in the treatment of neurological disease. The National Institute of Neurological Disorders and Stroke trial that tested alteplase opened the door for successful treatment of acute stroke, reducing death and disability.3 In 2015, the results of 5 trials that evaluated endovascular treatments showed the profound benefit of early removal of thrombus in anterior circulation strokes.4 Lessons from Finland taught us to reorganize our care, bypassing the red tape of "checking in patients" to adopt a "door-to-CT" approach that substantially reduced "door-to-needle" times and improved outcome.5 In developed countries, medical progress has promoted the growth of specialized care units and tailored treatment of stroke, traumatic brain injury, dementia, and Parkinson disease. These advances have opened the door for dedicated nursing training with certification programs such as Emergency Neuro Life Support aimed at improving care in the first critical hour after any neurological emergency. However, all of these advances come at a cost.

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As the care of neurological disease becomes more sophisticated, the countries that are least able to afford the equipment or mobilize highly subspecialized teams will experience a widening gap.6 Treatment that relies on extensive resources may be impractical when it is accomplished at the expense of other critical services. It is impossible to consider an endovascular approach to stroke care when 2 patients are sharing a bed and generator power is, at best, intermittent. The challenge is to surround these countries with a range of solutions to provide best care within their existing resources.


A thoughtful evaluation that assumes nothing is essential. Scales and scores used to grade neurological disease may be different in every country.7-9 In some countries, nurses still do not perform a neurological examination. This level of evaluation still resides at the physician level. Changing patterns of care is highly political and requires an advanced working knowledge of education standards, workforce utilization, and the available support for change. For example, if a nurse is responsible for the care of 45 patients, the overwhelming burden of basic care tasks may exclude more advanced neurological evaluation. The physical challenges of available supplies may also be a barrier. They may lack the funds to purchase or maintain neuromonitoring equipment or have access to the qualified staff needed to insert such devices. Local roles and responsibilities may differ substantially, and education programs must be carefully crafted with the patient as the central focus.


The World Federation of Neuroscience Nurses (WFNN) represents more than 8800 members worldwide with representation from 13 countries. Initiatives during the last decade have been aimed at connecting nurses globally to promote the professional practice of neuroscience nursing, foster an open dialogue about the care of neurological disease that crosses cultures and national boundaries, and support the development of professional neuroscience nursing societies. Language barriers are an important factor when developing international nursing education.10 For the last 8 years, WFNN education projects have been concentrated on developing basic skills such as neurological assessment. An easy-to-understand neuro examination video was developed and translated into multiple languages using local experts to ensure accuracy. Although these resources are helpful, the true value of an international nursing organization is in uniting its members. In partnership with the member nations, the WFNN Quadrennial Congress connects nurses from across the world to share nursing research, expand the fund of knowledge, and forge international friendships that raise the standard of care worldwide.


As the global burden of neurological disease rises, we must leverage professional partnerships to improve regional education. The American Association of Neuroscience Nurses and other WFNN members must work together to meet the growing challenge by improving access to basic neuroscience nursing training. The risk of neurological disease in low- and middle-income countries has been linked to classic preventable cardiovascular factors.11 Public education focused on prevention is equally important. Key partners working in tandem with this effort include the European Association of Neuroscience Nurses, Neurocritical Care Society, World Federation of Neurological Societies, World Stroke Organization, Movement Disorders Society, World Parkinson's Association, International League Against Epilepsy, Multiple Sclerosis International Federation, World Federation of Neurorehabilitation, and numerous others.


In 2021, the WFNN will welcome nurses from across the world to join us in Australia for the 13th Quadrennial Congress. The Congress represents a unique opportunity to learn from one another and advance global knowledge. If you have not attended a congress but want to share your nursing knowledge with the world, more information is available on the website at As a benefit of membership in the American Association of Neuroscience Nurses, your membership with the WFNN is already paid. If you have developed leadership skills and you are looking for a global challenge, WFNN is accepting applications for leadership positions. Information can be found at


The authors declare no conflicts of interest.




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