Effectiveness of a FOUR Consciousness Assessment Workshop on Nurses’ Knowledge and Competence in Managing Head Trauma:A Pre-Experimental Study

Penulis

  • Eva Yustilawati Nursing Study Program,Faculty of Medicine and Health Sciences, Universitas Islam Negeri Alauddin Makassar
  • Ardian Adhiwijaya Nursing Study Program,Faculty of Medicine and Health Sciences, Universitas Islam Negeri Alauddin Makassar
  • Ilhamsyah Nursing Study Program,Faculty of Medicine and Health Sciences, Universitas Islam Negeri Alauddin Makassar
  • A. Inda Fadhillah Ramadhani Nursing Study Program,Faculty of Medicine and Health Sciences, Universitas Islam Negeri Alauddin Makassar

DOI:

https://doi.org/10.32382/medkes.v21i1.2059

Kata Kunci:

Competence, FOUR Scale, traumatic brain injury, knowledge, workshop

Abstrak

Based on global epidemiological trends over the years, traumatic brain injury (TBI) remains one of the most common neurological disorders and continues to pose a substantial public health burden worldwide. The FOUR Scale, which is more comprehensive than the GCS because it evaluates brainstem reflexes and respiratory patterns and is applicable to both intubated and non-intubated patients, remains underutilized in several hospitals due to limited nurse knowledge and insufficient training, highlighting the need for structured educational interventions. This study aimed to evaluate the effectiveness of a FOUR Scale consciousness assessment workshop in improving nurses’ knowledge and competence in managing head trauma patients at RSUD Syech Yusuf, Gowa Regency. A quantitative approach using a pre-experimental one-group pretest–posttest design was applied, involving 40 nurses selected through total sampling. Data were collected using a validated and reliable knowledge questionnaire and competence observation sheet (Cronbach’s α  0.738) and analyzed using the Wilcoxon Signed Rank Test based on Z-scores, p-values, and effect sizes. The findings demonstrated a significant increase in knowledge (Z = –5.231; r = 0.827; p = 0.001) and competence (Z = –6.325; r = 0.99; p = 0.001) after the workshop. The large effect sizes indicate that the workshop had a strong positive impact on participants’ clinical abilities. These results confirm that training incorporating theoretical instruction, simulation, case discussions, and reflective learning can effectively enhance clinical competence. The FOUR Scale workshop proved effective and is recommended for routine implementation as part of emergency care quality improvement and as a component of hospital Standard Operating Procedures (SOPs)

Referensi

1. Abebe T, Alemu T, Sorato MM. Incidence, risk factors and outcomes of traumatic head injury among trauma patients visited at the Yanet Trauma and Surgery Specialized Centre, Sidama region, Hawassa, Ethiopia: cohort study. Front Neurol. 2024;15. doi:10.3389/fneur.2024.1431999

2. Padaruntung CS, Firdaus R, Hidayat A. The Correlation between Revised Trauma Score (RTS) and Head Injury Mortality in the Emergency Room. Formosa Journal of Science and Technology. 2023 Jul 31;2(7):1789–802. doi:10.55927/fjst.v2i7.5048

3. Suswitha D, Arindari DR, Tafdhila. Response Time Tindakan Keperawatan Dengan Penanganan Cedera Kepala Di Ruang Instalasi Gawat Darurat Rumah Sakit Palembang. Jurnal Ilmu Kedokteran dan Kesehatan. 2023;10.

4. Freile EIR, Farino DFR. Severe head injury and its therapeutic approach. Bibliographic review. MOJ Public Health. 2023 Feb 7;12(1):24–8. doi:10.15406/mojph.2023.12.00405

5. Mulyono D. Perbedaan Glasgow Coma Scale dan Rapid Emergency Medicine Score dalam Memprediksi Outcome Pasien Trauma Kepala di Instalasi Gawat Darurat Difference between Glasgow Coma Scale and Rapid Emergency Medicine Score in Predicting Outcome of Head Trauma Patients in the Emergency Departement. Jurnal Kesehatan [Internet]. Online; 2020. Report. Available from: http://ejurnal.poltekkes-tjk.ac.id/index.php/JK

6. Airlangga PS, Hamzah H, Santosa DA, Subiantoro A. FOUR Score sebagai Alternatif dalam Menilai Derajat Keparahan dan Memprediksi Mortalitas pada Pasien Cedera Otak Traumatik yang Diintubasi. 2020. Report.

7. Nining Indrawati, Christin Novita Kupa, Era Marthanti Putri, Lona Lorenza Lesimanuaya, Veronica Evi Alviolita, Viky Septiani. Komparasi Glasgow Coma Scale (Gcs) Dan Full Outline of Unresponsiveness (Four) Untuk Menilai Mortalitas Pada Pasien Cedera Kepala Di Area Perawatan Kritis: Literatur Review. Journal of Health (JoH). 2021;8(1):19–27. doi:10.30590/joh.v8i1.213

8. Yuvaraj B, Thenmozhi P, KalaBarathi S. Prediction of Mortality using Full Outline of Unresponsiveness Versus Glasgow Coma Scale Scores in Traumatic Brain Injury Patients: An Observational Comparative Study. 2023 Mar 1;(26):772–7. doi:10.18137/cardiometry.2023.26.772777

9. Wani A, Khan M, Hire R. Comparative Analysis Of Diagnostic Accuracy Of Glasgow Coma Scale With Full Outline Of Unresponsiveness (Four) Scale In Pediatric Non-Traumatic Coma Cases. Internasional Journal Of Scientific Research. 2024;13. doi:10.36106/ijsr

10. Meilando R, Studi P, Keperawatan I, Delima C, Belitung B. CITRA DELIMA : Jurnal Ilmiah STIKES Citra Delima Bangka Belitung Analisa Kemampuan Perawat dalam Mengklasifikasi Pasien Cedera Kepala Berdasarkan Nilai Glasgow Coma Scale (GCS). JI. 2020;4(1). doi:10.33862/citradelima

11. Sari WP, Kosasih CE, Emaliyawati E. Perbandingan GCS dan Four Score dalam Penilaian Kesadaran pada Pasien: a Scoping Review. MAHESA : Malahayati Health Student Journal. 2025 Jul 1;5(7):2863–76. doi:10.33024/mahesa.v5i7.18693

12. Keerthi S, Doshi A, Doshi R, Khandelwal P, Ketkar M, Sudambrekar S. Comparative analysis between GCS (Glasgow coma scale) and FOUR (Full Outline of Unresponsiveness) score in preliminary assessment and prognostication of traumatic brain injury. Nepal Journal of Neuroscience. 2023;20(1):32–8. doi:10.3126/njn.v20i1.45210

13. Suryani R, Widyastuti S. Barriers to the application of FOUR Score in nursing practice. J Clin Nurs. 2025;32(2):56–64.

14. Ross Abrina Yglesias M, Suson EIB. Nurses’ Awareness And Perception Of Four Score Scale Versus Glasgow Coma Scale Tool Used Among Intubated Patients. Malaysian Journal Of Nursing. 2020 Jul 1;12(1):63–72. doi:10.31674/mjn.2020.v12i01.008

15. Heryana N, Wiratmo PA. Pengantar Metodologi Penelitian [Internet]. 2023. Report. Available from: https://www.researchgate.net/publication/374169624

16. Aly A, Gaballah S, El Sayed H. Bite-Sized Teaching Sessions Effects on Emergency Nurses’ Knowledge and Practice Regarding Traumatic Brain Injury. 2021 Jul 16;505–19.

17. Oyesanya TO, Thomas MA. Strategies nurses use when caring for patients with moderate‐to‐severe traumatic brain injury who have cognitive impairments. J Clin Nurs. 2019 Nov 3;28(21–22):4098–109. doi:10.1111/jocn.14958

18. Oyesanya TO, Turkstra LS, Brown RL. Development, Reliability, and Validity of the Perceptions of Brain Injury Survey. J Nurs Meas. 2020 Aug 1;28(2):229–58. doi:10.1891/JNM-D-19-00007

19. Yousef N, Ozigi AK, Hussain M, Perveen K, Afzal M. Impact Of Educational Pedagogy On Registered Nurses’ Knowledge In Neurological Assessment Of Traumatic Brain Injury Patients. Pak J Physiol. 2021;17(3).

20. Yuvaraj B, Thenmozhi P, KalaBarathi S. Prediction of Mortality using Full Outline of Unresponsiveness Versus Glasgow Coma Scale Scores in Traumatic Brain Injury Patients: An Observational Comparative Study. 2023 Mar 1;(26):772–7. doi:10.18137/cardiometry.2023.26.772777

21. Prasetyo R, Hadi Purwanto N. Analisis Tingkat Pengetahuan Perawat Dalam Pengaplikasian Skala Four Score Di Ruang Intensive Care Unit (Icu). Jurnal Pengembangan Ilmu Dan Praktik Kesehatan [Internet]. 2025 Aug;4:243–58. Available from: http://e-journal.lppmdianhusada.ac.id/index.php/PIPK

22. Nelson LD, Wilson L, Albrecht JS, Arciniegas DB, Barthélemy EJ, Fontaine SN, et al. Toward More Holistic Early Traumatic Brain Injury Evaluation and Care: Recommendations from the 2024 National Institute of Neurological Disorders and Stroke Traumatic Brain Injury Classification and Nomenclature Initiative Psychosocial and Environmental Modifiers Working Group. Journal of Neurotrauma. Mary Ann Liebert Inc.; 2025. p. 1023–37. doi:10.1089/neu.2024.0569 PubMed PMID: 40464097.

23. Shehab MS, Ibrahim NM, Abd-Elkader H. Impact of an Educational Program on Nurses’ Knowledge and Practice Regarding Care of Traumatic Brain İnjury Patients at Intensive Care Unit at Suez Canal University Hospital. International Journal of Caring Sciences. 2018;11(2):1104–16.

24. Promlek K, Currey J, Damkliang J, Considine J. Thai trauma nurses’ knowledge of neuroprotective nursing care of traumatic brain injury patients: A survey study. Nurs Health Sci. 2020 Sep 10;22(3):787–94. doi:10.1111/nhs.12730

25. Ehwarieme T, Esewe R, Emina A. Educational Intervention Effect on Nurses’ Knowledge of Glasgow Coma Scale for Neurological Patient Assessment in Tertiary Hospitals in Edo State, Nigeria. Evidence-Based Nursing Research. 2024 Jul 1;6(3):20–31. doi:10.47104/ebnrojs3.v6i3.339

26. Wijaya N, Sumarno S, Hendrarti R. The role of continuing education in improving nurses’ skills in using FOUR Score. Journal of Nursing Education. 2023;15(6):350–8.

27. Ehwarieme TA, Anarado AN, Osian EA, Nnahiwe B. Clinical nurses knowledge, skills and learning needs about glasgow coma scale for neurological patients’ assessment in tertiary hospitals in Edo state, Nigeria: A mixed method study. Int J Afr Nurs Sci. 2021;15:100321. doi:10.1016/j.ijans.2021.100321

28. Vas A, Chapman S, Aslan S, Spence J, Keebler M, Rodriguez-Larrain G, et al. Reasoning training in veteran and civilian traumatic brain injury with persistent mild impairment. Neuropsychol Rehabil. 2016 Jul 3;26(4):502–31. doi:10.1080/09602011.2015.1044013

29. Cheng J, Wu Y, Huang L, Wu Y, Guan Y. Integrating Kolb’s experiential learning theory into nursing education: a four-stage intervention with case analysis, mind maps, reflective journals, and peer simulations for advanced health assessment. Front Med (Lausanne). 2025;12. doi:10.3389/fmed.2025.1616392

30. Vergílio MSTG, Toledo VP, Silva EM. Workshops as a democratic proposal in order to change the supervision work in nursing. Rev Bras Enferm. 2018 Jul 1;71(4):2050–4. doi:10.1590/0034-7167-2017-0286 PubMed PMID: 30156695.

31. Kelsey O, Zabihi S, Shelton P, Shaw J, Shanmuganathan J, Rauf M, et al. Systematic evidence and policy review of how education and training best equips the care workforce for people with chronic neurological disorders. 2025. doi:10.21203/rs.3.rs-7966163/v1

32. Brun FK, Fagertun VH, Larsen MH, Solberg MT. Comparison of Glasgow Coma Scale and Full Outline of UnResponsiveness score to assess the level of consciousness in patients admitted to intensive care units and emergency departments: A quantitative systematic review. Australian Critical Care. 2024 Jan 1. doi:10.1016/j.aucc.2024.03.012

33. Connor KA, Korte R. Mini-Workshop Series for Minority Serving Institutions with ECE Programs. 2021. Report.

Diterbitkan

2026-06-29

Cara Mengutip

Yustilawati, E., Adhiwijaya, A., Ilhamsyah, I., & Ramadhani, A. I. F. (2026). Effectiveness of a FOUR Consciousness Assessment Workshop on Nurses’ Knowledge and Competence in Managing Head Trauma:A Pre-Experimental Study. Media Kesehatan Politeknik Kesehatan Makassar, 21(1), 42–56. https://doi.org/10.32382/medkes.v21i1.2059