HYBRID EVENT: You can participate in person at Baltimore, Maryland, USA or Virtually from your home or work.

8th Edition of Nursing World Conference

October 17-19, 2024 | Baltimore, USA

October 17 -19, 2024 | Baltimore, USA
NWC 2023

Anandhi Amirtharaj

Speaker at Nursing Conferences - Anandhi Amirtharaj
Sultan Qaboos University, Oman
Title : Can full outline of unresponsiveness tool supersede GCS? Are we ready for the change?


Accurate assessment and monitoring of level of consciousness is fundamental for prompt management and recognizing warning signs of deterioration. The aim of study was to compare the Glasgow coma scale (GCS) and full outline of unresponsiveness -FOUR score (FS) tool for neurological assessment and predicting functional outcome. 131 patients selected from two major teaching hospitals at middle eastern countries. Patients were assessed on admission, day 2 & 4 and evaluated using the Glasgow outcome tool on discharge. Results: Using the Glasgow outcome score in predicting outcome, the area under the curve (AUC) was 92% (CI- 95%, 0.870-0.975) for FS and 74.73 % (CI-95%, 0.825-0.951) for GCS. Conclusions: The FS tool is precise in predicting mortality than GCS.
Implications on Nursing: The nursing education and practice must be constructed on evidence reflected from nursing research. GCS has a been long standing tool used for neurological assessment which fails to recognize brain stem reflexes, evaluation of irregular breathing and localization of deficits in coma. FOUR score accurately identifies the above deficits which assists the nurses in early identification of deteriorating consciousness, recognize initial warning signs and provocatively intervene to prevent complications like hypoxic brain damages. The essential domains of nursing care involve assessment and identifying initial warning signs that enables the nurse to modify the care accordingly to prevent complications. Hence, our nursing education must integrate updated tools that will facilitate and empower the students to use advanced assessment strategies, management guidelines and protocols in practice for rendering holistic care. And with introduction of new concepts based on nursing research will advance nursing education to distinguished nursing practice. In addition, such new concepts will benefit nurse educators to build its own unique knowledge in nursing.

Audience Take Away Notes:

  • To introduce the concept of FOUR score and identify the advantages over the GCS tool
  • To enable the audience in the application of FOUR score tool among patients with varied level of consciousness and different types of coma
  • To assess the inter- rater reliability and accuracy in scoring among the audience with the use of FOUR score


Mrs. Anandhi Amirtharaj is dedicated and a passionate Nursing teacher with 25 years of experience in clinical, nursing education. Resourceful to develop and review curriculum that prepares students on global bench marking. Integrating EBP in teaching and clinical practice to produce globally competent students.

1. Teaching

  • Clinical Teaching and Supervision of Undergraduate practicum experiences Acute Care setting- ICU, EMD in Critical Care Nursing, Adult Health I and II of minimum 18 hours/ week
  • Didactic Teaching- Level 2 and 3 courses- Communication Group Dynamics, Critical Thinking
  • Served as a resource person for faculty development activities like Advising Workshop, Simulation, EBP
  • Participated in curriculum revision and preparation of course outline, course coding, scheduling.
  • Developed course materials, including lectures, assignments, exams and PowerPoint presentations.
  • Served as faculty member in accreditation process- ACN Baccalaureate Nursing Program
  • Developed innovative teaching strategies using Games in MOODLE, OSCE, Case Scenarios, Immediate feedback assessment technique using Scratch Off Sheet
  • Committed with continuing education activities to update to the professional requirement and practice.

2. Research

  • Conducted research on clinical practice topics- GCS Vs FOUR Score, Education- Studying preference- Hard copy text book Vs Soft copy
  • Competent in authoring research proposal, compiling reports and
  • Published in Scopus indexed, peer reviewed journals
  • Efficient use of Database in identifying and retrieving EBP articles and applying in clinical teaching
  • Knowledgeable in use of SPSS, ENDNOTE
  • Participated in community activity based on needs assessment


  • Comparison of  FOUR Score against GCS in the prediction of  functional outcome among patients with neurological insult (Internal Grant ; 2019-2020, 905 OMR)
  • The choice of reading tools, Hardcopy versus E- books and readiness in acceptance of E- books among students at sultan Qaboos university (Dean’s Fund ; 2022, 150 OMR)
  • Impact of cardiopulmonary resuscitation duration on functional outcome among Out of Hospital Cardiac Arrest (OHCA) patients: A retrospective chart review ( Research Project for 2023, Processing for Postgraduate deanship funding)