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Background The ability to perform a conscious level assessment forms a vital part of a nurse's skill base. By accurately assessing a patient's conscious level, the nurse is able to detect neurological changes and initiate prompt action. The clinical implications of this are grave and assessment errors are serious and have potentially important clinical consequences.How does knowledge and attitude affect a nurse's performance of conscious level assessment?Which demographic factors are the most salient in affecting a nurse's performance of conscious level assessment?Are nurses performing conscious level assessment accurately, and how does it compare to other healthcare professionals?Types of studiesThis review considered any high quality quantitative papers that addressed factors which impacted nurses' performance of conscious level assessment. This review included data from cohort, case control, cross-sectional, and descriptive studies.Types of participantsThe participants of this review were nursing staff working in acute hospitals, specifically working in settings, such as intensive care.Types of intervention(s)Studies which examined knowledge, attitudes and demographic factors and their impact on nurses' performance of conscious level assessment were considered.Types of outcomesThe outcomes of interest:The degree of accuracy and inter-rater reliability of nurses' performance of conscious level assessmentThe skill level of nurses performing conscious level assessmentThe consistency in nurses' performance of conscious level assessmentSearch strategy A three-step search strategy was utilised in this review. An initial limited search of MEDLINE and CINAHL was undertaken. A search strategy was then developed using identified keywords and MeSH headings. Lastly, the reference lists of all identified studies were examined. All searches were limited to English Language studies published between 1990 and 2010.Assessment of methodological quality The reviewers used the JBI Critical Appraisal Checklist for Cohort / Case Control Studies and the JBI Critical Appraisal Checklist for Descriptive / Case Series Studies to assess methodological quality.Data extraction Data were extracted using The JBI Data Extraction Form for Comparative Cohort / Case Control studies and the JBI Data Extraction Form for Descriptive/Case Series studies.Data synthesis Due to the heterogeneous nature of the study methods, the findings of this systematic review are presented in a narrative summary.Results Fifty papers were identified through the various database searches and review of reference list and bibliographies, based on their titles and abstracts. Thirteen studies were included in this review. Knowledge and experience were found to be the most significant factors in determining nurses' performance for conscious level assessment. Formal training was found to be effective in improving assessment skills and experience greatly affected the accuracy of conscious level assessment The agreement rates between healthcare staff were moderate to high, however there were still instances of disagreement.Conclusion This review demonstrated that knowledge and experience are the most significant factors to impact nurses' performance of conscious level assessment. There was variability between results of the studies found. This may have been due to differences in the setting, the target population as well as study methodology. However, these findings suggest that the factors impacting a nurses' performance of conscious level assessment may be more complex than what was initially assumed.Implications for practice It is suggested that formal training be on a continual basis to maintain skills in conscious level assessment. Secondly, nurses who are more experienced in the use of the conscious level assessment should mentor those less experienced.Implications for research The effect of training courses has not been studied comprehensively. Further research should be conducted concerning the accuracy and reliability of nurses using other conscious level assessment instruments.