A DESCRIPTIVE STUDY TO ASSESS THE KNOWLEDGE AND PRACTICE OF 3RD YEAR BSC NURSING STUDENTS REGARDING MANAGEMENT OF PSYCHIATRIC PATIENTS WITH EPILEPSY, IN SELECTED COLLEGES OF TUMKUR, IN A VIEW TO DEVELOP INFORMATION GUIDE ON PREVENTION OF POTENTIAL HAZARDS OF EPILEPTIC EPISODES
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
Mr. ANIL KUMAR GURJAR
MENTAL HEALTH NURSING
Akshaya College of Nursing,
Tumkur, Karnataka.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
1. Name of the Candidate : Mr. ANIL KUMAR GURJAR
And address M.Sc Nursing, 1st Year
Akshaya College of Nursing,
Tumkur, Karnataka.
2. Name of the Institution : Akshaya College of Nursing
3. Course of Study : M.Sc. Nursing 1st year,
And Subject Mental Health Nursing
4. Date of Admission to : 28/06/2008
Course
5. Title of the Topic :“ A Descriptive study to assess the knowledge and practice of 3rd year BSc nursing students regarding management of psychiatric patients with epilepsy, in selected colleges of Tumkur, in a view to develop information guide on prevention of potential hazards of epileptic episodes.”
6.BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
Epilepsy is a brain disorder in which clusters of nerve cells, or neurons, in the brain sometimes signal abnormally. In epilepsy, the normal pattern of neuronal activity becomes disturbed, causing strange sensations, emotions, and behavior or sometimes convulsions, muscle spasms, and loss of consciousness. Epilepsy is a disorder with many possible causes. Anything that disturbs the normal pattern of neuron activity - from illness to brain damage to abnormal brain development - can lead to seizures. Epilepsy may develop because of an abnormality in brain wiring, an imbalance of nerve signaling chemicals called neurotransmitters, or some combination of these factors. Having a seizure does not necessarily mean that a person has epilepsy. Only when a person has had two or more seizures is he or she considered to have epilepsy. EEGs and brain scans are common diagnostic test for epilepsy1.
Once epilepsy is diagnosed, it is important to begin treatment as soon as possible. For about 80 percent of those diagnosed with epilepsy, seizures can be controlled with modern medicines and surgical techniques. Some antiepileptic drugs can interfere with the effectiveness of oral contraceptives. In 1997, the FDA approved the vagus nerve stimulator for use in people with seizures that are not well-controlled by medication1.
Most people with epilepsy lead outwardly normal lives. While epilepsy cannot currently be cured, for some people it does eventually go away. Most seizures do not cause brain damage. It is not uncommon for people with epilepsy, especially children, to develop behavioral and emotional problems, sometimes the consequence of embarrassment and frustration or bullying, teasing, or avoidance in school and other social setting. For many people with epilepsy, the risk of seizures restricts their independence (some states refuse drivers licenses to people with epilepsy) and recreational activities. People with epilepsy are at special risk for two life-threatening1.
Scientists are studying potential antiepileptic drugs with goal of enhancing treatment for epilepsy. Scientists continue to study how neurotransmitters interact with brain cells to control nerve firing and how non-neuronal cells in the brain contribute to seizures. One of the most-studied neurotransmitters is GABA, or gamma-aminobutyric acid. Researchers are working to identify genes that may influence epilepsy. This information may allow doctors to prevent epilepsy or to predict which treatments will be most beneficial. Doctors are now experimenting with several new types of therapies for epilepsy, including transplanting fetal pig neurons into the brains of patients to learn whether cell transplants can help control seizures, transplanting stem cells, and using a device that could predict seizures up to 3 minutes before they begin. Researchers are continually improving MRI and other brain scans. Studies have show that in some case, children may experience fewer seizures if they maintain a strict diet - called the ketogenic diet - rich in fats and low in carbohydrates1.
6.1NEED FOR THE STUDY
Epilepsy is the most common serious brain disorder worldwide with no age, racial, social class, national or geographic boundaries2.
· There are 40-50 million sufferers in the world today, 85% of whom live in developing countries.
· An estimated two million new cases occur each year globally.
· At least 50% of cases begin at childhood or adolescence.
· 70% to 80% of people with epilepsy could lead normal lives if properly treated.
· In developing countries, 60% to 90% of people with epilepsy receive no treatment due to inadequacies in health care resources and delivery, and due to social stigma2.
A study was conducted by the Department of Medicine, Khon Kaen University, Thailand. On basic knowledge of epilepsy among medical students. The medical students' knowledge about basic medical neuroscience in the preclinical level may be fragmented and incomplete. One hundred ten fourth-year medical students' knowledge was accessed by a self-administered questionnaire. The results revealed that 91.8% of respondents knew that epilepsy arose from a transient dysfunction in the brain. Generalized tonic-clonic seizures were the most common type (91.5%) they knew and absence seizures were the least common type (33.6%) they knew. All of them knew that eating pork and punishment of gods did not cause epilepsy3.
However 50% thought that genetics was a cause and 80.3% did not know that stroke and sleep deprivation (92.7%) cause epilepsy. About treatment and prognosis, only 28.2% of respondents thought epilepsy can be cured and patients should take antiepileptic drugs for seizure free 2-5 years (48.2%), life long (33.6%). They knew that the patients should be prohibited from driving (80%), working on machinery (74.5%), and (27.3%) avoid drinking. However, they knew that the patients could marry (100%), get pregnant (98.2%), and lactate (91.9%). Regarding the first aid management, 50.9% of them recommended that placing a piece of wood between the teeth during a seizure and perform chest compressions (20.0%). Means knowledge scores is about 60%, the highest score is the definition of epilepsy (90.2%) and the lowest is type of seizure (43%). The findings indicated that lecturers should review aspects of pathophysiology and emphasize on type of seizure, cause, consequences, and prognosis including first-aid management3.
A study was conducted by the Samvedna Clinic, New Delhi. On Psychiatric knowledge & orientation of non-psychiatrist doctors.52 Non-psychiatrist doctors were evaluated in order to know their psychiatric orientation with the help of clinical case history along with questionnaire. Only one doctor subject could give all the diagnosis correctly on the basis of clinical stories; on the other hand all the doctors gave the diagnosis of epilepsy correctly. This reflects basic lack of understanding of psychiatry resulting from poor theoretical teaching and exposure at undergraduate level. Other characteristics of the sample and finding are discussed here4.
Today’s student nurses are tomorrow’s staff nurses. As 3rd year BSc nursing students study psychiatric nursing as per the curriculum, it is important to enlighten them about the relationship between brain-epilepsy-psychotic disorders in order to, improve their managerial skills to attend efficiently during epileptic episodes among psychiatric patients in their clinical training period also future career. Thus the researcher decided to design information guide comprising the, causes, types, stages and management of psychiatric patients with epilepsy. The information guide will focus specifically on prevention of potential hazards of epileptic episodes by understanding the meaning and recognition Aura which usually precede the attack .
6.2 REVIEW OF LITERATURE
A study was conducted by the Department of Neurological Sciences, Rush University Medical Center, Chicago, on Common errors made in the diagnosis and treatment of epilepsy. This article is a compilation of some of the frequent mistakes that are made in the evaluation and management of patients with epilepsy. It encompasses errors in the clinical diagnosis that result in the choice of the erroneous antiepileptic drug (AED), errors in the way auxiliary tests like the electroencephalogram and magnetic resonance imaging studies are ordered, mistakes in the recognition of subclinical status epilepticus, errors in the selection of AEDs, consequences of the failure to factor in the pharmacokinetic and pharmacodynamic properties of AEDs in the choice and dosification of medication, misconceptions on the expectations of therapeutic effect of AEDs, delay in recognition of refractory epilepsy with consequent delay in a timely identification of patients whose epilepsy can be cured with surgical treatment, and mistakes in the recognition and management of comorbid psychiatric disorders. In addition to a discussion of the reasons for the errors, the article provides practical solutions5.
A study was conducted on ,withdrawn: Specialist epilepsy nurses for treating epilepsy.Epilepsy is a common serious neurological condition with a 0.5% prevalence. As a result of the perceived deficiencies and suggestions to improve the quality of care offered to people with epilepsy, two models of service provision have been suggested by researchers: specialist epilepsy out-patient clinics (as opposed to the management of patients in general neurology clinics or general medical clinics) and nurse-based liaison services between primary (GP) and secondary/tertiary (hospital-based) care. OBJECTIVES: To overview the evidence from controlled trials investigating the effectiveness of specialist epilepsy nurses compared to routine care. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (TheCochraneLibrary Issue 4, 2004), MEDLINE (October 2004), GEARS, EMBASE, ECRI, Effectiveness Healthcare Bulletin, Effectiveness Matters, Bandolier, Evidence Based Purchasing, National Research Register and PsycINFO databases. SELECTION CRITERIA: Randomized controlled and quasi-randomized trials which considered specialist epilepsy nurse interventions with standard or alternative care were included in this review. DATA COLLECTION AND ANALYSIS: Two reviewers independently selected trials for inclusion and extracted data. Outcomes investigated included: seizure frequency; appropriateness of medication prescribed; social or psychological functioning
scores; knowledge about epilepsy scores; costs of care and adverse effects. MAIN RESULTS: Three trials were included, two based in general practice and one in a neurology centre. The population of patients differed between trials, for example one study excluded patients with learning disabilities, and one only recruited patients with a new diagnosis. In view of this heterogeneity we decided not to pool results in a meta-analysis.As yet, there is no convincing evidence that specialist epilepsy nurses improve outcomes for people with epilepsy overall. Important outcomes (eg seizure frequency, psychosocial functioning, knowledge of epilepsy, general health status, work days lost, depression and anxiety scores) show no significant improvement.There is some evidence that people who have not had an epileptic seizure in the last six months are less at risk for depression. There is also evidence that newly diagnosed patients whose knowledge about
epilepsy is poor may improve their epilepsy knowledge scores after nurse intervention. AUTHORS' CONCLUSIONS: It is clearly plausible that specialist epilepsy nurses could improve quality in epilepsy care. However, there is as yet little evidence to support this assumption as the present research base is small. Further research is needed to investigate the effectiveness of specialist epilepsy nurses before such recommendations can be made6.
A study was conducted by the Indiana University School of Nursing, Middle Drive, Indianapolis, on The Seizures and Epilepsy Education (SEE) program for families of children with epilepsy: a preliminary study.We investigated the usefulness of the Seizures and Epilepsy Education (SEE) program in improving quality of life, management of the seizure condition, and health care utilization in families having a child with epilepsy. Members of 15 families attended the program, with at least one parent from each family represented. Children attended if they were at least 12 years of age. Participants completed research instruments prior to attending the SEE program, and also 1 and 6 months after attendance. Both parents and children reported improvement in quality of life relating to child mental health after attending the SEE program. Parents reported reduced emotional impact of the child's condition, fewer worries, and greater knowledge related to epilepsy. Results suggest that attending the SEE program may be beneficial to families having a child with epilepsy; however, further study is needed with a more robust research design7.
A study was done on Epilepsy: being ill in more ways than one.The majority of patients with epilepsy suffer from one or more psychiatric or somatic comorbid conditions, whose nature and prevalence vary with age and sociodemographic factors. In these patients, comorbid conditions have a major adverse effect on overall health and quality of life and substantially increase health care costs. Although there is an understanding of epidemiological aspects of the comorbidity of epilepsy, little is known about causal relationships, clinical interventions to prevent comorbidities, or the management of patients with multiple coexisting conditions. Both the effects of epilepsy therapies on comorbidities and the effects of comorbidities on the efficacy of epilepsy treatments warrant further study8.
A study was conducted by the NHS Lothian, Learning Disability, Psychiatry, 65 Morningside Drive, Edinburgh, on Designing and delivering an epilepsy course for GPs to help meet their educational needs.The recent publication of comprehensive evidence based guidelines and the inclusion of epilepsy in the new GMS contract in the UK the importance of epilepsy to primary care has become clear. There seem to be many deficiencies in GP service provision for epilepsy including a lack of structured review and poor information provision for patients. Therefore, it is likely that further education on epilepsy management is essential. AIM: To ascertain what GPs wish to learn about epilepsy and their preferences as to which methods should be used to achieve this. To use this information to design and then deliver an epilepsy teaching programme for GPs. DESIGN OF STUDY: Cross-sectional. SETTING: Primary care, Lothian region, Scotland. METHODS: A questionnaire was designed and delivered to 50 GPs to obtain information related to the aims of the study. These results were used to aid the design of an epilepsy teaching day for GPs. This course was then delivered in West Lothian, Scotland. RESULTS: GPs seemed to prefer weekday, half-day teaching using multidisciplinary lectures and case studies. Drug treatment, referral guidelines and diagnosis were considered the most important topics and the teaching programme received mainly positive feedback from participants. CONCLUSION: It would appear that a short course on epilepsy management, when designed with the preferences of participating GPs in mind, can be readily delivered and well received9.