DISSERTATION ON
“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING HOME CARE MANAGEMENT OF EPILEPSY AMONG THE MOTHERS OF CHILDREN WITH EPIELSPY IN NEUROLOGY OUTPATIENT DEPARTMENT AT INSTITUTE OF CHILD HEALTH AND HOSPITAL FOR CHILDREN, EGMORE, CHENNAI 08.”
M.Sc. (Nursing) DEGREE EXAMINATION BRANCH – II CHILD HEALTH NURSING
COLLEGE OF NURSING
MADRAS MEDICAL COLLEGE,CHENNAI – 03.
A dissertation submitted to
THE TAMILNADU DR.M.G.R MEDICAL UNIVERSITY, CHENNAI –600 032
In partial fulfilment of requirements for the degree of
MASTER OF SCIENCE IN NURSING
OCTOBER 2019
DISSERTATION ON
“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING HOME CARE MANAGEMENT OF EPILEPSY AMONG THE MOTHERS OF CHILDREN WITH EPIELSPY IN NEUROLOGY OUTPATIENT DEPARTMENT AT INSTITUTE OF CHILD HEALTH AND HOSPITAL FOR CHILDREN, EGMORE, CHENNAI 08.”
Examination : M.Sc(Nursing) Degree Examination
Examination month and year : OCTOBER 2019
Branch & Course : II - CHILD HEALTH NURSING
Register Number : 301716256
Institution : COLLEGE OF NURSING,
MADRAS MEDICAL COLLEGE, CHENNAI – 600 003
Sd: ____________________________ Sd: ____________________________
Internal Examiner External Examiner
Date: __________________________ Date: __________________________
THE TAMIL NADU DR.M.G.R.MEDICAL UNIVERSITY, CHENNAI – 600 032
CERTIFICATE
This is to certify that this dissertation titled “A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING HOME CARE MANAGEMENT OF EPILEPSY AMONG THE MOTHERS OF CHILDREN WITH EPIELSPY IN NEUROLOGY OUTPATIENT DEPARTMENT AT INSTITUTE OF CHILD HEALTH AND HOSPITAL FOR CHILDREN, EGMORE, CHENNAI 08.” is a bonafide work done by P. SARASWATHI, M.Sc (N) II year Student, College of Nursing, Madras Medical College, Chennai -03, submitted to the Tamil Nadu Dr.M.G.R. Medical University, Chennai in partial fulfilment of the requirement for the award of the degree of MASTER OF SCIENCE IN NURSING BRANCH – II, CHILD HEALTH NURSINGunder our guidance and supervision during academic year 2017 – 2019.
A.Thahira Begum, M.Sc (N)., MBA., M.Phil., Principal
College of Nursing, Madras Medical College, Chennai -03
Dr.R.Jayanthi, MD, FRCP(Glasg) Dean
Madras Medical College Chennai -03
“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING HOME CARE MANAGEMENT OF EPILEPSY AMONG THE MOTHERS OF CHILDREN WITH EPILEPSY IN NEUROLOGY OUTPATIENT DEPARTMENT AT INSTITUTE OF CHILD HEALTH AND HOSPITAL FOR CHILDREN, EGMORE, CHENNAI 08.”
Approved by dissertation committee on 24. 07.2018 CLINICAL SPECIALITY GUIDE
Mr.A.SENTHIL KUMARAN, M.Sc (N).,
Lecturer in Child Health Nursing, College of Nursing,
Madras Medical Nursing, Chennai-03.
HEAD OF THE DEPARTMENT
Mrs.A.THAHIRA BEGUM, M.Sc (N)., MBA., M.Phil., Principal,
College of Nursing, Madras Medical College, Chennai-03.
DEAN
Dr.R.JAYANTHI, M.D., F.R.C.P.(Glasg).,
Dean,
Madras Medical College, Chennai – 03.
A Dissertation submitted to
THE TAMILNADU DR.M.G.R MEDICAL UNIVERSITY, CHENNAI-600 032.
In partial fulfillment of the requirement for award of the degree
MASTER OF SCIENCE IN NURSING OCTOBER – 2019
CERTIFICATE OF PLAGIARISM
This is to certify that the dissertation work titled “A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING HOME CARE MANAGEMENT OF EPILEPSY AMONG THE MOTHERS OF CHILDREN WITH EPILEPSY IN NEUROLOGY OUTPATIENT DEPARTMENT AT INSTITUTE OF CHILD HEALTH AND HOSPITAL FOR CHILDREN, EGMORE, CHENNAI 08.” of the candidate P.SARASWATHI, for the partial fulfilment of M.Sc. Nursing programme in the branch of Child Health Nursing has been verified for plagiarism through relevant plagiarism checker. We found that the uploaded thesis file from
introduction to conclusion pages and rewrite shows % of plagiarism ( % uniqueness) in this dissertation.
CLINICAL SPECIALITY GUIDE/SUPERVISOR Mr. A.Senthilkumaran, M.Sc (N).,
Lecturer in Child Health Nursing, College of Nursing,
Madras Medical College, Chennai – 03.
PRINCIPAL
Mrs. A. Thahira Begum, M.Sc (N)., MBA., M.Phil., Principal,
College of Nursing, Madras Medical College, Chennai – 03.
ACKNOWLEDGEMENT
Gratitude calls never expressed in words but only by deep perceptions, which makes words to flow from one’s inner heart.
First of all, I praise God Almighty, merciful and passionate, for providing me this opportunity and granting me the capability to complete this study successfully .I lift up my heart in gratitude to God Almighty, I feel the hand of God on me, leading me through thick and thin heights of knowledge. It is he who granted me the grace and the physical and mental strength behind all my efforts.
I express my genuine gratitude to the Institutional Ethics Committee of Madras Medical College for giving me an opportunity to conduct this study.
I express Mysincerethanks to Prof. Dr. JEYANTHY, M.D, Dean,Madras Medical College, Chennai-3 for extending his support to conduct this study.
With great privilege to extend my heartfelt thanks and gratitude to Mrs.A.THAHIRA BEGUM.,M.Sc(N).,MBA.,MPhil.,Principal, College of Nursing,
Madras Medical College, Chennai-3 for her innovative, constructive guidance, valuable suggestions and continuous support to me which made my study a fruitful one.
I express my heartfelt sincere thanks toDr.R. SHANKARSHANMUGAM, M.Sc(N)., Ph.D.,Reader in Nursing Research Department, College of Nursing, Madras Medical College, Chennai for his valuable suggestions and immense direction for conducting and completing my study in a successful way.
I immensely extend my thanks to Mrs. SEETHARAMAN VIJIYALAKSHMI, M.Sc(N).,MBA.,ReaderandHead of the Department in Child Health Nursing, College of Nursing, Madras Medical College, Chennai-03 for extending her support, and in conducting of this study.
I also thanks toDr.G.MALA, M.Sc(N).,Ph.D.,Nursing tutor and Mr.K.KANNAN, M.Sc(N).,MBA.,Nursing Tutor in Department of Nursing Researc,
College of Nursing, Madras Medical College, Chennai-03 for their valuable suggestions and immense direction for conducting my study in a successful way.
I express my sincere thanks to Mrs.G.MARY, M.Sc (N), Reader in Child Health Nursing for her valuable suggestion and guidance for the selection of my topic for the dissertation.
I am deeply grateful to Mrs.JEYASELVI M. Sc (N), Head of the Department, Department of Paediatric Nursing, Bilroth College of Nursing, Maduravoyal for validating the tool and her valuable suggestions and guidance to conduct my study successfully.
I express my sincere thanks to all the faculty members of College of Nursing, Madras Medical College, Chennai-3 for their guidance and valuable suggestions for this study.
I wish to express my special thanks to Dr.K.JEYACHANDRAN, M.D, DCH,Director& Superintendent, Institute of Child Health & Hospital for Children, Egmore, Chennai -8. for granting permission to conduct the study successfully.
I express my deep sense of gratitude to Prof. Dr. C. LEEMAPAULINE, M.D, D.M, Professor & Head of the Department of Neurology, Institute of Child Health
& Hospital for Children, Egmore, Chennai-08 for giving me the permission to conduct study and validating the tool and valuable suggestions and guidance.
I extend my sincere thanks to Mr.A.VENKATESAN, Msc, M.Phil.
(Statistics) P.G.D.C.ALecturer in statistics Madras medical college, Chennai-03 for his expert advice and guidance on statistical analysis.
I am deeply grateful to Mrs.M.VELANKANNI, M.A., social worker, Neurology Department; for her valuable suggestions and guidance to conduct my study successfully.
Words are beyond expressions for meticulous effort of my Parents MR.K.A.PANNEER SELVAM and MRS.P.DEVAKI for their loving support, encouragement, constant prayer which enabled me to complete my study.
I extend my gratitude to thank my lovable Brother P.SANKAR and my Sister in law P.PARAMESHWARI for their encouragement to complete this study.
I extend my thanks to Mr. RAVI, BA.,B.L.I.S., Librarian, College of Nursing, Madras Medical College, Chennai-03 for his help in availing library facility.
I express my heartfelt gratitude to Mr. MALLIGA,M.A.,B.Ed.,Head Master, English Teacher, For guidance, correction and English editing for my study and Mrs.R. RAJESHWARI, M.A., B.Ed., M.Phill.,Tamil Teacher, Govt. Girls Hr Sec school,Ashok Nagar,Chennai-83 for their untiring guidance and Tamil editing for my study.
I owe my special intimacy to my husband Mr. D. SARAVANAN for sharing my work-related stress and his moral support and encouragement from the beginning to the end of my study. I am highly indebted to my child S. DHARSHINI for helping me to the creative diagrams and helped me completing the study successfully.
I deeply appreciate the help rendered by Mr. SyedHussain,B.Sc (Comp)for help and untiringpatience in printing the manuscript and completing the dissertation work which enable for me complete study.
I take this opportunity to thank all myTeaching and Non-Teaching Staff Members, Librarian and Office staff Members, Colleagues and Friendsof Madras Medical College-College of Nursing, Chennai-03 for their cooperation and help rendered.
I would like to extend my special thanks todear friendsMrs.MANIMEKALA, Mrs.MADHURIMA,Mrs.CHITHRA,Mrs.REVATHYandMiss.SIVARANJANIfo r their constant encouragement and helped towards the successful completion of my study.This thesis became possible with the support, love and tolerance of my classmates who provide timely support, guidance and motivation throughout my research.
Lastly, I would like to appreciate the respondents who participated in my study for their co-operation to conduct the study successful.
ABSTRACT INTRODUCTION
Epilepsy is a chronic disorder of the brain that occurs worldwide affecting the people of all age groups. It refers to a clinical phenomenon rather than a single disease entity, characterized by recurrent seizures. People believed that, epilepsy is a communicable disease and hesitates to help or touch that person who has fallen in a seizure, Even this happen in a hazardious places such as water or near an open fire .The stigma associated with epilepsy has a greater effect on the education of children and young people and they mostly lead to isolation from the society.Nurses’ plays a major role in providing high Quality, cost effective care for the children with epilepsy and emotional supports should be provided by the nurse to their families.
TITLE:
“A study to assess the effectiveness of structured teaching programme on knowledge regarding home care management of children with epilepsy among the mothers of children with epilepsy in Neurology Outpatient Department at Institute Of Child Health And Hospital For Children, Egmore, Chennai 08.”
OBJECTIVES:
1.To assess the pretest knowledge of mothers regarding home care management of epilepsy as measured by a structured knowledge questionnaire between the experimental group and control group. 2. To assess the post-testlevel of knowledge on home care management of epilepsy among the mothers of children in experimental group. 3. To compare the pre-test and post-test level of knowledge on home care management of epilepsy among the mothers of children between experimental and control group.4. To find out the association between the post test scores of the experimental group with the demographic variables regarding home care management of epilepsy among the mothers of children with epilepsy .
METHODOLOGY:
The study was conducted with 120 samples (mothers) in Quantitative approach.
Randomized Controlled Design was used for the study. Sampling selection was done by Simple Random Sampling Technique(Lottery Method). Pre existing knowledge was assessed by using semi structured questionnaires. After the pre-test, Structured Teaching Programme was given regarding the home care management of epilepsy among the mothers after 14 days of STP, Post-test was conducted by using same tool.
RESULTS:
Experiment mothers are having 24.05 knowledge score and control group mothers are having 15.10 knowledge score, so the difference is 8.95, this difference is large and it is significant. It was tested using Student independent t-test.so the experimental group gained more knowledge after administration of Structured Teaching Program. Considering overall Knowledge score, in pre-test Experiment group mothers are having 14.13 knowledge score and in posttest they are having 15.10 knowledge score, so the difference is 0.97, this difference is large and it is significant.
It was tested using Student paired t-test.Overall knowledge score, Experimental mothers are having 24.05 knowledge score and control group mothers are having 15.10 knowledge score, so the difference is 8.95, this difference is large and it is significant. It was tested using Student independent t-test
CONCLUSION:
The nurses must have the holistic knowledge regarding home care management of epilepsy. Nurses play a vital role in providing adequate knowledge to the mothers of children with epilepsy. The present study was supported by a series of other studies which confirmed that the knowledge on home care management of epilepsy is important to prevent the child from complications. Data analysis and result was found that structured teaching program on home care management of epilepsy in children was an effective method for providing adequate knowledge to the mothers.
INDEX CHAPTER
NO.
TITLE PAGE
NO.
I INTRODUCTION
1.1 Background of the study 3
1.2 Need for the Study 4
1.3 Statement of the Problem 8
1.4 Objectives of the Study 9
1.5 Operational Definition 10
1.6 Assumption 10
1.7 Hypothesis 10
18 Delimitation 10
1.9 Conceptual Framework 11
II REVIEW OF LITERATURE 14
III RESEARCH METHODOLOGY
3.1 Research Approach 27
3.2 Study Design 27
3.3 Duration of the Study 28
3.4 Study Setting 28
3.5 Study Population 29
3.6 Sample 29
3.7 Sample Size 29
3.8 Sample Criterion 3.8.1 Inclusion Criteria 3.8.2 Exclusion Criteria
29
3.9 Sampling Technique 29
3.10 Research Variables 30
3.11 Development and Description of the Tool 3.11.1 Development of the tool
3.11.1.Description of the tool
30
3.12 Content validity 31
3.13 Reliability of the Tool 32
3.14 Protection of Human Subjects 32
3.15 Pilot Study 32
3.16 Data Collection Procedure 33
3.17 Intervention Protocol 34
3.18 Plan for Data Entry and Analysis 36
IV ANALYSIS AND INTERPRETATION OD DATA 37
V DISCUSSION 66
VI SUMMARY,IMPLICATION,LIMITATION, RECOMMENDATION & CONCLUSION
77
6.1 Summary of the Study 77
6.2 Findings of the Study 77
6.3 Implication of the Study 81
6.4 Limitation 83
6.5 Recommendation 83
6.6 Conclusion 84
REFERENCES APPENDICES
LIST OF TABLES TABLE
NO
TITLE PAGE
NO 1.1 Statistics of Epilepsy at Institute of Child Health and Hospital
for Children, Egmore, Chennai-08 for the Year 2014 -2018.
6
3.1 Schematic Representation of Research Design. 28 3.2 Blue Print for Semi Structured Questionnaire. 31
3.3 Scoring Interpretation of knowledge score. 32
4..1 Description of Demograpahic profile of the mothers 38 4.2 Description of the profile of the children. 40 4.3 Each domainwise Pre-test Percentage of knowledge on home
care management of epilepsy among the mothers
45
4.4 Pre-test level of knowledge between the experimental and contro group
46
4.5 Each domainwise Post-test Percentage of knowledge on home care managemnt of epilepsy among the mothers
47
4.6 Post-test level of knowledge between experimental and control group
48
4.7 Domainwise comparison of pre-test mean knowledge score 49 4.8 Domainwise comparison of post-test mean knowledge score 50 4.9 Comparison of pre-test and post-test mean knowledge
score(experiment)
53
4.10 Comparison of pre-test and post-test mean knowledge score(control)
54
4.11 Comparison of pre-test and post-test level of knowledge score 55 4.12 Each domainwise Percentage of knowledge gain score 56 4.13 Effectiveness of Structered Teaching Programme and
generalization of knowledge gain score
57
4.14 Association between Post-test level of knowledge score and mother’s demographic variables(experiment)
58
4.15 Association between Post-test level of knowledge score and children demographic variables(experiment)
60
4.16 Association between Post-test level of knowledge score and mother’s demographic variables(control)
63
4.17 Association between Post-test level of knowledge score and children demographic variables(control)
65
LIST OF FIGURES
FIGURE NO
DESCRIPTION
1.1 Common misconception about the epilepsy
1..2 Prevalence of Ideopathic Epilepsy as per the Age and Sex 1.3 Statistics of Epilepsy in Neurology OP at ICH & HC, Egmore.
1.4 Role of Pediatric nurse Model
1.5 Conceptual Framework based on Rosen Stock’s Health Belief Model 3.1 Schematic Representation of Sample Selection Technique
3.2 Schematic Representation of the Research Methodology
4.1 Multiple cone diagram shows distribution of age group of the mother 4.2 MultipleCone diagram shows distribution of education status of the
mothers
4.3 Multiple Cylindrical diagram shows distribution of education status of the father
4.4 multiple Cylindrical diagram shows distribution of monthly income of the family
4.5 Multiple bar diagram shows distribution of occupational status of the father
4.6 Multiple Cylindrical diagram shows distribution occupational status of the mother
4.7 Line diagram shows distribution of type of the family system 4.8 Multiple diagram shows distribution of type of marriage
4.9 Multiple Cylindrical diagram shows distribution of family history of epilepsy
4.10 Multiple bar diagram shows distribution of birth history of epilepsy
4.11 Cone diagram shows distribution of monthly income of the family
4.12 Multiple bar diagram shows the distribution of age of the child with epilepsy
4.13 Multiple Cone diagram shows that distribution of sex of the child 4.14 Multiple Cylindrical diagram shows the distribution of age of onset of
first seizures
4.15 Multiple Cyindrical diagram shows distribution of duration of taking antiepileptic medications by the chidren
4.16 Multiple bar diagram shows distribution of type of seizure in children 4.17 Multiple Cylindricald diagram shows the pre-test level of knowledge score
of the experimental and control group
4.18 Multiple Post-test level of knowedge score between experimental and control group
4.19 Comparision of Pre-test and Post-test mean knowledge score of experimental and control group
4.20 Multiple Cylindrical diagram shows distribution of Post-test level of knowledge score and mother’s age.
4.21 Multiple cone diagram shows the distribution of association between Post- test level of knowledge score of the mother and Type of family.
4.22 distribution of association between mother’s post-test level of knowledge score and birth history of the mother
4.23 distribution of association between the mothers post-test level of knowledge score and place of living
4.24 distribution of association between mothers post-test level of knowledge score and usage duration of antiepileptic drugs
LIST OF APPENDICES
APPENDIX NO
ANNEXURE
1. Certificate approval by Institutional Ethics Committee 2. Cetificate of content validity by Experts
3 Letter seeking permission to conduct the study 4. Informed Consent form – Tamil
5. Informed Consent form – English
6. Tools for Data Collection (English and Tamil) Section A- socio Demographic data of the mothers
Section- B- Knowledge about home care management of epilepsy 7. Lesson Plan OnStructured Teaching Programme regarding Home care
management of epilepsy In English and Tamil
8. Flash Cards on Home care management of epilepsy in children 9. Cetificate for English edting
10. Cetificate for Tamil editing.
11. Photos
LIST OF ABBREVATION
ABBREVATION EXPANSION
DF Degree of Freedom .
ICH&HC Institute of Child Health and Hospital for Children.
NS Non Significance.
P Significance .
SD Standard Deviation .
STP Structured Teaching Programme.
SUDEP Suden Unexpected Death in Epilepsy.
WHO World Health Organizarion . EEG Electro EncepahaloGraphy
CT Computerized Tomography MRI Magnetic Resourch Imaging
PIP Patient Information Pamphlet
QOLCE Quality Of Life in Children with Epilepsy.
IPES Impact of Pediatric Epilepsy on the family Scale ILAE International League Against Epilepsy.
AED AntiEpileptic Drugs
CHAPTER -1
INTRODUCTION
CHAPTER- 1 INTRODUCTION:
“The most beautiful necklace a mother can wear is not gold, but her child’s arms around the neck.”
‘Epilepsy’ is derived from the Greek word “Epilambanein”meaning is “to be seized”.The word Epilepsy is used both in verbal and written context for more than 4000 years.Epilepsy is a chronic disorder of the brain which means recurrent seizure
activity which affects worldwide the people of all age groups. It refers to a clinical phenomenon rather than a single disease entity, characterized by recurrent seizures.
A new child has a bundle of anticipation and expectations. Any illness that the child may have like seizure,seems terrible to the parents and family.The stigma that some people still associate with seizures and epilepsy creates unique challenges.
Seizures in a newborn usually subside quickly but may recur as epilepsy in later childhood or even in adulthood.
Epilepsy Fondation celebrates the National Epilepsy Awareness month at November.to create awareness among tepublic.It argues that,Accoring to the WHO Oganization,Epilepsy is the most common brain disorders worldwide.Moreover, Public understanding about epilepsy causes social challenges like bullying, discrimination and depression, People donot want to talk about the disease.
Currently, epilepsy affects 50 million people worldwide, and 80% of them live in the developing world..It is a chronic non –communicable disease of the brain that affects the people of all ages.Epilepsy is not contagious. The most common cause of epilepsy is idiopathic 6 out of 10 people. Second cause of epilepsy is Brain damage .Prenatal causes, severe head injury a stroke that restricts of oxygen to the brain, an infection of the brain such as encephalitis, Neurocysticercosis and certain genetic syndrome are certain etiological factors of epilepsy.
Signs and symptoms arise due to excessive synchronal activity of the brain.
Studies suggest that 4-10% of children have an experience of seizure before 16 years of age.Febrile seizures occurring commonly between 6 months to 16 years of age,account for 2-5 % of children experiencing first episodes of seizures before 5 years of age and happens inhazardious places such as water or near an open fire.
CT scan and MRI scan plays an important role in the etiological diagnosis of seizures. It has important role in focal seizure or persistent seizure activity,focal neurological deficit, signs of increased intracranial pressure,VPshunt,Trauma. Petit mal seizure and absence seizure are an uncommon seizure that begins suddenly and occurs without any warning signs. 2of every 1000 children are affected,these are caused by abnormal and intense electrical activity of the brain
In olden days, epilepsy mainly linked to the culture of a particular part of the world. The forced cry, loss of consciousness, fall, twitching, foaming at the mouth is linked to “possession by the spirit”. People believed that, epilepsy is a communicable disease and hesitated to help or touch that person who has fallen in a seizure. The stigma associated with epilepsy has a greater effect on the education of children and young people and they mostly lead to isolation from the society.
Figure: 1.1. common misconception about epilepsy– (who-2019)
1.1.BACKGROUND OF THE STUDY
1.Worldwide, one in 10 people will have the seizure and one in 26 will be diagnosed as epilepsy.In United States, 3.4 million people living with active epilepsy. Statistics
2.Epilepsy is the fourth common neurological problem. Epilepsy accounts for 1% of the global burden of diseases. Among those 80% of the disease burden is in the developing countries. Epilepsy is a disease of grave social stigma throughout the world that is the reason for increased risk of mortality including in India. Peculiar natureof the disease involves involuntary movements. It carries apprehension and anxiety in the caregivers of the child.
3.SUDEP is defined as the sudden, unexpected, witnessed or unwitnessed, non-traumatic, and non-drowning death in patients with epilepsy with or without evidence for a seizure, and excluding documented status epilepticus, in which postmortem examination does not reveal a structural or toxicological cause for death16Although a large number of descriptive studies have suggested that male gender is a significant risk factor for SUDEP.
4. 1.2 % of Unite States People have active Epilepsy, among those 34 million people are affected nationwide and more than 65 million people are affected globally.
Incidence rate is higher in young children under the age of 2 years and adults older than 65 years of age.About 50 to 60 percent of children with seizures will eventually grow out of them and never experience seizure at an adult stage. Worldwide, a Quarter of newly diagnosed cases of epilepsy are children. In Americans more than 3 million people affected with epilepsy around 4,70,000 cases. Among those 6.3 out of every 1000 cases suffers with epilepsy. (Child Neurology Foundation - 2018)
1.2. NEED OF THE STUDY
GLOBAL BURDEN OF THE DISEASE
Epilepsy is a chronic disorder of the brain that affects the people of all age groups.
Approximately 50 million people have the epilepsy worldwide,80% of the people with epilepsy live in low and middle income countries. Approximately 70% of the people with epilepsy respond to treatment. On the contrary, three fourth of the people with epilepsy living in low and middle income countries do not get the treatment. In most of the countries, People with epilepsy and their families suffer from stigma and discriminations (WHO 2018 Statistics)
Figure 1.2 prevalence of Ideopathic epilepsy as per Age and Sex (WHO- 2019 )
Shakiruiiah,Niaz Ali (2014) Study related to prevalence ,incidence and etiology of epilepsy revealed High prevalence was found in adolescence and early age group children .In North America there was a high prevalence in Males than female children .on the contrary ,In Asian countries such as China ,India ,Turkey were prevalence of epilepsy high in females than males .Moreover, Generalized Seizure is high in America ,Asia,, Europe and Africa than other types of Epilepsy .Few data only available about the incidence of Epilepsy especially from the low and middle income
countries ,so overall incidence for prevalence was high in males than female children due to the causes of Head Injury ,Birth Trauma ,Intra Cranial Infection.
Nazishakhter, ( 2018) A cross sectional Study was conducted on Awareness and prevalence of Epilepsy in educational Hubs atShringal, Khyber Pakhtunkhwa study was conducted by a survey from April to September 2015 . Sample size was calculated as NO:5308,Target Population 20,000. A total No:114(2.18%) positive cases were found irrespective of educational level High prevalence rate were found in Females at primary (60.7%) and secondary level (35.7%) ,on the other hand high rate of prevalence of males(20.9%) at tertiary and professional level respectively
INDIA
In 2018, Overall incidence of epilepsy (number of new cases observed over a period of time) lies between 20-50 cases per year per 100,000 persons in a general population .The usual prevalence rate (number of new persons with epilepsy during a specific period of time ) is 500-1000 cases per 100,000 persons of population among those 2,600-6500 new cases of epilepsy every year in New Delhi alone and 2,00,000 to 5,00,000 new cases in the whole of India (estimated population about 1.3crores ). At present approximately 65,000-1,30,000 persons with epilepsy in New Delhi and 50- 100 lakhs in whole of India respectively. (Epilepsy foundation-2018)
Shyamk.jaishwal (April 2017) A CohortStudy was conducted on Incidence of unprovoked seizures, epilepsies and epilepsy syndromes in a cohort of children accessing primary schools and organizations’ of Seizures and epilepsies.7408 children accessing education in 18 government primary schools in Hyderabad district inTelenganastate,India. The annual incidence for unprovoked seizures and epilepsy was 71.35 per 1, 00,000 and 57.79-57.92 per 1,00,000 population respectively .
Annan’s Academy of Neurology(2014)There are 50 million people worldwide and most of them reside in developing countries like India. 10 million people are residing with epilepsy ,Most of the people with epilepsy does not take the medication properly that leads to large treatment gap .The main reason for these lack of knowledge about
the antiepileptic medications,Poverty, cultural beliefs, Stigma, Poor health Infrastructure and shortage of trained Personnel in the health care setting. Moreover in India, Infectious disease plays a major role seizure and long term burden causing both New-onset of Epilepsy and Status Epilepticus. Study concluded that proper education and appropriate health care services can make tremendous changes in India .
Table : 1.1. Statistics of epilepsy in Neurology OP, Institute of Child Health and Hospital for Children, Egmore, Chennai-08.
2014 2015 2016 2017 2018
1176 2456 2654 2876 3015
Figure 1.3.Line Graph shows that Statistics of Epilepsy in Neurology OP, ICH &HC , Egmore, chennai-08
Based on the below model, as a pediatric nurse should empower and educate the mothers who is taking care of children with epilepsy. Pediatric nurse plays a major role in health care settings. As a nurse educator should provide the adequate knowledge to the mother .It is the evidence based core competencies that prioritize the knowledge, skills and attitude needed to begin the practice as a professional nurse in a health care setting.
Team co-ordinator
manager
Child care advocate
1176
2456 2654 2876
3013
0 2000 4000
2014 2015 2016 2017 2018
PREVALENCE OF EPILEPSY
PREVALENCE OF EPILEPSY
Recreationist
Health educator
Primary care giver
Social worker
Nurse researcher
Nurse cosultant
Figure: 1.4 Role of Paediatric Nurse
Nurse researcher has selected this study because of the epilepsy plays major problems around the world due to poor knowledge of the caregivers and misconceptions about the disease conditions. As nurse counselor, impart the knowledge to the mothers regarding myths and truths about the epilepsy. This motivated the investigator to undertake a study on knowledge regarding the home care management of epilepsy among the mother of children with epilepsy.There is a need for creation of awareness about the epilepsy among the caregivers especially, mothers who is providing physical and emotional support to their children with epilepsy.
Nurses play a major role in providing high quality, cost effective care for the children with epilepsy and emotional supports should be provided by the nurse to their families. So, the nurses are in an essential part of a multidisciplinary team providing information and support for the people with epilepsy. She can reduces the seizure
• social worker
• Nurse- counsellor
• Health educator
• Primary caregiver
Team
coordinator Manager
Recreationist Child care
advocate
Nurse researcher Nurse
consultant
duration and side effects of the medications, improve the self-management of epilepsy through the Health education, reduces epilepsy related deaths and accidents through the risk management, reduces misdiagnosis by Nursing process.The nurse plays a key role in managing the child with epilepsy.
1.3. STATEMENT OF THE PROBLEM:
“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING HOME CARE MANAGEMENT OF EPILEPSY AMONG THE MOTHERS OF CHILDREN IN NEUROLOGY OUTPAIENT DEPARTMENT AT INSTITUTE OF CHILD HEALTH AND HOSPITAL FOR CHILDREN, EGMORE, CHENNAI-08.”
1.4.OBJECTIVES
To assess the pretest knowledge of mothers regarding home care management of epilepsy as measured by a structured knowledge questionnaire between the experimental group and control group.
To assess the post-test level of knowledge on home care management of epilepsy among the mothers of children with epilepsy between the experimental group and control group
To compare the pre-test and post-test level of knowledge on home care management of epilepsy among the mothers of children with epilepsy between experimental and control group.
To find out the association between the post testknowledge of the mothers of the experimental group with their demographic variables
1.5. OPERATIONAL DEFINITION ASSESS
Assess refers to process of the critical analysis, valuation and judgment of the knowledge of mothers about the home care management of epileptic child
EFFECTIVENESS
It refers to the significant increase in the level of knowledge of mothers regarding management of epilepsy which is measure from the response of pre-test.and post- test.
STRUCTURE TEACHING PROGRAMME
It refers to systematically planned instructional module to provide adequate information regarding management of epilepsy among the mothers who are attending neurology outpatient department ICH,Egmore,Chennai .
KNOWLEDGE
Knowledge refers to awareness and understanding of management of epilepsy among the mothers
MOTHERS
The person who is having the child with epilepsy and providing physical and emotional bond to their children.
HOME CARE MANAGEMENT
Care of the child in the home in the aspect ofcause,triggering factors, safety measures, first aid management ,increasing awareness to the mother about the importance of medication, myths facts and prevention of epilepsy .
EPILEPSY
Epilepsy is a condition in which a person has recurrent seizures. A seizure is defined as an abnormal, disorderly discharging of the brain's nerve cells, resulting in a temporary disturbance of motor, sensory, or mental function.
1.6. HYPOTHESIS:
The following hypothesis will be tested
H1 -There will be significant difference between the pre-test and post-test knowledge scores onKnowledge regarding home care management of epilepsy children among the mothers in experimental group.
H2-There will be a significant association between the post-test level of Knowledge scores with their demographic variables regarding the
home care management of epilepsy among the mothers of children with Epilepsy.
1.7.ASSUMPTIONS The study assumes that
1) Mothers will have some knowledge regarding the management of epileptic child prior to the administration of structured teaching program.
2) Administration of Structured teaching programme will enhance the knowledge of mothers regarding management of child with epilepsy .
1.8. DELIMITATION
The study period is limited to one month
1.9.CONCEPTUAL FRAMEWORK
A framework is the overall concepts of a study. Every research study should have a framework .so ,a conceptual framework is a theoretical approach to a specific problems .more over the conceptual framework is scientific based and it emphasizes the selection ,arrangements and classification of it concepts.This Study is based on the Health Belief Model.
Health Belief Model is the most widely used models to explain to the people about the preventive Health Action ,This model was first explained by the Hochbaum (1958)Becker(1974), Rosen Stock (1977) .
THIS MODEL CONSISTS OF THREE PRIMARY COMPONENTS
Individual perception.
Modifying factors.
Likelihood of initiating action.
I .INDIVIDUAL PERCEPTION PERCEIVED SUSCEPTIBILITY
An individual‘s estimated probability is encountering the specific health problems in my Study, there is a inadequate knowledge, poor management , beliefs on myths and facts about the epilepsy, preventive measures and susceptible for complication.
PERCEIVED SERIOUSNESS
Thedegree of concern on experiences created by the thought of disease or problems associated with a given health condition .In this present study ,perceived seriousness referred to willingness to take preventive measures and minimizing the episodes of seizures and their complication .
PERCEIVED THREAT
The combined impact of perceived susceptibility and perceived seriousness were the problems perceived by the mothers of children with epilepsy .In this study ,perceived threat referred to impact of increased numbers of seizure attack in a short duration and complication arises due to poor home care management during the time of seizure . To identify the perceived threat of the mothers of children with epilepsy ,assess the knowledge level through a pre-test . Questionnaire developed for the assessment of Knowledge for the study .
II MODIFYING FACTORS
Modifying factors includes selective demographic,socio-psychological and structural factors of the mother of children with epilepsy. In this present study, the investigator used the demographic variables of the mother such as age, type of the family, educational status of the mother and father,occupation of the mother and father,monthly income of the family and place of living as well as the child’s demographic variables such as age,sex,birth order of the child, type of seizure and age of onset of the seizure are included in this study.
CUES TO ACTION
Cues to action includes strategies of activities of readiness, it refers to Television, Radio, friends, Magazines and advice from others.
THE LIKELIHOOD OF TAKING ACTION
It is the positive differences between perceived benefits and perceived barriers in this study. The perceived benefit includes adequate knowledge about the epilepsy and the home care management of children with epilepsy.On the contrary, Perceived barrier includes poor knowledge regarding the home care management of children with epilepsy.
RECOMMENDATION
It is the development and administration of a structured teaching programme to the mothers on home care management of children with epilepsy.
FEEDBACK
It refers to monitoring and evaluating health promotion activity. In the present study,the post –test is planned to assess the knowledge of mothers regarding home care management of Epilepsy after administering the Structured Teaching Programme.
r
MODIFYING FACTORS
PERCEIVED SUSCEPTIBILI TY Risk factors such as Family
history of epilepsy, Inadequate knowledge about
the first aid measures, poor
home care management of
epilepsy.
PERCEIVED SERIOUSNESS Willingness to take preventive
measures, reducing the episodes of seizure and
duration
DEMOGRAPHIC VARIABLES OF
MOTHER Age, education, occupation, type of
family, type of marriage,mode of
delivery, birth history, place of
living CHILD Age, sex, onset of
first episode of seizure,type of
seizure
PERCEIVED BENEFITS Knowledge gained regarding the home
care management of epilepsy PERCEIVED
BARRIERS Such as ignorance,
family background, beliefs,cutures truths and myths
RECOMMENDATIONS FOR ACTION
Researcher organised a Structurd teaching programme
for home care management of epilepsy
PERCEIVED THREAT
Episodes of epilepsy complication due to poor
knowledge
CUES TO ACTION: Health personnel ,TV, Radio, Mass Media, Friends, Magazines, Advice from relatives.
INDIVIDUAL PERCEPTION LIKELIHOOD ACTION
P R E T E S T EXPERIMENTAL
GROUP
CONTROL GROUP
P O S T T E S T
FEEDBACK
FIGURE 1.5 MODIFIED HEALTH BELIEF MODEL (ROSENSTOCK-1977 )
STRUCTURED TEACHING PROGRAMME
ADEQUATE
MODERATELY ADEQUATE
INADEQUATE
CHAPTER II
REVIEW OF LITERATURE
CHAPTER-II REVIEW OF LITERATURE
THE REVIEW OF LITERATURE IS DIVIDED INTO FIVE PARTS I.Reviews related to Incidence and prevalence of epilepsy in children ii . Reviews related to knowledge and attitudes of the parents
iii. Reviews related to effectiveness of structured teaching program iv . Reviews related to management of epilepsy
v .Reviews related to psychosocial impact to the mothers of children with epilepsy I. PREVALENCE OF EPILEPSY IN CHILDREN
Azza Kamal Alshahawy et al. (2018) the Cross –sectionalstudywasconducted a study on Prevalence of unknown epilepsy among the school going children in Gharbia.
Validated questionnaire was distributed among rural and urban primary and preparatory school children. 9545 students completed the questionnaire. Among those 69 students proved that they have idiopathic epilepsy. Prevalence of idiopathic epilepsy among school children 6-14 years was 7.2/1000 in their life. Prevalence rate was high in males and in children from urban areas. Family history of epilepsy was 73.9%. Parental consanguinity were evident and 21.7% of the epileptic children.
Among those Odd ratio was 23.9 for idiopathic epilepsy in children with family history .
Najafi et al. (2018) Association of Family History of Epilepsy with Earlier Age Onset of Juvenile Myoclonic Epilepsy1915 epileptic patients were assessed. Totally, 194 (10%) Juvenile Myoclonic Epilepsy.patients were diagnosed, and 102 (53%) cases were female Seventy-seven cases (40%) of JME patients were positive family history, first-degree relatives were 58 (75%) and 19 (25%) had second degree relatives. Regarding the gender, there were no significant differences between PFH
and NFH patients (P>0.05). Occurrence of JME before 18 yr old among PFHE patients was significantly higher.
Nizish Akhter (2018)A cross sectional survey was conducted on Awareness and prevalence of Epilepsy in educational Hubs at Shringal, Khyber Pakhtunkhwa Sample size was calculated as NO:5308,Target Population 20,000. A total No:114(2.18%) positive cases were found irrespective of educational level.High prevalence rate were found in Females at primary (60.7%) and secondary level (35.7%), On the other hand high rate of prevalence of males(20.9%) at tertiary and professional level respectively.
Vincenzo Buono et al. (2019)A cross sectional study were conducted on Epidemiology and familial clustering of pediatric epilepsy in the geographic isolate of Ischia. Totally 61,086 individuals, 8381 of them aged from 0 to 14 years. Thirty-six children and adolescents were included. 4.3 per 1,000 (95% CI 3.0–5.9)was the prevalence of epilepsy in the Ischia island. Incidence was 51.7 / 100,000 person-years (95% CI 36.2–71.6). Sixteen (44.4%) patients had a genetic (idiopathic) origin, 20 (55.6%) a symptomatic (structural/metabolic) etiology. Their pedigrees were proved of dominant inheritance in six and of recessive inheritance in three families.
Kirsten.Met al. (2017)A systemic review and meta-analysisof international studies were investigatedonprevalence and incidence of epilepsy. They were taken a total of 222 studies (198 on prevalence and 48 on incidence ). The annual incidence rate was 61.44per 1,00,000 person /year(95% CI 50.75-74.38) . The prevalence of epilepsy did not differ by age, sex, study quality.The prevalence and incidence rate were higher in low and middle income countries.Idiopathic cause and generalized seizures had the highest prevalence.
Peter Camfield et al. (2015)A systemic review were conducted on Incidence,
prevalence and aetiology of seizures and epilepsy in children The incidence rate in childrenupto the age 12 years were ranges from 41–187/100,000. Higher incidence is reported from underdeveloped countries, particularly from rural areas. The incidence rate was very high in Infancy period of about 3.2/1000 in developed countries. On the
contrary, in underdeveloped countries this range were about 3.6/1000. Prevalence is higher in ruralareas.
Elizabeth ablah et al (2014)A study revealed that prevalence of epilepsy The Crude Prevalence Rate of epilepsy was investigated by utilizing the resources such as medical record survey methods. There were 404 active epilepsy people were participated. The overall prevalence 7.2 per 1000 cases of active epilepsy found.
Ideopatic seizure was about 71.3% of cases. Among the 76 cases with known and classifiable seizure type, 55.3% had focal with secondary generalized seizures..17 per 1000 population wre found overall estimated prevalence in Kansas countries
Laura Ochoa-Gómez. ( 2017)A cohort study was conducted of epilepsy according to the age at onset was investigated up to 3 years in a regional reference pediatric neurology unit . A total of 4595 children participated during the study period. The diagnosis of epilepsy was established in 605 (13.17%): 277 (45.79%) symptomatic, 156 (25.79%) idiopathic, and 172 (28.43%) with cryptogenic epilepsy. More than one- quarter (26.12%) of epilepsies began at the age of one year, and 67.72% were symptomatic. Refractory epilepsy was seen in 25.29%, 42.46% with cognitive impairment, 26.45% with motor involvement.
Kari ModalsiAaberg et al. (2017) conducted nationwide study on incidence and prevalence of epilepsy .epilepsy affects 0.5% to 1% of children due to chronic neurological conditions. Incident rates of epilepsy among the children is low in high income countries than low income countries 112 744 children aged 3 to 13 years (mean 7.4 years) 587 (66%) met the criteria for diagnosis of epilepsy . The incidence rate of epilepsy was 144 per 100 000 person-years in the first year of life and 58 per 100 000 for ages 1 to 10 years. The cumulative incidence of epilepsy was 0.66% up to the age 10 years, specifically 0.62% having active epilepsy.
Shakiruiiah et al. (2014)wereconductedthe investigation on The prevalence and incidence and etiology of epilepsy by the methods of Sytematic review .In North America there was a high prevalence in Males than female children .on the contrary, In Asian countries such as China ,India ,Turkey were prevalence of epilepsy high in females than males. Moreover, Generalized Seizure is high in America ,Asia,, Europe
and Africa than other types of Epilepsy. Few data only available about the incidence of Epilepsy especially from the low and middle income countries, overall incidence for prevalence was high in males than female children due to the causes of Head Injury ,Birth Trauma ,Intra Cranial Infection.
Karl Titze(2015) A prospective longitudinal study was conducted on Prenatal and family risks of children born to mothers with epilepsy effects on cognitive development. Total 116 children were participated .Half of the mothers with epilepsy (n=29) had one or a maximum of two generalized seizures during pregnancy. the number of women with two seizures was above average (p=0.002, χ2=11.929). on the other hand, to researchers expectation, the seizure frequency of women without AED therapy was comparable to that of women in the combined AED therapy groups (46%
VS 45%) IQ scores investigated at 6 years of age not differ between study participants and those who dropped out (n= 105, n = 104; ANOVA df =208; F=1.2; p=0.27) Carolyn Gardella et al. (2001) a systemic review were conducted on the effects of sequential use of vacuum and forceps for assisted vaginal delivery on neonates and maternal outcomes. They found that Neonatal seizures 1.3 per 1000 infants delivered by a vacuum extractor and forceps than spontaneous delivered (only 0.2 per 1000 infants affected} so, the study were concluded that instrumental delivery place a major risk on neonatal epilepsy.
II. REVIEWS RELATED TO KNOWLEDGE AND ATTITUDE OF THE PARENTS OF CHILDREN WITH EPILEPSY
Ali-asgharkolahi et al (2017)A descriptivecross sectional study was conducted on knowledge ,attitudes and practices among the mothers of children with epilepsy through face to face interview method which was done by a trained female general practitioners.Total206 participants were analysed, More than 98% of the mothers were having the inadequate knowledge, 2% of the mothers having moderatey adequate level of knowledge and no one having adequate level of knowledge.According to their findings , mothers were hide their children disease though they have been referred to the health care center, 84% of mothers had provided their children with ineffective
treatment, mostly based on superstition.so there is a need for effective educational programs to improve the knowledge.
Andreas Chiabi et al (2016) A cross sectional and descriptive study revealed that Knowledge and attitude of parents towards the first seizure episode in children was conducted over a period of Six months. All parents (98%) were frightened by theseizure, and the main reason for fear of child’s death (91%), spiritual beliefs (2%
each) and suffocation, meningitis, coma (1% each). Concerning their knowledge on the home management of seizures only 31 (20.9%) admitted they will immediately take the child to a hospital for urgent treatment. Thirty-two (21.6%) have possessd that child inhale a strong odour, 22 (14.9%) placed the child’s head in latrine and 11 (7.4%) they did not have any idea about the epilepsy management.
AysegulNesaCitakurt (2018) A descriptive cross sectional study was conducted the knowledge and attitudes of parents about epilepsy Totally 1200 parents, Among those,a total of 746 (62.2) mothers and 454 (37.8) fathers participated in this study.
The mean Age was 36.3 + 92 years .the educational level was high school or higher in 65.3%. The mother and the father had similar level of knowledge and attitude. The highest knowledge level and the best attitudes about epilepsy according to the educational level was in the “ University or higher “ group. A positive correlation was found between the knowledge level and positive epilepsy attitude of the parents. At the end, a more positive attitude and better knowledge about the epilepsy with increasing educational level. So, the study concluded that parents had the negative attitudes towards the epilepsy were caused by lack of information .
JalleTeferi and ZewduShewangizaw(2015) A community based cross-sectional study was conducted on assessment of knowledge, attiude and practices related to epilepsy.682 study participants among those 72% of the participants were rural dwellers. so they have the very less knowledge (AOR=0.58, 95% CL=0.35-0.96) due to distance between the home and health institutions.( more than 61 minutes ) rural dwellers, living alone , formal education heard information about the epilepsy ,distance of health facility from the community prior knowledge about the epilepsy
and unsafe practices related to epilepsy, unfavourable attitudes towards epilepsy were factors responsible for impact of knowledge ,attitudes and practices of epilepsy . MU Akpan et al (2012) were carried out a comparative study between urban and rural school teachers regarding knowledge of seizure disorder with respect to cause, diagnosis, and treatment. Among the rural school teachers 6.1% of them believed that seizure disorder is caused by evil spirits. Similarly, 22.4% of rural school teachers in South‑Eastern asiaand 0.6% of teachers in Zimbabwe. A urban respondents (28.8%) were believed on the sane concept of rural respondents, 27.7% of the teachers were found in middle belt of Nigeria but more than 0.9% were found among Thailand school teachers. So, Overal knowledge regarding the seizure disorder among the schoolm teachers were believed mostly based on the evil spirit that leads to negative attitudes towards the disease condition.
Shrikant Desai (2015) experimental study was conducted on knowledge regarding the effectiveness of planned teaching programme in epilepsy management in school children among the school teachers. 50samples (25 experimental and 25 control group pre-test both experimental and control group 84% had inadequate knowledge 16% had moderate knowledge and no one of the respondants had adequate knowledge. So he was concluded that there is a need for planned teaching program in epilepsy management in school children among the school teachers
III. STUDIES RELATED TO EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME REGARDING EPILEPSY
Aruljothi(2018) A experimental study was carried out to assess the effectiveness of Structured teaching Program on Knowledge, Attitude and Practices on Home care management of epilepsy among the family members of patients with epilepsy. The study revealed that pre-test level of knowledge 48% had inadequate knowledge, 16%
of them had moderately adequate knowledge and only 36% of the family members had the adequate knowledge .After STP, 84% had adequate knowledge,16%of them
had moderately adequate knowledge and o one had inadequate knowledge.This study strongly proved that effectiveness of Structured Teaching Progromme.
Mayada Taha Mohamed Sabealet al (2018) a Quasy experimental research study were carried out on educational program for school health nurses and teachers regarding primary school children with epilepsy.249 teachers were participated in this study and all the school health nurses were participated. the results were found in this study ,there were significant improvement in knowledge, attitudes and practices regarding epilepsy.(4.23±1.23 to 5.14±1.08 and 1.49±1.07 to 4.57±1.46,) (6.91±1.60 to 10.68±2.06and 2.59±2.32to 9.26±2.21) (2.27±2.55 to 3.18±2.46 and 0.78±1.79 to 3.27±2.38) after the educational program implementation respectively .
Hanne Hagemann (2017) A quantitative pre and post experimental research design was conducted on efficacy of educational programs of epilepsy among the parents Parents of the FAMOSES group significantly improved in epilepsy-specific knowledge (group × time interaction: p b .001), coping (p b .01), epilepsy-related fears (p b .05), and in speaking about epilepsy with their child (p b .05) compared with the control group..71% of the parents had adequate knowledge and 27% of the parents had moderately adequate knowledge only 2% of the parents had inadequate knowledge after the educational intervention The efficacy of the FAMOSES parents' program was confirmed. The results indicate that imparting knowledge and the interactive approach help parents in coping with their child's epilepsy and reduce epilepsy-related fears.
Rohit Kumar et al (2019) A randomized controlled trial were conducted on Impact of structured teaching program on the parent's knowledge of domiciliary management of seizure to assess the combined effects Structure Teaching Program and thePatient Information Pamphlet on caregivers of children with epilepsy .Intervention Group:
STP along with PIP, Control Group only PIP given.The outcome of the questionnaire was measured. The control group has shown no significant difference in the knowledge scores at one-month follow-up (p = 0.58). Post-intervention knowledge scores (p < 0.01) and mean difference in the knowledge scores (p < 0.01) were
significantly higher in the intervention group when compared with controls.
Structured teaching program regarding first-aid measures for convulsion along with PIP was effective in improving the knowledge of caregivers than PIP alone
Jyothi George et al (2014)aexperimental one group pre-test post-test only design were used to evaluate the effectiveness of Structured Teaching Programme regarding knowledge on management of febrile seizures among the mothers of under five children. The results of this study was the mean knowledge score in pretest was 11.5 and SD = 3.59 and in posttest mean was 24.41 and SD = 3.2. to conclude, mean posttest knowledge of mothers of under five children regarding management of febrile convulsion was significantly greater than their mean pretest knowledge score.'t'= 37.6 significant at p > 0.01.
Naveen kumar Sharma et al (2014)a Pre experimental research design were used for the investigation regarding effectiveness of structured teaching program on knowledge regarding Epilepsy in children among the school teachers they found that pre-test knowledge score of teachers on epilepsy in children, 5(8%) teachers had inadequate knowledge, 41(80%) had moderate knowledge and 4(12%) had adequate knowledge.
In the post test , 50(100 percent) were having adequate knowledge .The mean post-test knowledge score was 36.10 which is higher than mean pre-test score, 25.38. The scores denoted that the structured teaching program was effective.
Fawsia El Sayed Abusaad et al (2014) aquasi experimental study werecompassedonImpact of Educational Sessions for Epileptic Children Mothers on Their knowledge, Adherence to Antiepileptic Drugs and Seizures Severity among their Children. 100 mothers were investigated. (59%) of the mothers have poor knowledge and only (3%) of them have good knowledge. but after three and six month of intervention, The majority of them 95% & 98% have the adequate knowledge. They become adherent to drugs administration and decreasd the severity level of seizure among children respectively. This study proved that Educatioan sessions improved the knowledge effectively.
Akpan MU et al (2013)across sectional study were conducted on knowledge and attitudes towards seizure disorders among the urban and rural school teacheersinAkwaIbom State, The study period was 4 months. Total 132 Urban Teachers and an equal number of their rural teachers were completed the questionnaire. Most of the urban (60.6%) and rural (57.6%) school teachers were National Certificate of Education holders. Thirty-eight (28.8%) of urban respondents versus eight (6.1%) of rural respondents thought seizure disorder was caused by evil spirits. On the contrary, 60 (45.5%) urban respondents compared to 80 (60.6%) of rural respondents felt seizure disorder was infectious disease of the brain. There was no significant difference in the mean overall knowledge and attitudes of school teachers to seizure disorder in the two settings (P = 0.33 for knowledge and 0.28 for attitudes). Teachers’ high level of education had a positive influence on their knowledge and attitudes towards children with seizure disorder. To conclude,The study proved that both Urban and Rural teachers had the poor knowledge regarding the seizure disorder
IV. STUDIES RELATED TO MANAGEMENT OF EPILEPSY
Ann hazard Sharlene J.(2019) adescriptive study was conducted on Factors related to adherence of medication regimens in paediatric patients. The 35 paediatrc patients at a public hospital serving to the Low-income patients .Parent and child satisfaction with medical care was associated with greater adherence .Parents worry about the child’s health was positively correlated with the various numbers of behavioural restrictions placed on the child’s health and both the variables were negatively related to a adherence .so the Authors hypothesized that anxiety-based denial and perceived threats to patient autonomy was interfere with the medication adherence .
RobortoCarabello (2019) A qualitatiove research study Childhood only episodes with generalized tonic –clonic seizures , a well defined epileptic syndrome by observational methods was used to conduct this study Over a 12 year period (2005- 2017 ) 26 patients met the inclusion criteria of epilepsy with Generalized Tonic – Clonic Seizures only .Mean age of onset was 5 years of age the Seizure occured while
awake for 16 patients ,during the sleep at night patients had seizures .the duration of seizure was around 3 minutes .Generalized spike and wave discharged were observed in all patients when awake and during the sleep in eight and twenty- six patients respectively .among those 19 well responded with the medications of valproic acid or Leviteracetam .initially, 2 patients who received the Clobazam did not respond’s well with that later on switched on to the vlproic acid results in excellent seizure control . Eric H.kossoff (2018)A qualitative Study multi-center Clinical Trials was revealed on Optiml clinical management of children receiving dietary therapy for epilepsy in childre. Ketogenc Diet therapy was conducted Non –pharmacological Treatments were established treatment for intractable childhood epilepsy. It had been helpful for drawing a protocols for Ketogenic diet Therapy.The guidelines present a revised versionwith additional authors ,clarifying indication for use,sideeffects during initiation and ongoing use,value of supplements and methods of Ketogenic Diet Therapy discontinuation .
Rob smith (2017)Aexperimental study was conducted Midazolam for status epileticusmidazolam is the first line of treatment for status epilepticus. Thedrug can be given through the several routes. Among this transmucosal route is the safest route and effective and easier to use.Transmucosal Pre-hospital administration by caregivers is recommended for parents for parents with prediction of prolonged seizures or those have the limited access to emergency hospital care .this reduces the time duration of seizures .For pre-hospital use 5mg in 1 ml plastic Ampoules is recommended . Midazolam is a benzodiazepine which is the recommended first-line drug for treatment of status epilepticus. When used according to guidelines for infants, children and adults it appears safe and effective.
