Patients with epilepsy care experiences: Comparison between services with and without an epilepsy specialist nurse

Integrated Care in Epilepsy Management: A Scoping Review of the Models and Components of Health and Social Care Delivery

Introduction

Epilepsy is the most common neurological condition globally. Integrating health and social care is fundamental in epilepsy management, but the scope of progress in this area is unclear. This scoping review aimed to capture the range and type of integrated care components and models in epilepsy management.

Methods

Four databases were searched for articles published since 2010 that reported on integrated care in epilepsy. Data were extracted and synthesised into components of integrated care that had been implemented or recommended only. Models of integrated care were identified, and their components tabulated.

Results

Fifteen common and interrelated components of integrated care emerged that were aligned with four broad areas: healthcare staff and pathways (e.g., epilepsy nurses); tasks and services (e.g., care coordination); education and engagement (e.g., shared decision making); and technology for diagnosis and communication (e.g., telehealth). Twelve models of integrated care were identified; seven were implemented and five were recommended.

Discussion

There is a growing evidence-base supporting integrated, person-centred epilepsy care, but implementation is challenged by entrenched silos, underdeveloped pathways for care, and deficits in epilepsy education.

Conclusion

Integrating epilepsy care relies on changes to workforce development and policy frameworks to support whole-of-system vision for improving care.

Impact of educational actions on the quality of life of patients with epilepsy: A randomised controlled trial

INTRODUCTION

Epilepsy is a common and disabling disease for patients and their families. The care of these patients is no longer limited to the simple control of seizures, but considers, in a more global way, their quality of life (QOL). Improving the QOL is precisely one of the main objectives of therapeutic education. The aim of this study was to evaluate the impact of educational actions on the global QOL of patients with epilepsy.

MATERIALS AND METHODS

This study was carried out between October 2016 and August 2018. 80 patients were included over 18 years old with an epileptic condition diagnosed for at least 6 months and treated in the University Hospital of Caen Normandy in France. They were randomised to either the control group with usual care or the experimental group with the group educational sessions. The overall score for the QOLIE-31 survey was assessed from the inclusion (M0) and 6 months late.

RESULTS

At the M0 mark, the score of the control group (58.1 ± 12.3) was significantly lower than that of the experimental group (61.1 ± 14.3). After 6 months, the overall QOL score, was significantly higher for the experimental group compared to the control group (p = 0.002). In the experimental group, the overall score went from 61.1 ± 14.3-69 ± 14.2 and in the control group it went from 58.1 ± 12.3-58 ± 16.2.

DISCUSSION

The quality-of-life overall score for patients having participated in educational actions provided by epilepsy specialist nurses improved significantly. Complementary research is necessary to assess the sustainability of these effects and interactions with the caregivers.

Construction of nursing-sensitive quality indicators for epilepsy in China: A Delphi consensus study

OBJECTIVE

The quality and safety of epilepsy care are of great importance because seizures are unpredictable. The aim of this study was to develop a set of nursing-sensitive quality indicators (NSQIs) for assessing and improving the quality of epilepsy nursing care in China.

METHODS

An international literature review, a cross-sectional survey and a qualitative study were conducted to identify candidate NSQIs for epilepsy care and compile a questionnaire. Then, two rounds of electronic Delphi studies were conducted with a panel of 27 independent experts to identify the final NSQIs for epilepsy.

RESULTS

Thirty-nine candidate NSQIs were extracted for the Delphi process. The recovery rates in the first and second rounds of expert consultations were 92.6% and 96.2%, respectively. The experts' authority coefficients of the two rounds were 0.876 and 0.878, respectively. The Kendall W value of the two rounds ranged between 0.094 and 0.200 (p<0.001). Eight structure indicators, 9 process indicators and 7 outcome indicators that represented the following three domains were included in the set of NSQIs for epilepsy: nursing resource allocation, implementation of nursing care, and outcomes of patients with epilepsy.

CONCLUSION

These NSQIs for epilepsy provide a primary foundation for monitoring and improving the quality of epilepsy nursing care in China. However, the effects of these indicators on improvements in epilepsy care and outcomes in patients need to be verified in clinical practice.

Determining the role and responsibilities of the community epilepsy nurse in the management of epilepsy

AIMS AND OBJECTIVES

The aim of this study is to enhance the understanding of the core elements and influencing factors on the community-based epilepsy nurse's role and responsibilities.

BACKGROUND

Internationally, epilepsy nurse specialists play a key role in providing person-centred care and management of epilepsy but there is a gap in understanding of their role in the community.

DESIGN

A national three-stage, mixed-method study was conducted.

METHODS

One-on-one, in-depth semi-structured qualitative interviews were conducted online with 12 community-based epilepsy nurses (Stage 1); retrospective analysis of data collected from the National Epilepsy Line, a nurse-led community helpline (Stage 2); and focus group conducted with four epilepsy nurses, to delve further into emerging findings (Stage 3). A thematic analysis was conducted in Stages 1 and 3, and a descriptive statistical analysis of Stage 2 data. Consolidated Criteria for Reporting Qualitative studies checklist was followed for reporting.

RESULTS

Three key themes emerged: (1) The epilepsy nurse career trajectory highlighted a lack of standardised qualifications, competencies, and career opportunities. (2) The key components of the epilepsy nurse role explored role diversity, responsibilities, and models of practice in the management of living with epilepsy, and experiences navigating complex fragmented systems and practices. (3) Shifting work practices detailed the adapting work practices, impacted by changing service demands, including COVID-19 pandemic experiences, role boundaries, funding, and resource availability.

CONCLUSION

Community epilepsy nurses play a pivotal role in providing holistic, person-centred epilepsy management They contribute to identifying and addressing service gaps through innovating and implementing change in service design and delivery.

RELEVANCE TO CLINICAL PRACTICE

Epilepsy nurses' person-centred approach to epilepsy management is influenced by the limited investment in epilepsy-specific integrated care initiatives, and their perceived value is impacted by the lack of national standardisation of their role and scope of practice.

NO PATIENT OR PUBLIC CONTRIBUTION

Only epilepsy nurses' perspectives were sought.

Evaluation of Health Science Students' Health Fatalism and Perception Towards Patients With Epilepsy: A Cross-Sectional Global Study

Introduction The social acceptance of patients with epilepsy is largely determined by society's opinion of epilepsy; therefore, individuals with epilepsy could face prejudice and stigma as a result of negative impressions. Religious beliefs and mystical notions have been shown to influence attitudes toward epilepsy. Health fatalism could also be detrimental to society's and caregivers' approach toward such patients. In extreme settings, this could hinder them from obtaining an adequate treatment process. Methods A cross-sectional exploratory study was conducted from February 2022 to May 2022 in Saudi Arabia, Spain, Scotland, and Italy using an online questionnaire consisting of 33 questions concerning the Health Fatalism Scale (HFS), the Epilepsy Knowledge Scale (EKS), and the Epilepsy Attitude Scale (EAS). Results A total of 735 health science students (HSS) participated in the present study. The majority of participants were females (64.1%) while male participants represented 34.6% of the study. Health science students currently studying in Saudi Arabia represented the majority of participants with a percentage of 58.5%. Among the four countries, students in Saudi Arabia presented with the highest knowledge mean score. Students in Spain had the highest mean attitude score. Muslim students had the highest mean fatalism scores followed by Christian students. Conclusion In general, a high level of knowledge was observed among the participants, most notably, among Saudis who presented with the highest level of knowledge across the four countries. Regarding attitude, Spanish students presented the best attitude towards patients with epilepsy. Low fatalism scores were commonly observed across all countries regardless of their different demographic characteristics. Fatalism perception should be further detailed to ensure optimal services are delivered without prejudgment by future healthcare workers.

Enhancing patients' experiences of living with epilepsy

Epilepsy is a multifaceted neurological condition that has many causes. Living with epilepsy can have significant physical, psychological and social effects on an individual and their family. A patient's experience of living with epilepsy can be influenced by multiple factors, such as pre-existing comorbidities or underlying risk factors for developing comorbidities. This article explores the experiences of patients with epilepsy at the point of diagnosis, in hospital and when taking anti-epileptic drugs. It also details various evidence-based interventions that can improve these patients' experiences and the quality of care that they receive.

Evaluating the knowledge of and attitudes toward epilepsy among Turkish undergraduate nursing students: A cross-sectional study

AIM

This study was conducted to examine the knowledge of and attitudes toward epilepsy among nursing students.

METHOD

This descriptive and cross-sectional study was conducted with 369 nursing students. Data were collected through an anonymous online questionnaire prepared using the Introductory Information Form, Epilepsy Knowledge Scale (EKS), and Epilepsy Attitude Scale (EAS). Descriptive statistics, the Mann-Whitney U test, Student's t test, one-way ANOVA, and Pearson correlation test were used in the data analysis. A p value of 0.05 was considered the threshold for statistical significance.

FINDINGS

The sample of the study consisted of nursing students, and more than half of the students (63.4%) were females. 32.2% of the students were third-year students, and the mean age was 21.36 ± 2.12 years. The mean scores obtained on the EKS and the EAS were 10.03 ± 33.21 and 56.39 ± 5.40, respectively. A significant positive correlation was found between the knowledge and attitude scores of the students regarding epilepsy (p < 0.05), and students' attitude scores toward epilepsy increased with increased knowledge of the subject matter. Overall, female students had better knowledge levels and a more positive attitude toward epilepsy than male students (p < 0.05). Further, the students who had witnessed an epileptic seizure, knew someone with epilepsy, or provided care for patients with epilepsy, had higher scores on the EKS, and displayed better knowledge toward epilepsy (p < 0.05).

CONCLUSION

Nursing students were found to have moderate knowledge of and a positive attitude toward epilepsy. The positive attitude toward epilepsy increased with the increasing knowledge of epilepsy.

Using a mixed method to develop consensus-based aims, contents, intended learning outcomes, teaching, and evaluation methods for a course on epilepsy for postgraduate or continuing education in community health nursing programs

BACKGROUND

Knowledge deficits with regard to epilepsy have been reported among healthcare professionals. This study was conducted to develop consensus-based aims, contents, intended learning outcomes, teaching, and evaluation methods for a course on epilepsy for postgraduate or continuing education in community health nursing programs.

METHODS

A mixed method which combined a thorough search of literature, the nominal group technique, the Delphi technique, and survey of students' agreement was used. The databases MEDLINE/PUBMED, EMBASE, COCHRANE, CInAHL/EBESCO, SCOPUS, Google Scholar, Google Books, and Amazon were searched to identify potential aims, topics/contents, intended learning outcomes, teaching, and evaluation methods. Discussions and deliberations in serial meetings based on the nominal group technique were attended by educators/academicians (n = 12), neurologists (n = 2), practicing nurses (n = 5), pharmacists (n = 2), patients with epilepsy (n = 2), and students in postgraduate and continuing education programs (n = 7) to supplement and refine the data collected from the literature. The qualitative data were analyzed using RQDA tool for R. The Delphi technique was used among educators/academicians (n = 15), neurologists (n = 2), practicing nurses (n = 5), pharmacists (n = 2), patients with epilepsy (n = 3), and students in postgraduate and continuing education programs (n = 8) to achieve formal consensus.

RESULTS

Consensus was achieved on 6 aims, 16 intended learning outcomes, and 27 topics in the course. Of the topics, 13 were relevant to nature of epilepsy and seizures, 2 were relevant to the impact of epilepsy and seizures on different life aspects of patients with epilepsy, 4 were relevant to advocating for the patients and supporting their choices, 5 were relevant to educating patients and their caregivers, and 3 were relevant to assessments and services.

CONCLUSION

Consensus-based aims, topics/contents, intended learning outcomes, teaching, and evaluation methods of a course on epilepsy for postgraduate or continuing education in community health nursing programs were developed. Consensus-based courses could bridge knowledge gaps and improve educating community health nursing programs on epilepsy. Further studies are needed to determine if such consensus-based courses could promote care of patients with epilepsy.

Carer evaluations of paediatric epilepsy services with and without epilepsy specialist nurse provision

PURPOSE

To compare paediatric epilepsy services with and without Epilepsy Specialist Nurse (ESN) provision on measures of carer satisfaction and accessibility of service.

METHODS

In Study 1, carers in Northern England (n = 69 with an ESN, n = 27 without an ESN), completed the Parent Report of Psychosocial Care Scale to measure satisfaction with service provision. A measure of accessibility of service was also included. In Study 2, in depth semi-structured interviews with 58 carers (51 of whom had also participated in Study 1) were examined for talk related to accessibility of service.

RESULTS

In Study 1, Satisfaction with service levels were high across all areas, (ESN areas Mdn = 9.04, IQR = 1.48, non-ESN areas Mdn = 8.29, IQR = 2.41; maximum score = 10), but with carers from ESN areas over 3 times more likely to endorse scores at the median or above relative to non-ESN areas (OR = 3.28). For accessibility, carers in ESN areas were over 5 times more likely to have a median score or higher (ESN areas Mdn = 10, IQR = 0.45, non-ESN areas Mdn = 8.4, IQR = 5, OR = 5.43). In study 2 a majority of all carers reported having made at least one attempt to contact services between appointments, for a wide range of reasons, with timely resolution reported in ESN areas, but more variable resolution occurring in non-ESN areas.

CONCLUSION

Paediatric ESNs provide a critical and timely service to children with epilepsy and their carers.

Classifying epilepsy pragmatically: Past, present, and future

The classification of epilepsy is essential for people with epilepsy and their families, healthcare providers, physicians and researchers. The International League Against Epilepsy proposed updated seizure and epilepsy classifications in 2017, while another four-dimensional epilepsy classification was updated in 2019. An Integrated Epilepsy Classification system was proposed in 2020. Existing classifications, however, lack consideration of important pragmatic factors relevant to the day-to-day life of people with epilepsy and stakeholders. Despite promising developments, consideration of comorbidities in brain development, genetic causes, and environmental triggers of epilepsy remains largely user-dependent in existing classifications. Demographics of epilepsy have changed over time, while existing classification schemes exhibit caveats. A pragmatic classification scheme should incorporate these factors to provide a nuanced classification. Validation across disparate contexts will ensure widespread applicability and ease of use. A team-based approach may simplify communication between healthcare personnel, while an individual-centred perspective may empower people with epilepsy. Together, incorporating these elements into a modern but pragmatic classification scheme may ensure optimal care for people with epilepsy by emphasising cohesiveness among its myriad users. Technological advancements such as 7T MRI, next-generation sequencing, and artificial intelligence may affect future classification efforts.

The emerging role of the advanced practice epilepsy nurse: A comparative study between two countries

AIMS AND OBJECTIVES

The aim of the study was to compare advanced practice in epilepsy nurses in Spain and United Kingdom, identifying differences in the domains of standard advanced practice.

BACKGROUND

Europe has recently faced the challenge of providing high-quality care for patients with epilepsy, a disease that generates many health demands. In some countries, such as the United Kingdom, advanced practice nursing is well established and could serve as a guide for implantation in countries where it is still in development, as is the case of Spain.

DESIGN

A multicentre cross-sectional descriptive cohort study compared differences in the roles of advanced practice nurses in Spain and the United Kingdom.

METHODS

The Advanced Practice Role Delineation Tool and its validated Spanish version were administered using an online questionnaire in a cohort of advanced practice epilepsy nurses in both countries. A convenience sample was recruited between January to December 2019. The study complied with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist.

RESULTS

Most United Kingdom nurses in our sample came from community environments, in contrast to Spanish nurses who worked in hospital. All domains analysed in the survey had significantly higher scores in the United Kingdom than in the Spanish cohort, especially in the research and leadership domains.

CONCLUSIONS

The advanced practice role in Spain is underdeveloped compared with the United Kingdom. Differences in the settings of advanced roles in epilepsy nurses may be explained by greater community practice in the United Kingdom and differences in organisational and health systems.

RELEVANCE TO CLINICAL PRACTICE

Our study showed the need to implement specific policies to develop advance practice nurse roles in Spain to improve the quality of care of patients with epilepsy.

Coproducing health and well-being in partnership with patients, families, and healthcare providers: A qualitative study exploring the role of an epilepsy patient portal

BACKGROUND

Coproduced epilepsy care sees people with epilepsy (PwE), their care-proxies, and healthcare providers (HCPs), working together as partners to build strong relationships, improve communication, trust, and share decision-making. Coproduction underpins good quality patient- and family-centered care (PFCC) that is responsive to individual patient needs, preferences, and values. By facilitating information sharing and exchange between partners, electronic patient portals (ePortal) can enable coproduction. This paper explores what HCPs, PwE, and their care-proxies value from their user experience of PiSCES, the Irish epilepsy ePortal.

METHODS

A purposeful sample of actors involved in the receipt and delivery of epilepsy care and services were recruited via adult epilepsy centers at St James's and Beaumont Hospitals in Dublin. Interactive codesign sessions, surveys, and focus groups were used to elicit perspectives from PwE, care-proxies, and HCPs to understand their perception of how PiSCES could enhance or inhibit the epilepsy care process.

RESULTS

Results illustrate that participants welcome the role PiSCES can play in: empowering PwE/care-proxies, strengthening confidence in the healthcare system; aiding memory; advancing health literacy, motivating PwE to understand their condition better; acting as a passport of care between different clinical settings; and creating a foundation for stronger coproduction partnerships. PiSCES was generally embraced; however, some HCPs expressed plausible concerns about how clinical implementation might impact their work practices.

CONCLUSION

"Nothing about me without me" is a core value of the PiSCES initiative, recognizing that people need to be included in the planning of their own treatment and care. Our data show that PwE, their care-proxies, and HCPs value PiSCES potential, particularly in bolstering healthcare partnerships that foster inclusion, confidence, and trust.

Determining the role and responsibilities of the Australian epilepsy nurse in the management of epilepsy: a study protocol

INTRODUCTION

Epilepsy is a common neurological condition affecting between 3% and 3.5% of the Australian population at some point in their lifetime. The effective management of chronic and complex conditions such as epilepsy requires person-centred and coordinated care across sectors, from primary to tertiary healthcare. Internationally, epilepsy nurse specialists are frequently identified as playing a vital role in improving the integration of epilepsy care and enhancing patient self-management. This workforce has not been the focus of research in Australia to date.

METHODS AND ANALYSIS

This multistage mixed-method study examines the role and responsibilities of epilepsy nurses, particularly in primary and community care settings, across Australia, including through the provision of a nurse helpline service. A nationwide sample of 30 epilepsy nurses will be purposively recruited via advertisements distributed by epilepsy organisations and through word-of-mouth snowball sampling. Two stages (1 and 3) consist of a demographic questionnaire and semistructured interviews (individual or group) with epilepsy nurse participants, with the thematic data analysis from this work informing the areas for focus in stage 3. Stage 2 comprises of a retrospective descriptive analysis of phone call data from Epilepsy Action Australia's National Epilepsy Line service to identify types of users, their needs and reasons for using the service, and to characterise the range of activities undertaken by the nurse call takers.

ETHICS AND DISSEMINATION

Ethics approval for this study was granted by Macquarie University (HREC: 52020668117612). Findings of the study will be published through peer-reviewed journal articles and summary reports to key stakeholders, and disseminated through public forums and academic conference presentations. Study findings will also be communicated to people living with epilepsy and families.

Patient satisfaction with information provided by epilepsy specialist nurses: Results of an online survey

The aim of this study was to investigate the perspective of Norwegian patients with epilepsy regarding the information that they have received about epilepsy-related issues and to determine whether there was a difference in information received between those who had been followed up by an epilepsy specialist nurse (ESN) and those who had not. Further, were there differences regarding satisfaction with the information between the two groups? We conducted an online survey in close collaboration with the Norwegian Epilepsy Association. A total of 1859 respondents (1182 patients with epilepsy and 677 carers for patients with epilepsy) completed a web-based questionnaire. They were asked about epilepsy-related issues on which they had received information, the extent to which they were satisfied with this information, and whether they were being followed up by an ESN or not. Significantly more patients followed up by an ESN had received information about the epilepsy diagnosis, antiseizure drugs (ASDs), routine use of ASD, and risk of seizure-related injuries as compared to those not followed up by an ESN. In addition, patients followed by an ESN were more likely to be satisfied with the information they received. Just above or under half of the respondents had received or were satisfied with information about depression, anxiety, premature death, and sexual wellbeing. Our results indicate that follow-up by ESNs results in improvements in the information provided to patients with epilepsy; ESNs should be an integral part of comprehensive epilepsy service.

Agreement of Palestinian nursing students with recommendations to eliminate epilepsy stigma and change perception of the general public about epilepsy: A cross-sectional study

OBJECTIVE

This study was conducted to assess the degree of agreement of Palestinian nursing students with recommendations and key messages to eliminate/reduce epilepsy stigma and change perception of the general public about epilepsy and people with epilepsy (PWE).

METHODS

A cross-sectional observational study was conducted among undergraduate nursing students. The study tool was a questionnaire with 24 items which collected the sociodemographic and academic characteristics of the participants (6 items) and agreements with 18 recommendations and key messages to eliminate/reduce epilepsy stigma.

RESULTS

A total of 342 nursing students completed the questionnaire with a response rate of 68.4%. The participants agreed with the 6 recommendations to inform media, improve awareness, and educate the general public on epilepsy (agreement rates: 87.7% to 92.4%), 4 recommendations to coordinate efforts to improve awareness and educate the general public on epilepsy and PWE (agreement rates: 89.8% to 93.0%), and 8 key messages to eliminate/reduce epilepsy stigma (agreement rates: 70.2% to 93.9%). In general, female students tended to express significantly higher levels of agreement with the recommendations and key messages (p-value < 0.05).

CONCLUSION

Results of the present study highlighted the importance of involving nurses and future nurses in eliminating/reducing epilepsy stigma and changing perception of the general public about epilepsy and PWE. Further studies are to be conducted to investigate if these recommendations and messages can eliminate or significantly reduce epilepsy stigma and change perception of the general public about epilepsy and PWE.

Towards a pragmatic epilepsy classification: Future considerations

The Integrated Epilepsy Classification was recently proposed to merge the 2017 International League Against Epilepsy classification and the four-dimensional epilepsy classification updated in 2019. The efforts in developing the concept of an Integrated Epilepsy Classification scheme are encouraging. However, consideration of brain age, validation in contexts that differ in socioeconomic status and with poor healthcare infrastructure, and incorporation of a team-based approach are necessary. These advancements allow for better clinical management of people with epilepsy and empower people with epilepsy globally.

Crossword puzzles improve learning of Palestinian nursing students about pharmacology of epilepsy: Results of a randomized controlled study

OBJECTIVE

This study was conducted to investigate if crossword puzzles as active learning tools can improve the knowledge retention of nursing students in pharmacology of epilepsy and improve their performance in writing the correct spelling of antiepileptic drugs (AEDs).

METHODS

The present study was a randomized controlled prospective parallel study in which a control group design with pretests and posttests were used among nursing students. Students were randomly allocated to either control group (n = 114) who received routine learning or intervention group (n = 110) who received crossword puzzles. Both control and intervention groups had to complete multiple-choice question (MCQs) and spelling pretests and posttests.

RESULTS

Scores of the MCQs and spelling pretests were not statistically different (p-value > 0.05) for participants in all achievement categories in both control and intervention groups. In the intervention group, scores in the first and second MCQs and spelling posttests were significantly higher than their corresponding scores in the pretest scores for participants from the all achievement categories (p-value < 0.05) and scores of the first and second MCQs and spelling posttests were not significantly different (p-value > 0.05). Data analyses showed that there were significant normalized changes between scores of students in across all achievement categories.

CONCLUSION

Findings of this study suggested that crossword puzzles were effective in improving the learning of nursing students about the pharmacology of epilepsy and writing correct spelling of AEDs. Educators should consider using crossword puzzles as active learning tools to improve knowledge of nursing students about the pharmacology of epilepsy.

Quality of life and its association with comorbidities and adverse events from antiepileptic medications: Online survey of patients with epilepsy in Australia

OBJECTIVE

This study aimed to explore the quality of life (QoL) of adult patients with epilepsy (PwE) in Australia and its relationship with comorbidities and adverse events (AEs) from antiepileptic drugs (AEDs).

METHODS

Cross-sectional surveys were completed by PwE, or carer proxies, recruited via the online pharmacy application MedAdvisor and Australian PwE Facebook groups from May to August 2018. Data were collected on demographics, epilepsy severity and management, AEs, comorbidities, and QoL (using the Patient-Weighted Quality of Life in Epilepsy Inventory [QOLIE-10-P] total score). Two linear regression models were constructed to explore associations between AEs or comorbidities and QOLIE-10-P score, with possible confounders determined using stepwise selection.

RESULTS

Nine hundred and seventy-eight of 1267 responses were eligible (mean age of respondents: 44.5 years, 64% female, 52% employed). Recent AED use was reported by 97%; 47% were on AED monotherapy, 35% had ≤2 lifetime AEDs, and 55% were seizure-free for >1 year. After stepwise selection, control variables included in both models were time since diagnosis, employment status, seizure frequency, number of currently prescribed AEDs, and number of general practitioner (GP) visits per year. In the model for comorbidities, "psychiatric disorders" was associated with the largest QOLIE-10-P score decrease (-23.14, p < 0.001). In the model for AEs, which additionally controlled for depression and anxiety disorder, self-reported "memory problems" was associated with the largest decrease in QOLIE-10-P score (-14.27, p < 0.001).

CONCLUSIONS

In this survey of Australian PwE, many of whom had relatively well-controlled epilepsy, psychiatric and self-reported memory problems were common and associated with the greatest detrimental impact on QoL. Further research is needed to better understand the underlying causes of impaired QoL and thereby improve its management.

Factors influencing the implementation of Epilepsy Specialist Nurse role: Using the Consolidation Framework for Implementation Research

BACKGROUND

Research to support the added value of including Epilepsy Specialist Nurses as members of the multidisciplinary team is developing, yet little information exists on factors influencing the translation of these roles into practice.

AIM

To describe the enabling and inhibiting factors to the implementation of the Epilepsy Specialist Nurse role in the Republic of Ireland.

METHODS

A qualitative design involving semi-structure interviews, observation and analysis of documents, such as portfolios was used. The sample included 12 Epilepsy Specialist Nurses, 24 multidisciplinary team members, and 35 individuals with epilepsy and family members. Data were analysed using the Consolidation Framework for Implementation Research. Reporting rigour is demonstrated using the COREQ checklist (See Appendix S1).

RESULTS

While there was overwhelming support for the role, barriers and enablers were identified across all domains of the Consolidation Framework for Implementation Research. Enablers included national policies and guidelines, leadership from senior nursing and medical colleagues, climate of learning and mentorship, networking opportunities, infrastructural supports and competence of Epilepsy Specialist Nurses. Barriers included the limited consideration of service expansion and the increasingly complex nature of clinical cases on workload capacity. Deficits in infrastructural supports, challenges in relation to role preparation, role implementation and role responsibility, including concerns around lone practitioner models and concerns that the role was a cost-saving measure, also emerged as potential barriers to future sustainability.

CONCLUSION

The Consolidation Framework for Implementation Research offers researchers a pragmatic typology for analysing interrelationships between enabling and inhibiting factors that impact implementation of advanced practice roles, across different evidence sources, disciplines and boundaries.

RELEVANCE TO CLINICAL PRACTICE

In order to secure role sustainability, managers need to address the rate of service expansion, models of role development, deficits in supports and perceived motivations for role development on the quality, acceptability and sustainability of services provided.

Are patients ready for integrated person-centered care? A qualitative study of people with epilepsy in Ireland

The National Clinical Programme for Epilepsy (NCPE) in Ireland aims to deliver a holistic model of integrated person-centered care (PCC) that addresses the full spectrum of biomedical and psychosocial needs of people with epilepsy (PwE). However, like all strategic plans, the model encompasses an inherent set of assumptions about the readiness of the environment to implement and sustain the actions required to realize its goals. In this study, through the lens of PwE, the Irish epilepsy care setting was explored to understand its capacity to adopt a new paradigm of integrated PCC. Focus groups and semi-structured one-to-one interviews were employed to capture the qualitative experiences of a sample of Irish PwE (n = 27) in the context of the care that they receive. Participants were from different regions of the country and were aged between 18 and 55 years with 1 to 42 years since diagnosis (YSD). Highlighting a gap between policy intent and action on the ground, findings suggest that patient readiness to adopt a new model of care cannot be assumed. Expectations, preferences, behaviors, and values of PwE may sustain the more traditional constructions of healthcare delivery rather than the integrated PCC goals of reform. These culturally constituted perceptions illustrate that PwE do not instinctively appreciate the goals of healthcare reform nor the different behavior expected from them within a reformed healthcare system. Recalibrating deep-rooted patient views is necessary to accomplish the aspirations of integrated PCC. Patient engagement emphasizing the meaningful role that they can play in shaping their healthcare services is vital.

Assessing knowledge and attitudes of Palestinian undergraduate nursing students toward epilepsy and patients with epilepsy: A cross-sectional study

OBJECTIVE

This study assessed knowledge and attitudes of undergraduate nursing students toward epilepsy and patients with epilepsy (PWEs). Associations between different sociodemographic and academic variables and knowledge and attitude scores were also assessed.

METHODS

The present study was conducted in a cross-sectional observational design among Palestinian undergraduate nursing students using a prevalidated and reliable questionnaire of 38 items. After collecting sociodemographic and academic characteristics, students answered a knowledge test (16 items) and attitude test (13 items).

RESULTS

The questionnaire was completed by 342 nursing students. The median knowledge score was 65.6 with an interquartile range (IQR) of 31.3, and the median attitude score was 81.5 with an IQR of 20.0. Multiple linear regression analyses showed that higher knowledge scores were predicted by being female in gender (p-value <0.05), had a course/studied about epilepsy (p-value <0.001), self-rated knowledge about epilepsy as high (p-value <0.05), and ever witnessing a PWE experiencing seizures (p-value <0.001). Higher attitude scores were predicted by self-rated knowledge about epilepsy as high (p-value <0.001), had a course/studied about epilepsy (p-value <0.05), and ever witnessed a PWE experiencing seizures (p-value <0.05).

CONCLUSION

Nursing students had moderate knowledge of epilepsy and had generally positive attitudes toward PWEs. Findings of this study highlighted knowledge gaps and areas for improvement. As knowledge scores were positively correlated with attitudes, probably, findings of this study might suggest that educational/training interventions can improve knowledge as well as positive attitudes of nursing students with regard to epilepsy and PWEs.

Igniting intersectoral collaboration in chronic disease management: a participatory action research study on epilepsy care in Ireland

Models of care developed to improve the lives of people with chronic diseases highlight integrated care as essential to meeting their needs and achieving person (patient)-centered care (PCC). Nevertheless, barriers to collaborative practice and siloed work environments persist. To set in motion some groundwork for intersectoral collaboration this study brought two expert groups of epilepsy care practitioners together to engage in participatory action research (PAR). The expert practitioner groups were hospital-based epilepsy specialist nurses (ESNs) and community-based resource officers (CROs). The PAR highlighted, that while the participants share a mutual interest in caring for people with epilepsy, underdeveloped CRO-ESN relationships, arising from unconscious bias and ambiguity can result in missed opportunities for optimal care coordination with consequent potential for unnecessary replication and waste of finite resources. However, through dialogue and critical self-reflection, a growing emotional connection between the disciplines evolved over the course of the PAR. This allowed for buds of collaboration to develop with CROs and ESNs working together to tackle some of the key barriers to their collaboration.

Disclosure strategies in adults with epilepsy when telling, "I have epilepsy": The How2tell study

OBJECTIVE

To generate evidence-based knowledge about the strategies that adult people with epilepsy (PWEs) use in the process of telling others about their epilepsy.

METHODS

In-depth, one-to-one interviews explored PWEs' first-hand experiences of self-disclosure (or not), and grounded theory methods of inductive-deductive analysis were used to identify strategies used in disclosing. Interviews were audio-recorded, transcribed, coded, and independently recoded by two researchers using a coding framework specifically developed in this study. To account for maximum variation, PWEs (aged 18+ years) with different life experiences and situations relating to (1) gender, (2) age, (3) employment status, (4) personal relationships, (5) family relationship, (6) support group involvement, and (7) seizure frequency were included. Given the many variables and psychosocial issues associated with epilepsy, demographic details and validated measures including Quality of Life in Epilepsy-10-P, Coping Inventory of Stressful Situations-Adult, and Patient Health Questionnaire-9 were used to describe the characteristics of participants and to contextualize the results.

RESULTS

Forty-nine adults with epilepsy participated. Data analysis revealed six interrelated categories (with subcategories) of the strategies that PWEs reported using in the process of disclosure: (1) concerns about disclosing; (2) weighing up who and when to tell; (3) opportunities for telling; (4) moment of disclosure-how to construct the message; (5) tailoring the message to audience needs-altering the message when telling family members, partner, friends, children, or employer and workplace colleagues; and (6) managing reactions by making it ordinary.

SIGNIFICANCE

People with epilepsy use a range of different strategies during the process of disclosing their epilepsy. These strategies were used to inform the development of the How2tell multimedia self-management resource for PWEs on self-disclosure in everyday social and life situations. How2tell is designed to benefit PWEs by empowering them with practical information about the process of telling another person, "I have epilepsy."

The rhetoric and reality of integrated patient-centered care for healthcare providers: An ethnographic exploration of epilepsy care in Ireland

In line with healthcare reform across the world, the National Clinical Programme for Epilepsy (NCPE) in Ireland describes a model that aims to achieve holistic integrated person (patient)-centered care (PCC). While generally welcomed by stakeholders, the steps required to realize the NCPE ambition and the preparedness of those involved to make the journey are not clear. This study explored the perceptions of healthcare providers in the Irish epilepsy care ecosystem to understand their level of readiness to realize the benefits of an integrated PCC model. Ethnographic fieldwork including observations of different clinical settings across three regions in Ireland and one-to-one interviews with consultant epileptologists (n = 3), epilepsy specialist nurses (n = 5), general practitioners (n = 4), and senior healthcare managers (n = 3) were conducted. While there is a person-centered ambiance and a disposition toward advancing integrated PCC, there are limits to the readiness of the epilepsy care environment to fully meet the aspirations of healthcare reform. These are the following: underdeveloped healthcare partnerships;, poor care coordination;, unintended consequences of innovation;, and tension between pace and productivity. In the journey from policy to practice, the following multiple tensions collide: policy aims to improve services for all patients while simultaneously individualizing care; demands for productivity limit the time and space required to engage in incremental and iterative improvement initiatives. Understanding these tensions is an essential first step on the pathway to integrated PCC implementation.

Evidence-based practice among epilepsy specialist nurses in the Republic of Ireland: Findings from the SENsE study

AIM

To describe how epilepsy specialist nurses in Ireland enact the evidence-based practice dimension of their role.

BACKGROUND

The importance of epilepsy specialist nurses (ESNs) delivering evidence-based care to people experiencing epilepsy is unquestionable, yet research into this aspect of the role is relatively sparse.

METHODS

A qualitative design was used, involving 12 epilepsy specialist nurses working in five units in Ireland, 24 multidisciplinary team members working with them and 35 people with epilepsy and their family members. Data were collected using individual and focus group interviews, observation and documentary analysis.

RESULTS

These ESNs were active in accumulating, translating, applying, generating and disseminating evidence. All were actively involved in, or leading audit and service evaluations, and used findings to improve practice. Their research activity mainly consisted of small-scale unfunded research projects.

CONCLUSIONS

These ESNs acted as opinion leaders and role models in relation to evidence-based practice, including the generation of new knowledge through audit and research.

IMPLICATIONS FOR NURSING MANAGEMENT

Organisations and managers need to support ESNs by ensuring that they have the necessary resources and competencies to accumulate, translate, apply, generate and disseminate relevant evidence. Future research should explore the impact of ESNs' evidence-based practice on patient outcomes.

Rising to the challenge: Epilepsy specialist nurses as leaders of service improvements and change (SENsE study)

PURPOSE

To report the leadership role and change activities of epilepsy specialist nurses (ESNs) in Ireland; findings from the SENsE study.

METHOD

A mixed methods study design was used, involving 12 epilepsy specialist nurses working in five units in Ireland, 24multidisciplinary team members working with them, and 35 people with epilepsy and their family members. Data were collected using individual and focus group interviews, observation and documentary analysis.

RESULTS

Five key areas in which ESNs demonstrated leading on the change agenda were identified. These included: Initiating new clinical practice developments; Building capability within the multidisciplinary team; Developing education programmes and resources for people with epilepsy, family and the public; Exerting influence through membership of committees and lobbying; and Advancing the ESN role.

CONCLUSION

Though the epilepsy specialist nurse role was first established in the UK in 1988, much of the literature that discusses or describes the ESN role is founded on anecdotal evidence, or focusses on their clinical expertise. Findings from this study provide empirical evidence that the ESNs were involved as key players in leading changes within the services, in the education of others, and the continuous advancement of epilepsy care.