Improving the epilepsy service: the role of the specialist nurse

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.

The epilepsy specialist nurse: A mixed-methods case study on the role and activities

PURPOSE

To describe the role and activities of epilepsy specialist nurses (ESNs) operating as a team in the setting of a hospital specialising in the diagnosis and management of seizure disorders.

METHODS

We conducted a descriptive mixed-methods embedded single case study. We recruited 9 ESNs, 14 of their professional colleagues and 9 'key informants' to analyse their perceptions of the role and activities of ESNs. We collected data through interviews, questionnaires, observations, and documentation. The study was conducted at the Filadelfia Epilepsy Hospital, Denmark.

RESULTS

The team of ESNs offers holistic care to patients and their caregivers regarding the clinical, social, and emotional aspects of epilepsy. The ESNs are integrated in a multidisciplinary team and promote collaboration among the team members. ESNs also contribute to organisational aspects and perform research activities.

CONCLUSION

A structured group of ESNs can operate effectively and extensively in a specialised hospital setting. Our findings contribute to clarifying the description of the ESN's role, and provide an example of how ESNs can be incorporated into a hospital's organisational structure.

Effects of an Algorithm-based Education Program on Nursing Care for Children with Epilepsy by Hospital Nurses

Purpose

Epilepsy is the most common neurological disorder in childhood. Hospital nurses, who are the first to recognize seizures in epilepsy patients in the ward environment, possess expertise related to epilepsy and play a central role in epilepsy management. The purpose of this study was to develop an algorithm-based education program and to improve nurses’ knowledge and self-efficacy related to providing nursing care to children with epilepsy.

Methods

The education program consisted of lectures on the definition, cause, classification, diagnosis, treatment, and nursing of epilepsy based on a booklet, as well as practice using an algorithm for nursing interventions when a child experiences a seizure. Twenty-seven nurses working at pediatric neurological wards and a pediatric emergency room participated in the education program. The data were analyzed using descriptive statistics and the paired t-test.

Results

Nurses’ knowledge and self-efficacy showed a statistically significant improvement after participation in the education program on nursing care for children with epilepsy.

Conclusion

The application of this education program for hospital setting is expected to improve nurses' capability to care for children with epilepsy, thereby contributing to a higher quality of nursing.

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.

[Epilepsy, medical and nursing news]

So far, the context of care supply does not meet all the needs of patients, especially those with chronic diseases. In epileptology in particular, the impact of the disease on patients' quality of life is serious enough that a lack of or insufficient care is added to critical risks, to those with existing multiple disabilities or the lack of specialised patient follow-up.

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.

A Survey of Epilepsy-related Knowledge, Attitudes and Practices of Home Healthcare Nurses in the San-in Region of Japan

Background

Comprehensive care is necessary for people with epilepsy (PWE) to lead a fulfilling life at home and in the community. The purpose of this study was to determine the epilepsy-related knowledge, attitudes and practices of home healthcare nurses (HHNs) in the San-in region of Japan.

Methods

A questionnaire survey was conducted by mail of 546 HHNs working in Tottori and Shimane Prefectures. The questionnaire assessed the epilepsy-related knowledge, attitudes and practices of HHNs. For the analysis, simple and cross tabulation of questionnaire responses were conducted, and the chi-squared test was used for statistical testing.

Results

A total of 285 HHNs participated in the study. Of the respondents, 43.9% had experience taking care of PWE in a home healthcare nursing setting. Regarding the cause of epilepsy, in descending order the percentage of correct responses were 86.7% for stroke, 85.3% for head injury, and only 13.3% for dementia. Concerning how to respond to an epileptic seizure, almost all respondents answered correctly, but 29.8% gave the incorrect answer of "place something inside the mouth." Regarding the practices of HHNs in relation to caring for PWE, nurses scored 52.0% for collaborating with the attending physician, indicating the need for improvement. The score for "provide information about social resources" was low at 18.4%. Of the respondents, 95.8% answered that epilepsy-related knowledge and technical skills were necessary for home healthcare nursing practice, and 87.7% were interested in participating in a workshop on epilepsy.

Conclusion

The study revealed an inadequate level of knowledge of epilepsy with dementia and corresponding epileptic seizures, a low awareness of nursing care in collaboration with physicians, and the importance of providing information about social resources. There is a need to offer information and education on the latest knowledge about epilepsy to HHNs.

[The psychosocial challenges of epilepsy and the role of the clinical nurse specialist]

Epilepsy in children is a complex disease with significant psychosocial consequences for the child and their family. The intervention of a multidisciplinary team enables the care to be adapted and provides support for the families. At Sainte-Justine Hospital in Montreal, Canada, the nurse clinician specialised in epilepsy plays a key role in this team.

Implementing epilepsy guidelines within a learning disability service

PURPOSE

To investigate the usefulness of the implementation of NICE guidelines when reviewing care within an outpatient learning disability service.

METHODS

We set up a multi disciplinary specialist epilepsy clinic and reviewed all patients with a diagnosis of epilepsy using a specific assessment document based on NICE guidance. We then audited clinical documentation prior to and after the implementation of the clinic.

RESULTS

We reviewed 23 patients and found that implementing NICE guidelines showed improvements to individuals' seizure assessments and epilepsy management. When comparing specific areas related to NICE implementation we found that 83% compared to 6% of patients had accurate name and detailed seizure descriptions. We made changes to seizure diagnosis in 76% of patients and improved the level of recording of seizure frequency and severity. Finally 91% compared to 50% of consultations led to changes in treatment plans.

CONCLUSION

We found that implementing the NICE guidelines allowed us to use a systematic approach to epilepsy management, which in turn led to identifiable improvement in documentation and patient care.

A structured, nurse-led intervention program improves quality of life in patients with epilepsy: a randomized, controlled trial

We tested the hypothesis that structured epilepsy nursing improves quality of life (QOL). One hundred fourteen adult patients with uncontrolled epilepsy were randomly assigned to either an intervention group or a control group. The intervention group was offered an interactive, 1-day group education program followed by extended nurse follow-up and counseling. The nurse was present at as many outpatient consultations as possible and performed repeated consultations by telephone. All patients completed the QOLIE-89 before randomization and after 2 years. QOL was significantly improved from inclusion to completion of study in the intervention group (P=0.019), mainly in the subitems for Health Discouragement (P=0.01), Medication Effects (P=0.035), and Physical Role Limitations (P=0.05). To our knowledge, this is the first study to demonstrate a significant effect of a structured nurse-led intervention program in QOL of patients with epilepsy.

How can paediatric epilepsy services best be delivered in secondary care?

OBJECTIVE

To produce practical evidence-based guidelines for the management of paediatric epilepsy in secondary care settings.

DESIGN

Question-specific systematic literature review and local service audit.

MAIN OUTCOME MEASURES

Grade of recommendation for specific management issues.

RESULTS

There is little good quality research to support many existing epilepsy guidelines for secondary care.

CONCLUSION

Practical guidelines for the provision of children's epilepsy services can be evidence influenced but until more relevant research is undertaken, not evidence based.

The role of the clinical nurse specialist in epilepsy

PURPOSE

To review and describe the key roles of the UK clinical nurse specialist in epilepsy (CNSE), and to identify the specialist nurses' contribution to care through an exploration of CNSE's perceptions of their roles.

METHOD

Using the Delphi technique [Applied Project Design and Analysis, 3rd ed., Churchill Livingstone, London, 2000, p. 243] a national survey of all known UK CNSEs was completed. One hundred and thirty questionnaires identifying nine key hypotheses central to the role of the CNSE were distributed and 76 valid questionnaires returned.

RESULTS

The response rate was 63% and was geographically representative of the UK population of CNSEs. CNSEs were employed in a range of hospital and community settings with differing patient groups. Seventy-two percent of respondents held higher academic nursing qualifications but only 36% had previous epilepsy or neurology experience. Thirty percent of respondents had been employed in the role of CNSE for more than 5 years and 84% were employed as a G or H grade nurse. Only 39% of CNSEs held nurse-led clinics and of those 32% were responsible for all decisions made during their clinic. Furthermore, 40% of CNSEs saw new patients who had not previously been reviewed by one of the medical team. The level of responsibility for drug management was mainly at a monitoring and advisory level but a small number of CNSEs held much greater responsibility. The responses to the nine hypotheses were compared using cross tabulations.

CONCLUSION

The findings of the study and the review of the CNSE in the UK revealed that the key roles of the CNSE were difficult to define. Yet, the respondents identified that there were common core features central to their contribution to care as specialist nurses.

The epilepsy nurse specialist at a tertiary care hospital-improving the interface between primary and tertiary care

Recent literature suggests that access to an epilepsy nurse specialist (ENS) may help improve patients understanding and management of their condition and in doing so may decrease morbidity and mortality. This paper describes the role of the ENS at a large tertiary referral epilepsy centre, the National Hospital for Neurology and Neurosurgery (NHNN) in supporting patients with refractory epilepsy in the hospital and community. Approximately 300 patients were referred to the ENS in the first 6 months of the service. A questionnaire was posted to 193 patients, 69% responded. Most patients had multiple seizures each month, took polytherapy, underwent frequent antiepileptic drug (AED) dose changes and often experienced drug side effects. Sixty percent of patients contacted the ENS for urgent medical advice. Important aspects of the service were access by telephone to medication advice, information, support and adequate time to discuss issues. The ENS improved continuity of, and accessibility to, care for patients, has become a key member of the multidisciplinary epilepsy team and has freed up scarce medical time.

The difference in perceptions of educational need between epilepsy patients and medical personnel

PURPOSE

This study was undertaken to determine what patients with epilepsy need to know about their condition, and to discern what differences exist between patients' perceptions of this need and the medical profession's perception of what patients should know.

METHODS

Seventy-five consecutive patients with epilepsy and 56 medical personnel (residents and nurses) who were working in either Neurology or Neurosurgery Units were studied using a structured questionnaire consisting of 3 subsets with a total of 27 questions.

RESULTS

Using a Likert scale, epilepsy patients gave high priority to their need for more information about "how epilepsy is diagnosed," "the structure of the brain" (p < 0.05, p < 0.01, respectively), and "the diet that might prevent the attack" (p < 0.05) than did medical personnel. Our study also revealed that men were more concerned with questions regarding smoking and drinking than were women (p < 0.05, respectively), whereas married patients gave higher scores in the category of employment (p < 0.01) and contraception/pregnancy (p < 0.05) than did unmarried patients. The patients with one or more seizures per month rated higher scores on questions concerning the first aid at the time of attack and dosage of antiepileptic drugs (AEDs; p < 0.05, respectively) than did the patients with fewer than one seizure per month. The patients taking poly-AED treatment gave higher scores on six items related to AED therapy than did those receiving monotherapy. No significant differences were found with regard to the length of time patients had the condition, nor to educational level or current employment status.

CONCLUSIONS

An educational program for epilepsy patients should be developed on the basis of understanding that there are differences in perspectives among patients with different sociocultural contexts as well as between patients and medical personnel.