EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME (STP) ON KNOWLEDGE OF PRIMARY SCHOOL TEACHERS ABOUT EPILEPSY IN PRIMARY SCHOOL CHILDREN IN SELECTED PRIMARY SCHOOLS AT BANGALORE.
M.Sc. Nursing Dissertation Protocol submitted to
Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore.
By
MR. ASHOK M NAIK
M.Sc NURSING 1ST YEAR
2011-2012
Under the Guidance of
PSYCHIATRIC HEALTH NURSING
ANURADHA COLLEGE OF NURSING,
Hegganahlli Cross
Sunkadakatte
Vishwaneedam Post
Magadi Road
Bangalore –91
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. / NAME OF THE CANDIDATEAND ADDRESS /
Mr. ASHOK NAIK,
1st YEAR M. Sc. NURSING,
ANURADHACOLLEGE OF NURSING,
HEGGANAHALLI CROSS, SUNKADAKATTE, VISHWANIDAM POST, VIA, MAGADI ROAD
BANGALORE - 560 091.
2. / NAME OF THE INSTITUTION / ANURADHACOLLEGE OF NURSING,
HEGGANAHALLI CROSS, SUNKADAKATTE, VISHWANIDAM POST, VIA, MAGADI ROAD
BANGALORE - 560 091.
3. / COURSE OF STUDY AND
SUBJECT / M. Sc. NURSING
PSYCHIATRIC NURSING
4. / DATE OF ADMISSION TO THE COURSE / 31-05-2011
5. / TITLE OF THE TOPIC
EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME (STP) ON KNOWLEDGE OF PRIMARY SCHOOL TEACHERS ABOUT EPILEPSY IN PRIMARY SCHOOL CHILDREN IN SELECTED PRIMARY SCHOOLS AT BANGALORE.
6. BRIEF RESUME OF THE INTENDED WORK
6.1 INTRODUCTION
Health is a common theme in most cultures; in fact all communities have their concepts of health, as part of their culture. Among definitions still used, probably the oldest is that health is the absence of disease. In some cultures, health and harmony are considered equivalent, harmony being defined as being at peace with the self, the community, god and cosmos. The ancient Indians and Greeks shared this concept and attributed disease to disturbances in bodily equilibrium of what they called humors.
Preventive and promotive measures are essential particularly for children. Home based preventive management techniques i.e., counseling parents on general principles of child and usage of behavioral management techniques are effective in reducing clinical disorders in the risk children.
The term “Epilepsy” is derived from the Greek word “Epilamabavian” meaning is “to seize or to take hold of”. To the Greeks, epilepsy was a sacred disease of the brain. In later ages it became known as ‘the falling sickness” and was viewed as a form of mental illness, with victims being consigned to asymptoms for the insane. Regardless of the insights gained into epilepsy, stigma and fear are still associated with this problem. Public awareness of the true mature of epilepsy is needed to dispel the misconceptions and fears associated with this health problem1.
Epilepsy is a chronic condition characterized by uncertainty. It affects more than 50 million people worldwide and is an important public health problem (WHO,2004) .Some studies in developing countries suggest the prevalence of epilepsy to be more than 10 per 100(WHO.2003).In Zimbabwe country in southern Africa, available estimates show the prevalence at 1%-2%( Epilepsy support foundation of Zimbabwe, 2001).Quality of life will suffer because of the social consequences of epilepsy which may include active discrimination in employment, stigma, problems in family relationships, reduced participation in community and civic activities2.
Epilepsy is a chronic seizure disorder of the cerebral tissues characterized by recurrent paroxysmal episodes of disturbed skeletal motor function, sensation autonomic visceral function, behavior or consciousness. The disorder, characterized by recurring seizures commonly referred to as epilepsy represents one of the most common neurological problems affecting individuals, irrespective of geographical location’s and race3.
A study reported in the third congress held in Delhi by the Asian and ocean epilepsy organization in November 2000. Those in India around 5000,000 persons have epilepsy at any given point of time (in an estimated population of 1,000,000,000). Epilepsy is a peculiar neurological disorder because people can develop seizures at any given point of time in their life. Further those who develop epilepsy tend to be at risk to develop seizures for many years despite appropriate treatment, which makes epilepsy a chronic disease. Therefore “life time prevalence” of epilepsy would be many times more than the “point prevalence” rates in any population4.
Sudden unexpected death in epilepsy (SUDEP) represents a significant category of mortality in the population with epilepsy. These observations support the view that both central and obstructive apnea. Play an important part in the development of SUDEP. The findings also suggest that the optimization of seizure control is also important in the prevention of these deaths. The child and family members subsequently deal with the stress and adapt to the chronic condition depend upon the psychosocial problems they face. Martin and Nisa (2004) described that the chronic illness disturbs the lives of children, limiting their roles in schools, recreational and vocational pursuits. Parents and siblings often experience social, economic and personal disadvantages. If the care is oriented to the “whole child” and if it facilitates ‘family control’ in the various stages of child’s illness, then there will better coping with the chronic condition5.
In India, there are 30 million people affected by epilepsy in 2004. According to Meadow and Smithells (2005) about 1 in 200 school children are affected with epilepsy about 1 person in 20 has a seizure of some type during life, and in the population at large about 1 in 200 has epilepsy. Most of those who develop idiopathic epilepsy do so before the age of 20 years. The general systemic conditions in which seizures most commonly occur in children is due to hypoxia or high fever. As the understanding of its physical and social burden has increased, it has moved higher up in the world health agenda6.
Both parents and teachers should involve themselves in matters concerning their Childs seizure disorder. It is important that brothers and sisters be involved too, and help to understand the condition as much as possible, they may have all kinds of fears and misinformation that we can correct. In many families, the Childs mother tends to come closer to the situation. Often, she is the parent who visits the doctor, or meets the teacher or talks to other parents at the local level. As she learns more about the epilepsy, it becomes much easier to adjust with the idea of having a child with seizure disorder. However, her husband not having had these experiences may still retain many of the feelings and worries that they both started out with. He may even reject the idea that his child his child really has epilepsy, and this can lead disputes and the tension between parents7.
There are approximately 5 million people with epilepsy in India, and economic burden due to epilepsy to the nation isRs.13.500 million. According to this report there are only 400 Neurologists in India i.e., 1 Neurologist for 13.500 persons with epilepsy. The prevalence of epilepsy in the Parsee community of Bombay is high8.
In many settings nurses and teachers focus on individual’s treatment but interventions with the teachers will greatly assist not only the individual but also the rest of family members. The role of the teachers in the management and education of parents with an epileptic child and their families is mist important. Teachers are highly valued for providing care, advice and support in explaining the social aspects of epilepsy9.
6.2 NEED FOR THE STUDY
"Safe and supportive environment helps children to emerge as responsible adults"
- Health Dialogue 2003
Epilepsy is largely a disease of younger people approximately three fourth of the sufferers have seizures it is always a shock when a teacher learns that a child has epilepsy. But attitudes may also be affected by the frightening experience of having seen a child during a severe seizure, by the belief that mental detoriation always occurs in epilepsy and by the fact that the tendency to develop epilepsy may be inherited10.
In an understanding, loving, and accepting environment the child can grow with self confidence. A psychologist who has counseled families for many years believes that the way children learn at home to think about themselves and their epilepsy has a great deal to do with the kind of people they become in later life. If a child learns to be anxious and fearful about epilepsy, if he is sheltered from the outside world by well meaning parents, if he learns to regard his epilepsy as the dominant feature of his life, he may become dependent and immature, both in childhood and in adult life. If both parents involve themselves equally in the medical social progress of the child, it gives him additional support and keeps everyone in the family moving in same direction11.
First aid treatment of tonic clonic seizures is essential. It is not necessary to call an ambulance or send the patient to the hospital after a single seizure unless a single seizure prolonged. During an acute seizure it is important to protect the child from injury. This may involve supporting and protecting the head by turning the child to the side, loosening the cloth and easing the patient to the floor if seated. Regarding the care of the epileptic child, family education is crucial12.
The article on advances in epilepsy states that the prevalence rate of epilepsy in countries of Asian was [4.4], Japan [1.7], Pakistan India [4.7], Kashmir in India [2.4], Pakistan [9.85], Srilanka [9.0] and Guan [4.9] million. These prevalence rates indicates that prevalence of epilepsy in Asian countries is comparatively higher that world wide13.
Epileptic children express anxiety and embarrassment and see themselves as being different and inferior. A thorough evaluation of the patient’s attitude and expectations concerning health maintenance is essential. The attitude and expectations of family members should also be evaluated since their understanding and support is crucial to the patient’s ability to adjust to his condition. It is important for the nurse to be aware of potential prejudices which may be encountered by the client and his family14.
One of the most important aspects of epilepsy is changing the public attitude. The patient and public must be made to look convulsive seizures not as barrier catastrophes but as relatively normal events that should be dealt with rationally. Children with epilepsy have been segregated in separate schools and recently some major cities passed laws ensuring children with epilepsy have the right to attend public schools if they are under adequate medical care. In many schools, children are barred from the classroom according to the inclination of the teacher. Limitation of environment and educational opportunity often limits the patient’s knowledge but this doesn’t mean that their learning capacity is poor15.
One in 100 American teens has epilepsy [seizure disorder]. survey by the Epilepsy Foundation revealed that more than two-thirds of teens [68percent] said they would not know how to help if a friend or acquainting has made seizure education its focal point of and is entitled to respect public information campaigns, which seeks to raise awareness of epilepsy among all teens and ‘‘teens’’ [10-12 year olds], give them the knowledge to help in a seizure16
The investigators from his own experience in the clinical field observed that treatment advised by the physicians have not been correctly adhered to by teachers. They have also exhibited inadequate knowledge and coping towards their children with epilepsy. The investigator feels that both these tendencies may be associated with ignorance, which needs to be identified and solutions found.
6.3 REVIEW OF LITERATURE
Review of literature is considered as an essential step of research process. It involves systematic identification, location, scrutiny and summary of written materials that contain information on a research problem (Polit and Hungler 1995). 20
The overall process of review of literature is to develop a strong knowledge base to carry out research and other scholarly educational and clinical practice activities. It helps to determine the gaps, consistencies and inconsistencies in the literature about the particular subject under study. Review literature guides the investigator to design the proposed study in the scientific manner so as to achieve the desired results.
Every person has different knowledge, attitudes, a person’s knowledge and attitudes have a strong influence on his or her attitudes and behaviors.
A study conducted on teacher’s knowledge and revealed that the overwhelming impression is lack of knowledge and uncertainty in mothers of epileptic children about the condition is discussed in terms of effects of treatment and health educational programmes.18
A study conducted on teachers regarding knowledge of epilepsy and familiarity with this disorder. The author found that about half of all persons who have witnessed an epileptic seizure either in person or on television, about one third of all persons know someone with epilepsy but relatively few are familiar with epilepsy, how to respond to a seizure. The author states that the teacher have relatively little knowledge about epilepsy and recommends educational campaigns that inform the public about this disorder and about seizures should work through community settings to improve the general publics understanding of epilepsy. 19
A cross sectional Study conducted to identify beliefs and experiences of teachers with epileptic children with respect to the need for specific dietary restrictions in these patients, a total 125 schools participated in study. It was found that 55.25% believed there was a relationship between specific foods and the occurrence of seizures. A personal experience with seizure after conception of specific foods was reported by 31.2% of the schools. Dairy products, sour foods, fruits and vegetables were the most common foods reported to be responsible. It was clearly observed that the teachers desire to know if their students with epilepsy require dietary restrictions and hence, try to collect information from different and sometimes unreliable sources. The author states that it would be invaluable to consider the experience of teachers caring for an epileptic child when evaluating the relationship between consumption of specific food and seizure in future studies. This relationship may be due to a food-disease or food-drug interaction.20
A study conducted on 58 school children admitted with epileptic convulsions at university of Malaya medical centre, Malaysia to determine teachers’ response towards convulsions in school children and their understanding of first aid management of epileptic convulsions. Results found that the majority of teachers (93%) were frightened or were in a panic state on witnessing convulsions in school children. Teachers’ understanding on epileptic convulsions was deficient, particularly with regard to school management of acute seizures. The teachers’ main source of information was friends and relatives. The author states that immediate intervention to counsel and allay fears of teachers who have just witnessed convulsions in school children is required. More efforts must be made to educate teachers about convulsions with particular reference to school management of seizures. 21