Rajiv Gandhi University of Health Sciences, Bengaluru

Rajiv Gandhi University of Health Sciences, Bengaluru

Karnataka

SYNOPSIS PERFORMA FOR REGISTRATION OF

SUBJECT FOR DISSERTATION

Ms. LEKSHMY.S.RAJ

I Year M.Sc Nursing

Child Health Nursing

Year 2010-2011

SJB COLLEGE OF NURSING

BENGALURU-560060

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BENGALURU, KARNATAKA

ANNEXURE-I

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTFOR DISSERTATION

6. BRIEF RESUME OF INTENDED WORK

INTRODUCTION

“Half of the costs of illness are wasted on conditions that could be prevented”.

Dr. Joseph Pizzorriu.

Fever is one of the most common symptoms that can occur as a result of any type of infection. In children, fever can occur quite abruptly and the temperature can be very high. The thermostatic mechanism in babies and young children is underdeveloped and that is why febrile episodes in children can be dangerous. Febrile seizures or febrile convulsions can cause a lot of concern among parents because of its sudden frightening nature .1

A seizure in association with a febrile illness in the absence of central nervous system infection or acute electrolyte imbalance in children older than 1 month of age without prior febrile seizures.Febrile seizures are one of the most common neurologic conditions of childhood, affecting approximately 3% of children, with the average age of onset between 18 and 22 months. Simple febrile seizures occur in about 2 to 5% of young children. Vulnerable children between 6 months & 5 years of age may experience convulsions as a result of fever.2

A febrile seizure can occur as a onetime episode but sometimes recurrences occur in the specified age group.This in relation to the rapid rise in body temperature and is not related to the duration of the fever. If the parent has had febrile convulsion the chance of the child having is around 10% and this is increased if both parents have had history of febrile seizures.3

The main stay in the management of febrile seizures lies in bringing down the fever as quickly as possible. Sometimes anti-epileptic drugs is also given. Nursing care plays an important supportive role. Tepid sponging is also done to bring down the fever .the child is monitored and the parents are reassured , advised as to do during febrile convulsion.Since febrile convulsions usually occur during a rise in temperature rather than during an extended period of elevated temperature; preventive measures are more effective in order to reduce the occurrence of the fever.3

6.1 NEED FOR THE STUDY

A febrile seizure, also known as a fever fit or febrile convulsion, is a convulsion associated with a significant rise in body temperature. They most commonly occur in children between the ages of 6 months and 6 years and are twice as common in boys as in girls.4

Febrile seizures are the most common convulsive disorder of childhood, with a recurrence rate of 30 to 35% 5. It affects upto 1 in 20 children between the ages one and four. Approximately one third of children who have had a febrile seizure will experience recurrent seizure have only a 20% chance. The risk of recurrent seizure decreases with age. Infant younger than 12 months have a 50% chance of having second seizure. Children over 12 months have 30% chance .6

If either parent suffered a febrile convulsion,for a child the risk of getting it rises 10 to 2o%. If both parent has had febrile convulsion,the risk of another child getting it rises 20 to 30%.7

Risk factors for a first febrile seizure, recurrence of febrile seizures and development of future epilepsy are identifiable and varied. Children with febrile seizures encounter little risk of mortality and morbidity and have no association with any detectable brain damage. Recurrences is possible, but only a small minority will go on to develop epilepsy. Although anti-epileptic drugs can prevent recurrent febrile seizures, they do not alter the risk of subsequent epilepsy. This has led to a changing view of how we approach the treatment of these common and largely benign seizures.8

The American Academy of Paediatrics (AAP) has issued a clinical practice guidelines for the long term treatment of children who have simple febrile seizure has published these recommendations, addresses the risk and benefits of both continous and intermittent therapy as well as the use of antipyretics in children with simple febrile seizures.9 Febrile status epilepticus occurs in up to 5% of all cases of febrile seizures and has been linked to the development of focal epilepsy. Multiple insults are likely necessary for a child with febrile status epilepticus to develop epilepsy later in life.10

Febrile convulsion is a common and benign condition without any long term neurodevelopmentalsequelae. Clinical assessment to identify the underlying causes of fever, judicious selection of investigations,effective temperature control and parental education with collaborative input from medical and nursing staff help to determine the overall quality of care for children with this condition. CPG on febrile convulsion, developed in 2000, have been used as a reference standard to direct clinical care.11

An important inconsistency exists between the evidence available about the management of febrile seizures (FC) and its application in real practice. A very intensive effort is required to relieve parental anxiety after febrile convulsions. It is suggested that routine parental preventive education in this area be conducted.12

A febrile seizure can be a frightening experience for both the child and their parents. It is important that parents and care givers be educated about the low risk of simple febrile seizure and the measures that can be taken to ensure their child’s safety during and after a seizure. Anticonvulsant therapy recommended for a child with febrile seizure because of the general benign nature of the seizure.6

In view with the above need investigator has taken “a study to evaluate the effectiveness of self instructional module on knowledge regarding prevention and management of febrile convulsions in underfives among pre-school teachers at selected preschools in urban areas of Kengeri, Bengaluru”.

6.2 REVIEW OF LITERATURE

In the present study review of literature was complied and classified as

1. Literature related to febrile convulsion.
2. Literature related to knowledge towards prevention and management of febrile convulsion.
3. Literature related to effectiveness of Self Instructional Module.

1. Literature related to febrile convulsion:-

A study was conducted on frequency of recurrent convulsions after a first febrile seizure: two-year observation results. The aim of the work was to establish the frequency of convulsion recurrence through the retrospective study with regard to age, type of recurrence, and applied prophylaxis in children in Tuzla Canton in a two-year period after the first febrile convulsion. Amongst 716 patients, 21.9% had a recurrence. Recurrence of simple febrile convulsions occurred in 124 (78.9%), complex in 18 (11.5%), and 14 (9.8%) patients had afebrile convulsions. There was no statistically significant difference in recurrence appearance between patients who received continuous and intermittent prophylaxis. Knowledge of recurrence frequency according to age groups opens the possibility of recurrence prevention with adequate therapeutic measures, especially in home care conditions. Good parent education would represent the first step in recurrence prevention.13

A study was conducted onfebrile convulsions in children: relationship of family history to type of convulsions and age at presentation, was carried out in the Department of Paediatrics, HayatShaheed Teaching Hospital Peshawar from June 1999 to June 2000.Convulsions were labelled as febrile by excluding infections of central nervous system in developmentally normal children.In 30% children there was positive family history of febrile convulsions and febrile convulsions occurred at earlier age in these children. As a whole 44% of children had first febrile convulsions below 12 months of age and 56% above 12 months of age. Majority of febrile convulsions occurred in first two years of life. Complex febrile convulsions are more common when age at presentation is less than 12 months.14

2.Literature related to knowledge towards prevention and management of

febrile convulsion:-

A study was conducted onprevention and management of febrile seizures. It has been recognized that there is significant genetic component for susceptibility to febrile seizures. To make the diagnosis of febrile convulsion, meningitis, encephalitis, serious electrolyte imbalance and other acute neurologic illnesses are to be excluded. While managing acute attack the steps to be taken are-airway management, a semi-prone position to avoid aspiration, monitoring vital signs and other supportive care. Diazepam or lorazepam is the drug to be used. There is no reason to expect phenobarbitone administered at the time of fever to be effective in prevention of febrile convulsion. The parents should be counselled about the benign nature of the convulsion.15

A 12-year follow-up study was conducted in children with febrile convulsions of all ages from first presentation with an identified seizure. 220 children with a first febrile convulsion were identified from The National General Practice Study of Epilepsy (NGPSE) is a large prospective community-based cohort study of 1,195 patients Children were prospectively followed up to ascertain subsequent seizures, neurological problems and treatment. 207 patients were followed for a minimum of 8.4 years. In the Febrile Convulsion cohort, 6% of the children developed subsequent epilepsy.10% had neurological sequelae.11% of the children had received medication to prevent recurrence, and in one third of these cases, this was for simple Febrile Convulsion. Epilepsy is a significant if infrequent sequel to Febrile Convulsions. Factors associated with subsequent epilepsy are the number of Febrile Convulsions or a complex first Febrile Convulsion.16

A study was conducted to overtreated and undertreated children with febrile convulsion in a Malaysian district hospital retrospective audit on the inpatient assessment and care of children admitted with febrile convulsion .The case notes of 100 consecutive children admitted in 2004 were analyzed. Only 38% of the children received antipyretics and 53% were tepid-sponged during fever, with 23% having received tepid-sponging without concurrently receiving antipyretics. No parental education on febrile convulsion was recorded in half of the cases. Excessive unjustified investigations, deficient antipyresis when required and inadequate communication with the family of children with febrile convulsion were observed. Awareness of such deficiencies from this audit should lead to regular staff education, monitoring and future audits in order to improve the quality of our clinical care.17

A study was conducted on management of fever in children. This article summarizes the Italian Pediatric Society guideline on the management of the signs and symptoms of fever in children, prepared as part of the National Guideline Program (NGP)and the Cochrane Database of Systematic Reviews. The strength of the recommendations was categorized into 5 grades (A-E) according to NGLP methodology. Use of antipyretics-paracetamol (acetaminophen) or ibuprofen-is recommended only when fever is associated with discomfort. Combined or alternating use of antipyretics is discouraged. The dose of antipyretic should be based on the child's weight rather than age, caution is advised in cases of severe hepatic/renal failure or severe malnutrition. Newborns with fever should always be hospitalized because of the elevated risk of severe disease; paracetamol may be used, with the dose adjusted to gestational age.18

A study was conducted on recommendations for the management of "febrile seizures”. Febrile seizures are the most common seizure disorder in childhood, affecting 2-5% of children. Simple febrile seizure occurs during a febrile illness not resulting from an acute disease of the nervous system in a child aged between 6 months and 5 years, with no neurologic deficits and no previous afebrile seizures. These recommendations address the instructions for management of the first febrile seizures, giving criteria for hospital admission, diagnosis, differential diagnosis, and treatment of a prolonged seizure. The authors stressed the benign prognosis of the majority of cases and the risk factors for recurrence of febrile seizures and appearance of epilepsy later on. Both continuous and intermittent anticonvulsant therapy are efficacious in preventing single febrile seizures, in very selected patients.19

3.Literature related to effectiveness of Self Instructional Module:-

A study was conducted to examine the effects of self-instruction on learning, satisfaction with the teaching approach and health status of persons with rheumatoid arthritis (RA).A control-group pretest-posttest design was used.30 subjects receiving care at a rheumatology clinic who met study criteria were randomly assigned to two groups: (a) self-instruction and (b) control.One-way analysis of covariance on posttest Rheumatoid Arthritis Knowledge Inventory (RAKI) scores, with the pretest as covariate, was used to examine the difference in learning between the self-instruction and control groups .Participants who completed the self-instructional program had improved scores on the posttest as compared to the control. Subjects rated self-instruction as an effective teaching strategy in terms of promoting learning about RA and patient acceptability. Significant correlations were found between subject’s test scores and selected variables.20

A study was conductedto evaluate the effectiveness of a self-instructional module in increasing nurses' knowledge of genetics.Pretest/posttest study design.Study materials were mailed to 262 registered nurses involved in screening egg donors at 177 reproductive health centers in the United States from July to September 2000.100 of 262 eligible nurses completed the pretest (38% return rate) and 65 of these 100 nurses also completed the posttest (65% retention rate).A 22-page self-instructional booklet was given.There was a significant increase of 20.8% in participant’s mean knowledge score on the posttest.21

PROBLEM STATEMENT

“A study to evaluate the effectiveness of self instructional module on knowledge regarding prevention and management of febrile convulsions in under fives among pre school teachers at selected pre schools in urban areas of Kengeri , Bengaluru.”

6.3 OBJECTIVES

1. To assess knowledge regarding the prevention and management of febrile convulsions in under fives among pre-school teachers by pre-test scores.
2. To prepare and administer self instructional module regarding prevention and management of febrile convulsions in under fivesamong pre-school teachers.
3. To evaluate the effectiveness of self instructional module regarding prevention and management of febrile convulsions in underfives among pre-school teachers.
4. To find out the association between the knowledge score with selected demographic variables.

6.3.1 HYPOTHESIS

H1: There will be a significant difference in the pre-test and post-testknowledge

scores regarding prevention and management febrile convulsions in

underfives among pre-school teachers.

H2: There will be a significant association between the pre test knowledge scores with

selected demographic variables among pre-school teachers.

6.3.2 VARIABLES

1. Independent variable: Self instructional module on prevention and management

offebrile convulsions in under fives.

2. Dependent variable : Level of post test knowledge of pre-school teachers

regardingprevention and management of febrile

convulsions in under fives.

3. Demographic variable: Age, sex, religion, educational status, marital status.

6.4 OPERATIONAL DEFINITIONS

a) Evaluate: It refers to the response of pre-school teachers to self instructional module regarding prevention and management of febrile convulsion in under-fives and the comparison of their response to objective.

b) Effectiveness: It refers to gain in knowledge as determined by significant difference in pre-test and post-test knowledge scores regarding prevention and management of febrile convulsions in underfives.

c) Knowledge: It refers to level of understanding regarding prevention and management of febrile convulsions in underfives among pre-school teachers.

d) Self instructional module: It refers to systematically organized instructional aid for pre-school teachers regarding febrile convulsions in under-fives consisting definition, etiology, signs and symptoms, prevention and management of febrile convulsions and its reoccurrence.

e) Prevention and management: It refers to avoiding the chances of febrile convulsions and proper care of children during febrile convulsion.

f) Febrile convulsion:It refers to the convulsion associated with a significant rise in body temperature above 101o F.It most commonly occur in children between the age of 6 months to 5 years.

g)Under fives: It refers children who are below the age of five years.

h)Preschool: : It refers a school for children who are younger than five years old.

i)Preschool teachers:It refers qualified persons who have passed Teachers Training Course and teaching in school for children who are younger than 5 years old.

6.5 ASSUMPTION

1. Pre-school teachers may have some knowledge regarding prevention and management of febrile convulsions in underfives.
2. Self instructional module may improve the knowledge of pre-school teachers regarding prevention and management of febrile convulsions in underfives.

6.6 LIMITATIONS

Study is limited to

1. Pre school teachers.
2. Pre-school teachers working in selected pre-schools in urban areas of Kengeri,Bengaluru.
3. Pre school teachers who are willing to participate in the study.
4. Pre school teachers who can read and write Kannada or English.
5. Pre school teachers who are available during the time of study.

MATERIALS AND METHODS

7.1 SOURCES OF DATA : Pre-school teachers working in selected pre-

schoolin urbanareas of Kengeri.

7.1.1 RESEARCH APPROACH :Evaluative Approach.

7.1.2 RESEARCH DESIGN : Pre experimental one group pre-test post-test

design.

7.1.3 SETTING :Selected preschools in urban areas of Kengeri,

Bengaluru.

7.1.4 SAMPLE SIZE : 35 pre school teachers in selected pre schools in

urban areas of Kengeri, Bengaluru.

7.1.5 INCLUSION CRITERIA:

1. Teachers who are working in pre-schools.
2. Teachers who are willing to participate in the study.
3. Teachers who are available during the time of study.

7.1.6EXCLUSION CRITERIA :

1. Pre school teachers who are sick at the time of data collection.