Angela M. McNelis

Childhood Epilepsy and Asthma: Comparison of Quality of Life

Summary: We report results from the first data collection on an ongoing longitudinal study aimed at describing thenatural history of adaptation to childhood epilepsy andasthma in children and their families. We studied 136 children with epilepsy and 134 children with asthma aged 8–12 years. Data were collected from the children, theirmothers, and their school teachers through interviews, school records, and questionnaires. The two sampleswere compared on four domains of quality of life: physical, psychological, social, and school. Data were analyzed by a 2 × 2 between‐subjects multivariate analysis ofcovariance with type of illness (epilepsy or asthma) as theindependent variable and length of time since onset ofillness as a covariate. A significant main effect was notedfor illness [multivariate F (15, 236) = 11.36, p < 0.001].Our major finding was that children with epilepsy had arelatively more compromised quality of life in the psychological, social, and school domains. In contrast, children with asthma had a more compromised quality of lifein the physical domain. Our findings suggest that attention simply to seizure control in the clinical setting willnot address the full range of quality‐of‐life problems ofchildren with epilepsy.

A feasibility study of a family seizure management program: 'Be Seizure Smart'

&NA; A feasibility study of a psychoeducational family intervention, “Be Seizure Smart,” aimed at improving attitudes and increasing family functioning was conducted. The intervention was individually tailored for each family member by (a) providing information about epilepsy, treatment, and seizure management according to the individuals knowledge base, (b) addressing unique concerns and fears, and (c) providing emotional support. Participants were 10 families of children with epilepsy ages 7 to 13 years. Data were collected about 2 weeks before and after the intervention, which was delivered over 3 to 4 months, by using structured interviews. One‐tailed paired t tests were used to determine changes from pretest to posttest. Participants also were asked to evaluate the intervention and make suggestions about how the intervention could better meet their needs. Results generally indicated that the intervention had the anticipated effects. Knowledge scores increased for both parents and children. Children had fewer concerns and were more satisfied with family relationships. Information and support needs decreased for both children and their parents. Information need reductions were statistically significant for both parents and children; support need reductions were significantly reduced only for parents. Although child and parent attitudes were more positive after the intervention, this finding was not statistically significant. Moreover, parents indicated overall satisfaction with the program and appreciated the convenience of in‐home telephone interactions with the nurse and receiving information specific to their needs in the mail. It was concluded that the “Be Seizure Smart” intervention had strong potential to help children with epilepsy and their families and that the intervention should be developed further and piloted on a larger sample.

Stressors of parents of children with epilepsy and intellectual disability.

Past research suggested that parents of children who have both epilepsy and intellectual disability are at risk for increased stress, but the specific causes of stress have not been studied. Descriptions of the specific stressors are needed before effective interventions can be designed. The purpose of this study was to identify and explore these sources of stress. We invited parents of children with a diagnosis of both epilepsy and mild intellectual disability (i.e., estimated IQ of 55-75) to participate in one open-ended interview that was tape recorded and transcribed verbatim. Data analyses revealed five categories of sources of stress: concern about the child, communication with healthcare providers, changes in family relationships, interactions with the school, and support within the community. This study is a first step in developing a more thorough understanding of sources of stress for parents of children with epilepsy and intellectual disability. The identification of stressors provided a foundation for an assessment checklist and suggested avenues for future intervention.

Factors associated with academic achievement in children with recent-onset seizures.

Children with chronic epilepsy are more at risk for achievement problems than either children without seizures or children with other chronic disorders. Factors that lead to such problems in children with epilepsy, however, are not well understood. Exploring these factors is important because academic underachievement can lead to poor social outcomes and contribute to underemployment or unemployment in adulthood. This descriptive, cross-sectional study investigated a group of children who had been diagnosed with seizures approximately 12 months previously, providing the opportunity to describe relationships among family and child characteristics; parent, child, and teacher responses; and child academic achievement at the same point in time across the sample. Seventy-two children had standardized test total battery scores, 101 had a teachers rating of performance, and 67 had scores for both. Data were analyzed using multivariable regression. Child adaptive competency and seizure severity were associated with higher teacher ratings of academic performance (beta=0.73, p<0.0001 and beta=2.38, p=0.0182, respectively). Child adaptive competency was associated with higher total battery scores (beta=0.73, p<0.0001). Contrary to findings in studies of children with chronic epilepsy, mean academic achievement in this sample of children with recent-onset seizures was in the average range; however, 25% of the children were at or below one standard deviation below the mean on the teachers rating of performance and 10% on the total battery. It is therefore important for health professionals and educators to regularly assess the childs academic functioning and school performance to identify those at risk for problems. Health professionals and educators need to collaborate on assessment and interventions to help maximize child academic success.

Simulation as a Vehicle for Enhancing Collaborative Practice Models

Clinical simulation used in a collaborative practice approach is a powerful tool to prepare health care providers for shared responsibility for patient care. Clinical simulations are being used increasingly in professional curricula to prepare providers for quality practice. Little is known, however, about how these simulations can be used to foster collaborative practice across disciplines. This article provides an overview of what simulation is, what collaborative practice models are, and how to set up a model using simulations. An example of a collaborative practice model is presented, and nursing implications of using a collaborative practice model in simulations are discussed.

PSYCHOSOCIAL CARE NEEDS OF CHILDREN WITH NEW-ONSET SEIZURES

&NA; The Child Report of Psychosocial Care Scale was used to measure childrens satisfaction with health care received, need for information and support and seizure‐related concerns and fears in children with new‐onset seizures. The sample of 63 children (33 girls and 30 boys), 8–14 years, completed the scale two times, 3 months and 6 months after their first seizure. Results indicated that children need the most nursing care in two areas: information related to the seizure condition, especially managing their condition, and support, in the form of talking to other children with seizures. The scale provides direction for tailored nursing interventions that will meet the specific needs of children with seizures for information and support.

Research in Nursing Education: State of the Science

The purpose of this pilot study was to assess the educational research currently conducted in U.S. schools of nursing. In this article, we describe the results from a small sample of schools of nursing (N = 21) and report the prevalence, type and level of funding for educational research, perceived barriers to developing and conducting rigorous programs of educational research in nursing, and support required. The respondents reported conducting primarily descriptive studies, most of which were underfunded, as well as a variety of barriers to conducting programs of educational research. The findings from this study provide some initial insights into the state of nursing education science in the United States. Despite the small sample, the findings affirm the paucity of research in nursing education and that the discipline must attend to the developmental needs of nurse researchers who study phenomena related to nursing education.

Relationship of selected seizure variables in children with epilepsy to performance on school-administered achievement tests

This study investigated the relationship of age at onset, epilepsy syndrome, seizure type, and seizure frequency to the performance of children with epilepsy (CWE) on school-administered group achievement tests that measured reading, mathematics, language, vocabulary, and overall achievement. Also assessed was whether the subjects had been retained in a grade at school and if the seizure variables could discriminate between retained and nonretained children. Separate hierarchical regression models using the seizure variables as predictors and the achievement scores as criterion measures were established. Chi-square and discriminant function analyses were used to investigate the relationship of the seizure variables to being retained in a grade. There were no significant relationships between the seizure variables and the achievement scores, with variance accounted for, ranging from 5% to 14%. Children with secondary generalized seizures were more likely to have been retained in a grade, but there was no relationship between being retained and seizure type. The seizure variables could not significantly discriminate between retained and nonretained students. It is suggested that emphasis should be placed on reducing vulnerability of CWE to dropping out of school.

Revision and evaluation of the Indiana University School of Nursing baccalaureate admission process.

This descriptive study evaluated the implementation of a revised admission policy for the Indiana University School of Nursing baccalaureate program. On the basis of our decision that grade point average (GPA) alone should not determine admission, new admission criteria were developed and implemented in spring 2007. In addition to a weighted GPA, criteria were added to include an interview, a writing sample, and a service requirement. Following the completion of all interviews and prior to notification of applicants of their admission status, students and interviewers who participated in the first admission cycle were mailed a survey asking their anonymous perceptions regarding the new process for application to the program. Responses indicate that both interviewers (n = 45) and students (n = 165) thought that the new policy and the interview were extremely positive. Results suggest that this comprehensive and varied approach to student admission was successful in its initial implementation. Further longitudinal studies are needed to determine how the new criteria affect student diversity; examination and course grades; progression, retention, and graduation; Assessment Technologies Institute tests; National Council Licensure Examination for Registered Nurses (NCLEX-RN) scores; admission to graduate school; and satisfaction of faculty with students and future employers with graduates.

Classroom Performance and Adaptive Skills in Children with Epilepsy.

Abstract The relationships of age at onset, seizure syndrome, seizure type, and seizure frequency, respectively, to the classroom performance and adaptive skills of 131 children with epilepsy were studied. The Teacher Report Form of the Child Behavior Checklist was completed by the childrens teachers. Hierarchical multiple regression analyses were conducted on ratings of academic subject areas and overall adaptive skills. Significant results were obtained for English/Language, Reading, Mathematics, overall School Performance, Learning, Happy, and Total Adaptive skills. Epilepsy syndrome and frequency of seizures were significantly related to some of these analyses, with amounts of variance accounted for ranging from 11% to 23%. Children with secondary generalized epilepsy performed significantly worse than children with other epilepsy syndromes. The results suggest that a seizure disorder associated with a diffuse or multifocal brain insult can produce problems in achievement and school adaptation as manifested on a day-to-day basis. Suggestions for future research are presented.