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Abstract Epilepsy is a neurological disorder caused by malfunctioning nerve cell activity in the brain. These malfunctions caused episode called seizures. The stress of a new epilepsy diagnosis may play a significant role in the daily activities of families with children with epilepsy. Most parents are extremely upset when their child is diagnosed with epilepsy, mainly because of the stigma associated with the condition. Parents play the most significant role in helping the child with epilepsy adapt to his/her condition. In practical terms, their functions include seeking treatment, ensuring the child‘s compliance with treatment, facilitating the child‘s functioning in and outside the home, and recognizes the impact of epilepsy on child attitudes. The care of a child who has epilepsy is best achieved by an epilepsy specialist nurse. While, the nurses play a pivotal role in providing a close link between the children with epilepsy and their families. They are also, in an ideal position to establish a link between the doctors and the affected families and offering valuable advice and support. Aim of the Study: The aim of this study was to assess the stressors and coping patterns of mothers having children with epilepsy. Subjects and Methods: A-Research Design: A descriptive design was used in conducting this study.B-Research Setting: The study was conducted at the outpatient clinic in the Neurological Pediatric Outpatient Clinic affiliated to Ain Shams University Hospitals. C- Subjects: A convenient sample was used and included all available children having epilepsy that constituted of 100 children and their accompanying mothers, who fulfilled the study criteria (confirmed diagnosis of epilepsy, whatever the types of epilepsy and who were attended to the previously mentioned setting for management and follow up). D-Tools of data collection: Data were collected through using the following tools: I-Structured Questionnaire Sheet (Appendix II): It was developed by the researcher after reviewing the relevant and current literature and revised by the thesis supervisors, it was designed in a simple Arabic language to suit level of understanding of the mothers, it includes the following parts: -First part: A- characteristics of the mothers having children with epilepsy which included mothers‘ age, educational level, occupation, residence and family income.B- characteristics of children with epilepsy which included the child‘s age, gender, child‘s order and educational level.Also, data about duration and number of attack. -Second part: It was concerned with knowledge of the mothers regarding epilepsy such as: - Meaning and types of epileptic attack. - Risk factors of epileptic seizures and factors that mothers can follow to avoid these factors. - Types of treatment and its side effets. - The role of the mothers in care of their child when has a seizure and actions taken if a seizure not stopped. - The role of the mothers in care if their child vomits medication. - Compliance of follow up and drug regimen. - Safety measures that mothers follow with their child inside and outside the home. The types of questions were varied from multiple choice questions, short answer questions and essay questions and its number was 37 questions. Scoring system: The score of each question was determined according to its importance. The total score for the mothers, knowledge was determined according to their satisfactory level as following-Satisfactory level of knowledge ˃ 60% -Unsatisfactory level of knowledge ˂ 60% II-Parenting Stress Index (PSI) (Abidin, 1995) (Appendix III). Parenting Stress Index was developed by Abidin, (1995). It was used to assess parents, stress, it includes 36 items related to parents, functioning, the behavioral and temperamental qualities of the child and the parent-child relationship. This index was modified by the researcher in the form of omission for some statements not related to its relevance of the study. Accordingly, 29 statements were selected from this index for data collection. The scale divided into 3 kinds of stressors (physical, social and psychological). The researcher translated the index into a simple Arabic language to suit nature of the study. Scoring of the parenting stress index (PSI): The Parenting Stress Index is a five point scale, according to the degree of the mothers stressors, the numerical values allotted to each response as following: Scores were used (5) points for strongly agree, (4) points for agree, (3) points for not sure, (2) points for dis agree and (1) points for strongly disagree.Regarding the total degree of stressors: Score from ≤50% referred to low stressors. Score from 50<75% referred to moderate stressors. Score from≥75% referred to high stressors III-Coping Patterns Scale (Jalowiec and Powers, 1991) (Appendix IV). This scale was developed by Jalowiec and Powers, (1991), and used to assess the mothers coping patterns toward their children suffering from epilepsy. It was modified by the researcher and translated into the simple Arabic language to suit the nature of the study. The modification of this scale in the form of omission for some statements not related to the relevance of the study. Accordingly, 35 statements were selected in this scale for data collection from 60 statements. Scoring of the Coping patterns scale: The coping patterns scale is a three point scale according to the degree of coping, the numerical values allotted to each response was the always, sometimes and never. Measuring the scores of coping patterns of mothers rated on a 1-to 3-point Likert scale to indicate the degree of use (never, sometimes and always).Whereby (3) points for always, (2) points for sometimes, (1) points for never.According to the given responses the study subjects coping patterns were categorized into either: Score ≤35% referred to low ability to cope. Score 35<70% referred to moderate ability to cope. Score ≥70 % referred to high ability to cope. II-Operational design: A-The preperatory phase: These phases include reviewing of the past and current related literature. It covers various aspects of the research problems using available articles, periodicals, magazine and books, and also to develop the study tools for data collection. Validly of the study tools, was ascertained by a group of experts in pediatric nursing. Their opinions will be elicited regarding the format, layout, consistency, accuracy and relevancy of the tools. B- Pilot study: A pilot study was carried out with 10% of the total study sample in March, 2015 to test the study tools in terms of its clarity, arrangement, applicability of its items and the time required to fill in, involving a group of children and their accompanying mothers at outpatient clinics of Pediatric Hospital. The results of the data obtained from the pilot study were helped in modifications of the study tools, where certain items were corrected, such as safety measuresfollowed by mothers when their child has attacked and certain items were omitted in coping scale and parenting stress index also, certain items were added as needed such as mother`s response after first seizure for their child and the mothers source of information about their child with epilepsy. The pilot study sample was not included in the study sample. C-Field work: Data collection was carried out from April, 2015 to November, 2015; the researcher introduced herself to the mothers. Aim of the study and its expected outcomes was explained for the mothers prior to get the questionnaire sheet.The researcher attended the study settings 2days /week from 9am to 12pm in the previously mention setting. For data collection, each mother was interviewed individually in the waiting area. The study tools were filled within 30-45 minutes. III-Statistical design: Data entry and manipulated through statistical pakage for social science and revised, coded, tabulated and presented using statistics in the form of frequencies and percentages. Mean and standard deviations were used for quantitative variables. The qualitative data were also analyzed by applying appropriate statistical method qui square (x2) to determine whether there was a statistical significant difference or not. Statistical significant difference was considered as follows: Non significant (NS) p >0.05 Significant (S) p ≤0.05 Highly significant (HS) p ≤0.01 IV-Administrative design: An official written letters were issued from the Dean of Faculty of Nursing, Ain Shams University, to the director of the Pediatric Hospital of Ain Shams University to seek their approval for carrying out the study. -Ethical considerations: Oral consent was obtained from each mother prior to fill the study tools after clarification of the study aim and assuring them that, the gathered information will be used for scientific research purpose only and will be strictly confidential. Study subjects were free to withdraw from the study any time they want. Results The findings of the current study can be summarized as: As regards characteristics of the children it was found that, the mean age of the children is 5.78 ± 3.95 years and more than two fifth (41%) of them is ranked as third child and more in their families. More than half 52% of the children are males. As regards educational level of the children, less than half (43%) of them are not registered to school. As regards the characteristics of the mothers, the mean age of the mothers is 32.2 ± 6.0 years and less than one third (30%) of them had secondary education. As regards occupation, the majority (90%) of the mothers are housewives and three quarters (75%) of them areliving in an urban areas. As regarding the mothers total level of knowledge about epilepsy, more than half (53%) of the mothers have a satisfactory knowledge about epilepsy. As regards mother`s total stress with their children with epilepsy, 60% of the mothers have a high level of physical stressors, while, 52% of them have a moderate level of social stressors. Additionally 36% of the mothers have a moderate level of psychological stressors. Concerning distribution of the mothers according to their total coping patterns related to their children suffering from epilepsy, more than half (56%) of the studied mothers had a moderate coping patterns related to their children with epilepsy. While, 17% of them had low coping pattern related to their children with epilepsy. Concerning the relation between the mothers’ characteristics and their total level of stress, there is no statistical significant observed between mother’s occupation and residence and their total level of stress (X2 = 2.503, P >0.286). Where, 90% and 58.7% of mothers have high level of stress and are working and living in an urban area respectively. Moreover, there is a statistically significant is found between the age of the mothers, educational level, the family income and their total level of stress , while, 11.8% and 84 % of mothers have a moderate level of stress and are aged 40 ≤ 45 years and are highly educated. Inaddition 71.7 % and 70.4 % of mothers have a high levels of stress and have adequate income and have family history of epilepsy. Regarding the relation between the characteristics of the mothers and their total coping pattern, there is a very high statistical significant is observed between the age of the mothers, family income and their coping patterns, where, 67.9% and 61.1% of mothers have a moderate coping patterns, they aged 30- ˂ 35 years and are housewife respectively. Moreover, there is very high a statistical significant is observed between mothers occupation, residence and family history of epilepsy where, 10%, 49.3% and 60.9% of mothers have a moderate coping patterns and are working, living in an urban area and have no family history of epilepsy.While, there is no statistical significant concerning mothers educational level (X2 = 13.778, P 0.088) and their coping patterns. Where, 50% of mothers have high coping patterns and they are diploma education. There is a statistical significant between total level of stress of mothers’ and their total level knowledge (X2 = 9.112, P < 0.011). Where, 72.7% of the mothers have an unsatisfactory level of knowledge and have a low level of stress. Meanwhile, 65.5% of the mothers have a satisfactory level of knowledge and high levels of stress.There is a statistical significant between coping patterns of mothers’ and their total level knowledge (X2 = 14.211, P< 0.001). Where, 17.6% of the mothers have an unsatisfactory level of knowledge have low level of coping patterns. Meanwhile, 82.4% of the mothers have satisfactory level of knowledge and low level of coping patterns. There is a statistical significant between total level of stress of the mothers’ and their coping patterns (X2 = 15.871, P < 0.003).Where, 5.2% of the mothers have low coping patterns have high level of stress. Meanwhile, 65.5.0% of the mothers have moderate coping patterns and have a high level of stress. There is a statistical significant between total level of stress of the mothers’ and their coping patterns (X2 = 14.211, P < 0.003). While, 3.0% of the mothers have high coping patterns and low level of stress. Also, 38.0% of the mothers have moderate coping patterns and high level of stress. Conclusion: The findings of this study can be concluded that the mothers of children with epilepsy have a satisfactory level of knowledge about epilepsy and facing many stressors resulting from epilepsy and its long lasting consequences and prolonged continuous treatment. These stressors included all aspects of life as physical, psychological and social stressors. Also the mothers of children with epilepsy have a moderate coping pattern with their children with epilepsy. As well as there was a relation between coping of the studied mothersand their level of knowledge. Meanwhile, there is a positive relation between stress of the mothers and their coping patterns, where mothers having high coping patterns had low levels of stress. |