الفهرس 
Overview about Epilepsy in Children
Acquired causes of epilepsyOnly 14 pages are availabe for public view
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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.