psychiatric nursing

1. G U I D E : D R . ( M R S . ) J Y O T I S A R I N
D I R E C T O R - P R I N C I P A L , M . M . C O N
C O G U I D E : M R . Y O G E S H K U M A R
A S S O C I A T E P R O F E S S O R
C H I L D H E A LT H N U R S I N G
P R E S E N T E D B Y :
J Y O T I P H O U G A T
M . S C . N U R S I N G S T U D E N T
C H I L D H E A L T H N U R S I N G
Tool
presentation

2.  Diseases of the nervous system are fairly common in paediatric practice.
Seizures are the most common pediatric neurological disorder. The
incidence of seizures is highest i.e. 5% children experience convulsion
during the first 5 years of life, with a decreasing frequency in older age.
Most of seizures in children are provoked by somatic disorders
originated outside the brain such as high fever, infection, syncope, head
trauma, hypoxia, toxins other causes include genetic syndrome and
cerebrovascular diseases
 Seizure in childhood may interfere with familial life, sleep and social life
of parents, imposing tremendous stress and anxiety on them. Providing
sufficient information to the parents about seizure as well as the benign
nature of the disease is an important measure for relieving their stress
and anxiety
 Seizure control is more in the hands of the patient and the caregiver. The
prognosis of the seizures depends on the understanding and compliance
of the patient and parents entrusted with the treatment and management
of the disease.
INTRODUCTION

3.  In India little attention has been paid about providing knowledge of childhood
seizures and there are lots of myths and social stigma about seizures disorder.
 Parents is the primary care giver and responsible for meeting the basic needs of
the child. The important components of child rearing are maternal activities that
promote the children's physical, intellectual and psychosocial development. The
mother has to understand the disease process, first aid measures to treat seizures
and ways to prevent the recurrence of seizure.
 Nurses need to educate the child and family about the nature and causes of the
disorder, methods of treatment and prognosis for normal life. The nurses should
be advocates for childhood seizures so that they are not overly restricted by
caretakers who do not understand seizures and overprotect their child
 There are very less study conducted related to assessing the parents knowledge,
attitude, practices and concern regarding childhood seizures and Various
questionnaires about KACP can be found in the literature. However, further
studies are required for the application of questionnaires among different
cultures and than develop a FAQs which help to clear the doubts of parents
related to childhood seizures
NEED OF STUDY

4. A study to assess Knowledge, Attitude, Practices and
Concerns of parents regarding Childhood Seizures in
selected hospital of Haryana with A view to develop FAQs.
OBJECTIVES:
To assess the knowledge, attitude, practices and concerns of
parents regarding childhood seizures
To find out the relationship between knowledge, attitude and
practices of parents regarding childhood seizures
To find out the association of knowledge, attitude, practices of
parents regarding childhood seizures with selected variable
To develop a FAQs for parents regarding childhood seizures
Problem Statement

5.  H1-There will be significant association of knowledge of
parents regarding childhood seizures with selected variable
 H2-There will be significant association of attitude of parents
regarding childhood seizures with selected variable
 H3-There will be significant association of practices of
parents regarding childhood seizures with selected variable
 H-4There will be significant relationship between knowledge
and attitude of parents regarding childhood seizures
 H-5There will be significant relationship between attitude
and practices of parents regarding childhood seizures
 H-6There will be significant relationship between knowledge
and practices of parents regarding childhood seizures
HYPOTHESES

6. Knowledge: In this study it refers to the awareness or
familiarity of parents regarding childhood seizures. Measure by
structured knowledge questionnaire and categories as very
good (>75%), good (61-75%), average (51-60%), below
average (<50%)
Attitude: In this study attitude refers to the expression of
feeling, behaviour or thoughts exhibited by the parents
regarding childhood seizures, measured by five point likert
scale and categories as favorable(>75%), moderately
favorable(50-75%), unfavorable(<50%)
Practices: It refers to the customarily or habitually performed
practices as expressed by the parents at the time of childhood
seizure attack. Measure by practice checklist and categories as
good (>75%), fair (50-75%), poor (<50%)
OPERATIONAL DEFINITION

7. Concerns: In this study concern refers to A troubled or
anxious state of mind of parents regarding childhood seizures
FAQs: It refers to list of frequently asked question by the
parents and answered by the researcher in simplified
language.
Childhood Seizures: It refer to condition of child age less
than 15 year when there is a sudden, brief change in brains
work, imbalance in neurons activity and level of
consciousness, movement or action may be altered for a short
time, as diagnosed by physician and getting treatment. The
seizures must be unprovoked cause like there is no exposure
to toxin, head injury, low blood glucose, NCC
(Neurocysticercosis) etc.
CONT…

8. Selected Variable: It refers to Age, gender,
relationship with child, marital status, religion,
educational status, occupation of parents, family history,
source of information regarding childhood seizure,
treatment modality adopted for child and age, gender and
duration of illness of child with seizure disorder.
CONT…

9.  RESEARCH APPROACH
Non experimental approach
 RESEARCH DESIGN
Descriptive and survey design
 POPULATION:
In this study the population is parents of child having seizures
disorder.
METHODOLOGY

10.  ACCESSIBLE POPULATION:
Accessible population is parents of child admitted with seizures
and those who meet designated criteria and are available during
data collection.
 SAMPLE :
Parents of children diagnosed with childhood seizures and
admitted to the hospital of Ambala Haryana
 SAMPLING TECHNIQUE:
Purposive sampling technique.
CONT…

11.  Sample size:
150 parents of child diagnosed with childhood seizures.
 Inclusion criteria :
1. Parents of child diagnosed with childhood seizures
2. Parents those are willing to participate
 Exclusion criteria:
1. Parents of child having first episode of seizure
2. Parents of child having secondary cause of seizures
CONT…

12. Tool consist of following sections
 Section -A: - Consist of demographic variables
 Section-B: - Structured knowledge questionnaire. It comprises
of 30 knowledge items. These are multiple choice question, each
item has single correct answer
 Section-C: - Attitude scale i.e. 5points likert’s. It comprises of
30 statements( 16 positive and 14 negative statements)
 Section-D: - Practice checklist for parent regarding childhood
seizures
 Section-E: - Structured 5 points likert’s concern scale
Technique: Interview technique for collecting data
METHOD OF DATA
COLLECTION

13. ….
TOOLS FOR DATA
COLLECTION

14. DESCRIPTION OF TOOLS AND
TECHNIQUES cont..
SECTION A:-
It consists of performa to assess Demographic
variable having two parts:
Part-1 (Parent Profile): gender, age, type of with
child, marital status, religion, education status,
occupation, monthly income, place of domicile, family
history of seizure , source of information
Part-2 ( Child Profile): age, gender, duration of
illness, any associated problem with seizures

15. Part-I: Parents Profile
Code No.______
Instructions to the respondents : Read the following items
carefully and give appropriate response by placing a tick (√ )
mark against them.
1. Gender
1.1Male
1.2 Female
2. Age in years
2.1 < 21
2.2 21-25
2.3 26-30
2.4 31-35
2.5 36-40
2.6 > 41
Section –A
DEMOGRAPHIC VARIABLES

16. 3.Type of relationship with children
3.1Mother
3.2 Father
4.Marital status
4.1Married and living together
4.2 Widow
4.3Widower
4.4Divorced
5.Religion
5.1Hindu
5.2Muslim
5.3Christian
5.4Sikh
5.5 Others Specify ______________

17. 6.Educational Status
6.1 Non literate
6.2 Primary Education
6.3 Matriculation
6.4 Higher Secondary Education
6.5 Graduation
6.6 Post Graduation
6.7 Other specify_______________
7. Occupation
7.1 Home maker
7.2 Private employee
7.3 Government employee
7.4 Self employed
7.5 Unemployed
7.6 Any other _________________________

18. 8.Monthly income of the family in Indian rupees
8.1 < 5000
8.2 5000-10000
8.3 10001-15000
8.4 15001-20000
8.5 20001-25000
8.6 >25001
9. Place of domicile or residence
9.1 Rural
9.2 Urban
10. Is there any family history of seizures?
10.1 Yes
10.2No

19. 11Source of information which you have acquired
information regarding Seizures
11.1Television
11.2 Radio
11.3 Newspaper/Magazine
11. 4Family and friends
11.5 Workshop/ conference/ health awareness
programme3
11.6 Any other _____________________________

20. Part-2: Child Profile
1. Age (in years)
1.1 1-3 [ ]
1.2 3-6 [ ]
1.3 6-9 [ ]
1.4 9-12 [ ]
1.5 12-15 [ ]
2.Gender
2.1Male [ ]
2.2 Female [ ]

21. 3.Duration of illness of child
3.1 1month [ ]
3.2 2-5month [ ]
3.3 5-12months [ ]
3.4 12-17months [ ]
3.5 17 -24months [ ]
3.6 >24 months [ ]
4.History of any previous episode of seizure
4.1 Yes [ ]
4.2 No [ ]
5. Is there any associated problem with seizures?
5.1 No [ ]
5.2 If any specify _______________________

22. DESCRIPTION OF TOOLS AND
TECHNIQUES cont..
SECTION B:- Structured Knowledge Questionnaire
consists of 6 main areas having 30 test items. Every
correct answer will be awarded a score of one and every
wrong answer will be assigned a score of zero. The
maximum possible score will be 30 and minimum score
is 0. Criterion measures are-
KNOWLEDGE SCORES
Below average (>50%) 0-15
Average (51-60%) 16-18
Good (61-75%) 19-22
Very Good (>75%) 23-27

23. • Each correct answer carry one mark Code no: _______
1.What do you mean by seizures?
1.1 A curse
1.2 Black Magic
1.3 Evil Spirit
1.4 Electrical imbalance in the brain
2. Which of the following organ is affected in seizures?
2.1 Lungs
2.2 Brain
2.3 Heart
2.4 Kidney
3. Seizure disorder lead to
3.1 Mental illness
3.2 Kidney related problems
3.3 Neurological disturbance
3.4 Heart problem
SECTION –B
STRUCTURED KNOWLEDGE QUESTIONNAIRE

24. 4 What immediately will happen in Seizure?
4.1 Jerky Movements
4.2 Sleeping disturbance
4.3 Behavioral disturbance
4.4 Only a loud cry
5 In which age group seizures is more common?
5.1 0-10yr
5.2 11-20 yr
5.3 21-30yr
5.4 31-40yr
6.Factor that precipitate seizure attack in a child
6.1 Exposure to flickering light and sudden sound
6.2 Hard Study
6.3 Exposure to cold weather
6.4 Playing with friends

25. 7. Child seizures shall be treated
7.1 In lunatic asylum
7.2 Like other disease condition
7.3 Only in mental hospital
7.4 Only an outpatient basis
8.What happens if you touch a child having seizures?
8.1The disease will pass on to you
8.2 Nothing will happen
8.3 Sometimes it may spread
8.4 The duration of it will increase
9. Childhood seizure is transmitted by_________
9.1 family
9.2 Blood
9.3 Mosquito bite
9.4 It will not spread

26. 10. What could be the cause for seizure in children?
10.1 Bad thoughts
10.2 Changes in the blood
10.3 Problems during pregnancy and child birth
10.4 Nutritional Deficiency
11. Which following associated feature is most commonly seen
in child during seizure?
11.1 Sudden chest pain and perspiration
11.2 Skin color changes in to blue or pallor
11.3 Sudden holding of breath, fixing eye lids and jerky
movements
11.4 Do not know
12.The behavior change in a child soon after the fit
12.1 Confusion
12.2 Overactive
12.3 Madness
12.4 Shivering

27. 13. Which diagnostic procedure is most useful in diagnosis of
seizure?
13.1X-Ray
13.2 EEG
13.3 Blood Test
13.4 Screening
14. What would you do if you see a child having seizure?
14.1Turn the child to one side until the fit gets over
14.2 Give any iron object in the child’s hand
14.3 Restrain the child by holding tightly
14.4 Place him on the flat surface
15.What will you do if the seizure lasts about five minutes or
more?
15.1 Attempt to stop the fit by restraining
15.2 Give one extra dose of anti epileptic tablet
15.3 Take the child to near hospital
15.4 Just watch the child behavior

28. 16. Which is appropriate to offer the child during post seizure
period?
16.1 Epileptic medication as prescribed
16.2 Nothing to be given by mouth
16.3 Give meals
16.4Water/ cold or hot drink
17. Child with uncontrolled seizures should be
17.1Restrained
17.2Evaluated by a doctor
17.3Left without assistance
17.4Continue same treatment
18. Which treatment is best suited for childhood seizure ?
18.1 Witch Craft
18.2 Native medicine
18.3 Modern medicine
18.4 Without medicine other traditional methods

29. 19. How long anti epileptic drug be continued?
19.1One month
19.2 One year
19.3 3-5 years
19.4 Life-long
20. Anti epileptic drugs ideally to be given to child at home
20.1 Before seizure attack
20.2 During seizure attack
20.3 After seizure attack
20.4Regularly
21. What is the common side effect of anti epileptic drug in a
child?
21.1Improvements in concentration
21.2Drowsiness
21.3Dental retardation
21.4Overactive

30. 22.The missed dose of epileptic drug should be taken
22.1 Taken with next day dose
22.2 after 1 week
22.3 after 2 weeks
22.4 inform doctor during next visit
23. Childhood seizure can be controlled by taking
23.1Regular medicine
23.2Regular balance diet
23.3Regular exercises
23.4Regular rest
24. If the anti epileptic drugs produce severe side effects the drug
should be
24.1Dosage can be reduced
24.2Stop immediately and consult a doctor
24.3Should be taken alternative days
24.4Discontinued completely

31. 25. Regular follow up is needed for childhood seizures
25.1Assessment of the condition of the child
25.2To stop the drug
25.3To modify the diet
25.4To change the treatment
26.Seizure diagnosed child who is on treatment can
26.1Not participate in any activities
26.2Do any activities anywhere
26.3Not to go to school or continue studies
26.4Not play near fire, water, in height places and ride bicycle
with these Precautions can do any activities
27. The child with anti epileptic treatment should always remember to
carry
27.1Anti Epileptic tablets
27.2Hospital identification card
27.3Prescription Slip
27.4Address Proof

32. BLUE PRINT OF STRUCTURED
KNOWLEDGE QUESTIONNAIRE
CONTENT AREA KN
OWLED
GE
UND
ERSTAND
ING
APP
LICATIO
N
TOT
AL
PERCEN
TAGE
1. Beliefs about
seizure disorder
2 1,3.4 0 4 14.8%
2.Concept of seizures
disorder and its
causes
5,6,8,9,1
0
7,11 0 7 25.9%
3.Sign & symptom &
diagnostic measures
of seizure
14,15,16 12,13 5 18.5%
4.Care of child
during seizures
19 17,18,20 4 14.8%

33. BLUE PRINT OF STRUCTURED
KNOWLEDGE QUESTIONNAIRE cont..
4.Treatment 22,23,24,
25
21 5 18.5%
5.Home care of child
and follow up
26,27,28 29 30 5 18.5%
TOTAL 17 9 4 30 100%
PERCENTAGE 56.7% 30% 13.3% 100%

34. Section-C
DESCRIPTION OF TOOLS
Attitude scale consists of 5 content areas which having
total 30 statement.
Maximum possible score is 150 and minimum possible score is 30
CRITERION MEASURES-
Attitude SCORES
Unfavorable (>50%) 0-74
Moderately Favorable (50-75%) 75-112
Favorable (>75%) 113-150

35. Code no: _______
The following statements related to attitude of parents
towards seizure disorder of children.
• SA- Strongly Agree
• A- Agree
• U - Undecided
• D- Disagree
• SD –Strongly Disagree
Section- C
5 POINT’S LIKERT SCALE FOR ASSESING
ATTITUDE OF PARENTS TOWARDS CHILDHOOD
SEIZURES

36. S.N
o
STATEMENTS S
A
A U D S
D
1 Children with seizures disorder should not be
given any responsibility
2. Seizures occurs due to black magic
3 Child with a history of seizures should be
excluded from the group
4 Child with Seizure disorder is a cause for
constant worry in home
5 Children with seizures are not a burden to the
family or society
6 Child with seizure disorder has the basic rights to
attend school like other children.
7 Seizures can lead to learning difficulty in child
8 A child with seizures is inferior to other children.

37. S.
NO.
STATEMENTS S
A
A U D S
D
9 It is harmful to allow seizure diagnosed child to
mingle with other children in small gathering
10 External activities have to avoid by Child with
seizure.
11 Childhood seizure is not a stigma for family.
12 Parents has to accept clinical condition of child with
seizures it is essential
13 Seizure disorder is a cure able disease
14 Childhood seizures treated by itself without any
intervention
15 child on irregular treatment can become healthy
16 A child with uncontrolled seizures should be
hospitalized

38. S.
No.
STATEMENTS S
A
A U D S
D
17 Child with seizures should kept separately in the
family
18 Child with seizures need special coaching, help
and guidance from their teacher
19 Childhood seizures lead to mental illness
20 Children with seizures are accident prone.
21 Child with seizures can participate in strenuous
extra-curricular activities with certain precautions.
22 Child with seizures cannot sent to school where
normal children study.
23 Parents of child with seizure does not need
counselling
24 The diagnosis of seizures has an impact on your
family life

39. S. No. STATEMENTS S
A
A U D S
D
25 The diagnosis of seizures affect the attitude of
the friends towards the effected child
26 Seizure is a medical emergency
27 A child with seizure is able to cope with
demands of day to day activities
28 Seizure diagnosed child can lead independent
life.
29 The child with seizures does not possess a
normal life expectancy
30 Intelligence and concentration of the child
will be altered if child gets seizures
frequently/ repeatedly for long time.

40. Section- C
Blue Print Of Attitude Scale
S
.
NO.
CONTENT
AREA
ITEMS TOTAL
NO. OF
ITEMS
PERCENTAGE
1 Child personal
development
1,2,6,8,18,27 6 20%
2 Child socialization 3,4,5,9,12,17,24,25 8 26.6%
3 Treatment and
prevention of
diseases
11,13,14,15,16 5 16.6%
4 Risk factor 7,20,29 3 10%
5 Parent concept
related to childhood
seizure
10,19,21,22,23,26,
28,30
8 26.6%
TOTAL 30 30 100%

41.  Positive statements markings as: SA (Strongly Agree) -5,
A (Agree) -4, U (Undecided) -3, D (Disagree) -2,
SD (Strongly Disagree) -1
In this tool 16 are Positive Statements:
2,4,5,6,7,11,12,13,16,20,21,24,26,27,28,30
 Negative statements markings as: SA (Strongly Agree) -
1, A (Agree) -2, U (Undecided) -3, D (Disagree) -
4, SD (Strongly Disagree) -5
In this tool 14 are Negative:
Statement:1,3,8,9,10,14,15,17,18,19,22,23,25,29

42. Code no: _______
Read the statement properly and mark () on YES or NO according to
practices followed when child having seizure attack
Section-D
CHECKLIST
FOR ASSESING PRACTICES OF PARENTS FOR
CHILDHOOD SEIZURES
S.NO. PRACTICES FOLLOWED YES NO
If child having seizures ,the parents has to
1. Do Not taking any action
2. Start doing prayers
3. Try to restraint the child during
convulsion
4. Infliction of burn to child
5. Rubbing hands and feet of child

43. S.NO. PRACTICES FOLLOWED YES NO
6. Remove the nearby objects to prevent any
injury to child
7. Wait for the end of the seizures attack
8. Consult to folk healer
9. Bring Burning wood near to the feet of child
10. Give cow urine to the child
11. Keeping bad smell socks or shoe near to nose
12. Take child immediately to the hospital
13. Turn the child to one side during seizure
14. Try to put sharp object or spoon to open the
mouth

44. S.NO. PRACTICES FOLLOWED YES NO
15. Sprinkle the holy water on the child
16. Flickering of light into eyes
17. Loosen the child clothes
18. Maintain the ventilation in the room
19. Provide water or liquid to child during
seizures
20 First protect child from falling

45. Section-D
BLUE PRINT OF CHECKLIST
S
.
NO.
CONTENT AREA ITEMS TOTAL
NO. OF
ITEMS
PERC
ENTAGE
1 Practices which good
for child
6,12,13,17,18,20 6 30%
2 Practices which can
harm child
1,2,3,4,7,8,9,10,11,
14,19
11 55%
3 Practices which have
less effect on child
health
5,15,16 3 15%
TOTAL 20 20 100%

46. Code no: _______
Concerns of parents regarding childhood seizures. Choose one what
you think
Section –E
5 POINT’S LIKERT SCALE FOR ASSESSING
PARENTS CONCERN
REGARDING CHILDHOOD SEIZURES
S.No. PARENTS CONCERNS
Not
conc
ern
Infrequ
ently
concer
n
frequen
tly
concer
n
Extre
mely
conce
rn
Unde
cided
1. Is Childhood seizure is curable?
2. When will be the next seizures to
child
3. Do other siblings also prone to have
seizures?
4. Whether child having normal
intelligence as earlier

47. S.No
.
PARENTS CONCERNS
Not
concer
n
Infrequ
ently
concer
n
frequen
tly
concern
Extre
mely
concer
n
Undeci
ded
5. Do I have to keep child at
home lonely?
6. Child studies get effected
with this disease
7. Child having less chance to
marry in future
8. Not allow to move child alone
anywhere
9. Child having less chance to
get job in future
10 Since how long child has to
take medicine?
11. Is there is any side effect of
medication on child memory?

48. S.No
.
PARENTS CONCERNS
Not
conce
rn
Infrequ
ently
concern
frequ
ently
conce
rn
Extre
mely
concer
n
Undec
ided
12. Anti epileptic medication induces
sleep
13. Child able to perform his/her work
independently
14. Medicine Can stop if seizure no
longer than 6 month to 1year
15. Since how long the medication to
be taken by child

49. SECTION –E
Blue Print Concerns of Parents
S
.
NO.
CONTENT
AREA
ITEMS TOTAL
NO. OF
ITEMS
PERC
ENTAGE
1 Risk for child 1,2,3,6 4 26.7%
2 Child personal
&Social
development
4,5,7,8,9,13 6 40%
3 About
Treatment
10,11,12,14,15 5 33.3%
TOTAL 15 15 100%
Maximum possible score is 75 and minimum possible score is
15

50. • Positive statements markings as: (extremely concern)-5,
(frequently concern) -4, U (infrequently concern) -3, (not
concern) -2, (undecided) -1
In this tool 8 are Positive Statements: 2,3,4,6,10,12,13,15
• Negative statements markings as: (undecided) -1,
(extremely concern) -2,(frequently concern) -3,
(infrequently concern)-4, (not concern) SD -5
In this tool 7 are Negative Statement:1,5,7,8,9,11,14
Cont…

51. Ethical Clearance letter

52. • Marlow R. Dorothy, Redding A. Barabara. Textbook of
Paediatric Nursing. 6th Edition. Elsevier India pvt.ltd.2010.p
.957-966
• Ghai OP, Piyush Gupta, Paul VK. Ghai Essential Pediatrics. 8th
ed. New Delhi: CBS Publishers and distributors; 2013. p. 552-
560.
• Donna L Wong, Marilyn J Hockenberry. Nursing care of infants
and children.7th ed. Missouri: Mosby publications; 1999. p.
1691-1684-1698.
• Varupi Jain. Epilepsy: defogging the demon; 2005. New Delhi.
Available from http://www.indiatogether.org/2005/feb/hlt-
epilepsy.htm.
• Angela I. Frank-Briggs, E. A. D. Alikor. Knowledge and
Attitudes of Parents towards children with Epilepsy. Annals of
African Medicine. Vol. 10.2011. p. 238-242
LIST OF REFERENCES

53. • Sidig Amira, Ibrahim Gaafar, Hussein Abbasher, Safa et.al. A study of
knowledge, attitude, practice towards epilepsy among the relative of
epileptic patient in Khartoum state. Sudanese Journal of Public
Health,2009 vol.4 no.4. p 393-398
• M. Hazaveh Sajadi, M. Shamsi. Assessment of mother’s behavior in
preventing febrile convulsion in their children in Arak city: an application
of health belief model. Journal of Jahrom University of medical
sciences,2011. Vol.9 no.2. p-33-39
• Sridharan R, Murthy BN. Prevalence and pattern of epilepsy in India.
Epilepsia 40;(1999):631-636 Available from
http://www.ncbi.nlm.nih.gov/pubmed/10386533
• Sridharan R, Murthy BN. Challenges in the management of epilepsy in
resource poor countries: burden of epilepsy Available from
http://www.medscape.com/viewarticle/705599-2.
Cont..