RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE.

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

Ms MANITA UPADHYAY

1ST Year M. Sc Nursing

Medical Surgical Nursing

Year 2013-2014

PADMASHREE INSTITUTE OF NURSING

KOMMAGATTA

BANGALORE-560060

0

RAJIV GANDHI UNVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

1 NAME OF THE CANDIDATE AND ADDRESS

Ms. MANITA UPADHYAY

1st Year M. Sc Nursing,

Padmashree Institute of nursing,

Kommagatta– 560 060.

2 NAME OF THE INSTITUTE Padmashree Institute Of Nursing,

Bangalore.

3 COURSE OF THE STUDY AND SUBJECT

1 year M.Sc Nursing,

Medical Surgical Nursing.

4 DATE OF ADMISSION TO THE COURSE

2013

5 TITLE OF THE STUDY A study to assess the effectiveness of multifaceted intervention on adherence to treatment and knowledge regarding side effect to epileptic drug and prevention of complication of epilepsy among patients with epilepsy in a selected hospital, Bangalore.

1

6. BRIEF RESUME OF THE INTENDED WORK

6.1 INTRODUCTION

The nervous system is one of the major control systems of the body. As change occurs in

the external and internal environment of the body, the nerve cells receive this and transmit it to

other cells. The nervous system exerts primary control over the body’s muscular and glandular

activities, with the goal of maintaining homeostasis. This system is organized into the Central

Nervous System, which is composed of the brain and spinal cord, and the Peripheral Nervous

System, which consist of nerve fibers that carry information between the Central Nervous

System and other parts of the body. The nervous system is vulnerable to various disorders. One

of which is epilepsy.1

The term “Epilepsy” is derived from the Greek word “Epilamabavian” meaning is “to

seize or to take hold of”. To the Greeks epilepsy was a sacred disease, to Hipocrates it was a

disease of the brain. In later ages it became known as “the falling sickness” and was viewed as a

form of mental illness, with victims being consigned to asylums for the insane. Regardless of the

insights gained into epilepsy, stigma and fear are still associated with this problem. Public

awareness of the true mature of epilepsy is needed to dispel the misconceptions and fears

associated with this health problem.2

Epilepsy is a chronic disorder characterized by recurrent seizures and knows no

geographical, racial or social boundaries. It can begin at any age, but is most frequently

diagnosed in children, adolescents and the elderly. Psychiatric and cognitive disturbances are

relatively common in epilepsy.3

2

Epilepsy has been defined as “a disorder of the brain characterized by an enduring

predisposition to generate epileptic seizures, and by the neurobiological, cognitive, psychological

and social consequences of this condition”. The definition of epilepsy requires the occurrence of

at least one seizure. An epileptic seizure is defined as “a transient occurrence of sign and

symptoms due to abnormal excessive or synchronous neural activity in the brain”.4

The World Health Organization (WHO) estimates that 50 million people of all ages

around the world are affected by the world range from 5 to 10 per 1,000 people. However,

worldwide prevalence rate of epilepsy varies from 2.8 to 19.5 per 1,000 of the general population

and is more prevalent among children. The global burden of epilepsy (including epilepsy and

status epilepticus) is determined by estimating the number of productive life years lost due to

disability or premature death resulting from the disease (known as disability adjusted life years,

or DALYs). The DALYs lost annually due to epilepsy as 6,223,000 worldwide.4

3

Incidence of epilepsy in different countries.

Author with year of study

in parenthesis

Place of study Incidence rate per

1,00,000 population

Remarks

Pond (1960) Uk 70 All seizure

Krohn (1961) Norway 11 All seizure

Zielinsiki(1974) Poland 26 Seizure

excluding FS

Juol- jenson (1983) Denmark 39(men)

28(women)

Seizure excluding FS

Granieri(1983) Italy 31 Seizure excluding

FS,SS,PS

Placencia(1992) Ecuador 190 Excluding FS

Hauser(1993) USA 44 Excluding FS,SS,PS

Mani(1997) India 49.3 Excluding HWE

Ulafsson(2005) Iceland 57 All seizure

SS: Single seizure, FS: Febrile seizure, PS: provoked seizure, HWE: hot water epilepsy.4

4

Distribution of the global burden of epilepsy, by age group and level of economic

development.

0-4 5_14 15-29 30-44 45-59 60-69 70-79 80+ total0%

10%20%30%40%50%60%70%80%90%

100%

4% 7% 11% 17% 22% 26% 31% 37%

12%18%

29%34%

42% 35% 33% 29%26%

32%

78%64%

55%40% 42% 41% 40% 37%

56%

high mortality developing reasonlow mortality developing reason developed reason

Epileptic conditions are multifactorial disorders, and it is useful to discuss three

important factors. The first factor is predisposition, or threshold. Anyone with a functioning

brain is capable of having a seizure. Threshold is a dynamic phenomenon; it varies throughout

the day, it also changes in relation to hormonal influences during the menstrual cycle in women.

The second important factor for epilepsy is the epileptogenic abnormality itself. Epilepsies

attributable to identifiable brain defects are refer to as symptomatic epilepsies. Symptomatic

epilepsies can be caused by a variety of disorders, including brain malformations, infections,

vascular disturbances, neoplasm, scars from trauma, including strokes, and disorders of cerebral

metabolism. The third important factor is precipitating condition, which determines when seizure

occurs. The most common are photosensitive seizures induced by flickering light, but some

patients have very specific reflex epilepsy with seizure precipitated by such stimuli like music,

certain visual patterns, and reading, eating and hot-water baths.

5

The mainstay of epilepsy treatment is medical therapy. The number of available

antiepileptic drugs has more than doubled in recent years, and there is now a large selection of

agents from which to choose, each with its own set of indications and adverse effects. The

common drugs are phenoytoin, carbazepine, valporic acid, phenobarbitol.5

Although epilepsy is a largely treatable brain disorder and relatively cheap medication is

available, between 60% and 98% of individuals with this disorder in developing countries

receive no treatment. People with epilepsy present with health problems, while also having to

cope with a wide range of psychosocial difficulties that affect almost every aspect of their lives.

Many of these difficulties are a consequence of public misconceptions, prejudice and stigma.6

Adherence to medication is the backbone to effectiveness of a therapy. In the absence of

a definitive curative therapy, antiepileptic therapy is a key intervention aimed at pro-longing and

improving the quality of life of epileptic patients suffering from a disease known for its

stigmatization.7

Non-adherent behaviour is traditionally categorized into unintentional and intentional.

Unintentional non-adherence includes behaviours arising from forgetfulness, misunderstanding

and confusion. Intentional non-adherence describes patient choice that deviates from the

prescribed medication regimen. Unintentional and intentional non-adherence is not mutually

exclusive; thus, an amalgam of these behaviours often exists in any one patient. An

understanding of patient behaviour and its underpinning psychology plus the wealth of factors,

both internal and external that may influence medication taking, is crucial to understand how to

change patient behaviour and thus improve medication adherence.8

6

Epilepsy affects the individual on both the physical and the psycho-social levels. Indeed,

there is now general agreement that the incidence of neurobehavioral disorders is higher in

patients with epilepsy than in the general population.9

Epilepsy is usually controlled, but not cured, with medication. Once epilepsy is

diagnosed, it is important to begin treatment as soon as possible. For about 80 percent of those

diagnosed with epilepsy, seizures can be controlled with modern medicines and surgical

techniques. In 1997, the Food and Drug Administration approved the vogues nerve stimulator for

use in people with seizures that are not well-controlled by medication.10

Some of the common side effects of antiepileptic drugs are gingival hyperplasia, coursing

of features, ataxia, hyponatremia, diplopia, Gastrointestinal symptoms, tremor, weight gain, hair

loss, thrombocytopenia, sedation, rash, word finding difficulty, renal stones, weight loss,

insomnia, anxiety, and irritability.11

The vagus nerve stimulator is a small device similar to pacemaker which produces a

weak electrical signals that travel along the vagus nerve to the brain it has shown to be effective

in the treatment of partial seizures, who have not respond well to antiepileptic medicines, and

who are not candidates for epilepsy surgery. Vagus nerve stimulator does not eliminate the need

for the medication, but it can help reduce the risk of complications from sever or repeated

seizures.12

Status epilepticus is the most serious complications of epilepsy and a neurologic

emergency. It is a state of continous seizure activity or a condition in which seizure recur in rapid

succession without return to consciousness between seizures. Potential etiologies of status

epilepticus include acute metabolic disturbances, toxic or infectious insults damage to the brain,

7

and underlying epilepsy. Morbidity from status epilepticus can be high; outcomes depend largely

on etiology and duration. Status epilepticus is a medical emergency, the management of which

centers on stopping the seizure activity and preventing the occurrence of systemic complications.

The other complication includes difficulty learning, permanent brain damage, and aspiration

pneumonia.13

6.2 NEED FOR THE STUDY

Epilepsy is quite a serious problem in India. While 60% of people in urban India consult

a doctor after suffering a seizure, only 10% in rural India would do so. Also, epilepsy treatment

is long term and can take around two years time. Adherence to medications therefore is very

poor with only half adhering to the regimen. Once patients are seizure free for a few days, they

stop medication until they suffer another episode.14

Adherence is defined as ‘the extent to which the patient’s behavior matches agreed

recommendations from the prescriber’. Adherence shifts the balance between professional and

patient to suggest there should be agreement between professional and patient about the

prescriber’s recommendation. Nonadherence is a large problem but it should not be seen as the

patient’s problem. Rather, it represents a limitation in the delivery of healthcare, often due to a

failure to fully agree the prescription in the first place or to identify and provide the support that

patients need later on. Addressing nonadherence is not about getting patients to take more

medicines. It starts with an understanding of patients’ perspectives of medicines and the reasons

why they may not want or are unable to use them. Practitioners have a duty to help patients make

informed decisions about treatment and use appropriately prescribed medicines to best effect. 15

8

Reasons for non-adherence are complex and multilayered. Patients can accidentally fail

to adhere through forgetfulness, misunderstanding, or uncertainty about clinician’s

recommendations, or intentionally due to their own expectations of treatment, side effects, and

lifestyle choice. There are various strategies suggested for managing patient adherence but these

are highly dependent on the reasons why a patient has not followed clinician advice initially.15

Estimates suggest that 30–50% of patients prescribed medications for chronic illnesses do

not adhere to their prescribed medication regimen. This non-adherence has been demonstrated to

diminish treatment effect which can result in prolonged illness, additional investigations and

prescriptions that may otherwise have been unnecessary. A link between poor adherence and an

increased risk of mortality is also well established. Consequently, the World Health Organization

has described non-adherence as ‘a worldwide problem of striking magnitude’ and a priority for

healthcare researchers and policymaker. Despite the magnitude and potential gravity of

suboptimal medication adherence, a gold standard intervention remains elusive; a recent

Cochrane review highlighted the paucity of effective interventions in current practice. Evidence

suggests that complex, multifaceted interventions tailored to meet individual needs are most

likely to be efficacious, which is intuitive given the complex, multistage process that is taking

medication.16

The incidence of adverse effects is an important issue when prescribing antiepileptic

drugs, as some of the most effective medications for seizures are associated with a considerable

degree of toxicity. However, all antiepileptic drugs have the potential to exert detrimental effects

on cognitive function. A thorough appreciation of the negative cognitive effects linked to a

variety of antiepileptic drugs makes a crucial contribution to therapeutic success.17

9

Epilepsy can impair an individual’s functioning within work and educational domains. As

well as adverse cognitive effects, some antiepileptic drugs may have the advantage of improving

cognitive performance. Such beneficial influences may simply occur as a result of seizure

control, or in association with positive effects on mood or psychiatric profile. However, a

number of agents may demonstrate efficacy in enhancing cognitive function in a more direct

way, by improving alertness or cognitive capacity.17

A person with epilepsy can face many challenges and dangers as he or she manages his or

her condition. The seizures themselves can cause injury and, in some cases, death. Even when

not endangered by the seizures, a person with epilepsy must still come to grips personally with

the condition and with the misconceptions surrounding it. Treating epilepsy is also its

drawbacks. Surgery can be dangerous and drug treatments usually involve side effects, as well as

complitations.18

The nurses offer a unique perspective in the early education of patients with epilepsy. As

part of care team, the nurses assume an important role in providing comprehensive epilepsy

education. Epilepsy may occur at any time throughout the life, and age related needs necessitate

ongoing assessment and intervention. The initial approach is ongoing assessment and

intervention. The initial approach is to improve cognitive and behavioral pattern towards

adherence to treatment and to formulate individualized education. The goal of education is to

provide the patient with video-assisted teaching and informational tool needed to enhance their

knowledge of epilepsy regarding side effect of drugs and complication of epilepsy and

recommended treatment plan can lead to a great sense of power and control necessary for self

management and an improve quality of life by creating a foundation of trust with the patient,

10

health care providers can continue to monitor and manage the seizure disorder to attain optimal

patient outcomes.

In view of above the researcher opinions that patient with epilepsy should be well

equipped with knowledge regarding adherence to treatment, knowledge regarding side effect of

epileptic drug and complication of epilepsy and the patient will free from complications. It is

important for the client with epilepsy to live as normal life as possible. Most of the patients are

unaware of the disease condition and adherence to treatment. Hence the researcher felt a need to

give multifaceted intervention to the patient about epilepsy.

11

6.3 STATEMENT OF PROBLEM

A study to assess the effectiveness of multifaceted intervention on adherence to treatment

and knowledge regarding side effects to epileptic drug and prevention of complication of

epilepsy among patients with epilepsy in a selected hospital, Bangalore.

6.4 OBJECTIVES OF THE STUDY

1. To assess the pre-test level of adherence to treatment and knowledge regarding side effect

to epileptic drug and prevention of complication of epilepsy among patients with

epilepsy.

2. To assess the post-test level of adherence to treatment and knowledge regarding side

effect to epileptic drug and prevention of complication of epilepsy among patients with

epilepsy.

3. To assess the effectiveness of multifaceted intervention on adherence to treatment and

knowledge regarding side effect to epileptic drug and prevention of complication of

epilepsy among patients with epilepsy.

4. To correlate between adherence to treatment and knowledge regarding side effect to

epileptic drug and prevention of complication of epilepsy among patients with epilepsy.

5. To associate pretest level of adherence to treatment and knowledge regarding side effect

to epileptic drug and prevention of complication of epilepsy among patients with epilepsy

with their selected demographic variables.

12

6.5 OPERATIONAL DEFINITION

1. Effectiveness

It refers to the extent to which multifaceted intervention has desired effect on

adherence to treatment and knowledge regarding side effect to epileptic drug and

prevention of complication of epilepsy.

2. Multifaceted intervention

In this study multifaceted intervention refers to the systematically developed

cognitive and behavioral approach by the investigator, where the investigator will provide

cognitive approach using calendar method and flash card, and behavioral approach

through motivation and counseling.

3. Adherence to treatment

In this study adherence refers to level of following a recommended drug regimen

measured by morisky medication taking adherence scale-MMAS (4-item).

4. Knowledge

It refers to the understanding of adherence and side effect of epileptic drugs and

prevention of complication of epilepsy among epileptic patient.

5. Side effect of epileptic drug

It refers to an effect that is secondary to the treatment of epilepsy such as tremors,

hair loss, gastrointestinal symptoms, and anxiety.

13

6. Prevention of complication

Refers to the actions directed towards modifying the development of a complication

such as injury, loss of consciousness status epilepticus, life threatening complication such

as sudden unexplained death among epiletic patient .

7. Patients with epilepsy

In this study patients with epilepsy refers to the person who were diagnosed with

epilepsy for past two years.

6.6 ASSUMPTION

1. Patients may have lack of knowledge about epileptic drugs and its side effect and

complication of epilepsy.

2. Multifaceted intervention may enhance the knowledge regarding epileptic drug and

epilepsy.

6.7 RESEARCH HYPOTHESES

H1: There will be significant difference between the mean pre-test and post test score on

level of adherence to treatment and knowledge regarding side effect to epileptic drug and

prevention of complication of epilepsy among patients with epilepsy.

H2: There will be significant correlation between level of adherence to treatment and

knowledge regarding side effect to epileptic drug and prevention of complication of

epilepsy among patients with epilepsy.

14

H3: There will be significant association between pre-test level of adherence to treatment

and knowledge regarding side effect to epileptic drug and prevention of complication of

complication of epilepsy among patients with epilepsy with their demographic variables.

6.8 REVIEW OF LITERATURE

Review of Literature is a key step in research process. Nursing research may be

considered as a continuing process in which knowledge gained from earlier studies is an integral

part of research in general. In review of literature a researcher analyses existing knowledge

before delving into a new study and when making judgement about application of new

knowledge in nursing practice. The literature review is an extensive, systematic, and critical

review of the most important published scholarly literature on a particular topic.19

A house to house survey was done on a prospective incidence of epilepsy in a rural

community of West Bengal, India. A total of 38 cases were detected during the survey period in

a population of 20,966. The age adjusted average annual incidence rate was 42.08 per 100,000

persons per year. This rate was higher than many developed countries, but lower than the

developing countries. Cerebral infection was the most common putative factor observed. An

increasing trend of incidence of epilepsy has been observed over the years during the period of

the study.20

A longitudinal study was conducted to determine the prevalence, incidence,

and mortality rates of epilepsy in the city of Kolkata, India. A total of 52,377 (52.74% men)

individuals were screened by using a simple screening questionnaire, and the detailed follow-up

was done by neurologists, the result showed that, there were 309 prevalent and 66 incident cases

of active epilepsy, and during the 5-year period, 20 cases of active epilepsy died. Study

15

concluded that, the incidence rate of epilepsy is comparable to that observed in developed

countries, but mortality rate is higher.21

A door-to-door survey was conducted to study the prevalence and etiological profile of

active epilepsy in the rural population of Uttarakhand (India). A total of 14,086 populations were

interviewed by using questionnaire. The result showed that, 141 cases of active epilepsy was

detected giving a crude prevalence rate of 1%. After excluding acute and remote symptomatic

cases related to NCC (neurocysticercosis), the prevalence rate of epilepsy was 6.5/1000. Study

concluded that the region-specific prevalence rates of epilepsy in India are partly dependent on

the prevalence of NCC in the given community. To some extent, this may be responsible for

variable rates of epilepsy prevalence reported from different regions of the country. 22

A cross-sectional descriptive study design was conducted on Evaluation of Factors

Influencing Medication Adherence in Patients with Epilepsy. A sample of 272 patient with

epilepsy attending Ahmadu Bello University Teaching Hospital/Jicon Hospital Kaduna, who had

been on antiepileptic drugs (AEDs) for at least one year. The level of knowledge of epilepsy

based on signs and symptoms was high as 57.8% and 25.9% of the patient with epilepsy had

excellent and good knowledge respectively. This study showed that patients with epilepsy had

adequate knowledge of epilepsy and its treatment. Medication adherence was demonstrated to be

low due to forgetfulness, fatigue and being away from home.7

A cross sectional study design was used to determine knowledge, attitude and belief about

epilepsy among adults in a northern Nigerian urban community. The respondents (39.0%)

mention that epilepsy is manifested by convulsion. Other respondent included falling down

(36.0%), rolling of eyes (11.7%), foaming of mouth (10.3%), 25.2% didn’t know the cause of

16

epilepsy , heredity (19.9%), brain injury (19.2%), evil spirits (16.3%) and brain infection

(11.7%). Overall (n=52, 26%) of the respondents had good knowledge of epilepsy whereas

(n=62, 31%) and (n=86, 43%) had fair and poor knowledge of the disease respectively. Majority

of respondents (47.0%) opted for spiritual healing. This was followed by orthodox medical care

(34.0%) and the use of traditional herbal medicines (19.0%).23

A meta-analysis was conducted on cognitive-based behavior change techniques as

interventions to improve medication adherence. 26 studies (5216 participants) were included for

the study. An effect size (95% CI) of 0.34 (0.23 to 0.46) was calculated and was statistically

significant (p < 0.001). Heterogeneity was high with an I2 value of 68%. Adjustment for

publication bias generated a more conservative estimate of summary effect size of 0.21 (0.08 to

0.33). Cognitive based behavior change techniques are effective interventions eliciting

improvements in medication adherence that are likely to be greater than the behavioral and

educational interventions largely used in current practice.17

A study was conducted on Patient’s preferences towards antiepileptic drug therapy following

first attack of seizure in department of neurology, government Stanley medical college and

hospital, Chennai, . Included patients with first attack of unprovoked generalized tonic-clonic

seizure (GTCS) within 30 days of onset, aged between 18-60 years. They were followed up for

one year. In that they found 73 enrolled 54 males and 19 females among that 39 were preferred

to go on anti epileptic therapy (AED). The reasons for preferring AED therapy were; fear of

seizure recurrence54%, risky occupation 36% and fear of injury 10%. The reasons for deferring

were fear of adverse effects of long-term AED therapy 56% and preferring to wait for the second

attack 44%. Following first attack of unprovoked GTCS the decision regarding AED members

after adequate counseling and such decisions have more relevance from their perspective.24

17

A survey was developed to gather information from both patients with epilepsy and

community pharmacists on the issue of antiepileptic drug (AED) formulation switching, which

includes brand to generic, generic to brand, and generic to generic. Data were obtained from 82

patients (or parents of patients) with epilepsy and 112 community pharmacists. More than 92%

of patients and 85% of pharmacists agreed that switching between forms of the same AEDs may

cause an increase in seizures or adverse effects. More than two-thirds of our patient sample

reported having problems with formulation switching; many also reported knowing other

patients with problems. Just more than half (51%) of the pharmacists knew of patients who have

described problems when they have changed AED formulations. Less than 50% of both

populations knew that problems resulting from formulation switching should be reported as

adverse drug events to the FDA. Not many pharmacists and far fewer patients use Med Watch to

report these problems. The study conclude that both patients with epilepsy and pharmacists are

under informed and under involved with reporting adverse drug events.25

A study was carried out by a team of nurses on causes of death among the in-patients and

out-patients in the National Epilepsy Centre, Shizuoka. A total of 171 deaths were recorded

among the 20,000 out-patients, which were not necessarily sudden but unexpected. The

standardized mortality ratio for accident and trauma are higher, suggesting that accident and

trauma are frequent causes of death in epilepsy patients as compared to the general population.

Among the accidents, it has-been found that patients with seizures.26

A study was conducted on effects of educational intervention on changing parental

practices for recurrent convulsions in department of nursing, to evaluate the of educational

interventions on family members practices for recurrent convulsion. Total 326 sample were

selected among them 196 family members received pamphlets, 130 family members were

18

attained the educational program. In that they found family members who received pamphlets

did not shows significant improvements. Family members who attended the educational program

demonstrated significant improvements in the recommended practices, particularly in protecting

convulsive patient.27

7. MATERIAL AND METHODS

7.1 SOURCE OF DATA

The data will be collected from patient with epilepsy in abhaya hospital, Bangalore.

METHODS OF DATA COLLECTION

i. Research design

Pre experimental design- one group pretest and post test design.

PRE TEST(O1) INTERVENTION(X) POST TEST(O2)

19

Assess the pretest level of

adherence to treatment

measured by morisky

medication taking adherence

scale and knowledge

regarding side effect to

epileptic drug and

prevention of complication

of epilepsy using structured

interview schedule.

Investigator will provide

multifaceted intervention

through cognitive approach

using calendar method and

flash card, and behavioral

approach through

motivation and counseling.

Assess the post test level

adherence to treatment

measured by morisky

medication taking

adherence scale and

knowledge regarding side

effect to epileptic drug and

prevention of complication

of epilepsy using structured

interview schedule.

ii. Variables

Independent variables

Multifaceted intervention

Dependent variables

Adherence to treatment

Knowledge regarding side effect to epileptic drug and prevention of complication

of epilepsy among patients with epilepsy.

20

Demographic variables

Age, gender, religion, education status, marital status, occupational status, habits, family

income per month, any disease condition, duration of epileptic drug, previous knowledge,

and source of information.

iii. Setting

The study will be conducted in Abhaya hospital which is 100 bedded

multispecialty hospital located at Wilson Garden, Bangalore.

iv. Population

The population of the study will comprise of all the epileptic patients those who

are visiting OPD and are admitted in Abhaya hospital, Bangalore.

v. Sample

The patient who fulfill the certain inclusion criteria are selected for the study. The sample

size is 60.

vi. Criteria for the sample selection

Inclusion criteria

The study includes:

21

1. Patients who are diagnosed with epilepsy for past two years.

2. Both male and female epileptic patients between age group of 20 – 65 years.

3. Epileptic patients visiting OPD and admitted in abhaya hospital.

4. Epileptic patients who can understand Kannada, Hindi or English.

Exclusion criteria

The study excludes:

1. Epileptic patients those who are critically ill and are not able to comprehend.

2. Patient already with status epilepticus.

vii. Sampling technique

Non probability purposive sampling technique.

viii. Tool for data collection

The tool consists of the following sections

Section A: Demographic data includes age, gender, religion, education status, marital

status, occupational status, habits, and family income per month, any disease condition,

duration of epileptic drug, previous knowledge, and source of information.

Section B:- Morisky medication taking adherence scale will be used to assess the

adherence to treatment among patient with epilepsy.

22

Section C:- structured interview schedule will be used to assess the knowledge regarding

, side effect to epileptic drugs and prevention of complication of epilepsy

INTERVENTION PROTOCOL:

Multifaceted intervention will be given by the investigator through cognitive

approach and behavioral approach on the same day where cognitive approach is given by

calendar method for 15 minutes which consist of name of medication, day, time and dose.

Patients are asked to follow the medication pattern according to the calendar method for 7

days and teaching regarding side effect of epileptic drug and complication of epilepsy

through flash card is done for 20 minutes. The behavioral approach is provided through

motivation by giving intensive and counseling the patient for 25minutes.

ix. METHOD OF DATA COLLECTION

After getting formal administrative approval from concerning authorities and informed consent from

the samples the investigator personally collects the data. The data will be collected in following three

phase:-

PHASE 1: Pre-test will be conducted to assess adherence to treatment and knowledge regarding side

effect to epileptic drug and prevention of complication of epilepsy among patients with epilepsy using

morisky medication taking adherence scale and structured interview schedule.

23

PHASE 2: On the same day multifaceted intervention will be given by the investigator through cognitive

approach and behavioral approach. Where investigator in behavioral approach will provide 30 minute

counseling and motivation and in cognitive approach 20 minute teaching is provided using calendar

method and flash card.

PHASE 3: On 7th day, post test level of adherence to treatment and knowledge regarding side effect to

epileptic drug and prevention of complication of epilepsy among patients with epilepsy will be assessed.

x. Plan for data analysis

The data collected will be analyzed by means of descriptive and inferential statistics.

Descriptive statistics:

Frequency and percentage distribution will be used to assess the demographic

variables level of knowledge of patient with epilepsy.

Range, mean standard deviation and mean score percentage will be used to analysis

the level of knowledge regarding level of adherence to treatment, side effect to

epileptic drugs and prevention of complication of epilepsy among patient with

epilepsy.

Inferential statistics:

Paired‘t’ test will be used to compare the pre-test and post test knowledge regarding level of

adherence to treatment, side effect to epileptic drugs and prevention of complication of epilepsy among

patient with epilepsy.

24

Correlation co-efficient will be used to analyze correlation between the pre test and post test

knowledge regarding level of adherence to treatment, side effect to epileptic drugs and prevention of

complication of epilepsy among patient with epilepsy.

Chi-square test will be used to analyze the association between pretest knowledge on level of

adherence to treatment, side effect to epileptic drugs and prevention of complication of epilepsy among

patient with epilepsy with their selected demographic variables.

xi. Projected outcome

This study will assess the existing knowledge of patient with epilepsy. Administration of

multi faceted intervention will help to improve the patient’s knowledge on adherence to

treatment, side effect to epileptic drugs and prevention of complication of epilepsy among

patient with epilepsy.

7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTRVENTION TO BE

CONDUCTED ON PATIENTS OR OTHER HUMAN OR ANIMALES?

Yes, multifaceted intervention will be administered as an intervention for patient with

epilepsy.

7.4 HAS ETHICAL CLERANCE BEEN OBTAINED FROM YOUR INSTITUTION?

Yes, permission will be obtained from concerned authority of the hospital. The

informed concent will be obtained from samples. Confidentiality and privacy of data will be

maintained.

25

8. LIST OF REFERENCE

1. Roberta Kaplow, Sonya R. Hardin. Critical care nursing surgery for optimal outcome.

USA: Jones and Bartlett Publishers; 2007.

2. Hubley J. Communicating health–an action guide to health education and health

promotion. 1st edition. England: Macmillan; 2003; 351-353.

26

3. Psychiatric Disorders Associated with Epilepsy updated: Jun 8; 2011. Available from

http://emedicine.medscape.com/article/1186336-overview (access date 12/10/2013).

4. World Health Organization. Neurological Disorders. Switzerland: WHO Press; 2006

5. Frank W. Drislane, Micael Benatar, Bernard Chang, Juan Acosta, Andrew Tarulli, Louis

Caplan. Neurology. 3rd edition. New Delhi: Wolters Kluwer/ Lippincott Williams and

Wilkins.

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9. Signature of the candidate :

10. Remarks of the guide : Research is feasible and in

Nursing

11.1Name and designation of the guide : Mr. Venkatesan. B

Assistant Professor Medical Surgical Nursing

11.2 Signature :

11.3 Co- guide : Mrs. Prasanna. K

11.4 Signature :

11.5 Head of the department : Mrs. Prasanna. K

Medical Surgical Nursing Department

11.6 Signature :

12.1 Remarks of the Principal :30

31