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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 15  |  Issue : 3  |  Page : 217-227

Effect of nursing intervention on improving intellectual education teachers’ performance toward students with epilepsy


Community Health Nursing Department, Faculty of Nursing, Zagazig University, Egypt

Date of Submission03-Jan-2018
Date of Acceptance07-May-2018
Date of Web Publication28-Dec-2018

Correspondence Address:
Samia F Mahmoud
Community Health Nursing Department, Faculty of Nursing, Zagazig University, Zagazig
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ENJ.ENJ_3_18

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  Abstract 


Background Epilepsy is a major health problem that oftenoccursseen among intellectual schools. Students with seizures annoy their teachers.
The aim of this study was to evaluate the effect of nursing intervention on improving intellectual education teachers’ performance toward students with epilepsy atSharkia Governorate. A quasi-experimental design was used in this study. A purposive sample composed of 163 teachers from 13 intellectual schools working at least two years. Three tools were used: Tool (I): Teacher’s knowledge about epileptic student, self-administered questionnaire. Tool (II): Teacher’s practice observation checklist. Tool (III): Teacher’s attitudes toward students with epilepsy scale.
Results Most of the studied teachers were married. In addition, statistically significant improvements were detected in the teachers’ knowledge, practices, and attitudes, from pre-sessions to immediately after and 3 months of post sessions where the total mean score of their knowledge increased from9.61±3.30in pre-sessions, to 19.35±1.73 immediately post sessions and 18.67±2.61, at 3 months of post sessions. The total mean score of their practices increased from 3.31±5.081 pre-sessions to 26.72±5.46 immediately post sessions and 24.83±6.71, at 3 months of post sessions. The total mean score of their attitudes increased from 13.62±2.25 in pre-sessions, to 16.38±1.83 immediately post sessions.Therefore, it is recommended that in-service training courses to be conducted periodically among all intellectual schools teachers’.

Keywords: epilepsy, intellectual education, performance, teachers


How to cite this article:
Mahmoud SF. Effect of nursing intervention on improving intellectual education teachers’ performance toward students with epilepsy. Egypt Nurs J 2018;15:217-27

How to cite this URL:
Mahmoud SF. Effect of nursing intervention on improving intellectual education teachers’ performance toward students with epilepsy. Egypt Nurs J [serial online] 2018 [cited 2019 Jan 17];15:217-27. Available from: http://www.enj.eg.net/text.asp?2018/15/3/217/248968




  Introduction Top


Epilepsy is one of the most common secondary disabilities in students with mental retardation in intellectual schools; the prevalence is increasing with the severity of the intellectual disability. Approximately 50% of those with profound learning disability and between 10 and 20% of those with mild disability have experienced seizures at some point of time in their lives (Kalachnik et al., 2017). Moreover, epilepsy is one of the most common neurological disorders, with a worldwide prevalence between 5 and 10% per 1000 (Saraceno, 2002). Additionally, in Egypt, the prevalence was 6.98% per 1000 (El-Tallawy et al., 2010).

In Egypt, Mahmoud (2009) reported that seizures are the most common cause of visits to pediatric neurologists. Approximately 50% of cases of epilepsy begin in childhood or adolescence. The prevalence rate was 12.9 per 1000 children, and in children from 4–6 per 1,000 children. In addition, a study conducted by by Khedr et al. (2013), the prevalence of epilepsy is 9.3 per 1000, while the incidence rate is 1.5/1000. Epilepsy is slightly higher in males than in females. The highest prevalence is also recorded in early and late childhood groups.

Epilepsy knows no geographical, racial, or social boundaries. The etiology of seizures is multi-factorial in any given person (El-Tallawy et al., 2010). Epilepsy is a chronic brain disorder characterized by frequent seizures. A seizure is a sudden, transient disorder and disruption of brain function, manifested in an involuntary motor, sensor, autonomic, often accompanied by unconsciousness (Bernard et al., 2014). Epilepsy can be caused by genetic, structural, metabolic or unknown factors. Among structural factors, the most common causes in developing countries are infectious and parasitic diseases. Brain damage before birth, vascular disease and head trauma. The diagnosis of epilepsy depends on the causes of the disease as well as early and continuous treatment. It is estimated that up to 70% of people with epilepsy can live a normal life if they receive appropriate care (Perez, 2012).

Furthermore, Prevett and Brown (2013) reported that seizures are divided into three basic groups based on clinical and electroencephalographic manifestations: focal, generalized, and unknown. Focal epileptic seizures are those that originate within networks limited to one hemisphere (Combs and Pearl, 2013). In focal seizures, the abnormal neuronal discharges start in a localized area of the brain so that clinical manifestations vary widely depending on anatomical localization and spread of these discharges (Prevett and Brown, 2013). In the same context, generalized seizures are those that originate within bilaterally distributed networks in which the abnormal neuronal discharges are widespread and involve both cerebral hemispheres from the onset (Rudzinski et al., 2013). Similarly, generalized seizures may be nonconvulsive (such as absence seizures) or convulsive with bilateral tonic, colonic, or myoclonic movements.

Knowledge and practices about epilepsy are shown to be low in several studies from developing countries (Shafiq et al., 2007). Moreover, misconceptions have been associated with epilepsy since ancient times causing a great amount of stigma against its sufferers. Previous studies have shown a prevalence of incorrect perceptions on epilepsy and negative attitude toward epileptics among teachers even in resource-rich countries (Bhesania et al., 2014).

Teachers have the key role as educators and advisors in any society especially in a special education school than those in regular schools.Epilepsynurses are modern day professionals, who play a pivotal role in providing coordinated care and education to teachers with complex uncontrolled epilepsy. Recently, investigations on the effectiveness of epilepsy nurses in primary care also suggest that epilepsy nurse interventions are highly useful (Hosking, 2004).


  Significance of the study Top


Recently, the rationale for conducting this study is that epilepsy affects 50 million people worldwide, and 80% of them live in the developing world. Life-threatening emergencies can occur in any school at any time. Knowledge about epilepsy is important issue in determining teachers’ attitudes toward students with epilepsy. In general, teachers do not receive any formal instructions on epilepsy during their education and training despite the fact that as much as 40% of the student’s developing life is spent at school (Al-Hashemi et al., 2016). In Egypt, teachers are considered as social leaders and role models, thus influencing the student’s critical period of social and psychological development. For that reason, the study of teacher performance on epilepsy is useful in promoting future generations.


  Aim of the study Top


The aim of this study was to evaluate the effect of nursing intervention on improving intellectual education teachers’ performance toward students with epilepsy at Sharkia Governorate. This was accomplished through the specific objectives:
  1. Assess teachers’ knowledge and practices and attitudes before and after the nursing intervention sessions among intellectual education in Sharkia Governorate.
  2. Investigate the relation between teachers’ knowledge and attitudes regarding epilepsy.
  3. Plan, implement, and evaluate the effect of nursing intervention sessions on knowledge, attitudes, and practices regarding epilepsy among teachers intellectual education.


Hypotheses

  1. Teachers’ knowledge and practices score toward students with epilepsy will be improved after nursing intervention sessions.
  2. Teachers’ attitudes score toward students with epilepsy will be positive after nursing intervention sessions.



  Participants and methods Top


Study design

A quasi-experimental interventional design, with pre–post assessment.

Study setting

This study was conducted at all intellectual education schools in Sharkia Governorate (13 schools); these were, namely, DerbNegm, Menia-Elamah, Zagazig, Belbeis, Hihya, Abu-Kabir, Elasher of Ramadan, Abu-Hammad, Al-Qureen, Elashraf, Al-Maymunah Shanbara, Chiba, and the Daidamon.

Participants

A purposive sample of 180 out of 224 teachers, 17 teachers who shared in the pilot study was excluded from the sample.Therefore,thetotalnumbers of teachers were 163. The study sample was selected according to working at least two years, and accepts to participate in the study.

Tools of data collection

Three tools were used to collect the necessary data for achieving the study objectives, and there are a number of different types of questions such as multiple choice questions and essays.

Tool I: Teacher’s knowledge about students with epilepsy, using self-administered questionnaire. It consisted of two parts:
  1. Part A: Teacher’s sociodemographic characteristics, for collecting data pertaining to the caregivers developed by the researcher as age, sex, marital status, residence, qualification, years of experience, and number of teachers dealing with students with epilepsy (Q1–8).
  2. Part B: Teacher’s knowledge about students with epilepsy using self-administered questionnaire, which was used to assess teacher’s knowledge about students with epilepsy and was adapted from Mecarelliet al.(2015). It included definition, contagious, causes, symptoms, onset age of epilepsy, doctor referral, types, triggers of epilepsy, diagnosis, prevention, precautions, treatment, and source of information (Q9–22).


Scoring system

A complete correct answer was scored 2, while an incomplete correct answer was scored 1, and an incorrect answer was scored zero. For each area of knowledge, the scored elements were summed up. The total score of knowledge was (37) points. The teacher’s score 75% or more was considered satisfied and less than 75% considered unsatisfied.

Tool II: Teacher’s practice observation checklist to assess practices regarding students with epilepsy was adapted from the Edmonton Epilepsy Association (2011) and included 30 items, covering four parts, namely,
  1. Part A: it covers practices during the focal seizure. It consists of three items, such as do not blame the student, do not criticize the student, and record the number of times of seizure.
  2. Part B: it covers practices during epilepsy fits. It consisted of 13 items, such as stay calm, register time of the seizure, protect from injury and place something soft under the head, loosen anything tight around the neck, do not restrain the person, do not put anything in the mouth, gently roll the person onto his or her side, do not put onions or perfume in student’s nose or mouth, and avoid giving the student any food, drink, or even medication during the seizure until he/she fully wakes up. Moreover, avoid spraying the student’s face with water.
  3. Part C: it consisted of 10 items and covers practices when calling ambulance, such as if it is a first-time seizure, the student is injured, or has diabetes, as well as if a convulsive seizure lasts more than 5 min, if consciousness or regular breathing does not return after the seizure has ended, if seizure repeats without full recovery between seizures, and if a seizure occurs in water.
  4. Part D: it covers practices to be followed after epilepsy fits have been ended. The teacher should register time after the seizure and reassure and comfort the student if confusion follows the seizure. Additionally, help to reorient the student, allow the student to remain in the classroom until full awareness returns, allow rest if required, allow for the student to go to the restroom if the student lost bowel movement, and provide a change of clothing if required. Moreover, help others to understand what happened and proceed with regular class work.


Scoring system

Each step observed ‘done’ was scored one and the ‘not done’ zero. The practice was considered satisfied if total was more than 75%, and unsatisfied if it was less than 75% based on statistical analysis.

Tool III: it was composed of two components:
  1. Part A: this tool was intended to assess teacher’s attitudes toward students with epilepsy; it was adapted from Al-Hashemiet al.(2016). Teachers were asked to respond with any of 3 options: ‘Agree,’ ‘Disagree,’ or ‘Not sure,’ for each statement. Of the 23 attitude statements, eight indicated a positive attitude if answered by ‘Disagree,’ whereas the remaining 15 indicated a positive attitude if answered by ‘Agree.’ Hence, the attitude scale was considered positive if more than 75%, and negative if less than 75% based on statistical analysis.
  2. Part B: perception of intellectual school teachers about strategies regarding students with epilepsy was intended to assess perception of intellectual school teachers, developed by the researcher as provision of agree to write policy, training nurses, and training teachers, as well as written instructions, file with epileptic student, and periodic meetings with parents of epilepsy student.


Content validity and reliability of tools

Data collections of tools were tested by five experts. The two professors from the Community Health Nursing, one assistant professor from Psychiatric Health Nursing, Faculty of Nursing, Zagazig University, and 2 lecturers specialties in brain and nerves from the Faculty of Medicine, Zagazig University to assess clarity, relevance, application, and understanding of tools.All recommended modifications on the tools were done. Reliability of the proposed tools was done by Cronbach’s Alpha test; it was 0.859 for tool (I), 0.780 for tool (II) and 0.848.

Statistical design

Data collected throughout teachers’ history, basic clinical examination, laboratory investigations, and outcome measures were coded, entered, and analyzed using Microsoft Excel software. Data were then imported into Statistcal Package for the social Scence, version 20 (Chicago, Illinois, USA) for analysis. Data were collected and submitted to statistical analysis according to the type of data. Qualitative data were represented as numbers and percentages, and quantitative for continuous group represented by mean±SD. The following tests were used to test differences for significance. Differences between frequencies (qualitative variables) and percentages in groups were compared by χ2-test and paired by McNemaror sign test. Differences between parametric quantitative independent groups was assessed by t-test and paired by paired t-test. Correlation was assessed by Pearson’s correlation. P value set at less than 0.05 was considered significant results and less than 0.001 as highly significant results.

Field work

Data collection took eight months. Beginning of from October 2016 to end of May 2017. The researcher began collecting data for 3 days a week ranging between 10.00 a.m. to 12.00 noon during the 8 months. The study was carried out through four stages: assessment, planning, implementation, and evaluation.

Assessment phase

This phase involved data collection prior to intervention to assess the baseline. The researcher first introduced herself and explained the purpose of the research briefly to the directors of all the intellectual education in Sharkia Governorate and to the teachers. The Director of each school appointed Director of the School Training Unit to facilitate the administration of the questionnaires. The instructors served primarily as guide and helped in reaching the teachers in each school and ensuring them that the research will not interrupt normal school activities.

All the teachers were met and verbal agreements were obtained for participation. The pretest knowledge, and attitude were distributed and the same questionnaire was used after the sessions’ implementation for post assessment (post-test). The duration consumed for answering the study questionnaire ranged from 20–30 minutes and for the observational checklist ranged from 10–15 minutes. The data were analyzed initially to provide the basis for the design of the intervention session

Planning phase

Based on review of the literature, characteristics of the samples and the results obtained fromthe assessment phase, the researcher designed the intervention sessions’ content. The learning booklet was prepared by the researcher and its content was validated and then distributed to teachers to be used as a guide for self-learning.

General objective

The general objective of the teachers’ sessions was to raise their knowledge, practices and attitudetowards epilepsy.

Specific objectives: By the end of the sessions, the teachers should be able to do the following:
  1. Identify the definition of epilepsy and its causes.
  2. Discuss the symptoms of partial and generalized epilepsy.
  3. Identify the common age, periods of treatment, and referral of doctors of epilepsy.
  4. List the triggering factors of epilepsy.
  5. Recognize the diagnosis of epilepsy.
  6. Discuss the prevention measures of epilepsy.
  7. Describe the treatment of epilepsy.
  8. Explain the precautions of epilepsy.
  9. Explain the practice during the focal seizure.
  10. Apply the practice during and after epileptic fit correctly.
  11. Demonstrate when to call ambulance for generalized epilepsy.


Implementation phase

The intervention was implemented in the form of sessions; these were performed in the school library. The methods of educational training methods were lectures, group discussions, role play, and demonstration. The sessions were supported using video, pictures and posters through labtop data show to facilitate and illustrate teaching. To ensure that the teachers understand the content, each session was started by a summary about what was given through the previous one, followed by the objectives of the new one. The intervention was implemented in 3 sessions; the duration of each session was 25–35 minutes, the total sessions of all intellectual schools was 39 sessions. The number of teachers in each session was 5–10 teachers. The objectives of the sessions were as follows:

At the beginning of the first session an orientation to the session such as; the purposeof the subject, contents, time and location were clarified in order to establish good communication.

The objective of the second session was the explanation of the basic knowledge regarding epilepsy such as definition, causes, symptoms and types, triggering factors, and diagnosis, as well, the types of treatment and the precautions.

The third session was focused on applying the practice of the focal seizure epilepsy, as well as the practice during and after epileptic fit correctly emergency and finally, when to call ambulance for generalized epilepsy and global summarization and revision of the aim of the session and termination module sessions.

The last session was to evaluate the effect of health educational sessions on improving teachers’ knowledge, practices, and attitudes regarding epilepsy.

Evaluation phase

An evaluation of educational intervention for nursing was carried out immediately after the implementation of the sessions. A follow-up evaluation was carried out after three months through the application of the same tools of the pretest.

Pilot study

Before the main study, a pilot study was conducted on 17 teachers excluded from the main study. The purpose of the pilot study was to test questions about any ambiguity, and feasibility of the tools. It also helped the researcher to estimate the time requiredto fill out the forms.

Administrative and ethical considerations

Permission to carry out the study was granted by submission of official letters from the Faculty of Nursing to the responsible authorities of the study settings to obtain their permission for data collection. All ethical issues were taken into consideration during all phases of the study.


  Results Top


[Table 1] indicates that the mean age of the studied teachers was 44.30±7.6 years. In addition, 60.7% of studied sample reside in urban areas, and 90.2% of them were married. Considering teachers’ education, 35.6% were postuniversity graduates. Moreover, only 11.7% of the studied teachers had sufficient and saving income. The same table also demonstrates that 46.6% of the study teachers reported previous experience in intellectual school of more than 20 years. The percent of students who does not deal with teachers was 31.3%, whereas 63.2% of teachers dealing with students ranged from 1-<10.
Table 1 Sociodemographic characteristics of the studied teachers (n=163)

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[Table 2] reveals that the sources of teachers’ information for their knowledge about epilepsy were as follows: most of them had their information from internet (55.8%), followed by healthcare professionals (43.6%), then TV (42.9%), friends (28.8%), and family of students with epilepsy (28.2%).
Table 2 Sources of teachers’ information for their knowledge about epilepsy

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[Table 3] clarifies that statistically significant improvements in the teachers knowledge, practices, and attitudes from before sessions to immediately after and 3 months later, where the total mean score of their knowledge increased from 9.61±3.30 in presessions, to 19.35±1.73 immediately postsessions, and 18.67±2.61 at 3 months after. The total mean score of their practices increased from 3.31±1.7 presessions to 26.72±5.46 immediately postsessions and 24.83±6.71 at 3 months after. The total mean score of their attitude increased from 13.62±2.25 in presessions to 16.38±1.83 immediately after.
Table 3 Comparison of studied teachers according to their performance about epilepsy throughout the intervention (n=163)

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[Table 4] reveals that the total knowledge scores of the studied teachers were scored as satisfactory knowledge level by 6.7% in preprogram implementation, which improved to 76.7 and 57.7% in immediately implementation of nursing intervention sessions and at 3-month follow-up, respectively. Meanwhile, 93.3% had unsatisfactory knowledge at preprogram implementation that reduced to 23.3% and 42.3% immediately after and follow-up, respectively (χ2=194.3, P=0.00).
Table 4 Satisfactory knowledge of the studied teachers about epilepsy throughout the intervention (n=163)

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[Figure 1] illustrates that the total practice of the studied teachers was scored as adequate practice level by 5.5% in preprogram implementation, which improved to 91.4 and 87.7% in immediately after educational implementation and follow-up, respectively.
Figure 1 Adequate practice of studied teachers about epilepsy throughout the intervention (n=163).

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[Figure 2] indicates that adequate attitude total scores about epilepsy were 71.2% in preprogram sessions’ implementation, which improved to 90.8% after session.
Figure 2 Adequate attitude of studied teachers about epilepsy throughout the intervention (n=163).

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[Table 5] reveals relations of studied teachers’ adequate knowledge about epilepsy and their sociodemographic characteristics. There were statistically significant differences between teachers’ knowledge and their income (χ2=6.45, P=0.04), whereas other variables relations were not significant.
Table 5 Relationship of adequacy of knowledge about epilepsy among studied teachers according and their sociodemographic characteristics

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[Table 6] reveals that there were no statistical significance between teachers’ adequate practice and age, years’ of experience, and number of student with epilepsy deals with teachers.
Table 6 Relation with adequate practice and sociodemographic characteristics

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[Table 7] indicates that statistically significant positive correlations were found between preknowledge and postknowledge (r=0.500), preknowledge and follow-up knowledge (r=0.453), preknowledge and postpractice (r=0.277), preattitude and postattitude (r=0.205), postpractice and follow-up practice (r=0.939), and postknowledge and follow practice (r=0.383).
Table 7 Correlation matrix of teachers’ scores of knowledge, practice, and attitude in the study sample

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[Table 8] describes the perception of intellectual school teachers’ about strategies regarding student with epilepsy. The table shows that the most of the studied participants (89.6%) reported that the school has written instructions on management of students with epilepsy during epileptic seizures. The same percentage of the staff teachers reported that the school has a file with names and telephone numbers of parents of students with epilepsy, and periodic workshops for teachers and parents are provided.
Table 8 Perception of intellectual school teachers about strategies regarding students with epilepsy

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  Discussion Top


Epilepsy is a major health problem among intellectual school students.The role of teachers in the management of students with epilepsy and their families is the most important. Teachers are highly valued for providing care, advice and support in explaining the social aspects of epilepsy (Edmonton Epilepsy Association, 2011). Therefore, the current study aimed to evaluate the effect of nursing intervention on improving intellectual school teachers’ performance toward students with epilepsy in Sharkia Governorate.

The targeted population in the current study was the teachers with age ranged from 29 to 59 years, with a mean age of 44.30±7.6years. These intellectual school teachers were selected because intellectual school students spend most of their day away from home and their parents’ watchful eyes, and because students cannot be expected to understand their epilepsy treatment fully owing to misinformation or lack of knowledge, they may feel scared or awkward about the seizures. Epilepsy is one of the most common secondary disabilities in students with mental retardation among intellectual school. Hence, nursing intervention sessions were needed to support them at school. No such study was previously conducted in Sharkia Governorate, Egypt.

The current study result revealed that the teachers’ age ranged between 29 and 59 years, and their mean score was 44.30±7.6 years. The mean year of experience was 20.07±8.2 years, and more than three-fifths of the studied teachers were female. These results were consistent with the known women nature which makes them take the major responsibility of caring students in the school. These findings are in line with those of the study of El-Zeftawy et al. (2008), in Tanta, Egypt, who found that the teachers age ranged 24–56 years and 65.8% of teachers were female, and their mean years of experience was 19.76±2.31 years. This is in accordance with a study done in Pakistan by Akhtar et al. (2007), which reported that females represent 61.5% and males 38.5%. The mean age of the respondents was 37.0+9.2 years.

Regarding the number of students with epilepsy ever dealt with, the present study result revealed that one-third of teachers did not deal with students with epilepsy. However, more than three-fifths of teachers dealt with students with epilepsy from 1 to less than 10. Additionally, the highest percentage of teachers had their information from internet, followed by healthcare professionals, and an equal percentage of more than a quarter from the public media (TV), friends, and parents of students with epilepsy. These findings contradicted with those of Al-Hashemi et al. (2016) in Kuwait, which found that 70.7% of teachers did not deal with any students. In addition, almost one-fifth of participants reported that they have dealt with one student with epilepsy, 4.9% of them have dealt with two students, and 1.2% have dealt with three students. The same author mentioned three-fifths of them (60.5%) had their information from public media, followed by the internet (41.3%), education (25.4%), parents of students with epilepsy (19.2%), and healthcare professionals (19.3%).

Concerning the answering of the research hypothesis regarding the knowledge and practice about epilepsy among intellectual school teachers’ in Sharkia Governorate, the findings of the present study revealed that minority of the teachers had satisfactory knowledge as well as adequate practices before implementation of nursing intervention. This might be owing to lack of educational intervention in intellectual education teachers. Additionally, no such study was previously conducted in Sharkia Governorate. This result was in agreement with that of a study conducted in the USA by Bishop and Boag (2006), who found that teachers had significant deficits in basic knowledge about epilepsy. The result of the present study is supported by a study conducted in Bangalore by Rajan (2007), which revealed that most of the teachers had unsatisfactory knowledge and inadequate skills about epilepsy. In the same line, a study done by Akpan et al. (2013) in Nigeria assessed the knowledge and attitudes of school teachers toward children with seizure disorder, and the influence of urban residence on perception of seizure disorder by the teachers, and mentioned that school teachers in both urban and rural schools exhibited poor knowledge.

Moreover, Abulhamail et al. (2014), who conducted a study in Saudi Arabia to asses primary school teachers’ knowledge and attitudes toward children with epilepsy, reported that primary school teachers’ knowledge about epilepsy needs improvements. In this respect, as study conducted by Alkahil et al. (2017) in Riyadh, KSA, aimed to assess the awareness about the definition of epilepsy in pediatric ages, types of epilepsy, managing an epileptic fit in children and awareness about the impact of epilepsy on children’s educational and social performance among education teachers’, and they found a critical issue that most of school teachers do not have satisfactory knowledge about epilepsy. In contrast to this, Reyace et al. (2014) found the average level of teachers’ knowledge score was 13.9 out of 22. Overall, 70.9% of the teachers obtained average level of 17.7% as good level and 11.4% as weak level of knowledge. The contradiction with this study might be owing to differences of settings.

Concerning the answering of the hypothesis regarding teachers knowledge will be improved after implementation of nursing intervention sessions, the findings of the present study revealed that more than three-quarters had good knowledge, and most teachers had adequate practices and attitudes. This might be owing to success of nursing intervention sessions. This result was in agreement with that of a study conducted in Tanta, Egypt, by El-Zeftawy et al. (2008), who evaluated the effect of training program of elementary schools teachers about management of students with epilepsy and mentioned significant statistically improvements in the teachers knowledge and practices from presessions, to immediately after sessions; the total mean score of their knowledge increased from 36.43±20.60 in presessions, to 75.46±11.17 immediately postsessions, and the total mean score of their performance increased from 5.72±4.33 presessions to 19.74±1.99 immediately postsessions.

Additionally, the results of the present study are in line with a study by Desai et al. (2015) who assessed the effectiveness of planned teaching program on knowledge regarding epilepsy management in school children among primary school teachers working in selected primary schools at Malur, Kolar, Karnataka, and they found that the mean post-test knowledge score (16.72±2.99) was higher than mean pretest knowledge (5.4±2.69) score, and in post-test in the experimental group, 66% had satisfactory knowledge. This result was incongruent with that of Mohamed and Elalem (2015), in Port Said University, Egypt, who assessed the effect of health educational program on knowledge about epilepsy and its management among primary school teachers; the findings indicated that pre to post mean percent change of improvements were 55.46±130.27 and 56.05±135.40, respectively. This study was supported by another study carried among school primary school teachers in Italy by Mecarelli et al. (2015), which found that the educational intervention on epilepsy directed to 582 Italian primary school teachers has been successful in improving knowledge toward the disease.

Unfortunately, the improvements on the knowledge and management of epilepsy among intellectual school teachers in the next 3 months (follow-up test) were reduced; this might be owing to the long period between the implementation of the program and follow-up test, where this might be normal because teachers tend to forget some of what they learn as time passes by. So, this indicates the need to carry out a periodic nursing intervention about the disease at least every 6 months to guarantee that the teachers’ knowledge and practices are good to deal with such students. This result was in agreement with that of a study conducted in the Port Said University, Egypt, by Mohamed and Elalem (2015), who found that the mean percent greatly changed from post-test to follow-up. This finding is in the same line with that of a study by El-Zeftawy et al. (2008), in Tanta, Egypt, which mentioned that unfortunately the improvements on the knowledge and management of epilepsy among teachers in the next three months were reduced from 75.46±11.17 to immediately postsessions and 44.85±5.51, 3 months after the sessions. Moreover, the total mean score of their performance reduced from 19.74±1.99 immediately after sessions to 18.36.85±2.66, 3 months later.

The present study result revealed that there was a relation between teachers’ knowledge and their income. This finding is congruent with that of Mohamed and Elalem (2015), in Port Said, Egypt, who found that there was a strong significant correlation between teachers’ knowledge about epilepsy and their income. On the contrary, findings of the present study indicated that there were no correlations between teachers’ knowledge and their age, education, past experience and follow-up of the program. This finding is in line with Sharma et al. (2013), who reported that age, sex, and experience about epilepsy had no significant associations.

Concerning the answering of hypothesis, which stated that teachers’ attitudes toward students with epilepsy will be improved after nursing intervention sessions, as observed from the present study, most of studied teachers showed improvements in their attitude toward epilepsy from pretest scores, to post-test scores. There were statistically significant improvements in the teacher’s knowledge, attitudes, and practices from presessions, to immediately after, and 3 months after sessions. This is in accordance with a study carried out by Al-Hashemi et al. (2016), in Kuwait, who found that high proportion (91.3%) of participants showed a positive attitude. This finding is in line with that of El-Zeftawy et al. (2008) in Tanta, Egypt, who revealed that the total mean score of their attitude increased from 39.68±6.80 before to 44.67±5.65 immediately after sessions. Similarly, a study done in Pakistan by Akhtar et al. (2007) found that the attitude of the teachers toward epilepsy was generally positive.

Conclusion and recommendations

The present study concluded that teachers’ performance was greatly improved immediately after implementation of nursing intervention. Unfortunately, this improvement slightly declined in the next three months (follow-up test) but was still good. Therefore, the researcher recommended that educational nursing intervention about epilepsy should be provided periodically and continually to all teachers to equip them with the necessary knowledge and skills for proper management of students with epilepsy in the school.[27]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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