Systematic reviews of specialist epilepsy services

Construction of nursing-sensitive quality indicators for epilepsy in China: A Delphi consensus study

OBJECTIVE

The quality and safety of epilepsy care are of great importance because seizures are unpredictable. The aim of this study was to develop a set of nursing-sensitive quality indicators (NSQIs) for assessing and improving the quality of epilepsy nursing care in China.

METHODS

An international literature review, a cross-sectional survey and a qualitative study were conducted to identify candidate NSQIs for epilepsy care and compile a questionnaire. Then, two rounds of electronic Delphi studies were conducted with a panel of 27 independent experts to identify the final NSQIs for epilepsy.

RESULTS

Thirty-nine candidate NSQIs were extracted for the Delphi process. The recovery rates in the first and second rounds of expert consultations were 92.6% and 96.2%, respectively. The experts' authority coefficients of the two rounds were 0.876 and 0.878, respectively. The Kendall W value of the two rounds ranged between 0.094 and 0.200 (p<0.001). Eight structure indicators, 9 process indicators and 7 outcome indicators that represented the following three domains were included in the set of NSQIs for epilepsy: nursing resource allocation, implementation of nursing care, and outcomes of patients with epilepsy.

CONCLUSION

These NSQIs for epilepsy provide a primary foundation for monitoring and improving the quality of epilepsy nursing care in China. However, the effects of these indicators on improvements in epilepsy care and outcomes in patients need to be verified in clinical practice.

Challenges of patients with epilepsy and measures for improving epilepsy care in western China: A qualitative study

OBJECTIVE

The aim of this qualitative study was to explore the challenges that patients with epilepsy (PWEs) face and the opportunities or areas where changes in nursing care may improve epilepsy care in western China.

METHODS

Semi-structured interviews with open-ended questions based on a review of the literature were conducted at the epilepsy center of a tertiary hospital in western China. A total of 18 PWEs, 18 caregivers and 11 neurology nurses were interviewed by using purposive sampling. The data were transcribed verbatim, and a content analysis was used to conduct the framework analysis.

RESULTS

Three key themes were identified, namely, the impact of epilepsy, barriers to epilepsy management, and measures in nursing care for improving epilepsy care. Psychological stress, the side effects of drugs and accidental injury related to seizures were reported to be the main negative impacts on patients. Limited knowledge about epilepsy, poor adherence to therapy, and a lack of effective communication between patients and medical staff were the major barriers to epilepsy management. Strengthening health education, assessing the frequency and type of seizures, screening for psychological disorders and mental intervention, and maintaining continuity of care were identified as crucial measures for nurses to improve epilepsy care.

CONCLUSIONS

This study highlights the challenges among PWEs and opportunities for improving the quality of epilepsy care in western China. Limited knowledge and poor drug adherence are the main barriers to epilepsy management, which might be improved by more health education and continuing care provided by nurses. Assessing seizures, screening for psychological disorders and providing appropriate psychological care would help improve epilepsy care.

The emerging role of the advanced practice epilepsy nurse: A comparative study between two countries

AIMS AND OBJECTIVES

The aim of the study was to compare advanced practice in epilepsy nurses in Spain and United Kingdom, identifying differences in the domains of standard advanced practice.

BACKGROUND

Europe has recently faced the challenge of providing high-quality care for patients with epilepsy, a disease that generates many health demands. In some countries, such as the United Kingdom, advanced practice nursing is well established and could serve as a guide for implantation in countries where it is still in development, as is the case of Spain.

DESIGN

A multicentre cross-sectional descriptive cohort study compared differences in the roles of advanced practice nurses in Spain and the United Kingdom.

METHODS

The Advanced Practice Role Delineation Tool and its validated Spanish version were administered using an online questionnaire in a cohort of advanced practice epilepsy nurses in both countries. A convenience sample was recruited between January to December 2019. The study complied with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist.

RESULTS

Most United Kingdom nurses in our sample came from community environments, in contrast to Spanish nurses who worked in hospital. All domains analysed in the survey had significantly higher scores in the United Kingdom than in the Spanish cohort, especially in the research and leadership domains.

CONCLUSIONS

The advanced practice role in Spain is underdeveloped compared with the United Kingdom. Differences in the settings of advanced roles in epilepsy nurses may be explained by greater community practice in the United Kingdom and differences in organisational and health systems.

RELEVANCE TO CLINICAL PRACTICE

Our study showed the need to implement specific policies to develop advance practice nurse roles in Spain to improve the quality of care of patients with epilepsy.

Patients with epilepsy care experiences: Comparison between services with and without an epilepsy specialist nurse

The aim of this study was to determine whether there were differences in experiences of care, satisfaction with care and quality of life between those who were in receipt of care from a service with an epilepsy specialist nurse (ESN) and those who were receiving care from a service that did not include an ESN. A comparative design was used, which involved the completion of a confidential, self-completed survey. The survey was administered to a nonprobability convenience sample of patients with epilepsy who were attending services with an ESN (n = 244) and services where the treatment team did not include an ESN (n = 261) from each of the four health areas in Ireland. This study found that, in comparison to people with epilepsy (PWE) who attended a service without an ESN, PWE who attended a service with an ESN reported receiving greater amount of information, were more involved in their care, perceived care to be better coordinated, and had greater confidence in the information provided and greater comfort in discussing issues with an ESN. They also reported higher rates of satisfaction with the emotional and practical support offered. Thus, it may be concluded that models of care involving the input of ESNs enhance the quality of epilepsy care and care processes. The findings also emphasize the need to have an ESN as part of the multidisciplinary team.

Improved availability and quality of care with epilepsy nurse practitioners

BACKGROUND

This study investigated the quality of care delivered by nurse practitioner (NP)-physician teams employed to expand clinic appointment availability for patients with epilepsy.

METHODS

We performed a retrospective observational cohort study of patients with epilepsy presenting to the Penn Epilepsy Center for a new patient appointment in 2014. During this time, patients were seen either by an NP-physician team care model or a more traditional physician-only care model. These care models were compared with regard to adherence to the 2014 American Academy of Neurology epilepsy quality measures at the initial visit. Clinical outcomes of seizure frequency, presentations to the Emergency Department, injury, and death were assessed over the subsequent year.

RESULTS

A total of 169 patients were identified by our inclusion and exclusion criteria: 65 patients in the NP-physician team care model cohort and 104 patients in the physician-only care model cohort. The NP-physician team care model saw, on average, 3 more patients per clinic session. There were no meaningful differences between these cohorts in baseline characteristics. The NP-physician team care model showed equivalent adherence to the physician-only care model for the epilepsy quality measures, with superior adherence to the counseling measures of querying for side effects, provision of personalized epilepsy safety education, and screening for behavioral health disorders. The 2 care models performed similarly in all clinical outcomes.

CONCLUSIONS

An NP-physician team care model employed to increase availability of care could also improve quality of care delivered.

Implementing epilepsy guidelines within a learning disability service

PURPOSE

To investigate the usefulness of the implementation of NICE guidelines when reviewing care within an outpatient learning disability service.

METHODS

We set up a multi disciplinary specialist epilepsy clinic and reviewed all patients with a diagnosis of epilepsy using a specific assessment document based on NICE guidance. We then audited clinical documentation prior to and after the implementation of the clinic.

RESULTS

We reviewed 23 patients and found that implementing NICE guidelines showed improvements to individuals' seizure assessments and epilepsy management. When comparing specific areas related to NICE implementation we found that 83% compared to 6% of patients had accurate name and detailed seizure descriptions. We made changes to seizure diagnosis in 76% of patients and improved the level of recording of seizure frequency and severity. Finally 91% compared to 50% of consultations led to changes in treatment plans.

CONCLUSION

We found that implementing the NICE guidelines allowed us to use a systematic approach to epilepsy management, which in turn led to identifiable improvement in documentation and patient care.

Setting the agenda for neurological nursing: strategic directions

This paper explores a range of issues related to neurological care. The scope and scale of neurological conditions is described in order to illustrate disparities in research funding and care delivery as compared with cancer and cardiovascular disease. Financial implications, ethical issues and health service development are outlined as a context for the state of the art of neurological nursing. Areas for potential neurological nursing research are identified. Finally, it is argued that policy and research must be linked if neurological care, research and education are to receive greater resource allocation.

Evidence-based standards of care for adults with epilepsy—a literature review

Epilepsy is the most common serious chronic neurological condition. All patients with epilepsy regardless of location should receive the highest quality of services that can be provided. In order to do this current service provision has to be reviewed and bench marked against ideal standards of service provision that cover a comprehensive range of services to meet all patient needs. By critically reviewing the relevant literature, criteria were developed for an ideal epilepsy service. The literature review generated evidence-based ideal standards for the following service areas: - The role of primary care and the interface with secondary care in the management of epilepsy; - The role of Accident and Emergency (A and E) departments in the care of epilepsy; - Epilepsy clinics; - Specialist epilepsy nurses for treating epilepsy; - The role of the general practitioner (GP) specialist; - Services for adult epileptics with learning disabilities; - Services for complex epilepsy; and - User views. Although many of the recommendations are based on evidence of a lower grade, the direction of the existing evidence obtained from several sources, suggested similar standards for an epilepsy service. The effectiveness and value of epilepsy services, particularly in relation to the changes recommended above, must be further researched.

An easily performed group education programme for patients with uncontrolled epilepsy--a pilot study

The factual knowledge of epilepsy is often insufficient among patients with this disorder. Compliance problems due to ignorance are common, and counselling is extremely important. We have developed a simple 1-day, low-cost group education programme for patients with epilepsy, intended to be suitable in routine care. The programme aims to help patients to achieve an improved understanding of the disorder and was carried out for a total of 54 consecutive patients with at least one seizure during the last year. This hospital-based 6-hour interactive course is organised by an epilepsy nurse and contains the following elements: basic knowledge about epilepsy, living with epilepsy, visit to the EEG lab, social security system and medical treatment. It was evaluated by means of a semi-structured interview and was found generally useful by all the participants. Sixty-five percent considered the sharing of experience with other patients to be the most valuable element. The ideal group size was found to be six to eight. Heterogeneity concerning age, sex and competence seemed to increase the interaction within the groups. This pilot study indicates that group education may be a useful approach in the clinic.