الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Childhood epilepsy has an impact on the family, especially mothers leading to increase their stress. Most mothers are extremely upset mainly because of mothers’ loss of their healthy children. Mothers may become physically and psychologically exhausted due to constant care provided for their epileptic children. As the children grow, mothers’ stress are likely to increase due to management difficulties and increased financial demands. Mothers’ concern about their children‟s future may further increase stress and burden. Mothers’ distress may have an impact on their children‟s health, while children‟s health may have an impact on their mothers’ distress. The pediatric nurse plays a vital role in supporting epileptic children and their mothers. The nurse effectively contributes in assessment, planning, caring, teaching and counseling all family members, particularly mothers, in order to alleviate mothers’ and children’s stress and improve the epileptic children’ QOL. This study was carried out to investigate the relationship between mothers’ stress and their epileptic school-age children’s stress, quality of life and care provided. The study was conducted in the Neurological Clinic of Health Insurance at Smouha, the Neurological Clinic of Health Insurance Students’ Hospital at Sporting as well as Neurological Clinic and Neurological Department of Children’s University Hospital at Elshatby- Alexandria. A convenience sampling of 300 epileptic school-age children and their mothers comprised the study subjects. Four tools were used to collect the data namely: a) mothers‟ care of their epileptic school-age children structured interview schedule, to assess mothers’ care provided for their children, b) mothers of epileptic school-age children’ stress scale, to assess the stress level of mothers, c) perceived stress scale (pss-10), which was developed by Cohen et al. (1983) and modified to assess the perceived stress of school- age children with epilepsy and d) pediatric quality of life scale, which was developed by Verni et al. (1998) and modified to assess the quality of school- age children with epilepsy. Every child and his mother were individually interviewed to collect the necessary data. The main results of the present study were as follows:
- Two thirds of the mothers were at the age of 30 to less than 40 years (66.7%) with a mean age 37.70 ±7.394 years.
- Nearly half of mothers were either illiterate or read and write (44.6%).
- The majority of the mothers were housewives (83.7%) and about two thirds of them live in urban areas (67.3%).
- Less than two thirds of epileptic children were at the age of 10 to 12 years (60.7%) with a mean age of 9.15 ± 1.903 years and 54.7% of the children were males.
- Less than half of the children had epilepsy since three to less than five years (45.7%) and 68.3% were hospitalized.
- More than half of the epileptic children suffering from monthly attacks (58.0%), while the experienced attack lasts five minutes or more for 72.3% of the children
- One fifth of mothers defined epilepsy (22.3%), while 68.3% gave incomplete definition.
The majority of mothers anticipated the convulsive attacks (91.0%).
- Regarding physical stress of mothers, 56.7% and 55.3% of mothers stated that increase in heart rate and difficulty in breathing without clear cause result in stress for them respectively.
- Upsetting from waking- up a lot at night to check children’s condition was stressful for 50.7% of mothers.
- Forty seven percent of the mothers were stressed due to farness of home from the periodic follow-up place.
- Concerning psychological stress of mothers, children’s abnormal EEG-CT was the highest perceived psychological stressors as reported by 77.3% of mothers.
- Inability to help children during epileptic fits and dependence of children on AEDs throughout their life were stressful for 69.7% of mothers for each.
- Thinking in the future of children with epilepsy and feel worry almost of time due to children’s disease were stressful for 67.7% and 66.3% of mothers respectively.
- More than half of mothers reported that they were stressed because of their siblings feeling of sadness due to their epileptic brother/ sister (54%).
- With respect to mothers’ social stress, feeling embarrassed when others know that their children have epilepsy was a cause of stress for 64.7% of mothers.
- Siblings’ jealousy due to over attention and care provided to their brother/sister, as well as their feeling of sadness due to limited family social relationship with relatives and friends were stressful for 57% and 53.6% of mothers respectively.
- Two thirds of the mothers felt stress due to low scholastic achievement of their epileptic children (64.0%), and lack of teachers and school administrators’ sympathy with the children for 42.7% of mothers.
- Children’s care needs, especially drugs, that exceed of mothers’ financial capabilities and lack of sources that provide adequate information that help in children’s treatment were reported to be stressful for 59.7% and 53.3% of mothers respectively.
- As regards mothers’ stress related to AEDs administration, inability to give daily AEDs to their children at regular times was stressful for 63.0% of mothers.
- Repeated dose adjustment was a cause of stress for 56.0% of mothers.
- Children’s refusal to receive the drugs was stressful for 45.7% of mothers
- With respect to mothers’ stress related to children’s periodic follow-up, lack of doctors & nursing staff interest in giving adequate information about their children’s care as well as interfering the times of medical follow- up with children’s school time or with their work time were stresses experienced by 82.0% and 42.7% of mothers respectively.
- More than two thirds of mothers had ”high” level of stress (69.3%), while the rest had ”moderate” level of stress (30.7%).
Psychological stress was the highest stress reported by mothers followed by social then treatment and finally the physical stress as mentioned by 77.3%, 60.3%, 58.3% and 57.7% of mothers respectively.
- Slightly less than half of the mothers had ”high” level of stress regarding children’s follow-up (45.3%).
- Concerning epileptic school-age children’s stress, more than two thirds of the epileptic children were stressed ”most of the time” because of their inability to cope with all things that they had to do (66.3%).
- Difficulties piling up too high that children’s could not overcome them and angry because of epileptic fits that happened out of their control were ”most of the time” a cause of stress for 63.6% and 60.3% of children respectively.
- Upset from continuous occurrence of fits was stressful ”most of the time” for 56.7% of children.
- Regarding total epileptic school-age children’s stress levels, 77.7% of children had ”high” level of stress, while 21.7% had ”moderate” level of stress.
- The majority of both mothers and children had ”high” stress level (80.8%).
- With respect to epileptic school-age children’s physical functioning and health QOL, the epileptic children were ”often” feeling pain in all body parts after fits and doing sport activity or exercise as reported by 55.0% and 53.7% of them respectively.
- Mothers’ view of their children’s physical functioning and health QOL were the same, where 53.0% and 54.0% of them reported that their epileptic children had ”often” feeling pain in all body parts after fits and participated in sport activity or exercise respectively.
- Two fifth of the epileptic children were ”almost always” find it hard to sleep due to sudden occurrence of epileptic fits (40.7%), it was reported by 39% of mothers about their children’s emotional functioning QOL and 30.3% and 52.0% were either ”almost always” or ”often worry about what will happen in the future.
- Mothers reported that their children were either ”almost always” or ”Often” worry about what will happen in the future by 27.3% and 50.0% of them respectively.
- For epileptic school-age children’s social functioning QOL, 44.0% and 46.0% of the epileptic children were either ”almost always” or ”often” find hardness in getting along with other kids.
- Forty nine point six percent and 42.0% of mothers reported that their children were either ”almost always” or ”often” find difficulty in getting along with other kids.
- Almost half of the children ”often” reported that other kids do not want to be with their friends (49.0%), and ”often” reported by 42.3% of mothers about their children’s QOL.
Concerning epileptic school-age children’s QOL regarding school problems, 60.6% and 55.3% of the epileptic children were ”almost always” forgetting things and paying attention in class.
- More than half of mothers (57.7%) and 62.3 % of mothers stated that their children ”almost always” forgetting things and paying attention in class.
- Almost all epileptic children had ”low” QOL (97.7%), and almost all mothers stated that their children had ”low” QOL level (94.7%).
- Regarding school problems were the highest QOL domain reported by 97.7% of children followed by physical and emotional functions as mentioned by 89.7% of children for each, while social functions were the least one as reported by 80.0% of children.
- Regarding to children QOL according to their mothers’ report almost all of children had ”low” QOL regarding their school problems (99.3%) followed by emotional, social and physical function as reported by 96.0%, 94.0% and 93.7% respectively.
- Almost all of mothers told the school about their children’s illness (97.7%).
- Three quarters of mothers avoided their children to be in high place alone (72.3%) and 66.3% prevented them from closing bathroom door with key.
- Two thirds of mothers reported that their children were carrying an identification card (62.7%).
- The majority of mothers were giving drugs to their children at regular times (91.0%).
- When the attack decreases, 86.3% of mothers were keen to continue to give the drugs to their children, while 38.3% were seeking doctor’s advice in reducing the dose.
- In avoiding dose forgetfulness, linking the dose time with constant thing as meals or setting the alarm clock were reported by 67.7% and 40.7% of mothers respectively.
- In case of drugs side-effects, 72.7% and 63.7% of mothers continued giving the drug in the same dose and asked the doctor respectively.
- Care during seizures, 92.0% of mothers remaining with their children till the end of attack and regain their consciousness and 80.0% timed seizures duration.
- More than half of mothers did not place children in a safe place (56.3%).
- Three quarters of mothers did not put a piece of rolled cloth between their children’s teeth to prevent tongue biting (78.3%) or kept the sharp tools away from them (77.3%).
- The majority of mothers did not loose tight clothes around children’s neck or protected the head by placing soft pillow under it (85.7% and 85.3% respectively).
- After seizure, 84.7% of the mothers were keen to record the duration of fit and three quarters cleaned their children’s mouth from discharges after the attack (75.0%).
More than two thirds of mothers delayed introducing food or drink till their children regain their consciousness completely (67.0%).
- Fifty four point seven percent and 69.7 of mothers did not place the children on their side or back with head at one side after fits or examined their children for involuntary urination or defecation during attack respectively.
- Almost all of mothers did not observe children’s ability to move extremities or examined them for any injury or wound (97.0% and 96.0% respectively).
- Less than three quarters of the mothers had ”poor” practices score (72.0%), while 28.0% had ”satisfactory” score of practices.
- Almost all the epileptic school-age children of ”low ”QOL level had ”low” QOL in their mothers’ reports (95.6%).
- Almost all of epileptic school-age children with ”high” stress level had ”low” QOL (98.3%).
- Almost all mothers with ”high” stress level had children with ”low” QOL (98.6%).
- Three quarters of mothers with ”moderate” and ”high” stress levels provided ”poor” care for their epileptic children (75.0% and 70.7% respectively).
- There is a significant weak positive correlation between mothers and their epileptic children regarding their stress level, where the high the mothers’ stress level, the high the stress level of their children (r = 0.166, P = 0.004).
- There is a significant weak negative correlation between mothers’ stress & their report about their children’s QOL, where the high the mothers’ stress level, the low the QOL levels they reported about their children (r = - 0.151, P = 0.009).
- There is a weak negative correlation between mothers’ stress and the care provided, where the high the mothers’ stress level, the low the care they provided for their children (r=-0.005, p=0.928).
- There is a significant weak negative correlation between children’s stress & their reported QOL, where the high the children’s stress level, the low the QOL levels they have (r= -0.113, P=0.050).