Abstracts

Rationale: Anecdotal evidence suggests even clinically experienced caregivers can become anxious when treating acute seizures. In a study of hospice nurses and physicians, seizures were identified as a major source of anxiety for staff. (McCluggage HL Int J Palliative Nurs. 2006 12:254). Emotional discomfort with care of seizures is not only a potential cause of job related stress for nurses, but may also adversely effect patient’s attitudes toward their condition. Attitudes of hospital nurses caring for seizure patients have not been previously assessed. We hypothesized that nurses with little experience in seizure care would have higher anxiety, and sought causes for this anxiety. Methods: We distributed a voluntary, anonymous 22 question survey to nurses at Mayo Clinic Arizona working in the epilepsy monitoring (EMU) and intensive care units (ICU). The majority of questions were scored on a 5 point Likert-type scale. Results were statistically analyzed with t-test or ANOVA. Results: 25 surveys were returned, 13 from EMU and 12 from ICU staff. ICU nurses had significantly greater total years of clinical experience, but less exposure to patients with seizure (mean 11-30 versus 51-100 prior seizure patients seen by EMU staff). There was no significant difference in prior exposure to status epilepticus. ICU staff were significantly more likely to report anxiety when caring for a patient with a seizure (70% vs 33% in EMU reporting moderate anxiety, p=0.03). Both agreed with statements that seizures are “dangerous” and “painful”, while ICU nurses associated convulsive seizures with a high risk of death (>11-25%). ICU nurses were less confident in their ability to recognize seizure activity, provide appropriate nursing care for seizure, or to answer patient questions pertaining to seizure. ICU staff were also less likely to agree that nursing care increases patient safety and comfort after seizure. Both groups agreed that medications were effective in treating seizures, but EMU staff were more likely to agree that medications increase patient comfort. ICU staff rated both their clinical skills and emotional comfort for treating seizure significantly lower compared to stroke, cardiac arrest, or acute respiratory distress. Conclusions: Caring for a patient with a convulsive seizure provokes anxiety even in experienced nurses. Seizures were identified as a greater source of emotional stress for nursing staff than other medical emergencies. Potential sources of anxiety identified were lack of confidence in knowledge about seizures, lack of faith in the effectiveness of nursing intervention to improve patient comfort and safety, and a misperception that seizures are associated with high patient mortality. Education about epilepsy addressing these areas has the potential to improve the experience of both patients and hospital staff.