Abstracts

Rationale: Tonic-Clonic seizures can be very dramatic and frightening for the observer, which may result in a state of panic. A state of panic often leads to lack of appropriate nursing actions, patient injury, or unnecessary request for emergency services. The purpose of this study is to identify an expected evolution and phases of a secondarily generalized tonic-clonic seizure, teach nursing staff the expected phases and timing of a tonic-clonic seizure, promote nursing knowledge, improve nursing comfort levels, and establish nursing guidelines based on these findings.Methods: Study Design This is a two part study quantitative research design utilizing the Magnet NK1E0 framework. Research Sample Part 1 Subjects The subjects of this study were patients aged 14 years to 64 years who experienced a secondarily generalized tonic-clonic seizure while undergoing video EEG monitoring in a level four epilepsy monitoring unit. We studied 20 generalized tonic-clonic (GTCs) in 20 patients where all of the seizures were classified as complex partial seizures with secondarily generalized tonic-clonic seizures. Data Collection Methods The archived videos were retrospectively reviewed by the clinical nurse educator and EEG technician. Each tonic-clonic seizure video was reviewed and the following five phases were measured for order of occurrence and length of time. Head turning, audible vocalization, tonic phase, tonic-clonic phase, time to first breath. The timing of each phase was measured and the data was interpreted using descriptive statistics method. Research Sample Part 2 Seventeen Staff Nurses who care for the epilepsy patients on the Epilepsy EMU. Data Collection Methods Epilepsy course was offered for staff nurses. Pre and post-course surveys utilizing a Likert Scale were conducted in regards to nurses’ comfort level and knowledge when caring for patient experiencing a tonic-clonic seizure. The results were analyzed using descriptive statistics. All ten questions had a trend in the desired direction post-nursing education.Results: Data Analysis Part 1 data analysis showed there is an expected sequencing of the five phases common to a secondarily generalized seizure. Each phase was timed and a mean in seconds for each phase was determined. Part 2 data analysis reveals teaching this new knowledge to nurses improves nurses’ comfort levels when caring for the epilepsy patients experiencing a tonic-clonic seizure.Conclusions: This study revealed there is an expected observable evolution of the different phases of a patient experiencing a secondarily generalized tonic-clonic seizure. Incorporating this knowledge into teaching curriculum improves nursing knowledge for staff nurses caring for the epilepsy population. This study shows what is a normal seizure and what the expected time would be for each phase, and it also provides the nurse with the knowledge of when a seizure is not normal, and when to call for help. Further research needs to be conducted regarding best method for teaching all nursing staff caring for patients on the EMU, and degree of improvement in nursing care for patients experiencing tonic-clonic seizures.