2. A neurological disorder By: Kimberly Gaffney

3. * Summary (Colley, 2014) (Stecker &Stecker, 2012)

4. * The effects of education on nurses’ assessments in an epilepsy monitoring unit. * Authors: Mona and Mark Stecker * Journal: Canadian Journal of Neuroscience Nursing. * This research study addressed…. * Justification (Stecker &Stecker, 2012)

5. Novice to Expert – Patricia Benner * Expert nurses develop skills and understanding of patient care over time through a sound educational base and a multitude of experiences. * Knowledge and skills can be gained without ever learning the theory * The development of knowledge in nursing is the extension of practical knowledge through research and the understanding of clinical experience. ( Nursing Theory, 2012)

6. * Source * Ethics * Purpose * Literature Review * Research Design * Data collection * Sample * Level of measure (Stecker & Stecker, 2012) ( Singleterry, 2014)

7. * Statistics * Results * Limitations * Recommendations (Stecker & Stecker, 2012) ( Singleterry, 2014)

8. * Accurate and Concise Assessments * Individualized Care Plans * Education for patients and family (Smeltzer, Bare, Hinkle & Cheever, 2010) (Stecker & Stecker, 2012)

9. (Colley, 2014) 1.IDENTIFY… the variables in this situation 15 y.o.. female History of seizure activity Works full time to Student 2. RELATE…Or put the variables together to form propositions. Primary Proposition: Patient is seizing because there is an increased amount of stress from juggling a stressful full time job and attending high school. Possible Assumptions: Pt had a head injury Drug or alcohol abuse Metabolic or nutritional imbalance Brain tumor or abscess Having a job and going to school is too much of a workload for her Patient knows what triggers the seizures Possible Confounding Variables: 15 year old girl wants to fit in at school Saving enough money for college is important because she can’t attend college otherwise. 3. UNDERSTAND…the importance of the propositions, assumptions, and confounding variables. Proposition: If seizures are not managed patient could go into status epilepticus. Significance of Assumptions: If the patient is using drugs and or alcohol then patient is not going to be taken serious, less likely to receive treatment, and possibly sent home sooner. If a head injury or brain tumor is present then patient needs to be treated for underlying cause of seizure activity, to eliminate the seizures. If patient doesn’t know what’s triggering the seizure she could be aggravating them. Patient needs to be educated on the importance of proper nutrition and the effects it has on metabolic function that could contribute to the seizure occurring. Possible Confounding Variables: Being in the hospital (not working or attending school) may add anxiety, hostility and stress to life. Having recurrent seizures may prevent her from fitting in with peers. Situation: A fifteen year old female who is being seen following a suspected epileptic seizure. Following the initial consultation, the patient was referred for an electroencephalogram (EEG). However, before the appointment came through she had another seizure, similar to the first, witnessed by her mother. She was admitted to hospital and ambulatory EEG confirmed a diagnosis of generalized epilepsy with tonic-clonic and myoclonic seizures. The patient is at the top of her class academically and is working full time to save money for college. The nurse is a 25 year old BSN prepared RN and recent graduate who has had minimal exposure to diverse situations.

10. (Colley, 2014) 4. EXPLAIN…the significance of the situation to those involved based on their individual KSVME Proposition: Explain that generalized epilepsy affects the entire brain and that mytonic and tonic- clonic, are terms that describe the seizure movement and that it occurs bilaterally. Also explain that seizure activity can increase in frequency and duration if stress is not managed. Assumptions: Explain importance of proper nutrition. Explain importance of managing and recognizing stress and its relationship to the seizure activity. Confounding Variables: Encourage patient to join a support group specifically for patients who have seizures. Explain alternative of working so many hours, maybe after high school she could work for a couple of years and save enough money to then attend college. 5. PREDICT…what will happen in this situation if one or more variables are not changed. Proposition: If stress is not managed or decreased seizures will continue and patient could go into a status epilepticus. Which could result in fatal brain damage and affect other systems in the body. Assumptions: If patient cooperates with reducing and managing stress, seizures activity will lessen or stop. Confounding Variables: If patients need to fit in at school can be addressed and less hours at work can be agreed upon, then seizures should lessen. 6. INFLUENCE…someone to change one or more variables in order to achieve a desired outcome or prevent an undesirable one. Proposition: Make sure patient understands importance of reducing and managing stress and its relationship to the seizures. Assumptions: Make sure patient understands importance of proper nutrition, identifying individual stressors in life and how drugs, alcohol, and injuries can contribute to seizure activity. Confounding Variables: Ensure seizure control will happen. Ensure that she will still be able to attend high school 7. CONTROL…one or more variables in order to achieve a desired outcome or prevent an undesirable one. To control isn’t an issue of wanting to dominate or do what is unreasonable or unwanted, but simply a matter of changing one or more variables in order to bring about a desired outcome when influence is not possible, realistic, or advisable. Patient is not allowed to work for more than 20 hours per week while school is in session. Patient will identify ways to help reduce and manage stress in life.

11. * Individualizing Care * Empathy * Advocating ( Smeltzer et.al, 2010)

12. (ANA, 2010) Advocating Planning Evidence –based practice Quality of Practice

13. References *Nursing Theory. (2011). From Novice to Expert Patricia E. Benner. Retrieved from http://currentnursing.com/nursing_theory/Patricia_Benner_ From_Novice_to_expert.html *Stecker, M. & Stecker, M. (2012). The effects of education on nurses’ assessments in an epilepsy monitoring unit. Canadian Journal of Neuroscience Nursing, 34(2): 23-30. *Singleterry, L. (2014).NURS 350 Research in Nursing [syllabus]. Department of Nursing, Ferris State University, Big Rapids, Michigan. *Colley, S.L. (2014).NURS 441 Nursing Theory 3 [syllabus]. Department of Nursing, Ferris State University, Big Rapids, Michigan. *Smeltzer, S.C., Bare, B.G., Hinkle, J.L.,& Cheever, K.H. (2010). Brunner & Suddarth’s textbook of Medical-Surgical Nursing (12 th ed.). Philadelphia, PA: Wolters Kluwer Health and Lippincott Williams & Wilkins.