RAJIVGANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTFOR DISSERTATION

1. Name of the candidate and

Address

Ms. MUHSINATH.A.R.Dr.SYAMALA REDDY COLLEGE OF NURSING, #111/1, SGR MAIN ROAD, MUNNEKOLALA, MARATHAHALLI, BANGALORE-560037.

2. Name of the Institution Dr. Syamala Reddy College of Nursing

3. Course of the Study and

Subject

M.Sc Nursing I year

Pediatric Nursing

4. Date of Admission to Course 09.06.2008

5. Title of the TopicA study on effectiveness of structured teaching program among mothers regarding care of children with convulsion in selected hospital and institutions at Belgaum.

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6. BRIEF RESUME OF THE INTENDED WORK:-

6.1. INTRODUCTION:-

“Children are not only our future

They are the present . . .

And we need to take their

Voices very seriously”

(UNICEF)

How beautiful to behold are the colors of a mothers love. The gift of life is

through a woman’s body. Together with her man, the woman will be reproducing and

generating life. This awe inspiring process by which a tiny cell gets converted into a

baby kicking with life. Mothers are the potters and the children are the clay. For better

or for worse a baby is a precious gift from Heavenly Father. A baby makes his mother

sleeps more lightly and his father appears to sleep more soundly.

Convulsion or seizures is among the most frequently occurring neurologic

disorder in children. It is a common symptom in childhood. In ancient times

convulsions are considered as divine curse. Today also people with epilepsy confront

superstition, insensitivity, and dissemination. Epilepsy’s this attitude can be changed

once the scientific cause of this condition is defined and the public is enlightened

through education.

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Epilepsy is one of the most frequent and hidden disorder and many cases are

not reported. There may be as may as 40 million epileptics worldwide. Approximately

25% of epileptics experience seizures that are uncontrolled by current forms of

treatment. Seizures are recurrent neurologic disorders among children between the age

group 2 to 16 years with an incidence rate of 4 to 10% of children.

The seizures or convulsive disorders are affecting millions worldwide and

presents as a major medical and health problem in the pediatric age group. The world

health organization estimates that 6 to 10 per 1000 of the total world population have

epilepsy. Yearly around 45000 new cases of epilepsy is reported in India.

There are so many underlying causes for epilepsy. The children are the

common victims of epilepsy. Epilepsy is a hidden disorder and can catch hold of the

victim at any moment of their life like playing, studying, walking, bathing etc. There

are so many incidences of deaths during the seizure due to lack of attention. The main

reasons for deaths due to convulsion are aspiration, head injury due to falls etc. The

proper care and prevention of complications during the period of epilepsy will save the

life of the children.

The child with epilepsy can lead a normal life like all other healthy persons, if

they are properly treated and doing the follow up. The child and parents should be

aware of the complications of epilepsy. It is the responsibility of the health

professionals to educate the parents of children with convulsion about the

complications and care of convulsions. Elder children should be taught about the

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period of aura so that they can identify the onset of seizure and thus the further injury

can be prevented.

6.1. NEED FOR THE STUDY :-

Convulsions are more common among children between 6 months of age and 15

years and in new born period. It has been estimated that about 4 to 6% of all children

will have fits sometime or other during their lifetime and 90% of convulsive disorders

have their onset in early life. One in 15 or 20 children admitted in hospitals give a

history of convulsion.

The risk of epilepsy for an individual with a positive family history is one in 40

as compared to one in 250 for the general population. Globally 40 to 50 million people

have epilepsy. Nearly three quarters of the affected –mostly those with epilepsy in non

individualized nations-receive no treatment whatsoever for their seizures.

The incidence of epilepsy under the age group of 18 is about 20000. The

incidence and prevalence rate is highest among the pediatric age group, that is, 0-18

years.45000 children under the age of 15 years develop epilepsy every year.

Epilepsy is very common in the specialized population among the children,

that is 50% of the children with both mental retardation and cerebral palsy, 35% of the

children with cerebral palsy, 20% of the children with mental retardation, 15% among

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inpatients, 11% among the out patients, 8.7% of children of mothers with epilepsy, 8%

of children without other neuronal disorders, 2.4%of children of fathers with epilepsy.

Through out the world, misunderstanding, fear and ill informed public attitude

towards this common medical condition contributes to wide spread dissemination,

isolation, and social rejection of people with epilepsy.

It is very common in the rural areas that the people used to be very spiritual

and they believe that epilepsy is due to the anger of God or due to the evil spirit on the

body. So they will not be taking care of the patient and instead they take the child to

the saints for pooja and ultimately we may be loosing the life of the patient. So these

stigmas about this common problem can be eliminated through educational programs.

According to health specialists it is always advisable to start treatment for

epilepsy as soon as it is diagnosed. Studies of prolonged seizures have estimated that

the longer the duration of seizure episode before treatment, more difficult it is to stop

and there is also a greater risk of long term neurological sequels. Early and effective

treatment is essential to prevent the morbidity and mortality associated with epilepsy.

Epilepsy is curable with the sophisticated technologies and thus the initiation of early

treatment is a necessity.

The family members should be enlightened that convulsion is not a curse from

God but it is like other diseases like fever or common cold. This can be done through

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education of the mothers. Mothers are the primary care givers for the children. So

mothers need more information about the care of children with convulsion. They need

to be educated to assess the onset of seizures, aura, positioning of the child during the

period of convulsion, care of the children during convulsion and to prevent further

complications.

Most of the mothers have superstitious believes about the care of the child with

convulsion. To create awareness among mothers about the convulsive disorders, its

causes, manifestations, treatment, and prevention; a structured teaching program is

necessary.

6.2. REVIEW OF LITERATURE:-

Convulsion or seizures is among the most frequently occurring neurologic

disorder in children. About 5% children experience convulsions during the first five

years of life. A good description of the seizures including mode of onset, details of

aura, type of seizure, automatism, associated behavioral abnormalities,

and the post-ictal phase will help in the identification of convulsions at its early stage.

THE RELATED REVIEW OF LITERATURE IS ARRANGED AND

PRESENTED IN THE FOLLOWING ORDER:

1. Meaning of convulsion

2. Incidence and prevalence of convulsion

3. Etiological factors of convulsion

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4. Classification of convulsion

5. Clinical manifestations of convulsions

6. Diagnostic procedures of convulsion.

7. Management of convulsion.

8. Home care of children with convulsion.

9. Complications of convulsion

10. Studies related to the knowledge, attitude, and practice of

parents regarding care of children with convulsion.

1. MEANING OF CONVULSION:

Commission on Epilepsy Foundation (1998) described the term epilepsy first.

The word epilepsy is derived from a Greek word called “Epilepsia” which can be

divided into two words that is epi-means upon and lepsis – means to take hold of.

Convulsion or seizure is a transient disorder of brain function manifested by

involuntary motor, sensory, autonomic, or psychic phenomenon alone or in any

combination usually having associated with alteration in consciousness (Marlow,

2001).

Convulsion or seizure is a paroxysmal time limited change in motor activity

and or behavior that results from abnormal electrical activity in the brain (Suraj Gupte,

2002).

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Seizure is a sudden change in behavior due to abnormal electrical activity in

the brain (Wikipedia, 2006).

2. INCIDENCE AND PREVALENCE OF CONVIULSION:

Manandhar (1989) conducted the prospective study to assess the prevalence of

epilepsy among children with a sample of 400 children between the age group of 1

month to 13 years with a history of convulsion. There were more male children than

female children and also the epilepsy is more prevalent in winter season than in

summer season. The study found that 77% of children suffered with febrile

convulsions, 11.2% with a febrile convulsion or epilepsy; and 5.7% epilepsy

associated with hypocalcaemia, 4.4% with CNS infection, and 0.8% with lead

intoxication.

Ontario (2001) listed that globally the mortality rate of children

associated with seizure is about 10%. Mortality rate for children with epilepsy remain

largely unknown. But the latest studies shows that children with symptomatic epilepsy

that is seizure demonstrated with antecedent convulsion such as head injury, cerebral

palsy, malformation of central nervous system, may have 20 fold increases in risk of

death. The studies show that globally about 3.8 per 1000 population is the estimated

mortality rate among children with epilepsy.

Mustafa et al (2002) conducted a study on outcome of severe refractory status

epilepticus in children. The result of the study showed that after treatment with high

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dose of suppressive therapy in children between the age group of 4-5 months to 18

years the overall mortality rate was 7 out of 22 affected children.

Vrajesh (2005) says that the prevalence rate of convulsion in India is 5.59 per

1000 population with no gender and geographic differences.

SEAR-WHO (2006) published certain studies from different parts of India

reveal that the problem varies from 9 per1000 population in Bangalore, 5 per1000

population in Mumbai, 3 per1000 population in Calcutta, and 4 per1000 population in

New-Delhi. From a recent study in Bangalore, the problem of convulsion is 2.5 times

higher in rural areas than in urban areas. In Bangalore 24% of rural children and 10%

of urban children with convulsion are not on treatment.

Bourgeois (2007) says that the incidence of epilepsy was highest under the age

of 2 years. Nearly 45000 new cases of epilepsy are reported every year among

children in U.S.A.

WHO-Epilepsy Statistics (2007) published the latest statistics that around 50%

of children having cerebral palsy and mental retardation are the highest prevalent

group with epilepsy and convulsive disorders.

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3. ETIOLOGICAL FACTORS OF CONVULSION:

The etiological factors related to convulsions are mainly the following:

a)idiopathic(no definite cause is identified) b) prenatal asphyxia c) intra cerebral

injuries d) postnatal vascular accidents e) congenital or metabolic disorders like

hypoglycemia, hyponatremia, hypocalcaemia etc. f) head injuries g) infection like

meningoencephalitis. h) hereditary.

Teri (2002) conducted a study on the various factors of pediatric epilepsy shows

that there is a significant evidence of genetic, congenital, and developmental

conditions associated with pediatric epileptic clients.

Nagarajappa and Rana (2003) quoted that seizures are caused by malfunctions

of the brain’s electrical system that result from the cortical neuronal discharge.

Epilepsy also known as the “falling sickness”, the normal pattern of the neuronal

activity becomes disturbed. This causes the strange sensations, emotions, and behavior

or sometimes convulsions. The major causes include cerebral infections, head injury,

metabolic disorders, fever, cerebral palsy, mental retardation etc.

4 . CLASSIFICATION OF CONVULSION:

The international classification of epilepsies is currently classified epilepsy

into partial (including simple and complex partial) and generalized (including absence

and generalized tonic clonic) seizures. O. P. Ghai (2004).

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Partial seizures begin focally and result from abnormal electrical discharges in a

circumscribed portion of the brain. The partial seizure may be clinically manifested by

a comparably restricted disturbance of cognition, behavior, sensation or movement.

Partial seizure may be simple or complex. Marlow (2001).

Generalized seizures involve both cerebral hemispheres symmetrically.

Consciousness may be impaired immediately. Absence seizures and tonic clonic

seizures are examples of generalized onset seizures. Marlow (2001) .

International League against Epilepsy (2003) in 1964, classified epilepsy into

epileptic and non epileptic seizures. Epileptic seizures have no apparent trigger or

cause and occur repeatedly. These seizures are called as a seizure disorder or epilepsy.

Non epileptic seizures are triggered or provoked by a disorder or another condition

that irritates the brain. In children fever can trigger non epileptic seizure. Seizures with

no apparent cause are called idiopathic seizures. Rarely seizures are triggered by

repetitive sounds, flashing lights, video games, or even touching certain body parts. In

such cases the disorder is called reflex epilepsy.

5. CLINICAL MANIFESTATIONS OF CONVULSIONS:

The clinical manifestations of convulsion can be listed according to the phases

of seizures. Aura is a transitory premonitory symptom heralding the onset of seizure.

During the tonic phase skeletal muscles go into a sustained spasm. A shrill cry due to

the spasm in laryngeal muscle spasm. Muscular rigidity will be present. Flexions of

arms, extension of lower extremities are the common manifestation of muscular

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rigidity. Altered consciousness, pale face, dilated pupils, rolling of eyes, frothing from

the mouth, involuntary passage of urine and stool, etc are the associated features. O. P.

Ghai (2004).

In clonic phase rhythmic alternating contractions of muscle groups will be

identified. O. P. Ghai (2004).

The post-ictal phase is manifested with headache, confusion, automatisms,

alteration in memory etc. O. P. Ghai (2004).

Blumstein (2006) says that about 20% of people who have epilepsy or seizure

disorders, seizures are preceded by unusual sensation (called “aura”) such as the

following:

1. Abnormal smells or tastes

2. Butterflies in the stomach

3. A feeling of “déjà vu”.

4. An intense feeling that a seizure is about to begin.

Wikipedia (2006) published a journal describing common symptoms of

seizure include the following:

Change in consciousness; so that the patient cannot remember some period of time.

Change in sensation of the skin; usually spreading over the arm, leg, or trunk.

Change in vision including flashing lights, hallucinations etc.

Loss of muscle control and falling often very suddenly.

Muscle movement such as twisting that might spread up an arm or leg.

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Muscle tension or tighting that causes twisting of the body or head, legs or arms.

Testing a bitter or metallic taste or flavor

6. DIAGNOSTIC PROCEDURES OF CONVULSION:

To assess the child with epilepsy, a complete history should be collected, the

physical examinations should consist a detailed neurological examination. The routine

laboratory blood studies include a complete blood count and levels of glucose,

electrolytes, calcium and magnesium. Urine and blood toxicology screens are

conducted on appropriate patients since some prescribed or illicit drugs e.g.:

amphetamines may cause seizures. A lumbar puncture is usually done if there is a

suspicion of central nervous system infection or inflammation. Julia. A. McMillan.

(2006).

The electroencephalogram is extremely helpful in demonstrating the

mechanisms or type of the seizure. The EEG gives clues about the type of epilepsy

and discriminates the focal from generalized seizures. Long term monitoring for few

hours to several days increases the chances of recording an attack. Kleigman (2006).

Ancillary neurodiagnostic tests include roentgenogram, computed axial

tomography, positron emission tomography, magnetic resonance imaging etc also can

be used to diagnose convulsion. Hockenberry (2007).

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7. MANAGEMENT OF CONVULSION:

The management includes medical management and surgical management. The

medical management include anticonvulsant therapy, dietary therapy etc. The common

drugs include carbamazepine, phenobarbitone, phenytoin, primidone, valporic acid,

clonazepam, diazepam etc. Marlow (2001).

Zoe (2006) a study on effectiveness of sahaja yoga practice on seizure control

found that meditation improved the brain wave activity of people with seizures

disorders leading to a reduction in seizures.

Current medicine group from current neurology and neuro science (2007)

conducted a study to evaluate the effectiveness of complementary and alternative

medicine and found that the trend of using CAM for treating epilepsy doesn’t differ

from that in other medical conditions which nearly one half of patient using CAM.

The major CAM used for treatment for epilepsy includes mind body medicine such as

reiki and yoga; biologic based medicine such as herbal remedies, dietary supplements

and homeopathy.

Diet therapy is another mode of treatment for convulsions. It includes a

ketogenic diet, which stimulates the ketosis and acidosis of starvation. The diet is

relatively low in carbohydrates and proteins but high in fat thus providing a

satisfactory calorie intake. The advantage of the diet is that it controls certain seizure

disorders. Marlow (2001)

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8. HOME CARE OF THE CHILDREN WITH CONVULSION:

Michael (2006) published an article about the care of children during

convulsion in home saying that loosen any clothing around the head or neck. Do not

try to wedge the child’s mouth open or place any object in between the teeth and do

not try to restrain the movements of the child.

Blumstein (2007) says that stay with the person until recovery or until you

have professional medical help. Meanwhile monitor their pulse and rate of breathing.

After a generalized seizure, most people go into a deep sleep. Do not prevent from

sleep.

Epilepsy Foundation America (2007) insisting that don’t try to give food,

liquid or medication by mouth to a child who has just had a seizure.

Daniel (2008) says that home care of the child with convulsive disorders is very

important. Most seizures occurs suddenly and stops by themselves, however a person

having a generalized seizure may be injured, breath food, fluid or vomit into the lungs

or not gets enough oxygen. A child who is having a seizure should be placed on the

ground or floor in a safe area. Observe the breathing of the child; if he or she is not

breathing within one minute after seizure stops, and then start mouth to mouth rescue

breathing or CPR. Once the seizure seems to have ended, roll the child onto his or her

side, so that if they have vomiting it will be expelled out. Any delay in the care can

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lead to a permanent deformity. So as the primary caregivers (mothers) should be more

aware of the immediate care of children with convulsion. Most of the studies suggest

that the mothers need to be educated about the care of children with convulsive

disorder.

9. COMPLICATIONS OF CONVULSION:

The common complications include injuries due to falls, aspiration due to

vomiting, temporary memory loss, confusion and recurrence. Parthasarathy (2000).

Neurological society of India (2002) conducted a study to find out the factors

responsible for recurrence of the seizures in controlled epilepticus for more than one

year after withdrawal of anticonvulsant drugs. The convulsion was about 19% of

patients after withdrawal of anticonvulsant drugs; over a period of 3-4 months

recurrence was noted. Eighty one percentages (81%) of patients did not have

recurrence. The recurrence rate was influenced adversely by factors like adolescent

age, later onset of seizures, pretreatment precipitating factors like emotional stress,

lack of sleep and meals, positive family history of epilepsy, focal neuro deficit etc.

10 . STUDIES RELATED TO KNOWLEDGE, ATTITUDE AND PRACTICE OF PARENTS REGARDING CARE OF CHILDREN WITH CONVULSION:

Parmar (2001) a study was conducted to assess the parental anxiety and

apprehension related to inadequate knowledge on convulsion estimates that 59.3%

could not recognize the convulsion, 90.7% did not carryout any intervention prior to

getting the child to hospital.

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SEAR-WHO (2006) shows that the result of a comparative study on knowledge,

attitude and practice towards epilepsy representing that the knowledge of developed

states is comparable with developing state, that is the level of knowledge among the

people of both developed and developing states are positive. But attitude towards

epilepsy among the people of developing states was negative .But in Kerala despite of

high literacy rate the attitude is extremely poor and generally epilepsy is believed to be

a mental illness. The educated understand that epilepsy is a treatable condition and

that appropriate drugs are available whereas the uneducated continue to believe that

epilepsy is untreatable and is caused by previous bad karma. Many people response

their faith in alternative system of medicine such as Ayurveda.

Surekha, Rohit & Surekha (2007) conducted a study on knowledge, attitude, and

practices with regard to epilepsy in rural northwest India. The result of the study was

generalized seizures were the most common type of seizure that is 84%. The most

common antiepileptic drug used was phenytoin. Ayurvedic treatment was the most

common alternative therapy used. Evil spirits were believed to cause epilepsy by

26.4% of people in the year 2000 but only 11.2% in the year 2004. Faith in curative

power of drugs increased from 18% in 2000 to 59% in 2004.

Geeta, Guruban and Neera (2007) conducted a study on knowledge and

attitude among parents of children with epilepsy. Majority (77%) was having a positive

attitude towards epilepsy and had complete seizure control after treatment and around

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6% attributed their epilepsy to the curse of God and 14% saw their affliction as a form

of punishment for bad deeds committed in the past life. Epilepsy was considered as

contagious by 13% of them, 7% of the subjects became skeptics and less religious while

29% become more religious. Only 2% of patients had reported mythic experiences like

evil spirit entry to the body. Delay in treatment and poor compliance due to false

religious beliefs, ignorance and superstitious was observed in 33%. Eighty percentage

(80%) cases felt that religion had helped them in coping with epilepsy.

Sandeep (2008) conducted a study to assess the health seeking

behavior and practices employed by parents after seizures in children. The measures

recommended to the parents were; 1) Go to hospital. 2). Administration of diazepam

by per rectal route. 3). Use of mouth gag. 4). Use of an oral drug. But most of them

(89.3%) had forgot all the measures during the period of convulsion and about 3.1% of

parents took the child immediately to the hospital. Remaining had delayed to take the

child to hospital.

6.3. STATEMENT OF THE PROBLEM:-

A study on effectiveness of structured teaching program among mothers

regarding care of children with convulsion in selected hospital and institution at

Belgaum.

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6.4. OBJECTIVES OF THE STUDY:-

1. To describe the level of knowledge of mothers regarding care of children with

convulsion before structured teaching program.

2. To determine the effectiveness of structured teaching program among mothers

regarding care of children with convulsion.

3. To find out the association between the sociodemographic variables with the level

of knowledge of mothers regarding care of children with convulsion.

6.5. HYPOTHESIS:-

H1:-There is a significant difference in the level of knowledge among mothers

regarding care of children with convulsion before and after structured teaching

program.

H2:- There is a significant association between sociodemographic variable and level of

knowledge of mothers regarding care of children with convulsion.

6.6. OPERATIONAL DEFINITION:-

1. EFFECTIVENESS: - It is the desired changes brought about by the planned

teaching program using posters and flash cards for mothers about the care of children

with convulsion such as signs and symptoms, therapies, home care etc and measured

in terms of significant knowledge gain in the post test using structured questionnaire.

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2. STRUCTURED TEACHING PROGRAM: - A planned teaching program for

mothers about the care of children with convulsions such as signs and symptoms,

therapies, home care etc using poster and flash cards.

3. MOTHER: - Mothers who are having children with convulsion.

4. CHILDREN: - Children with convulsion in between the age group of 1year to 12

years.

5. INSTITUTION: - The centres where the essential care for the children with

convulsion are given.

6. HOSPITAL: - The health care agency that provides care for the sick people.

6.7. ASSUMPTION:-

1:- Structured teaching program influences the level of knowledge of mothers

regarding care of children with convulsion.

2:- Period of convulsion has an effect on mother’s knowledge level regarding care of

children with convulsion.

3:- Level of knowledge differs from one mother to other mother.

4:- Socio-demographic variables contribute to the level of knowledge of mother’s

regarding care of children with convulsion.

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7. MATERIALS AND METHODS:-

7.1. SOURCES OF DATA:-

The data will be collected from the mothers of children with convulsion.

7.2. METHOD OF DATA COLLECTION PROCEDURE:-

Research Method: Quasi experimental method.

Research design: One group pre test post test design.

Sampling technique: Convenient sampling.

Sampling size: 50 mothers.

Setting of the study: Selected institutions and hospitals at Belgaum.

7.2.1. SAMPLING CRITERIA:-

INCLUSION CRITERIA:-

Mothers of children with convulsion.

Mothers who are willing to participate in the study.

Mothers of children with convulsion, age group between 1-12 years.

EXCLUSION CRITERIA:-

Mothers of children with febrile convulsion.

Mothers of Infants with convulsion.

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7.2.2. DATA COLLECTION TOOL:-

A structured questionnaire will be prepared to assess the knowledge of mothers

regarding care of children with convulsion. A structured teaching program will also be

prepared about the care of children with convulsion. Content validity of the tool will

be ascertained in consultation with guide and experts from various fields like nursing

and pediatric medicine. Reliability of the tool will be established by split half method.

Prior to the study, written permission will be obtained from the concerned

authority. Verbal consent will be taken from the mothers regarding their willingness to

participate in the study.

7.2.3. DATA ANALYSIS METHODS:-

Data analysis can be done using descriptive and inferential statistics. The

descriptive statistics used will be frequency distribution, percentage, mean, standard

deviation and inferential statistics such as a ‘t’ test and chi square.

7.3. HAS ETHICAL CLEARANCE BEEN OBTAINED?

YES.

Confidentiality and anonymity of the subjects will be maintained. Consent will be

obtained from mothers before conducting the study. A written permission from

institutional authority will be obtained.

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8. LIST OF REFERENCES:-

a) TEXTBOOKS:-

1. Carol Williams and Asquith; Pediatric Intensive Care Nursing ;( 2002); First

Edition; Churchill Livingstone Publishers.

2. Dr. Monika Dutta; Pregnancy; (1999); first edition; Sterling Publishers.

3. Eleanor. D and Thompson; Introduction to Maternity and Pediatric Nursing; Second

edition; Saunders publishers.

4. Hockenberry and Wilson; Wong’s Nursing Care of Infants and Children; 18th

Edition; Elsevier publishers.

5. Hockenberry, Wilson, Winkelstien and Klive; Wong’s Nursing Care of Infants and

Children; 7th Edition; Elsevier publishers.

6. Julia. A McMillan; Oski’s Pediatrics; 4th Edition; Lippincott publishers.

7. J. Viswanath, A.B.Desai; Achar’s Text Book of Pediatrics; 3rd Edition; Orient

Campus publishers.

8. Kleigman, Behrman, Jenson, and Stenton; Nelson’s Text Book of Pediatrics;

volume 2; Elsevier publishers.

9. Marlow and Redding; Textbook of Pediatric Nursing; 6 th Edition; Elsevier

Publishers.

10. Martha, Douglas, Lourdes, Maria, Barbara, Thomas and Megselene; Pediatric

Nursing; 1st Edition; McGraw-Hill publishers.

11. Parthasarathy, A. Menon, Nair.M.K.C. IAP Text Book of Pediatrics; 2nd Edition;

Jaypee publishers.

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12. O.P.Ghai and Piyush Gupte; Ghai Essential Pediatrics; 6 th Edition; CBS

publishers.

13. Suraj Gupte; the Short Text Book of Pediatrics; 8th Edition; Jaypee publishers.

14. Suraj Gupte; Text Book of Pediatric Emergencies; 1st Edition; Jaypee Publishers.

b) JOURNALS:-

15. The Nursing Journal of India; March 2007; Vol.XCVIII; No: 3; 50.p.p.

16. The Nurses of India; November2002; Vol: 3, Issue 11; 2, 9-11.p.p.

17. Dr. Nagarajappa and Lakshmi Rana; Home management of child with convulsion;

the Nursing Journal of India; October 2003; Vol: LXXXXIV; No: 30.

18. Mrs. Lavanya Nandan; Possible Nursing Interventions of Epilepsy; The

Nightingale Nursing Times; Issue 8; Volume 3; November 2007.

19. Indian Journal of Medical Sciences; 2008; Vol: 62; Issue 8; 331-335.p.p.

20. International Journal of Kuwait University of Health Science centre; 1989; Vol: 1;

No: 4.

21. Annals of Indian Academy of Neurology Journal; 2007; vol: 10; Issue 3; 165-

168.p.p.

22. Vrajesh Udani; Indian Journal of Pediatrics; 2005; Issue 4; Vol: 72; 309-313.p.p.

23. S.Thomas; Seizure; vol: 10; Issue 5; 370-373.p.p.

24. National Neuroscience Institute Singapore; 2004; Vol: 1; Issue 9; 31-32.p.p.

25. Neuro Epidemiology; 2006; Vol: 26; No: 4.

26. The New York Times; 2008; Vol: 3; Issue 1; 35-40.p.p.

27. Indian Pediatrics; 2005; Vol: 42; 82-183.p.p.

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c) WEBSITES:-

28. www.hindunews.com

29. www.blackwell_synergy.com

30.www.interscience.wiley.com

31. www.springerlink.com

32. www.nih.com

33. www.annalsofian.com

34. www.americanepilepsy.org.com

35. www.who.com

36. www.unicef.com

37. www.neurosciences_pediatrics.org.com

38. www.colmbia_encyclopedia.com

39. www.epilepsy_ontario.org.com

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9 SIGNATURE OF CANDIDATE

10 REMARKS OF THE GUIDE

11 NAME AND DESIGNATION

11.1 GUIDE

11.2 SIGNATURE

11.3 CO-GUIDE

11.4 SIGNATURE

11.5 HEAD OF THE DEPARTMENT

11.6 SIGNATURE

12 12.1 REMARKS OF THE CHAIRMAN AND PRINCIPAL

12.2 SIGNATURE

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