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Most frequent nursing diagnoses in patients admitted to the Epilepsy Unit
Diagnósticos enfermeros en pacientes ingresados en la Unidad de Epilepsia
María Palanca Cámara
Unidad Multidisciplinar de Epilepsia Refractaria, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Calculations suggest that epilepsy affects around 1% of the population and that between 1% and 3% of the population will suffer from an epileptic seizure in their lives.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> In Spain, although there is a lack of data regarding prevalence, it has been calculated that there are some 400,000 epilepsy patients. Around 5%–10% of the population will at some time experience a seizure and up to 20% will suffer from recurrence of the same. Hospital admittance for epilepsy accounts for 35 patients out of every 100,000 admitted, with a mean cost of €6,935 per patient with refractory epilepsy<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a>: i.e. those patients who do not respond appropriately to the antiepileptic drugs, which have been taken correctly and for a considerable time, since the presence of seizures persists with relatively high frequency and/or prevents them from leading a normal life.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">A Multidisciplinary Epilepsy Unit has existed in the Hospital Universitario y Politécnico La Fe of Valencia since 2006, and it has been endorsed by the Ministry of Health as a unit of national reference (CESUR Centre) since December 2010. In this unit they essentially treat cases of drug-resistant epilepsy with prolonged video-EEG monitoring. Both surface electrodes applied with the international 10:20 system are used and also invasive electrodes (oval foramen electrodes, deep electrodes or subdural electrode blankets), aimed at:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0020" class="elsevierStylePara elsevierViewall">Assessment the possible treatment alternatives (vagus nerve stimulator, resective surgery, etc.).</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0025" class="elsevierStylePara elsevierViewall">Implementing a precise pharmacological adjustment.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0030" class="elsevierStylePara elsevierViewall">Correct diagnosis of the condition (non epileptic seizures, type of epilepsy).</p></li></ul></p><p id="par0035" class="elsevierStylePara elsevierViewall">The nurse, as the bedside professional, is the link with the patient, and a specific healthcare plan will help to improve the patient's quality of life.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Objectives</span><p id="par0040" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">•</span><p id="par0045" class="elsevierStylePara elsevierViewall">Be aware of the situation of the patients admitted to a multidisciplinary epilepsy unit through nursing evaluation.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">•</span><p id="par0050" class="elsevierStylePara elsevierViewall">Establish which nursing diagnoses and interventions are the most standard in these patients.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">•</span><p id="par0055" class="elsevierStylePara elsevierViewall">Establish several nursing objectives and interventions to propose quality care in these patients from the NANDA, NOC diagnoses, the NOC and NIC indicators with their activities, measurable through the NOC indicator scales and the NIC activities.</p></li></ul></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Material and method</span><p id="par0060" class="elsevierStylePara elsevierViewall">To accomplish the above said objectives a retrospective, observational study was conducted which included all the patients admitted to our epilepsy unit between the months of May and September 2013 (No.<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>46).</p><p id="par0065" class="elsevierStylePara elsevierViewall">The nursing evaluation was used by following the Virginia Henderson's nursing theory model, which is standard in our hospital.</p><p id="par0070" class="elsevierStylePara elsevierViewall">The data were obtained from the nursing evaluation which was performed on admittance and the epilepsy file which was made by the nursing unit, where specific data were collected on the condition (type of seizure, age when condition presented for the first time, frequency of seizures, precipitating factors of a seizure).</p><p id="par0075" class="elsevierStylePara elsevierViewall">Once the nursing evaluation data were collected, percentages of appearance within the group were obtained, fixing as relevant those which appeared in at least 30% of the studied sample.</p><p id="par0080" class="elsevierStylePara elsevierViewall">The patients signed a general consent form on hospital admittance permitting any data obtained from their monitoring to be used for medical and educational ends.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0085" class="elsevierStylePara elsevierViewall">The study sample (No.<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>46) was obtained from all patients admitted into hospital between the months of May and September 2013 in our Multidisciplinary Epilepsy Unit. 43.48% of the sample were men and 56.52% were women, with a mean age of 35.7 years. From them, 4.35% were assessed using invasive electrodes (deep electrodes) and the remaining 95.65% with surface electrodes. Of those patients assessed with surface electrodes, 6.52% presented with general epilepsy–i.e. affecting the whole brain. 60.87% presented with a focal epilepsy, i.e. the seizure was focused on one area of the brain. 2.17% were patients who were being re-monitored because they had not had epileptic seizures during previous hospital stays. 4.35% were patients who had undergone surgery for epilepsy who continued presenting with seizures. 19.57% had seizures which were non epileptic, and 2.17% had not presented with any type of seizure (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">The patients were assessed by the Virginia Henderson 14 needs model and the history of nursing for epilepsy, where data regarding the condition itself were collected, among which the precipitating factors were useful for our objective, as the limiting factors. We established the factors which appeared in at least 30% of the sample, from which the following results were obtained<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">4–6</span></a> (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>):<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">1.</span><p id="par0095" class="elsevierStylePara elsevierViewall">Risk of falls related to deterioration in mental state and prior history of falls. (100%).</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">2.</span><p id="par0100" class="elsevierStylePara elsevierViewall">Risk of aspiration related to reduction in level of consciousness (100%).</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">3.</span><p id="par0105" class="elsevierStylePara elsevierViewall">Malaise motivated by expressing a feeling of being uncomfortable related to lack of environmental control and lack of situational control (100%).</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">4.</span><p id="par0110" class="elsevierStylePara elsevierViewall">Willingness to improve self-care motivated by expressing desires to increase independent in maintaining health and well-being (76.1%).</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">5.</span><p id="par0115" class="elsevierStylePara elsevierViewall">Ineffective development of the role motivated by alteration in perceptions of role, conflict with the system related to inappropriate socialisation of the role, neurological defects (41.3%).</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">6.</span><p id="par0120" class="elsevierStylePara elsevierViewall">Tendency to adopt high risk behaviour for health motivated by minimising change in state of health related to negative attitude towards health changes (30.4%).</p></li></ul></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0125" class="elsevierStylePara elsevierViewall">In view of the results obtained, several NOC were established with their respective indicators and several NIC with their respective nursing activities aimed at providing a solution to these problems.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">5–7</span></a> (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><p id="par0130" class="elsevierStylePara elsevierViewall">Observing the table we may see that nursing activities for these patients should be particularly aimed at providing education and support regarding the disease and its evolution, since there is still a great lack of knowledge about the condition in itself and its limitations to both patient and family.</p><p id="par0135" class="elsevierStylePara elsevierViewall">In our hospital there is a pioneering project undergoing consolidation, conducted by the Epilepsy Association of the Community of Valencia. We are working together, establishing patient support from the Patient Services and Information and with the “Programa Respira” to families where the patient has been admitted into the monitoring unit. They are covering several of the areas detected in this study, and particularly social aspects and acceptance of the disease.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusions</span><p id="par0140" class="elsevierStylePara elsevierViewall">Despite the small study sample, it may be said that the social aspect is of major important in this type of patient, for whom their disease limits their relations with family members (inability to fulfil their role) and places strain on their social and working lives due to the major stigma still attached to these people because they suffer from epilepsy. As a result, they often hide their disease and acquire risky patterns of behaviour (driving etc.) to feel more accepted and even to gain employment.</p><p id="par0145" class="elsevierStylePara elsevierViewall">Due to this, reassurance, information and education have to be the basic keystone for nursing care of these patients. Within the unit and during monitoring, our work as nurses has to aim at prevention of risks from epileptic seizures, such as falls and aspirations, and also the provision of psychological support to patients and their family members.</p><p id="par0150" class="elsevierStylePara elsevierViewall">Patient associations carry out psychological support work and promote health through patient services, as is happening in the Community of Valencia, thanks to the Epilepsy Association of the Community of Valencia, They have recently implemented a programme for family respite inside the hospital, for patients admitted for monitoring. This is currently undergoing consolidation, but above all may have a positive effect for the family.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflict of interests</span><p id="par0155" class="elsevierStylePara elsevierViewall">The author has no conflict of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres950727" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methodology" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results and conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec922541" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres950728" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Metodología" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Resultado y conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec922540" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Objectives" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Material and method" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conclusions" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflict of interests" ] 11 => array:2 [ "identificador" => "xack321440" "titulo" => "Acknowledgements" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-11-21" "fechaAceptado" => "2016-05-30" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec922541" "palabras" => array:5 [ 0 => "Epilepsy" 1 => "Diagnosis" 2 => "Physiological monitoring" 3 => "Education" 4 => "Nursing care" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec922540" "palabras" => array:5 [ 0 => "Epilepsia" 1 => "Diagnóstico" 2 => "Monitorización fisiológica" 3 => "Educación" 4 => "Cuidado de enfermería" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Epilepsy is a neurological disease consisting of abnormal electrical discharges in the brain that produce a clinical condition, affecting 1–3% of the population. The Multidisciplinary Epilepsy Unit of the <span class="elsevierStyleItalic">Hospital Universitario y Politécnico La Fe de Valencia</span>, since 2006, has conducted studies with prolonged video-EEG monitoring of patients diagnosed with refractory epilepsy. The role of the unit is to provide these patients with both a diagnostic and a treatment solution.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This study aims to determine, using NANDA-NIC-NOC language, the basic needs of these patients and to assess how the quality of nursing care can be improved in this type of patient, during their admission and afterwards.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methodology</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Data were collected from a sample of 46 patients monitored in the unit between May and September 2013, and by using nursing assessment, data was obtained on the percentage occurrence of diagnosis.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results and conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The patients are very limited socially and occupationally, with added risks specific to the disease that we must not forget. The nursing role should be to standardise their situation as much as possible so that they can lead as full a life as possible, have proper health education, and prevent further injuries during admission (falls, etc.). From our experience, the epileptic patient support program from the Epilepsy Association of the Community of Valencia, and its incorporation into the <span class="elsevierStyleItalic">Programa Respira</span> for admission to the monitoring unit, gives good results.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methodology" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results and conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La epilepsia es una enfermedad neurológica consistente en descargas eléctricas del cerebro de forma anormal que producen una clínica, llegando a afectar a entre un 1-3% de la población. La Unidad Multidisciplinar de Epilepsia del Hospital Universitario y Politécnico La Fe de Valencia realiza, desde el 2006, estudios con monitorización prolongada por videoelectroencefalograma a pacientes diagnosticados de epilepsia refractaria. Desde la unidad, se busca dar una solución a estos pacientes tanto en el diagnóstico como en el tratamiento.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Objetivo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Con este estudio se pretende dejar constancia, mediante el lenguaje NANDA-NIC-NOC, de cuáles son las necesidades fundamentales de estos pacientes y valorar en qué se podría mejorar la calidad asistencial enfermera en ellos, tanto durante el ingreso como después del mismo.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Metodología</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se recogieron datos en una muestra (N<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>46) de pacientes monitorizados en la unidad entre mayo y septiembre 2013, a través de la valoración de enfermería, obteniendo datos de porcentaje de aparición del diagnóstico.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Resultado y conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Son pacientes muy limitados social y laboralmente, con unos riesgos añadidos propios de la enfermedad que no debemos olvidar, y la función de la enfermera debería ir encaminada a normalizar lo más posible su situación para que puedan llevar una vida lo más plena posible, hacer una correcta educación en salud y evitar daños mayores durante el ingreso (caídas, etc.). Desde nuestra experiencia, el programa de apoyo al paciente epiléptico desde la Asociación de Epilepsia de la Comunidad Valenciana y su consolidación en el programa respira durante el ingreso en la Unidad de monitorización, da buenos resultados.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Metodología" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Resultado y conclusiones" ] ] ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Palanca Cámara M. Diagnósticos enfermeros en pacientes ingresados en la Unidad de Epilepsia. Rev Cient Soc Enferm Neurol. 2017;46:6–10.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Prize for the best SEDENE poster at the XXI Annual SEDENE Congress 2014.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1575 "Ancho" => 1639 "Tamanyo" => 96701 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Distribution of patients by pathology.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Diagnosis NANDA \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">NOC \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">NOC indicator \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">NIC \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">NIC activity \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Risk of falls r/t deterioration of mental state, history of falls \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Detection of risk<br>Safe health care environment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Identify possible risk to health (190802) scale m<br>Use of protocols of practice based on proof (193425) scale f \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prevention of falls<br>Teaching: disease process \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Identify cognitive or physical disabilities of the patient which may increase the possibility of falling in a given environment. Instruct the patient to minimise the risks of their disease \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Risk of aspiration r/to reduction in level of consciousness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Self control of convulsions<br>Performance of the main carer: direct care \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Describes the precipitating factors of the convulsions (162001) scale m<br>Awareness of the disease process (220503) scale f \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Identification of risks<br>Management of convulsions \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Give instructions on risk factors and plan risk reduction<br>Guide movements to prevent lesions \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Malaise m/b expressing feeling uncomfortable r/t lack of environment control and lack of situational control \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">State of physical comfort<br>Anxiety level<br>Sleep \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Physical well-being (201002) scale a<br>Anxiety verbalised (121117) scale n<br>Quality of sleep (404) scale a \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Reduction of anxiety<br>Environmental management: well-being \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Explain all procedures<br>Make patient comfortable \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">76.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Willingness to improve self care m/b expressing desire to increase independence in maintaining health and well-being \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Health promoting behaviour \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Use behaviours to prevent risk (160201) scale m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Help to change oneself \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Help the patient to identify the effects of target behaviour on their social and environmental ambiances \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">41.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ineffective development of the role m/b change in perceptions of the role, conflict with the system r/to inappropriate socialisation of the role, neurological defects \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Acceptance of their state of health<br>Adaptation of physical disability<br>Social interaction skills \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Recognises the reality of their health situation (130008) scale m<br>Change life style to fit in with disability (130804) scale m<br>Relationships with others (150212) scale m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Increase support systems<br>Promote family normalisation<br>Improve confrontation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Support and family respite programme ALCE<br>Encourage family to continue habits, rituals, and normal routines<br>Promote relationships with people who have common interests and objectives \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">30.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tendency to adopt risk behaviour for health m/b minimising change in state of health r/t negative attitude towards health changes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Acceptance: state of health \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Adapts to change in health situation d (130017) scale m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Modification of behaviour<br>Advisory service<br>Risk identification<br> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Encourage patient to examine their own behaviour<br>Provide objective information as necessary and appropriate<br>Identify biological, environmental, and behavioural risks as well as their interactions \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1609737.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">NANDA-NOC-NIC in patients in the Epilepsy Unit.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tratado de epilepsia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. 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Available from: <a href="http://www.nnnconsult.com/">www.nnnconsult.com</a> [accessed July 2014]" ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack321440" "titulo" => "Acknowledgements" "texto" => "<p id="par0160" class="elsevierStylePara elsevierViewall">Our thanks to Vicente Macián and Mila Fernández, from the nursing teaching area of the Hospital Universitario y Politécnico La Fe de Valencia.</p> <p id="par0165" class="elsevierStylePara elsevierViewall">And to the Epilepsy Association of the Community of Valencia (ALCE).</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/2530299X/000000460000000C/v1_201712030713/S2530299X17300018/v1_201712030713/en/main.assets" "Apartado" => array:4 [ "identificador" => "66732" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/2530299X/000000460000000C/v1_201712030713/S2530299X17300018/v1_201712030713/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2530299X17300018?idApp=UINPBA00004N" ]
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| 2020 November | 0 | 47 | 47 |
| 2020 October | 0 | 22 | 22 |
| 2020 September | 0 | 25 | 25 |
| 2020 August | 0 | 13 | 13 |
| 2020 July | 0 | 8 | 8 |
| 2020 June | 0 | 12 | 12 |
| 2020 May | 0 | 24 | 24 |
| 2020 April | 0 | 13 | 13 |
| 2020 March | 488 | 29 | 517 |
| 2020 February | 793 | 35 | 828 |
| 2020 January | 540 | 31 | 571 |
| 2019 December | 535 | 32 | 567 |
| 2019 November | 956 | 31 | 987 |
| 2019 October | 946 | 26 | 972 |
| 2019 September | 1063 | 36 | 1099 |
| 2019 August | 649 | 17 | 666 |
| 2019 July | 994 | 32 | 1026 |
| 2019 June | 788 | 51 | 839 |
| 2019 May | 888 | 42 | 930 |
| 2019 April | 1094 | 44 | 1138 |
| 2019 March | 789 | 7 | 796 |
| 2019 February | 468 | 6 | 474 |
| 2019 January | 179 | 7 | 186 |
| 2018 December | 66 | 1 | 67 |
| 2018 November | 76 | 5 | 81 |
| 2018 October | 48 | 7 | 55 |
| 2018 September | 19 | 3 | 22 |
| 2018 August | 16 | 0 | 16 |
| 2018 July | 9 | 3 | 12 |
| 2018 June | 14 | 22 | 36 |
| 2018 May | 22 | 6 | 28 |
| 2018 April | 27 | 5 | 32 |
| 2018 March | 21 | 3 | 24 |
| 2018 February | 31 | 7 | 38 |
| 2018 January | 28 | 3 | 31 |
| 2017 December | 12 | 5 | 17 |
| 2017 November | 10 | 8 | 18 |
| 2017 October | 9 | 4 | 13 |
| 2017 September | 3 | 2 | 5 |
| 2017 August | 2 | 4 | 6 |
| 2017 July | 0 | 0 | 0 |
Show all