In This Issue

Transcription

In This Issue

Volume 29, Issue 1, 2007
In This Issue:
The relationship between body image and depression in
women diagnosed with relapsing remitting multiple sclerosis .........................................................8
Shampoo after craniotomy: A pilot study ...........................................................................................14
Quality of life in epilepsy ........................................................................................................................20
Synapses in the city: Making the connections
First call for abstracts: CANN Scientific Sessions, June 17–20, 2008 ...........................................26
Des synapses urbains… se formeron des liens
Premier appel de résumés — Sessions scientifiques de l’ACIISN du 17 au 20 juin, 2008 ............28
Board of directors, committee chairpersons and associated
organization representatives — Conseil d’administration, responsables
des comités et représentants des groupes associés 2007–2008
Executive
President/Présidente: Debra Beveridge
Vice-President and Secretary/
Vice-président et secretaire:
Janice Nesbitt
Past-President/Présdente sortante:
Wilma Koopman
Treasurer/Trésorière: Lucy Wardell
Councillors
British Columbia: Cindy Hartley
Alberta South: Sonia Rothenmund
Alberta North: Pauline Snow
Saskatchewan: Karen Waterhouse
Manitoba: Wendy McDiarmid
Ontario West: Maureen McKenzie
Ontario Central: Trish Haycock
Ontario East: Aline Mayer
Québec: Cindy McCartney
(co-councillor)
Sandra Berube (co-councillor)
New Brunswick/PEI: Shelley Paul
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Nova Scotia: Mark Bonin
Newfoundland and Labrador:
Nancy King
Portfolios
Legislation and Bylaws/Conseillère
des politiques: Wilma Koopman
Archivist: Geraldine Fitzgerald
Membership/Abonnement:
Jeanne Evans
Professional Practice/Practique
professionnelle: Deb Holtom
Research/Recherche: Andrea Fisher
Translation/Traduction:
Suzanne Mandino
Program Liaison: Rosa Sourial
Scientific Liaison/Scientifique:
Sharron Runions
Committees
Program Chair - Victoria 2008:
Cindy Hartley
Scientific Chair - Victoria 2008:
Trudy Robertson
Communications and
Marketing (Web): Sharron Runions
Communications and Marketing
(Subscriptions): Lynn Pratt
Editor – Canadian Journal
of Neuroscience Nursing/
Rédactrice en chef – Le Journal
Canadien des Infirmiers et Infirmières
en Sciences Neurologiques:
Sonia Poochikian-Sarkissian
Representatives
WFNN Representative:
Wilma Koopman
Think First: Jodi Dusik-Sharpe
Canadian Association of Brain Tumor
Coalition (CABTO): Yasmin Khalili
National Stroke Leadership Group:
Rosa Sourial
Canadian Council on Donation
and Transplantation (CCDT): Vacant
Canadian Nerve and Brain Coalition:
Darlene Schindel
Volume 29, Issue 1, 2007 • Canadian Journal of Neuroscience Nursing
Canadian Journal of Neuroscience Nursing
Le journal canadien des infirmiers et infirmières en sciences neurologiques
Volume 29, Issue 1, 2007
Editor/Rédactrice en chef
Sonia Poochikian-Sarkissian, University Health Network,
399 Bathurst St., MP 5-311, Toronto, ON M5T 2S8;
cjnn@cann.ca
Peer Reviewers/Réviseures
Jennifer Boyd, Toronto, ON;
Andrea Fisher, Ottawa, ON;
Debbie Holtom, Gananoque, ON;
Sandra Ireland, Hamilton, ON;
Lynn Joseph, Nepean, ON;
Wilma Koopman, London, ON;
Joanna Pierazzo, Ancaster, ON;
Mina D. Singh, Toronto, ON;
Nancy Thornton, Calgary, AB
The Canadian Journal of
Neuroscience Nursing is the peerreviewed journal of the Canadian
Association of Neuroscience
Nurses/Association canadienne
des infirmières et infirmiers en
sciences neurologiques. The
journal is published quarterly. We
welcome the submission of original manuscripts in the areas of
practice, research, theory, education, and policy, which are of
interest to the neuroscience nursing community. The views, statements, and opinions expressed in
the articles, editorials, and advertisements are those of the authors
or advertisers. They do not necessarily represent the views and
policies of CANN/ACIISN and
the editors and publishers dis-
• Canada: $50.00 (CAN)
• International [including United States]: $50.00 (US)
• Single Copy: $15.00 (CAN)
Make cheques payable to: Canadian Association of Neuroscience
Nurses/Les chèques doivent être émis à : L’Association canadienne des
infirmières et infirmiers en sciences neurologiques (ACIISN) : c/o
Linda Yetman, 593 Roehampton Avenue, Toronto, ON M4P 1S7.
Yearly subscriptions are included with a membership in
CANN/ACIISN ($75 Member, $65 Associate) or they may be
purchased separately. L’abonnement annuel à le Journal canadien des
infirmiers et infirmières en sciences neurologiques est inclus dans les
frais d’inscription à l’ACIISN (75,00 $ pour les membres actifs et
65,00 $ pour les membres associés).
Canadian Journal of
Neuroscience Nursing
For subscriptions, contact/Pour inscriptions :
Lynn Pratt, 6357 Lumberman Way, Ottawa, ON K1C 1V6;
canninfo@cann.ca
claim any responsibility or
assumption of liability for these
materials. The Canadian Journal
of Neuroscience Nursing is
indexed in the Cumulative Index
to Nursing and Allied Health
Literature, International Nursing
Index (INI) and Nursing Citation
Index ISSN # 1913-7176.
Mission statement
The Canadian Association of
Neuroscience Nurses (CANN)
sets standards of practice and
promotes continuing professional education and research.
Members collaborate with individuals, families, interdisciplinary teams and communities to
prevent illness and to improve
health outcomes for people
with, or at risk for, neurological
disorders.
Copyright
No part of this publication can be reproduced, stored in a retrieval
system or transmitted, in any form or by any means, without the
prior written consent of the publisher or a licence from the
Canadian Copyright Licensing Agency (Access Copyright). For an
Access Copyright licence, visit www.accesscopyright.ca or call
toll-free to 1-800-893-5777.
The Canadian Association of Neuroscience Nurses gratefully
acknowledges the funding provided to the Canadian Journal of
Neuroscience Nursing by the Social Sciences and Humanities
Research Council under the Aid to Transfer Journals program,
to support the operation and expansion of the journal,
2005–2008
Le journal canadien
des infirmiers et
infirmières en sciences
neurologiques
Le journal canadien des infirmiers et infirmières en sciences
neurologiques est le journal de
L’Association canadienne des
infirmières et infirmiers en sciences neurologiques. Cette publication est revisée par ses propres membres. Le journal est
publié quatre fois par année.
Nous acceptons les manuscrits
originaux se rapportant à la pratique du nursing, de la recherche,
de la théorie, de l’éducation, et de
l’éthique professionnelle, tous
des sujets qui suscitent l’intérêt
de l’ensemble du personnel en
neurosciences.
Les opinions, les points de vue, et
les énoncés exprimés dans les articles, éditoriaux et affiches publicitaires sont ceux des auteurs et
commerçants. Ils ne reflètent pas
nécessairement les idées et les
politiques de l’ACIISN. L’éditeur
et la maison d’édition n’acceptent
aucune responsabilité reliée au
contenu du matériel publié dans
le journal. Le journal canadien
des infirmiers et infirmièrs en
sciences neurologiques est rattachée au Cumulative Index to
Nursing and Allied Health
Literature, International Nursing
Index (INI) and Nursing Citation
Index ISSN # 1913-7176.
Énoncé de mission
L’Association canadienne des
infirmiers et infirmières en sciences neurologiques (ACIISN)
établit les standards de pratique
de la profession et fait la promotion de l’éducation permanente
et de la recherche. Les membres
collaborent avec les individus, les
familles, les équipes multidisciplinaires et la communauté en
général dans le but de prévenir
les maladies neurologiques et
d’améliorer la santé des gens qui
en sont atteints ou qui sont à
risque d’en souffrir.
CANN 2007 Conference:
Continue achieving milestones
Changing AXON to Canadian Journal
of Neuroscience Nursing
Recently, at the June 2007 CANN Conference in
Edmonton, our Canadian neuroscience nursing colleagues
shared their knowledge and experiences through various oral
and poster presentations, met old friends and established new
friendships.
The conference enabled us to listen to or view well-prepared
and quality presentations, which, I’m sure, gave us all a sense
of extreme pride in achieving such professional milestones in
the field of neuroscience nursing. I would encourage each and
every one of our colleagues to transform their presentations
in a written format as a manuscript and consider publishing in
our journal!
It was also at the CANN 38th Annual General Meeting on
June 21, 2007, in Edmonton, Alberta, that the CANN members unanimously approved a motion to change the name of
our journal from AXON to Canadian Journal of
Neuroscience Nursing. (Please see enclosed the minutes on
the general meeting on page 6.)
Neuroscience nurses improve quality of patient care through
the investigation of nursing practice issues. It is through our
collective efforts, our knowledge and research utilization that
we can promote nursing science that improves patient outcomes and leads to safer and better quality of life for neuroscience patients.
Sonia Poochikian-Sarkissian, PhD, APN, CNN(C)
Canadian Journal of Neuroscience Nursing, Editor
President’s Address 2007
Dear neuroscience colleagues and friends:
I welcome you to the 38th Annual Meeting and Scientific
Sessions of the Canadian Association of Neuroscience
Nurses, “From Neurons to Nursing: Pathways to Tomorrow.”
The Edmonton planning committee, under the leadership of
Kim Worton, Dorothy Burridge and Sue Young, has been active
with these preparations for a long time. Sometimes it seems like
yesterday when we left Montreal, anticipating this reunion.
At the Montreal meeting, I accepted the role of president of
CANN. I will easily admit my goals for this time period were
often interrupted by the immediate concerns that affected the
ongoing momentum of the association.
There have been challenges in publishing journal articles in
AXON, which resulted in delays and a decreased number of
issues for 2006/2007. Diane Duff has resigned as editor following seven years of hard work. She initiated and progressed with many projects including, SCHERC grant funding, first author award, and workshops for writing for publication and research at each scientific meeting. We would like
to thank her and we will be presenting her with a plaque in
recognition of her many volunteer hours on behalf of CANN.
We would like to welcome Sonia Sarkissian from UHN
Toronto who has accepted the role as AXON editor. Sonia
will be presenting proposal and writing workshops at this
conference and I encourage you to attend. Sonia, along with
her editorial team, is available to assist, mentor and perfect
your writing skills. Everyone who is presenting this week has
information waiting to be published. I challenge you to make
2007/2008 your year to publish for the first time. Two issues
of AXON are coming out within the next few weeks including a themed stroke issue. The board of directors of CANN
challenges other specialty groups to rise to the occasion and
produce papers leading to another themed edition of
AXON. We would like to thank Sonia for leaping in and
mastering the production of two AXON issues in a very
short time.
Our medical colleagues at the Canadian Congress of
Neurosciences (CCNS) have also undergone many changes
this year, principally a name change to Canadian Neurological
Sciences Federation (CNSF). We continue to work closely
with CNSF and are participating in the welcoming reception
of the CNSF and electronic posters presentations, as well as
the president’s banquet. In return, we continue to invite their
The Canadian Journal of Neuroscience Nursing is published by Pappin Communications /
La Journal canadienne est publié par Pappin Communications
The Victoria Centre, 84 Isabella Street, Pembroke, Ontario K8A 5S5, e-mail: info@pappin.com
Managing Editor: Bruce Pappin; Layout and Design: Sherri Keller
Advertising space is available/Disponibilité d’espaces pour messages publicitaires
For information, contact Heather Coughlin, Advertising Manager, Pappin Communications,
The Victoria Centre, 84 Isabella Street, Pembroke, Ontario, K8A 5S5; telephone: 613-735-0952; fax: 613-735-7983
E-mail: heather@pappin.com or visit our website at www.pappin.com
4
participation in the run for research, as well as our conference
activities. I am not sure if they were invited to join us at the
casino night, but I am sure they would like to.
The board of directors has planned new initiatives for the year
2007/2008. These are outlined below:
1. To explore electronic journaling
2. Offer electronic conference registration for 2008 conference
3. Restructure the CANN website
4. Establish a working group to revise standards of practice
5. Inaugurate a Canadian National Neuroscience Nurses Day.
Further details regarding these initiatives will be presented at
the annual general meeting Thursday morning. I encourage
you to attend and hear what the board of directors has been
doing for CANN.
The WFNN Congress 2009 will be held in Toronto at York
University with a congress bureau and contract signage completed recently. The first announcement is now available and a
WFNN Congress website will be in operation in January 2008.
I look forward to working with all of you and especially the
Toronto chapter in showcasing Canada and CANN to international neuroscience nurses.
Linkages with our American Association of Neuroscience
Nurses continue. The AANN President, Sue Fowler, is with us
today at this conference and we welcome her. Sue has also kindly offered to assist with the WFNN Congress. This WFNN
Congress will be an anniversary event (40 years) and Sue will
focus her attention on the celebration of this historical milestone.
Across Canada, councillors have been active in promoting
excellence in neuroscience nursing care, research and education. Certification, educational events and member recruitment have been particular areas of focus.
We are pleased to announce that we have recipients for the Dr.
Marlene Reimer Research Award and the Jessie Young Bursary,
as well as the Codman and Brain Tumor Foundation Awards.
However, we have not been able to award the Lynn Baldwin
Scholarship nor the Provincial Education Fund this year and
are appealing for applications.
The conference planning committee has organized a comprehensive conference with presentations highlighting clinical
neuroscience expertise. However, no trip to Edmonton is complete without a taste of local entertainment and provincial taxfree shopping. I know a few of you would love to spot Prince
Harry at the local cowboy’s bar.
I therefore insist you join us in the Walk/Run for research
Thursday morning, to help reach an elusive goal. This goal
may be personal or for CANN. On the other hand, a guilt-free
sleep is only achieved by sponsoring a colleague.
In conclusion, I would like to acknowledge Mark Bonin, councillor for Nova Scotia, to proceed with the inauguration of
Canadian National Neuroscience Day today, June 20, 2007.
Respectfully submitted,
Wilma Koopman, RN, MScN, ACNP, CNN(C)
President CANN
London, ON
Message de la Présidente
Chers collègues en neuroscience et amis
Je vous souhaite la bienvenue au 38e congrès annuel et sessions scientifiques de l’Association canadienne des infirmiers
et infirmières en neuroscience « From Neurons to Nursing :
Pathways to Tomorrow ».
Sous la direction de Kim Worton, Dorthy Burridge et Sue
Wong, le comité de plannification d’Edmonton s’est mis au
travail depuis un certain temps déjà. Il nous semble qu’il n’y a
pas si longtemps, nous étions à Montréal tout en projetant
cette future réunion avec anticipation.
Au cours de la conférence à Montréal, j’ai accepté le titre de
présidente de l’ACIISN. Je dois admettre que mes objectifs du
moment ont été transformés par les préoccupations actuelles
de l’association.
Nous avons encourue de grandes difficultés à publier des articles dans l’Axone, ce qui a causé beaucoup de délais et une
diminution du nombre de publications pour l’année
2006/2007. Diane Duff a laissé son poste de rédactrice en chef
après sept ans de travail ardu. Elle a mis sur pieds et développer plusieurs projets dont : « SCHERC » une fondation
pour demande de subvention, le prix d’auteur principal et
enfin, au cours des réunions scientifiques, elle donné des ateliers d’enseignement sur la publication d’articles et la
recherche. Nous aimerions la remercier et nous allons lui
remettre une plaque souvenir, au nom de l’ACIISN, en reconnaissance de ses nombreuses heures de travail.
Nous aimerions souhaiter la bienvenue à Sonia Sarkissian de
l’UNH de Toronto qui a accepté le rôle de rédactrice en chef de
l’Axone. Sonia dirigera un atelier sur la présentation de projets
et sur la composition d’articles pour publication au cours de la
conférence, je vous encourage à y participer. Sonia, ainsi que
son équipe d’éditorial, seront disponible pour vous guider vers
le développement de vos qualités d’écrivain. Chacun de ceux et
celles qui présentent cette semaine ont du matériel éducatif que
l’on pourrait publier. Je vous encourage à vous surpasser en
2007/2008 en publiant un article pour la première fois. Deux
éditions de l’Axone seront disponibles dans les prochaines
semaines dont l’une sera dédiée aux Accidents vasculaires
cérébraux. Le conseil administratif de l’ACIISN incite les autres
spécialités en neuroscience à se distinguer en produisant une
autre publication axée sur leur domaine. Nous aimerions
remercier Sonia pour sa bravoure et son succès à produire deux
exemplaires de l’Axone dans une très courte période de temps.
Nos collègues professionnels, les médecins du Congrès canadien des sciences neurologiques, ont aussi été touchés par
plusieurs changements dans leur organisation cette année
dont le changement de leur nom qui sera maintenant : La
Fédération des sciences neurologiques du Canada. (FSNC).
Canadian Journal of Neuroscience Nursing • Volume 29, Issue 1, 2007
5
Nous continuons à travailler de près avec la FSNC en participant à la réception d’accueil de la Fédération et au banquet des
présidents en plus de notre contribution à la présentation
d’affiches électroniques.
ment offert de nous aider avec le congrès de la « LA WFNN ».
Ce congrès sera un événement anniversaire soulignant les 40
ans d’existence de l’association. Sue concentrera son attention
sur la célébration de cette étape historique importante.
En retour ils sont toujours invités à participer à la course pour
la levée de fonds en recherche et ils peuvent se joindre à nous
pour toute autre activité durant la conférence. Je ne sais pas
s’ils ont été invités à la soirée de casino mais je suis certaine
qu’ils aimeraient bien l’être.
A travers le Canada, les conseillers se sont afférés à promouvoir l’excellence des soins, de la recherche et de l’éducation en
neuroscience. On a travaillé plus particulièrement sur
l’examen de certification, les événements éducatifs et le
recrutement de nouveaux membres.
Le Conseil administratif a planifié de nouvelles initiatives pour
l’année 2007/2008. Elles sont décrites ci-dessous :
• Explorer la possibilité d’un journal électronique
• Offrir la possibilité de s’enregistrer de façon électronique
pour la conférence 2008
• Restructurer le site Web de l’ACIISN
• Établir un groupe qui aura pour but de réviser les standards
de pratique
• Créer une journée nationale intitulée : Journée nationale des
infirmiers et infirmières en neuroscience.
Il nous fait grandement plaisir d’annoncer que nous avons des
récipients pour le prix en recherche Dr Marlene Reimer, pour
la bourse Jesse Young, de même que pour les prix de la fondation Codman et de la fondation des tumeurs cérébrales.
Lors de l’assemblé annuelle jeudi matin, plus de détails concernant ces initiatives seront présentés. Je vous encourage à y participer et à prendre connaissance des travaux accomplis par le
Conseil d’administration de l’ACIISN. Le congrès de la
« WFNN » (Fédération mondiale des infirmiers et infirmières
en science neurologique), de 2009 sera tenu à Toronto, à
l’Université York. Le bureau du congrès et l’affichage des contrats ont été mis sur pieds récemment. L’annonce officielle est
maintenant disponible et le site Web sera opérationnel en janvier 2008. J’anticipe grandement de travailler avec vous et, spécialement avec le groupe de Toronto, sur la promotion du
Canada et de l’ACIISN aux yeux des infirmières en neuroscience au niveau international.
Nos liens avec « l’AAN », (Association américaine des infirmières en neuroscience) se maintiennent. La présidente de
« L’AAN », Sue Fowler, est présente parmi nous, ici à la conférence et nous lui souhaitons la bienvenue. Sue a aussi genti-
Toutefois, nous n’avons pu attribuer la Bourse d’étude Lynn
Baldwin ni le Fond d’éducation provincial cette année mais
nous continuons à faire appel aux applications.
Le comité de planification a organisé une conférence de grande
ampleur mettant en évidence l’expertise en neuroscience.
Toutefois, un voyage à Edmonton doit inclure une participation aux divertissements locaux et au magasinage sans taxe
provinciale. Bien sûr, je comprends que certaines de vous
aimeraient bien rencontrer Prince Harry dans un bar local.
Donc je vous encourage fortement à participer à la marche ou
à la course pour la recherche, jeudi matin, afin de nous aider à
atteindre notre but ambitieux. Ce but peut être personnel ou
pour l’AIISN. De plus, pour éviter les remords durant le sommeil, il suffit de commanditer un ou une collègue.
Pour conclure, j’aimerais demander à Mark Bonin, conseiller
de la Nouvelle Écosse, de procéder à l’inauguration de la
Journée nationale des infirmiers et infirmières en neuroscience
aujourd’hui, le 20 juin 2007.
Respectueusement,
Wilma Koopman, RN, MScN, ACNP, CNN(C)
Présidente de l’ACIISN
London, Ontario
Annual General Meeting of CANN
Thursday, June 21, 2007 – Edmonton, Alberta
0900 – Meeting called to order
Executive present: Wilma Koopman, President; Patti
Gallagher, Past-president; Debbie Beveridge, Vice-president/Secretary; Lucy Wardell, Treasurer
Number present: 91 members (35%). A quorum is achieved.
1. Welcoming remarks given by Wilma Koopman.
2. Changes to agenda
• 5, 6, 8.1, deleted as already discussed in presidential
address.
• 8.2 deferred to mid-year.
Additions to agenda requested from the floor.
• 7. Update on CBNHC – Darlene Schindel
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• 8.3 Membership – Nancy Thornton
• 8.4 AXON name change – Sandra Ireland
Motion to accept agenda with the changes –
Maureen McKenzie
Seconded by Nancy Thornton.
No discussion.
3. Motion to accept the minutes of 2006 AGM made by Aileen
Mayer.
Seconded by Jill Kamensek.
No discussion.
Unanimous approval.
4.1 Legislation and Bylaws – Patti reviewed the information
printed in Winter issue of AXON regarding the addition of
chapters with councillor status.
Resolution 1. Be it resolved that Alberta has two chapters
with councilor representation on the board of directors. These
chapters shall be named Alberta South and Alberta North.
Discussion.
Motion for acceptance Lynn Pratt.
Unanimously approved.
Resolution 2. Be it resolved that the criteria for requests for
chapter status with councillor representation be accepted
within the legislations and bylaws.
Discussion.
Motion for acceptance Suzanne Baziuk.
Resolution 3. Be it resolved that the criteria for maintaining
chapter status with councillor representation in provinces
holding more than one councillor be accepted within the legislation and bylaws of CANN.
No discussion.
Motion for acceptance Nancy Thornton.
Seconded by Maureen McKenzie.
Amendment to motion proposed by Sandra: I move that the
title of AXON be changed to the Canadian Journal of
Neuroscience Nursing.
Moved by Sonia Sarkissian.
Seconded by Sandra Ireland.
Further discussion re. fundraising by asking other companies
to sponsor an award for a scientific paper led by Sandra
Ireland. Same agreed to work with Deb Holtom to develop
criteria, explore options and report back to the executive for
discussion at mid-year.
9. Patti presented the Slate of Officers for 2007-2008:
Executive
President: Debra Beveridge
Past-President: Wilma Koopman
Vice-President/Secretary: Janice Nesbitt
Treasurer: Lucy Wardell
Councillors
British Columbia: Cindy Hartley
7. Reports – Lucy presented the proposed budget for 20072008. Some highlights: last year’s budget, revenues were better than predicted. Profit for the year $57,805 mainly due to
the Montreal meeting.
Alberta North: Pauline Snow
In the 2007-2008 budget there is a predicted net loss of
$17,638. This is due to expenditure on worthwhile projects,
e.g., Standards of Practice that are being done this year.
Discussion.
Motion to accept the budget 2007-2008 Bev Irwin.
Seconded by Marlene Blackman. Unanimous approval.
Manitoba: Wendy McDiarmid
Darlene updated membership on the activities of the
CBNHC, specifically regarding a news release scheduled for
June 22, 2007. Stressed the importance of the participation of
CANN to this group. See website for report.
8. New business – Wilma acknowledged Sonia Sarkissian as
our new editor for AXON.
8.3 Nancy Thornton proposed that a new category for retirees
be considered for membership with voting privileges.
Associate members are not eligible to vote.
Discussion.
Decision to table the request for mid-year.
8.4 Sandra Ireland proposed a name change for AXON.
Discussion ensued.
Motion: I move that the membership approve the change in
title of AXON to the Canadian Journal of Neuroscience
Nurses, contingent on its consistency with CANN legislation
and bylaws.
Discussion. No conflict could be found by Wilma or Patti in
Legislation and Bylaws.
Moved by Sandra Ireland.
Seconded by Breeda O’Farrell.
Unanimous approval.
Motion carried.
Alberta South: Sonia Rothenmund
Saskatchewan: Karen Waterhouse
Ontario East: Aline Mayer
Ontario South: Maureen McKenzie
Ontario Central: Trish Haycock
Quebec: Sandra Berube/Cindy McCartney
New Brunswick: Shelly Paul
Nova Scotia: Mark Bonin
Newfoundland/Labrador: Nancy Walsh
Committee Chairpersons/
Portfolios/Meeting adjourned
See page 2 (contact list for BOD and committees, CANN
2007-2008).
Wilma Koopman made closing remarks and then the “gavel”
was turned over to Debbie Beveridge (President CANN
2007-2008).
AGM adjourned at 1040 a.m.
Motion Mark Bonin. Seconded Jodi Dusik-Sharpe.
Respectfully submitted,
Debbie Beveridge
July 2007
7
The relationship between
body image and depression
in women diagnosed with relapsing
remitting multiple sclerosis
By Shauna Kindrat
Abstract
Little is known about perceptions of body image in women
diagnosed with relapsing remitting multiple sclerosis (RRMS).
This descriptive correlational study was conducted to describe
how women perceive their body image while living with RRMS,
and to examine a potential relationship between body image
and depression in women who have RRMS.
A convenience sample of 30 women from a western Canadian
multiple sclerosis (MS) clinic completed a demographic questionnaire, the Body-Image Ideals Questionnaire (BIQ), and the
Beck Depression Inventory Short Form (BDI-SF).
Body image and depression scores were highly correlated (r =
0.814, p = 0.01) indicating that a more positive body image was
associated with less depression.
The findings of this study suggest that there are important psychological aspects to which clinicians might need to attend
when working with women who have RRMS. However, further
research needs to be done in this area.
Introduction
Multiple sclerosis (MS) is a relentless and insidious disease of
the central nervous system that strikes twice as many women
as men (Costello, Halper & Harris, 2003). Although MS has
been known to medicine for more than a century, there is no
definitive cause or cure for this disease (Costello et al.). It suddenly attacks healthy bodies, leaving a range of disabilities up
to and including paralysis. In one particular type of MS
(relapsing remitting multiple sclerosis [RRMS]), the afflicted
person’s function may return to normal or near normal after
an attack but, then, the inevitable next attack occurs and
erodes the nervous system a little more. These attacking
episodes strike repeatedly with little warning and on no predictable timetable, so that an RRMS diagnosis translates into
a tumultuous lifestyle of uncertainty.
Health care professionals, particularly the nurses who work
closely with MS patients, the majority of whom are women,
try to offer compassion and encouragement. Nurses play a
vital role by assisting the patient in reassessing her strengths
and weaknesses, prioritizing activities and identifying
resources within the home and community. An improved
understanding of the MS life experience and concerns of
women living with MS should positively impact their mental
8
outlooks and response to treatment. Nurses should be able to
educate the women about what body image changes to
expect, along with signs and symptoms of potential problems.
During our lives, our bodies go through many changes, some
of which are desired, others not. However, there have been
few studies on the experiences of those with body image
changes secondary to MS. In most cases, the focus of research
has been on the illness that is associated with body image
changes (Hinds, 2002; Newell, 2000). It is for this reason that
the women’s perception of body image, rather than their illness, RRMS, is the focus of this research.
Le rapport entre l’image de soi et la
dépression chez les femmes atteintes
d’une récidive de la sclérose en plaques
Résumé
Nous en savons très peu sur la perception de l’image de soi
chez les femmes diagnostiquées avec une récidive de la
sclérose en plaques à la suite d’une phase de rémission
« Relapsing Remitting Multiple Sclerosis » (RRMS). Cette
étude comparative descriptive avait pour but de définir
comment les femmes se perçoivent au moment de cette
rechute (RRMS) et d’examiner le rapport qui existe entre
l’image de soi et la dépression dont elles souffrent durant
cette période.
Un groupe de trente (30) femmes d’une clinique « Western
Canadian Multiple Sclerosis Clinic » a complété un questionnaire démographique, un questionnaire sur l’image de
soi appelé : « Body Image Ideals Questionnaire » (BIQ)
ainsi que le formulaire “The Beck Depression Inventory
Short Form” (BDI-SF).
Nous avons observé une corrélation très élevée (r = 0.814,
p = 0.01) qui indique qu’une meilleure image de soi correspond avec un degré inférieur de dépression.
Les résultats de cette étude démontrent qu’il est important
pour les médecins traitants de porter attention à l’aspect
psychologique durant le traitement des patientes qui sont
atteintes d’une récidive de la sclérose en plaques qui était
précédemment en phase de rémission (RRMS). Toutefois, il
est nécessaire de poursuivre la recherche dans ce domaine.
Women, MS, depression,
and body image
Western middle-class society places a high value on women
having an occupation, being productive at a job, and achieving success in the labour force. Also highly valued are social
interactions, physical and emotional independence, physical
attractiveness and youth, as well as intact marriages, a cohesive family, children and active sexual lives (DiBattista, 2002;
Simons, 1984). However, all of these can be compromised for
a woman with MS.
Depression (as a mood state) is commonly associated with
body image changes while having MS. Yet, there has been no
investigation of depression and body image in women who
have MS.
Women have been found to be more cognitively and behaviourally invested in their appearance than men (Cash &
Brown, 1989; Cash & Pruzinsky, 1990; Jackson, 1992;
Thompson, 1996). More women than men are likely to suffer
from depression and lower self-esteem associated with body
image dissatisfaction (Furnham & Greaves, 1994). Women
may, therefore, be especially sensitive to body image changes
associated with having MS because of the multiple physiological and physical changes that can occur. By acquiring a better
understanding of the relationship between depression and
perceived body image in women with MS, health care professionals (including primary nurses) can explore body image
and depression with women who have RRMS.
Purpose and research questions
The primary purpose of this study was to examine the relationship between body image and depression in women diagnosed with RRMS. The research questions were: 1) How do
women perceive their body image while living with RRMS,
and 2) What is the relationship between body image and
depression in women diagnosed with RRMS?
There is a city located in central Alberta, Canada, which is
considered a high-risk area for MS. This city and surrounding
regions have a high enough MS rate in the population to justify a dedicated MS clinic. This clinic serves 150 clients, and
100 of these clients are women.
Literature review
Multiple sclerosis (MS)
Canada has one of the highest rates of MS in the world, with
50,000 people affected (Multiple Sclerosis Society of Canada,
2004). For reasons yet unknown, MS affects 20- to 40-year-old
Caucasians more than any other racial group (Costello et al.,
2003; Cotran, Kumar, & Collins, 1999; Halper & Holland,
2002, Hickey, 2003; Minden, 1992). The etiology of MS is
unknown, but it is commonly believed that a combination of
environmental and genetic factors play a role (Costello et al.;
Cotran et al.; Hickey; Paty & Ebers, 1998).
Relapsing remitting multiple sclerosis (RRMS)
RRMS is the most frequently diagnosed form of MS with 70%
to 80% of all cases falling under this type (Costello et al., 2003;
Halper, 2001; Hickey, 2003; Paty & Ebers, 1998). An average
relapse occurs about one to two times per year with symptoms lasting days to weeks. RRMS is characterized by clearly
defined, acute attacks with either full recovery or with residual deficit upon recovery. During remission, MS may be inactive for months or years, symptoms are stable, and there is no
disease progression (Costello et al.).
Disease-modifying therapies
Although there are no known curative or preventative
agents, there are now disease-modifying therapies (DMT)
available for people with RRMS (Costello et al., 2003;
Goodin, Frohman, Garmany, Halper, Likosky, Lublin, et al.,
2002; Metz, 2002). Self-injected DMT drugs modify the
course of the disease process by reducing the frequency and
severity of relapses. These agents (Avonex [interferon beta1a], Rebif [interferon beta-1a], Betaseron [interferon beta1b], and Copaxone [glatiramer acetate]) slow disease progression by preventing or postponing long-term physical
disability (Canadian Pharmacists Association, 2004; Goodin
et al.; Metz). However, some of the DMTs can cause injection site reactions on the skin such as redness, swelling,
bruising and lipoatrophy that may further influence body
image.
Body image: Definition and gender
Body image is not a static concept, making it difficult to measure. However, there is utility in the attempt to measure it as
one way of better understanding how body image is affected
by RRMS. It would provide the “inside” viewpoint about the
body image of a woman with MS.
The definition of body image proposed by Cash and
Pruzinsky (1990) was used in this study. It is defined as
one’s perceptions, attitudes and importance in relation to
one’s own physical characteristics (Cash & Brown, 1989;
Cash & Fleming, 2002; Cash & Pruzinsky; Cash &
Szymanski, 1995; Muth & Cash, 1997). It is how a woman
sees herself, what she believes about her physical appearance, how she feels about her body, how she feels in her
body and how she believes others perceive her. It is, therefore, a subjective experience in relation to perceived ideals
and how important these ideals are. It refers to how comfortable she is with her emotions and physical sensations of
her body (DiBattista, 2002). Body image in this study was
operationally defined as the score on the Body-Image Ideals
Questionnaire (BIQ).
Most of the research in body image neglects the investment
(i.e., importance) of body image attitudes (Cash &
Pruzinsky, 1990). Researchers assess subjects’ satisfaction
and dissatisfaction with certain physical attributes, yet fail to
assess the psychological importance of these evaluations.
Thus, according to Cash and Pruzinsky, investment should
function as a variable that influences the evaluation of body
image.
Cash and Pruzinsky (1990) argue that when compared to
men, women are more dissatisfied with their bodies, place
more importance on physical appearance and are more critical of their appearances.
9
Body image: Self-discrepancy theory
One theoretical perspective useful in the study of body image
is Higgins’ Self-Discrepancy Theory (Higgins, 1987), which
relates discrepancies between self-states and emotions. The
three domains of self (actual, ideal, ought), and the view of the
self (own, other) illustrate each type of state (Higgins). The
actual self represents the attributes that she or someone else
believes she actually possesses. The ideal self corresponds to
the qualities that she or someone else would like her to possess (hopes or wishes for herself ). Finally, the ought self covers the features someone, including the patient, believes she
should possess (Higgins).
Discrepancy leads to unhappiness with body image, and a
poor body image becomes a private agony (Cash, Winstead, &
Janda, 1986). Differentiating between what others believe a
person should be and that person’s own belief about what they
would “ideally” like to be is the key to this theory. Therefore,
the greater the weighted discrepancy scores on the BIQ, the
greater the discrepancy.
Body image, multiple sclerosis and depression
The BIQ adequately addresses the attributes particular to
body image in the general population (facial features, hair texture and thickness, body proportions and height), as well as
attributes specific to MS patients (muscle tone and definition,
physical strength, physical coordination and overall physical
appearance). Also, there are symptoms seen in RRMS in particular that affect body image such as weakness, ataxia, spasticity, tremor, and bowel and bladder dysfunction, which are
highlighted in the BIQ.
Of all the mental state changes associated with MS, depression is the most common (Feinstein, 1999). Approximately
50% to 75% of MS patients experience depression at some
point during their illness (Caine & Schwid, 2002; Halper &
Holland, 2002; Minden, Orav, & Reich, 1987; Remick &
Sadovnick, 1997). Clinical depression lasts at least two weeks
and depressive symptoms must persist for most of the day,
nearly every day, interfering with ordinary functioning
(American Psychiatric Association, 2000).
The nature of MS and the potential for confusing certain complaints of the disease (such as fatigue, sleeplessness and effects
of prescription drugs) with symptoms of depression make it
difficult to differentiate what is being measured. For example,
clinical depression may be accompanied by aches and pains. In
the RRMS patient, these symptoms are usually attributed to a
patient’s chronic physical condition (Patten & Metz, 1997). In
MS patients who show features of depression as well as fatigue,
the question may be raised as to whether fatigue and depression are psychological or physical symptoms, or a combination
of the two (Feinstein, 1999; Remick & Sadovnick, 1997).
Identification of the depressed patient is, therefore, of utmost
importance, for it represents one of the most treatable causes
of morbidity and mortality in MS (Feinstein, 1999).
Methods/overview of research
A descriptive correlational, self-report survey method was
used in this study in order to determine a relationship rather
than infer cause-and-effect between body image and depres10
sion in women diagnosed with RRMS. Women were deemed
eligible for inclusion if they were clinically diagnosed with
RRMS by a neurologist, were clients of the western Canadian
MS clinic, were 18 years old or older, were currently in remission, had the ability to speak and understand the English language, were willing to speak about living with RRMS, had not
had a relapse in the last six weeks, and gave informed voluntary consent. A six-week relapse-free timeframe was chosen,
as this time period would allow time to pass from a subject’s
last exacerbation to hopefully resolve any transient body
image issues. Women were excluded if they had other clinically diagnosed, visible physical or mentally-related disabilities
(as their body image may be already altered), were currently
experiencing a relapse, and were currently pregnant (due to
potential influence of body image).
Recruitment and measures
Recruitment was initiated by the receptionist at the western
Canadian MS clinic since she had access to the patient database. The receptionist phoned those women who met the
inclusion criteria, informed them of this study, and asked
whether they would be willing to be contacted by the investigator.
This primary convenience sample was augmented through
targeted advertising. An advertisement of the study was submitted to the bi-monthly MS Society newsletter, which is distributed to all MS patients within the health region. An information brochure was developed and provided to women with
MS either by a staff nurse, or mailed by the receptionist.
During a brief interview, participants were able to provide
their responses through the following measures:
Body Image Ideals Questionnaire (BIQ)
The primary measure used in this study was the BIQ, which
reveals self-perceived discrepancies of ideal and importance
for multiple physical characteristics (Cash & Szymanski,
1995). Eleven attributes are appraised (1) height, (2) skin complexion, (3) hair texture and thickness, (4) facial features, (5)
muscle tone and definition, (6) body proportions, (7) weight,
(8) chest size, (9) physical strength, (10) physical coordination, and (11) overall physical appearance.
For each of the 11 mentioned attributes, participants rated
their personal ideal (how they wished or preferred to be) and
evaluated how well their body equaled this ideal. The participant chose one of the four options provided for each attribute.
The personal ideal (discrepancy) was rated on an interval
grading scale as 0 (exactly as I am); + 1 (almost as I am); + 2
(fairly unlike me); and + 3 (very unlike me). The more option
threes were selected, the more dissatisfied the subject was.
Participants then indicated the importance they placed on
each ideal graded as 0 (not important); + 1 (somewhat important); + 2 (moderately important); and + 3 (very important)
(Cash & Szymanski, 1995). The more option threes were
selected, the greater was the discrepancy for that attribute.
The Beck Depression Inventory-Short Form (BDI-SF)
One of the most common measures of depression is the
Beck Depression Inventory (BDI). Beck and Beck (1972)
established the BDI-SF as a brief screening test for depression in outpatient settings. The BDI-SF is an instrument that
can be easily applied, easily answered, rapidly scored, accurate and reliable. It provides a subjective index of depression.
It is short and, therefore, less fatiguing for the MS study participants. The BDI-SF also assesses the feelings of the participant over the past week rather than for a single day, making
it a more informative tool. Most importantly, this questionnaire addresses the topic of body image as well as suicide,
which is increased in MS patients (Caine & Schwid, 2002;
Feinstein, 1997; Sadovnick, Remick, Allen, Swartz, Yee,
Eisen, et al., 1996).
The BDI-SF assesses 13 items: (1) mood, (2) pessimism, (3)
sense of failure, (4) dissatisfaction, (5) guilt, (6) self-hate, (7)
suicidal thoughts, (8) social withdrawal, (9) indecisiveness,
(10) body image, (11) work inhibition, (12) fatigue, and (13)
appetite. Each symptom on the BDI-SF was rated on a fourpoint intensity scale arranged in increasing severity from 0 to
3 (Chibnall & Tait, 1994). To compute the total score, the
scores of all questions were summed. Higher scores represented more severe depression.
Results
Demographics
The ages of the 30 participating women ranged from 23 years
to 56 years, with a mean age of 39.5 years (SD = 8.70). The
ages of 28 women who did not participate ranged from 21
years to 55 years, with a mean age of 39.8 years.
Body Image Ideals Questionnaire (BIQ)
The overall mean score of the BIQ for the 30 RRMS women
was 1.54 (SD = 1.57), addressing the first research question.
This low score indicates that the body image of women diagnosed with RRMS in this study is fairly good.
Beck Depression Inventory – Short Form (BDI-SF)
The calculated minimum depression score was zero, and the
maximum was 23. The mean was 6.77 (SD = 6.00), and the
median was six, indicating an overall mild degree of depression.
Relationship
Pearson’s r correlation is a parametric statistic that shows the
strength of a relationship, with “0” indicating no relationship,
and (- 1) or (+ 1) being perfect relationships (Polit & Beck,
2004). To address the relationship between body image and
depression in women diagnosed with RRMS (second research
question), Pearson’s r correlation was used. The BDI-SF
depression score was significantly correlated with the BIQ
total score (r = 0.814; p = 0.01).
Discussion
In this study, BIQ questions 5, 6, 7, 9, 10 and 11 addressed
symptoms common to RRMS. The attributes of muscle tone
and definition, body proportions, weight, physical strength,
physical coordination and overall appearance were highly
valued, as these features are symptom-specific. When the
participants were asked about their muscle tone and definition (BIQ question 5), 57.0% (n = 17) had muscle tone
“almost like” they would like to be, 23.3% (n = 7) of women
claimed that muscle tone and definition were “very important” to them, and 3.3% (n = 1) stated it was “not important”.
For question 9, 36.7% (n = 11) of women found physical
strength “very important” and 50.0% (n = 15) found physical
coordination (question 10) “very important”. These are two
areas, in particular, that are primarily affected by RRMS, so
these results are not surprising.
The last question of the BIQ asks the participant to rate her
overall physical appearance. Forty per cent (n = 12) stated that
it is “very important” to them and only 6.7% (n = 2) noted
their overall appearance as “not important”. The women may
believe that it is salient to live to society’s standards as a middle-aged woman.
Kralik et al. (2003) performed a study on sexual self-identity
for women living with MS. Their results support the idea of a
relationship between societal ideals and body image with
regard to the cultural burden women suffer in maintaining
physical attractiveness while ill. This is relevant to this study
because, perhaps, these women believed it was still important
to look good, despite having a chronic illness.
In an unscientific, but nevertheless informative survey of
readers from Psychology Today magazine, 55% of women
were dissatisfied with their weight, 45% with muscle tone,
32% with upper torso and 38% with overall appearance
(Cash et al., 1986). The areas of the body that presented
most problems were the ones where women tend to store fat
post-puberty: stomach, hips and buttocks. The study conducted by Cash et al. parallels with the results of this study
where 57% (n = 17) of women were dissatisfied with their
weight, 57% (n = 17) with muscle tone and 40% (n = 12) with
overall appearance. These results are strikingly similar with
the exception of muscle tone. This reiterates the fact that the
MS women chose the symptom-specific attribute to be highly important to them.
Depression was quantified by administering the BDI-SF,
which asks respondents to rate their feelings about 13 different depressive mood symptoms. The shortened version of the
Beck depression scale was used, as it was obvious fatigue
played a large role in the lives of women with RRMS. Sixty per
cent (n = 18) of women stated that “it takes an extra effort to
get started at doing something” and 63.3% (n = 19) agreed that
“[I] get tired more easily than I used to”. This is congruent
with the fact that fatigue can be the most disabling symptom
of MS.
Depression literature shows that characteristics of fatigue,
indecisiveness, social withdrawal and body image are interconnected (Minden et al., 1987). This was true for the 30 participants in this study. Remembering that these women have
MS is important, since these depression characteristics are
also attributes of MS. Regardless, it clarifies the important
fact that depression and MS are intertwined.
Strengths and limitations
This study is original in that it represents a first step toward
determining whether or not there is a relationship between
11
perceived body image and depression in women diagnosed
with RRMS. Because this study is preliminary, there is potential for more research to be done in this area.
All 30 female RRMS patients who participated in this study
answered questionnaires that had not yet been tested on
this population. The method of test administration (telephone) was convenient and well-tolerated by the sample
population.
One limitation associated with the BIQ and the BDI-SF is that
these questionnaires forced participants to find answers that
best described their situation at one moment. They do not
render information about changes over time, which is unfortunate, as RRMS is chronic. Also, both questionnaires do not
provide an opportunity for open-ended responses.
The high correlation (r = 0.814) between perceived body
image and depression could be due to the fact that both the
BIQ and BDI-SF do not strictly measure what they are only
intended to measure.
The small sample size prevented the author from investigating the relationship between menopausal status (pre- and
post-menopause) and how women perceive their body
image while living with RRMS. The sample for this study
comprised 27 pre-menopausal women, and only three postmenopausal women. The small numbers of postmenopausal women prevented the investigator from undertaking complete data analyses.
Lastly, the focus of this study was only females with MS,
excluding the male population with the same diagnosis.
Nursing implications
Nursing encompasses counselling, educating and supporting patients at initial diagnosis and periods of exacerbation
throughout the disease (Halper & Holland, 2002). By acquiring a better understanding of the relationship between body
image and depression, nurses can explore the development
of these variables for women with RRMS. The question
could also be posed if nurses should be incorporating some
sort of assessment or screening of body image issues and
depression into their practice. Perhaps just being aware that
these elements exist and being cognizant of them may be
adequate. Thus, the nurse’s role may be to help women with
MS understand that even if their disease cannot be cured, it
can be lived with.
Recommendations
No Canadian or American values for the BIQ and BDI-SF are
available for male and female RRMS populations. Therefore,
there is a need to develop a statistical database across North
America for men and women with RRMS using both these
questionnaires.
Prospective longitudinal studies that follow MS patients
from the point of diagnosis onwards should also be undertaken. Phenomenological studies could explore possible
lived experiences of body image changes that may occur
over time.
Conclusion
The heart of this research project is more complex than just
studying a positive or negative perception of body image in
women with RRMS. This correlational study illuminated
some of the relationships between body image, depression
and age, and suggests areas for further research. An intent of
this study was to begin addressing a gap in the research literature regarding women’s perceived body image and their lives
with RRMS. By acknowledging the broader issues facing
women with RRMS, nurses can assist in smoothing the transition that confronts women living with this chronic illness. It
is hoped that this study’s findings contribute to developing
knowledge about women’s health and body image while living
with RRMS and understanding the health-related changes
associated with this condition.
About the author
Shauna Kindrat, RN, BN, MN, CNN(C), Calgary Stroke
Project Team, Calgary, AB. Correspondence regarding this
article should be addressed to the author by e-mail: shauna.brady@calgaryhealthregion.ca
References
American Psychiatric Association. (2000). Diagnostic and
statistical manual of mental disorders - Text Revision (DSM-IVTR) (4th ed.). Washington, DC: Library of Congress.
Beck, A.T., & Beck, R.W. (1972). Screening depressed
patients in family practice: A rapid technic. Postgraduate
Medicine, 52, 81-85.
Caine, E.D., & Schwid, S.R. (2002). Multiple sclerosis,
depression and the risk of suicide. Neurology, 59(5), 662-663.
Canadian Pharmacists Association. (2004). Compendium of
Pharmaceuticals and Specialties: The Canadian Drug Reference
for Health Professionals. Ottawa, ON: Author.
Cash, T.F., & Brown, T.A. (1989). Gender and body images:
Stereotypes and realities. Sex Roles, 21, 361-373.
Cash, T.F., & Fleming, E.C. (2002). The impact of body image
experiences: Development of the body image quality of life
inventory. International Journal of Eating Disorders, 31, 455460.
12
Cash, T.F., & Pruzinsky, T. (1990). Body images development, deviance, and change. New York, NY: The Guilford
Press.
Cash, T.F., & Szymanski, M.L. (1995). The development and
validation of the body-image ideals questionnaire. Journal of
personality assessment, 64, 466-477.
Cash, T.F., Winstead, B.A., & Janda, L.H. (1986). The great
American shape-up. Psychology today, 20, 30-37.
Chibnall, J.T., & Tait, R.C. (1994). The short form of the Beck
Depression Inventory: Validity issues with chronic pain patients. The
Clinical Journal of Pain, 10, 261-266.
Costello, K., Halper, J., & Harris, C. (2003). Nursing practice
in multiple sclerosis: A core curriculum. Library of Congress:
Demos Medical Publishing.
Cotran, R.S., Kumar, V., & Collins, T. (1999). Pathologic
basis of disease (6th ed.). Philadelphia, PA: W.B. Saunders
Company.
DiBattista, R.G. (2002). Female body image: A hot issue (1st
ed.). Berkeley Heights, NJ: Enslow Publishers, Inc.
Feinstein, A. (1997). Multiple sclerosis, depression, and
suicide. British Medical Journal, 315, 691-692.
Feinstein, A. (1999). The clinical neuropsychiatry of
multiple sclerosis. Toronto, ON: Cambridge University Press.
Furnham A., & Greaves, N. (1994). Gender and locus of
control correlates of body image dissatisfaction. European Journal
of Personality, 8, 183-200.
Goodin, D.S., Frohman, E.M., Garmany, Jr. G.P., Halper, J.,
Likosky, W.H., Lublin, F.D., et al. (2002). Disease modifying therapies
in multiple sclerosis. American Academy of Neurology, 58(2), 169178.
Halper, J. (2001). Advanced concepts in multiple sclerosis
nursing care. New York, NY: Demos Medical Publishing, Inc.
Halper, J., & Holland, N.J. (2002). Comprehensive nursing
care in multiple sclerosis (2nd ed.). New York, NY: Demos Medical
Publishing, Inc.
Hickey, J.V. (2003). The clinical practice of neurological and
neurosurgical nursing (5th ed.). Philadelphia, PA: Library of
Congress Cataloging-in-Publication Data.
Higgins, E.T. (1987). Self-discrepancy: A theory relating self
and affect. Psychological review, 94, 319-340.
Hinds, M.J. (2002). Focus on body image: How you feel
about how you look (1st ed.). Berkeley Heights, NJ: Enslow
Publishers, Inc.
Jackson, L.A. (1992). Physical appearance and gender –
Sociobiological and sociocultural perspectives. New York, NY:
State University of New York Press.
Kralik, D., Koch, T., & Eastwood, S. (2003). The salience of the
body: Transition in sexual self-identity for women living with
multiple sclerosis. Journal of Advanced Nursing, 42(1), 11-20.
Metz, L. (2002). Considering therapy for multiple sclerosis.
IMAG., 1, 1-16.
Minden, S.L. (1992). Psychotherapy for people with multiple
sclerosis. Journal of neuropsychiatry, 4, 198-213.
Minden, S., Orav, J., & Reich, P. (1987). Depression in multiple
sclerosis. General Hospital Psychiatry, 9, 426-434.
Multiple Sclerosis Society of Canada. (2004). What everyone
should know about multiple sclerosis. Channing L. Bette
Company, Scriptographic.
Muth, J.L., & Cash T.F. (1997). Body-image attitudes: What
difference does gender make? Journal of Applied Social
Psychology, 27, 1438-1452.
Newell, C. (2000). Measuring Health: A guide to rating
scales & questionnaires. Oxford University Press.
Patten, S.B., & Metz, L.M. (1997). Depression in multiple
sclerosis. Psychotherapy and psychosomatics, 66, 286-292.
Paty, D.W., & Ebers, G.C. (1998). Multiple sclerosis. (Vol. 50).
Philadelphia, PA: Library of Congress.
Polit, D., & Beck, C.T. (2004). Nursing research principles and
methods (4th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.
Remick, R.A., & Sadovnick, A.D. (1997). Depression and
suicide in multiple sclerosis. In Times Mirror (Ed.), Multiple
sclerosis: clinical challenges and controversies (pp. 243-251). St.
Louis, Missouri: Mosby.
Sadovnick, A.D., Remick, R.A., Allen, J., Swartz, E., Yee, I.M.,
Eisen, K., et al. (1996). Depression and multiple sclerosis. Neurology,
46(3), 628-632.
Simons, A.F. (1984). Multiple sclerosis – Psychological and
social aspects. Sydney, Australia: Biddles Ltd.
Thompson, J.K. (1996). Body image, eating disorders, and
obesity – An integrative guide for assessment and treatment.
Washington, DC: British Cataloguing-in-Publication Data.
Websites of interest
Canadian Association of Neuroscience Nurses –
www.cann.ca
Check this site often for updates on information. Reports will be on the website.
Canadian Nurses Association
www.cna-nurses.com
Canadian Congress of Neurological Society
www.ccns.org
Please check out their web-page to learn more about the society to which we belong. CANN is an affiliate of this society.
CCNS publishes the Canadian Journal of
Neurological Sciences, which is available on-line.
www.CJNS.org
World Federation of Neuroscience Nurses
www.WFNN.org
All CANN members are automatically members of WFNN.
13
Shampoo after craniotomy: A pilot study
By Sandra Ireland, Karen Carlino, Linda Gould, Fran Frazier, Patricia Haycock, Suzin Ilton, Rachel Deptuck, Brenda Bousfield,
Donna Verge, Karen Antoni, Louise MacRae, Heather Renshaw, Ann Bialachowski, Carol Chagnon and Kesava Reddy
Abstract
Objectives: The primary goal of this study was to assess the
effect of postoperative hair-washing on incision infection and
health-related quality of life (HRQOL) in craniotomy patients.
The objectives of this study were to 1) determine the effect of
postoperative hair-washing on incision infection and HRQOL,
2) provide evidence to support postoperative patient hygienic
care, and 3) develop neurosurgical nursing research capacity.
Research question: Does hair-washing 72 hours after craniotomy and before suture or clip removal influence postoperative incision infection and postoperative HRQOL?
Methods: A prospective cohort of 100 adult patients was randomized to hair-washing 72-hours postoperatively (n = 48), or
no hair washing until suture or clip removal (n = 52). At five to
-10 days postoperatively, sutures or clips were removed, incisions were assessed using the ASEPSIS Scale (n = 85) and participants were administered the SF-12 Health Survey (n = 71).
At 30 days postoperatively, incisions (n = 70) were reassessed.
Results: No differences were found between hair-washing and
no hair-washing groups for ASEPSIS scores at five to 10 days
and 30 days, and total SF-12 scores at five to 10 days postoperatively (p ≥ 0.05).
Conclusions: Postoperative hair-washing resulted in no
increase in incision infection scores or decrease in HRQOL
scores when compared to no hair-washing in patients experiencing craniotomy.
Introduction
The aim of clinical nursing research is to “generate knowledge
to guide nursing practice and to improve the health and quality of life of nurses’ clients” (Polit & Beck, 2004, p. 3).
Although research-based practice and evidence-based health
care has received a great deal of emphasis in recent years, a
relatively small proportion of frontline clinical nurses report
the use of research as a basis for their practice (Mulhall, 1998).
Lawler (1991, 1997) described nursing as a profession not
merely concerned with just the physical body, but one that
takes a more holistic perspective. From Lawler’s perspective,
nurses assess and intervene to meet not only the physical
needs of patients, but also their more immediate and personal concerns. In so doing, nurses are provided with opportunities to identify unique and innovative ways to assist patients to
endure and surpass the illness experience. This professional
vantage point provides staff nurses with opportunities to
identify research questions and evaluate the impact of interventions designed to meet the concerns of patients on care
outcomes. However, in our experience, frontline staff nurses
rarely have the opportunity to participate fully in research
projects that would put these innovations to the test. A recent
survey confirmed this understanding.
14
Using the Barriers Scale (Funk, Champagne, Wiese, &
Tornquist, 1991), a survey of approximately 1,000 nurses was
conducted by the Hamilton Health Sciences Nursing Research
Committee to identify barriers to the utilization of research in
nursing practice. The top three barriers were identified as 1)
not enough time to read research evidence, 2) not enough
authority to change patient care procedures, and 3) insufficient time to implement new ideas (Lee, Blatz, Dore, Ireland,
Étude sur les effets du lavage des
cheveux (shampooing) à la suite
d’une craniotomie récente
Résumé
Objectifs : Le but principal de cette étude était d’évaluer les
effets, en phase post-opératoire, d’un shampoing sur
l’incision et sur la qualité de vie (HRQOL) des patients
ayant subi une craniotomie. Les objectifs de cette étude
étaient de : 1. déterminer l’effet du lavage des cheveux
(shampoing), en phase post-opératoire, au niveau de
l’incision et l’effet sur la qualité de vie des patients ayant
subi une craniotomie. 2. promouvoir une meilleure hygiène
en phase post-opératoire. 3. contribuer au développement
de la recherche en nursing neurochirurgical.
Question à étudier : Est-ce que le fait de laver les cheveux
du patient dans un délai de 72 heures après une craniotomie et, avant l’excision des sutures ou agrafes, augmente le risque d’infection au site de l’incision? Et, est-ce
que cela affecte la qualité de vie du patient (HRQOL)?
Méthode : Au cours d’une analyse prospective d’un groupe
de 100 patients adultes, certains ont été assignés, au hasard,
à recevoir un shampoing 72 heures après la chirurgie (n=48)
et un autre groupe (n=52) a du attendre que les sutures ou
les agrafes soient enlevées pour recevoir un shampoing.
Après 5 à 10 jours, en période post-opératoire, les sutures ou
agrafes furent enlevées. La condition des incisions a été évaluée à l’aide de l’« ASEPSIS Scale » (n=85) et les participants furent administrés le « SF-12 Health Survey » (n=71).
Après 30 jours, en phase post-opératoire, toutes les incisions
ont été examinées à nouveau.
Résultats : Nous n’avons pas observé de différence entre le
groupe qui a eu un shampoing et celui qui n’en pas eu en
utilisant la méthode « ASEPSIS Score » entre 5 à 10 jours
et à 30 jours. De même, le calcul du total « SF-12 Health
Survey » n’a pas changé entre 5 et 10 jours en phase postopératoire. (p ≥ 0.05).
Conclusion : Administrer un shampoing, tôt en phase postopératoire, aux patients ayant subi une craniotomie,
n’augmente pas le risque d’infection au niveau de l ‘incision. De plus, il ne semblaient pas avoir une diminution de
la qualité de vie (HRQOL) en comparant les deux groupes
& Zychla, 2004). Over the past three years, this evidence has
been used to develop strategies to increase the utilization of
evidence in nursing practice and to support frontline staff
nurse participation in research projects such as this study.
This research project gave a group of frontline staff nurses on
a busy neurosurgical unit the opportunity to put an idea to
improve patient care to the test. They were not only involved
in the creation of a research question that specifically related
to their patient population, but also they were given the opportunity to be involved in designing, implementing, and evaluating a clinical nursing research study from beginning to end.
Background
Annually at Hamilton Health Sciences, approximately 400
patients require a craniotomy for a variety of neurosurgical
problems. These include 1) brain tumour, 2) subarachnoid
hemorrhage, 3) aneurysm, 4) arteriovenous malformation,
and 5) traumatic head injury. Surgical site infections (SSI) are
always a concern for these patients and preventative measures
are in place to minimize this risk. Historically, one such measure that has been reported by nurses to be based on physician
preference is the order that patients refrain from hair-washing
until sutures or clips are removed at approximately five to 10
days postoperatively. When the proposed study was discussed
with neurosurgeons, they agreed with the nursing staff that
evidence was needed to identify best practice to inform clinical decision-making and patient health teaching in this area.
In the development of this study, frontline neurosurgical nurses reported anecdotal evidence that patients perceived hairwashing after cranial surgery to be important to their selfesteem and feelings of well-being. They also reported that the
unclean appearance of their hair after surgery frequently
caused patients to be concerned about wound infection and
self-care after discharge. Nurses questioned whether the simple
act of postsurgical hair-washing had potential to help patients
“endure” and “surpass” a major neurosurgical illness experience. In order to evaluate the impact of hair-washing on patient
perceptions of well-being and incision infections and inform
hygiene health teaching, a research study was proposed.
Research question
Does hair-washing 72 hours after craniotomy and before suture
or clip removal influence 1) postoperative incision infection as
measured by a wound assessment scale at five to 10 days and 30
days, and/or 2) postoperative HRQOL at five to 10 days?
Literature review
A literature review identified several studies that reported the
influence of a variety of risk factors on surgical site infections
in neurosurgical patient populations. Findings from a metaanalysis conducted by Barker (1994) and a prospective multicentred trial conducted by Korinek, Golmard, Elcheick,
Bismuth, Effenterre, Coriat, et al. (2005) supported the efficacy of using prophylactic antibiotic therapy in reducing wound
infection rates in patients undergoing craniotomy. The results
of two other studies supported that cranial surgery without
hair removal did not increase the rate of post-surgical site
infections (Kumar & Thomas, 2002; Bekar, Korfali, Dogan,
Yilmazlar, Baskan, & Aksoy, 2001). A similar study conducted
by Miller, Weber, Patel, and Ramey (2001) confirmed these
results and also suggested that lack of hair removal improved
patients’ feelings of confidence and self-esteem during their
postoperative recovery. Korinek (1997) identified other risk
factors for infection in 2,944 patients with craniotomy: 1)
emergency versus elective surgery, 2) clean-contaminated and
dirty surgery, 3) operative time greater than four hours, and 4)
recent neurosurgery.
Two additional studies reported the effect of early hair-washing or bathing on the development of surgical site infections
in spinal and cranial surgical populations. Carragee and
Vittum (1996) studied the effect of early bathing on wound
infections in 100 patients undergoing lumbar microdiscectomy surgery. An intervention group was allowed to shower two
days postoperatively. A control group followed the traditional
protocol of no bathing until sutures or clips were removed. A
single infection occurred in the control group; no infection
was reported in the intervention group.
Goldberg et al. (1981) studied 200 outpatients with clean head
and neck lacerations that were surgically repaired in office
operating rooms or emergency rooms. All wounds were kept
dry overnight (eight to 24 hours) postoperatively. The following day, a randomly selected group of 100 patients was
allowed to use any soap available and water to rinse all about
and over the incised or lacerated area. Shampooing hair was
allowed, but patients were instructed 1) not to scrub over the
incision, 2) to let the soap and water run across it, and 3) to
apply an antibiotic topical ointment to the incision postcleansing. The control group was instructed to keep the incision dry until the sutures were removed. No wound infection
occurred in any of the 200 patients studied.
Although the evidence reviewed suggested that early cleansing of surgical incisions might not pose additional infection
risk in similar patient populations, it was inadequate to
answer the research question identified in this study. A pilot
research study was designed to provide preliminary evidence
to inform clinical decision-making and patient education
regarding the effect of hair-washing on craniotomy incision
infection rates and HRQOL. The study was approved by the
Hamilton Health Sciences Research Ethics Board.
Methods
Phase one
Four neurosurgical nurses and one infection control practitioner, all with greater than five years experience, participated
in three craniotomy wound assessment sessions prior to the
initiation of the study to establish rater reliability in assessing
craniotomy incision using the ASEPSIS Scale (Wilson,
Webster, Gruneberg, Treasure, & Sturridge, 1986).
Phase two
Using a randomized controlled trial study design, 100 adult
patients were enrolled in the study over a 16-month period at
the Hamilton General Hospital site. Included were patients
greater than 18 years of age who were scheduled for elective
or urgent craniotomy and recruited in a pre-operative clinic,
or within 72 hours postoperatively in an intensive care unit or
a neurosurgical unit. Exclusion criteria included 1) severely
15
immunocompromised patients related to recent chemotherapy or radiation treatment, 2) patients who were cognitively
impaired without a supportive caregiver or substitute decision-maker, 3) presence of an open head wound or ventricular drain, and/or 4) presence of active infection.
Eligible patients were identified through a daily nursing
review of clinic lists and operating room schedules. Once consent was obtained, participants were randomly assigned to the
“hair-washing group” after 72 hours (intervention group) or
the “no hair-washing group” before suture removal at five to
10 days postoperatively (control group). The nurse assigned to
care provided participants in the intervention group or their
supportive caregiver with health teaching outlining careful
hair-washing technique to be initiated at 72 hours postoperatively. They were also provided with a “shampoo record form’”
to record the number of times they had washed their hair. All
received a supply of a gentle shampoo. Participants in the
control group were instructed to keep the incision dry until
sutures or clips were removed.
Measures
ASEPSIS Scale. The Additional treatment, Serous discharge,
Erythema, Purulent discharge, Separation of deep tissue,
Isolation of bacteria, and Stay as an inpatient (ASEPSIS) Scale
was used for wound assessment (Wilson et al., 1986). This
scale was developed for the purpose of accurately grading surgical wound infections. Wound assessments were conducted
using the ASEPSIS Scale at five to 10 days postoperatively, at
the time of suture or clip removal and at 30 days postoperatively. Part A of the ASEPSIS Scale provides criteria to grade
the incision from 0 to 5 depending on the percentage of the
wound that demonstrates characteristics of 1) serous exudate,
2) erythema, 3) purulent discharge, and 4) separation of deep
tissues. Grading levels include a) absent, b) < 20%, c) 20-39%,
d) 40-59%, e) 60-79%, and f ) ≥ 80%. The scoring range is from
0 to 30. Characteristics of purulent exudate and separation of
deep tissue are assigned twice the value assigned to serous
exudate and erythema at each level.
Part B of the ASEPSIS scale provides for the assignment of
points for complications related to wound infection: 1) prescription of antibiotics (10), 2) surgical drainage (5), 3) wound
debridement (10), 4) positive wound culture (10), and 5) prolonged stay over 14 days (5). The scoring range is from 0 to 40.
The ASEPSIS Scale was originally created for use in a cardiac
patient population, but has since been utilized in a variety of
surgical patient populations. Wilson et al. (1986) reported a
repeatability coefficient of 4.2 in a sample of 51 sternal
wounds and 3.2 in a sample of 34 leg wounds. Wilson, Weavill,
Burridge, and Kelsey (1990) compared the ASEPSIS definition
of wound infection (score more than 20 points) with other
definitions in a sample of 1,029 surgical patients. ASEPSIS
scores of > 20 were more sensitive and as specific as the presence of pus in indicating changes in management as an indicator of medical diagnosis of infection.
SF-12 Health Survey. The short form of the MOS SF-36 Health
Survey, the SF-12, provided a summary measure of quality of
life domains of 1) general health, 2) limitations to activities of
daily living, 3) physical health and daily activities, 4) emotions
16
and daily activities, 5) the degree to which pain interfered with
work activities, 6) general health perceptions, and 7) social
functioning (Ware & Sherbourne, 1992; McHorney, Ware, &
Raczek, 1993). Participants were asked to rate their perceptions
based on a scale ranking scores from least to most. Each SF-12
item has an individualized rating scale and some items are
reverse ordered. For the purpose of this study, reverse-ordered
items were reordered to ensure that all lower scores denoted
poorer perception and higher scores denoted higher perceptions of quality of life. Using this method, the possible scoring
range was from 12 (lowest) to 47 (highest). The SF-12 provided
a high degree of correspondence between summary physical
and mental health measures when compared to the widely used
SF-36 in a European study of 1,483 people (Gandek, Ware,
Aaronson, Apolone, Bjorner, Brazier, et al., 1998).
Suture removal and wound assessment using the ASEPSIS
Scale Part A, the postoperative administration of the SF-12
Health Survey at five to 10 days, and the 30-day postoperative
wound assessment using ASEPSIS Part A and Part B were conducted by the study wound assessment nurses on the inpatient
unit or in an outpatient clinic after discharge. In some cases, a
physician in another hospital or a family practitioner completed the ASEPSIS Scales. Wound assessment nurses and physicians were blinded to the group assignment of participants.
Results
Phase one
Five craniotomy incision assessments using the ASEPSIS Scale
were conducted at each of three testing sessions resulting in a
total of 15 assessments performed by each of four nurses and
one infection control practitioner acting as a control. Percent
interrater reliability was established as a function of agreements
at 89.72% (reliability coefficient 0.89) (Polit & Beck, 2004).
Phase two
Descriptive statistics. The mean age of participants was 52.68
years (SD = 14.24 years). Fifty-seven per cent were female and
43% were male. Sixty-three per cent of surgeries were performed for brain tumour, 18% for cerebrovascular problems,
and 29% for other neurosurgical problems. Fifty-three per cent
had an ICU stay immediately postoperatively. Mean length of
ICU stay was 2.54 days (SD = 4.28). Mean length of hospital
stay, including on-site rehabilitation for some participants, was
10.13 days (SD = 8.83; range one to 40 days). Of those participants (n = 68) who completed the full 30-day wound assessment (Part A and Part B), three (4%) had total scores of > 20
indicating presence of infection based on ASEPSIS criteria
(Wilson et al., 1990).
Of the 100 participants recruited to the study, 48 were randomized to the “hair-washing group” and 52 to the “no hairwashing group”. The ASEPSIS Part A wound assessment at
five to 10 days was completed for 85 participants. The SF-12
at five to 10 days was completed for 70 participants. Fourteen
participants were unable to complete the SF-12 at five to 10
days due to decreased level of consciousness and/or cognitive
or sensory deficits, and one survey was incomplete.
At 30 days postoperatively, the ASEPSIS Part A was completed
for 70 participants and Part B was completed for 68 partici-
pants. Difficulties occurred in obtaining complete ASEPSIS
Part A and Part B data for eight participants who were transferred to other facilities. Eleven participants withdrew from the
study for the following reasons: 1) deteriorating health (three
participants), and 2) undefined reasons (eight participants).
Protocol errors occurred for four participants who were either
not provided with instructions appropriate to their study group
(three participants) or did not follow the prescribed hair-washing routine (one participant). Four participants were deceased
before follow-up. Five operations were cancelled.
Group comparisons. A student’s t test demonstrated no differences between the “hair-washing group” and the “no hair-washing group” means on ASEPSIS Part A scores at five to 10 days (n
= 85), total SF-12 scores at five to 10 days (n = 70), ASEPSIS Part
A scores at 30 days (n = 70), and ASEPSIS Part B Scores at 30
days (n = 68) (p = > 0.05). Means on only one of the seven SF-12
subscales demonstrated significant differences between the
groups (p = < 0.05). Higher mean scores on the single-item bodily pain subscale in the “no hair-washing group” indicated that
pain had interfered to a lesser degree with their normal work
(including both work outside the home and housework) in the
past week when compared with the “hair-washing group” (p =
0.031). Table one summarizes these results.
Developing capacity in
neurosurgical nursing research
A total of 14 neurosurgical nurses participated in the research
process. Included were those in the following practice roles:
staff nurses (five) advanced practice (two), operating room
first assistant (one), preoperative clinician (one), managers
(two), infection control practitioner (one), post-diploma student (one), and data analyst (one). Research roles assumed by
these nurses included 1) study design, 2) the development of
patient education tools, 3) staff education, 4) identification of
eligible patients, 5) consent-taking, 6) wound assessment, 7)
survey administration, 8) data collection, 9) data input, 10)
data analysis, and 11) reporting of results.
Although the overall research experience was reported by
frontline staff nurse researchers to be a positive one, barriers
to their participation included difficulty in ensuring continuity of coverage for the study associated with shift work and the
competing priorities of patient assignments and other duties.
Although study funding provided backfill for study nurses,
and management provided unlimited support, staffing challenges frequently made their full participation difficult.
Additionally, it was identified that pre-study training including a review of basic research methods and data management
would have enriched the research experience for nurses and
improved protocol efficiency.
Discussion
Given the reported low prevalence of incision infection rates
of 4% for neurosurgical procedures reported by Korinek
(1997) and confirmed by the findings reported here, the
small sample size utilized limits the generalizability of the
results of this study. Replication of this study in other neurosurgical patient populations is recommended to validate
these results. However, the findings of this study are consistent with evidence previously described that supported the
cleansing of surgical wounds in superficial cranial and other
than cranial locations.
Although the number of participants who were lost to five- to
10-day follow-up was less than 20%, the study team experienced significant challenges in ensuring that participants
were followed up at 30 days. This resulted in only 68% of participants completing all steps in the study process and a lostto-full-follow-up rate of 32%.
The study team has suggested that several measures to
improve follow-up be implemented in future neurosurgical
nursing research to include: 1) limiting recruitment to
patients living within the immediate hospital area, 2) randomization in the perioperative or immediate postoperative phase
of care, 3) routine telephone contact by the study nurses during the course of the study, and 4) investigating the possibility
of obtaining follow-up data from neurosurgeons at the
patient’s post-discharge appointment at six weeks. However,
in a patient population where postoperative morbidity and
mortality, and multiple care provider management are the
norm, it is suggested that follow-up challenges may be difficult to avoid.
Although all participants in the intervention group washed
their hair at least once in the period between their operation
Table One. Comparison of “hair-washing” and “no hair-washing” groups
Hair Washing Group
No Hair Washing Group
Sig.
N
M (SD)
N
M (SD)
p
39
1.28 (1.07)
46
1.35 (1.61)
0.82
ASEPSIS Part A 30 days
a
33
.52 (1.09)
37
.68 (1.45)
0.60
a
31
2.10 (6.80)
37
1.38 (4.80)
0.62
36
31.33 (6.41)
34
34.06 (7.30)
0.10
36
3.19 (1.33)
34
3.91 (1.40)
*0.03
ASEPSIS Part A 5-10 days
a
ASEPSIS Part B 30 days
b
SF-12 Total 5-10 days
b
SF-12 Subscale
Pain Limitations to Daily Activities
* p = < 0.05
a
b
higher scores indicate greater % of wound characteristics meet definition of infection
higher scores indicate higher SF-12 ratings of HRQOL
17
and suture or clip removal at five to 10 days postoperatively,
the shampoo records providing a measure of frequency were
not consistently completed and many were not returned.
Unfortunately, these data were inadequate to provide reliable
results and were excluded from the analysis. Full data would
have provided a measure of how the frequency of hair-washing influenced scores on the ASEPSIS and SF-12 measures. It
is recommended that future studies include measures to
ensure the collection of hair-washing frequency data.
A strength of this study was the resultant close monitoring
and consistent reporting of wound assessment and infection data over time. This resulted in improved wound
assessment skills and a heightened awareness of the need
for diligent wound surveillance on the part of all members
of the interdisciplinary team. The increased awareness
extended to the standardization of health teaching materials and procedures related to patient hygienic self-care
before and after hospital discharge, and increased follow-up
monitoring.
Acknowledgements
Funded by the Hamilton Health Sciences Foundation and the
Canadian Nurses Foundation.
Supported by Neurosciences and Trauma Program Staff, Dr.
Kesava Reddy, Dr. Mark Loeb, and Johnson and Johnson.
Approvals
This study was approved by the Hamilton Health Sciences
Research Ethics Board.
Permission to use the SF-12 Health Survey was purchased
from Medtronics.
About the authors
Sandra Ireland, RN, PhD, Chief of Nursing Practice,
Hamilton Health Sciences, Hamilton General Hospital,
Hamilton, ON. Correspondence regarding this article should
be addressed to Dr. Sandra Ireland by e-mail: irelasan@hhsc.ca
The 30-day follow-up visit provided staff nurses with an
opportunity to ensure that pre- and post-discharge care met
patient and family needs. At the 30-day visit, study nurses
reported that many participants required interventions ranging from monitoring medication levels and assessing for urinary tract infections to arranging semi-urgent appointments
for attendance at the neurosurgeon’s office or the regional
cancer centre to address outstanding concerns. Since these
findings were communicated to the neurosurgical staff, their
referrals of patients to the nurse-led follow-up clinic have
increased.
Karen Carlino, RN, BScN, Nurse Clinician, Neuroscience
Ambulatory Clinic, Hamilton Health Sciences.
It is a concern that those participants in the “hair-washing
group” reported significantly more pain-related limitations
to their work (including work outside the home and housework) activities in the past week (p = 0.03), as measured by
scores on the single-item SF-12 pain subscale. It is recognized that the SF-12 Health Survey measures pain indirectly
through its effect on work and other normal activities rather
than directly. It is recommended that future research supplement the single-item SF-12 bodily pain measure with a direct
measure of self-reported pain in order to validate this result.
Additionally, it would be important to collect these selfreport data at regular intervals during the postoperative period and before suture or clip removal in the “hair-washing” or
“no hair-washing” groups. Evidence-based management of
postoperative pain while the patient is in hospital and during
the early discharge period is a priority concern for neurosurgical nurses.
Suzin Ilton, RN, RNFA, Operating Room, Hamilton Health
Sciences.
Conclusions
Ann Bialachowski, RN, BScN, former Infection Control
Practitioner Hamilton Health Sciences, currently Regional
Infection Control Coordinator.
It can be concluded from the results of this pilot study, that in
a group of 100 participants undergoing craniotomy, hairwashing at 72 hours postoperatively resulted in no increase in
wound infection rating scores when compared with no hairwashing. Additionally, postoperative hair-washing did not
affect total scores on a health-related quality of life measure.
Further study is indicated to replicate the results of this study
in other neurosurgical patient populations.
18
Linda Gould, RPN, Stroke Data and Evaluation Specialist,
Neuroscience Ambulatory Centre, Hamilton Health Sciences.
Fran Frazier, RN, Staff Nurse, Neuroscience Unit, Hamilton
Health Sciences.
Patricia Haycock, RN, BScN, former Clinical Educator,
Neuroscience Unit, Hamilton Health Sciences, sessional
Instructor for Mohawk-McMaster Nursing Program.
Rachel Deptuck, RN, Staff Nurse, Neuroscience Unit,
Hamilton Health Sciences.
Brenda Bousfield, RN, Staff Nurse, Neuroscience Unit,
Donna Verge, RN, Staff Nurse, Neuroscience Unit, Hamilton
Health Sciences.
Karen Antoni, RN, BSc, MSc, ACNP, former ACNP in the
Intensive Care Unit at Hamilton Health Sciences, currently
ACNP for the Acute Pain Service.
Louise MacRae, RN, BScN, MBA, former Manager of the
Neuroscience Unit, Hamilton Health Sciences.
Heather Renshaw, RN, Clinical Manager, Neuroscience Unit,
Carol Chagnon, RN, BScN, Clinical Manager of the Cardiac
Care Unit Hamilton Health Sciences, BScN student who contributed to the study.
Dr. Kesava Reddy, MD, FRCS(C), Head of Service
Neurosurgery, Hamilton Health Sciences.
References
Barker, F.G. (1994). Efficacy of prophylactic antibiotics for
craniotomy: A meta-analysis. Neurosurgery, 35(3), 484-492.
Bekar A., Korfali, E., Dogan, S., Yilmazlar, S., Baskan, Z., &
Aksoy, K. (2001). The effect of hair on infection after cranial surgery.
Acta Neurochirurgica, 143(6), 533-537.
Carragee, E.J., & Vittum, D.W. (1996). Wound care after
posterior spinal surgery. Spine, 21(18), 2160-2162.
Funk, S.G., Champagne, M.T., Wiese, R.A., & Tornquist, E.M.
(1991). Barriers: The barriers to research utilization scale. Applied
Nursing Research, 4(1), 39-45.
Gandek, B., Ware, J.E., Aaronson, N.K., Apolone, G., Bjorner,
J.B., Brazier, J.E., et al. (1998). Cross-validation of item selection and
scoring for the SF-12 Health Survey in nine countries: Results from
the IQOLA Project. International Quality of Life Assessment.
Journal of Clinical Epidemiology, 51(11), 1171-1178.
Goldberg, H.M., Rosenthal, S.A., & Nemetz, J.S. (1981). Effect
of washing closed head and neck wounds on wound healing and
infection. American Journal of Surgery, 141(3), 358-59.
Korinek, A.M. (1997) Risk factors for neurosurgical site
infections after craniotomy: A prospective multicentre study of 2, 944
patients. Neurosurgery, 41(5), 1073-1081.
Korinek, A.M., Golmard, J.L., Elcheick, A., Bismuth, R.,
Effenterre, R., Coriat, P., et al. (2005). Risk factors for neurosurgical
site infections after craniotomy: A critical reappraisal of antibiotic
prophylaxis on 4,578 patients. British Journal of Neurosurgery,
19(2), 155-162.
Kumar, K., & Thomas, J. (2002). Cosmesis in neurosurgery: Is
the bald head necessary to avoid postoperative infection. Ann Acad
Med Singapore, 31(2), 150-154.
Lawler, J. (1991). Behind the screens nursing. Edinburgh,
UK: Churchill Livingstone.
Lawler, J. (1997). The body in nursing. Edinburgh, UK:
Churchill Livingstone.
Lee, R., Blatz, S., Dore, S., Ireland, S., & Zychla, L. (2004).
Results of a nursing research assessment. Unpublished, R. Lee,
McHorney, C.A., Ware, J.E., & Raczek, A.E. (1993). The MOS36 Item Short Form Health Survey (SF-36): Psychometric and clinical
tests of validity in measuring physical and mental health constructs.
Medical Care, 31(3), 247-263.
Miller, J.J., Weber, P.C., Patel, S., & Ramey, J. (2001).
Intracranial surgery: To shave or not to shave? Otology &
Neurotology, 22(6), 908-911.
Mulhall, A. (1998). Nursing, research and the evidence.
Evidence-Based Nursing, 1, 4-6.
Polit, D.F., & Beck, C.T. (2004). Nursing research: Principles
and methods. New York, NY: Lippincott Williams & Wilkins.
Ware, J.E., & Sherbourne, C.D. (1992). The MOS 36-item
short-form health survey (SF-36). Conceptual framework and item
selection. Medical Care, 30(6), 473-483.
Wilson, A.P., Weavill, C., Burridge, J., & Kelsey, M.C. (1990).
The use of wound scoring method “ASEPSIS” in postoperative
wound surveillance. Journal of Hospital Infection, 16(4), 297309.
Wilson, A.P., Webster, A., Gruneberg, R.N., Treasure, T., &
Sturridge, M.F. (1986). Repeatability of asepsis wound scoring
method. Lancet, 1(8491), 1208-1209.
19
Quality of life in epilepsy
By Sonia Poochikian-Sarkissian, Richard A. Wennberg, Souraya Sidani and Gerald M. Devins
Key words: Quality of life, health-related quality of life,
epilepsy, illness intrusiveness
This article will review disease, treatment and psychosocial factors in epilepsy that compromise overall well-being or QOL.
Abstract
Quality of life and
health-related quality of life
This article will review the various stressors in epilepsy and
disease, treatment and psychosocial factors that may contribute to disrupting daily activities and interfering with
lifestyles and interests, that impact on overall well-being or
quality of life (QOL). We will introduce the concept of illness intrusiveness in epilepsy that reflects disease- and
treatment-induced lifestyle disruptions that compromise
QOL.
Overview
Chronic and potentially life-threatening conditions, such as
epilepsy, introduce significant psychological challenges and
adaptive demands. Affected individuals experience the continuing threat of unpredictable and uncontrolled seizures and
prolonged periods of confusion that sometimes follow the
occurrence of seizures. These stressors collectively may contribute to disrupting daily activities, interfering with lifestyles
and interests, and generally compromising quality of life
(QOL). As compared to individuals without the condition,
people with epilepsy report a significant personal impact of
unpredictable seizures and the effects of seizure management
in terms of reduced social opportunities and leisure activities,
limitations on activities and ambitions, family dysfunction,
memory changes, increased anxiety and depression, and
reduced personal control and self-esteem (Shidharan,
Radhakrishnan, Ashok, & Mousa, 1986; Aziz, Ali, Frances,
Khan, & Hassan, 1994). These can significantly compromise
educational, employment and vocational opportunities, as
well as health-related quality of life (HRQOL).
In spite of pharmacological or surgical treatment, individuals
with epilepsy frequently experience various stressors.
Common stressors in epilepsy include unpredictable and
uncontrolled seizures with or without loss of awareness, medication side effects, cognitive changes, reduced physical
strength and memory, vocational problems, economic strains,
inability to drive, dependency on medications or caregivers
and/or complications of treatment that are generally believed
to introduce significant lifestyle disruptions or limitations
(Aziz et al., 1994; Engel, 2000).
Understandably, such disruptions are believed to compromise
the QOL extending far beyond the influence of the medical
situation alone (Dodrill, Batzel, Queisser et al., 1980; Jacoby,
Baker, Steen, Potts & Chadwick, 1996). Given both the chronic nature of epilepsy and its common psychosocial consequences, the goal of clinical intervention with pharmacological or surgical treatment has increasingly been extended
beyond the control of seizures to improve QOL as much as
possible (Jacoby, 1992).
20
Researchers have long been interested in addressing the
concept of quality of life (QOL) in chronic diseases.
“Quality of life” is a global and multidimensional concept
(Mayou & Bryant, 1993), including physical, functional and
psychological states, social interaction and somatic sensation (Schipper, Clinch, & Powell, 1990; Wagner, Keller,
Kosinski, Baker, Jacoby, Hsu, et al., 1995). It has been
defined and measured in various ways. Over the last two
decades, however, researchers in different fields of human
study have identified a consistent set of core domains as
important determinants of QOL. Initially among the most
frequently and consistently identified domains of QOL were
those that focused on “objective” QOL, which referred to
the circumstances of life, such as availability of higher education, occupational prestige, financial income, owning
one’s home, etc. (WHO, 1980). However, over the years,
researchers noted that objective QOL indicators did not
correlate significantly with “subjective” QOL indicators,
such as happiness or distress (Peters, 1995). This led
researchers in the “social indicators” movement to move
toward an emphasis on so-called subjective indicators of
QOL to the exclusion of “objective” indicators of QOL
(O’Donoghue, Duncan, & Sander, 1998). This evidence led
many in health research to focus on “subjective” QOL,
including psychological or emotional health, such as positive and negative mood, relationships and social support
that impact on daily activities and functional capabilities
(Baker, Smith, Dewey, Jacoby, & Chadwick, 1993).
Epilepsie et qualité de vie
Mots clés: qualité de vie, qualité de vie reliée à l’état de
santé, épilepsie, invasion de la maladie
Résumé
Cet article révisera les facteurs de risque de l’épilepsie, la
description de la maladie et le traitement incluant
l’aspect psychologique qui pourrait entraver les activités
journalières tout en altérant le style de vie et le choix
d’occupations qui contribuent au bien-être et à la qualité de vie. Nous allons discuter du concept de l’invasion
de la maladie (illness intrusiveness) qui se reflète dans
les changements du style de vie par l’entremise de la
combinaison maladie-traitement qui, en soi, occasionne
une diminution de la qualité de vie.
Health-related quality of life (HRQOL) has been described as
those aspects of QOL that relate specifically to a person’s
health (Patrick & Deyo, 1989). Ware (1987) stated that
HRQOL is a general measure from the patient’s viewpoint
that includes social and psychological functioning as well as
physical and physiologic aspects of performance. It includes
dimensions of physical functioning, social functioning, role
functioning, mental health and general health perceptions
(Ware, 1987), as well as the “judgment of one’s well-being
based on consideration of physical, mental, social, and general health status” (Vickrey, Hays, Graber, et al., 1992).
These definitions of HRQOL seem comprehensive and useful.
However, including various indices of physical, psychological
and social well-being may present some difficulties for the
measurement of QOL. The inclusion of health-related stressors as well as subjective well-being within a single concept of
QOL presents concerns for researchers who want to delineate
how disease and treatment affect QOL.
Quality of life in epilepsy
Although the term “quality of life” has been used only in the
last decade to identify an important health outcome in epilepsy, considerable attention has long been devoted to psychological and social issues. The QOL of an individual with
epilepsy has been proposed to derive from multiple determinants, such as financial status, relationships, housing, recreation, driving or health that encompass the effects of epilepsy
on daily activities or functional capabilities, perception of
control and depressive symptoms (Baker et al., 1993).
Depressive symptoms
Depression is the most common co-morbid condition associated with epilepsy, based on epidemiological studies. Its
prevalence in published studies ranges from 20% to 55% in
patients with recurrent seizures and three to nine per cent in
patients with controlled epilepsy (Lambert & Robertson,
1999). Clinicians have observed the strong association
between depression and epilepsy. Mendez, Cummings, and
Benson (1986) assessed 175 consecutive patients in an epilepsy clinic, using the Hamilton Depressive Rating Scale, and
found that 55% met criteria for depression. Jacoby et al. (1996)
conducted a community-based study that used the Hospital
Anxiety and Depression Scale and observed that 21% of 168
patients with recurrent seizures reported high levels of
depression. O’Donoghue, Duncan, and Sander (1999) used
the same scale and showed that from a group of 155 patients
in primary care practice in the United Kingdom, 33% of
patients with recurrent seizures and 6% of patients in remission had depression. Although these studies have some limitations in methodology, including self-reported diagnoses and
potential selection bias, depression is consistently reported to
be at least three to 10 times more prevalent in individuals with
uncontrolled seizures than the general population (Lambert
& Robertson), with overall implications on psychological
well-being and perception of QOL.
A study conducted by Lehrner, Kalchmayr, Serles, Olbrich,
Pataraia, and Aull (1999) investigated 56 consecutive patients
with temporal lobe epilepsy. HRQOL and depression were
measured with valid and reliable instruments developed for
native German speakers. The significant association of
depression with HRQOL persisted after controlling for
seizure frequency and seizure severity.
Gilliam and Kanner (2002) found a strong negative correlation between Beck Depression Inventory scores and selfreported health status in a cohort of 195 epilepsy clinic
patients. In a separate study, Gilliam, Kuzniecky, Meador et al.
(1999) found that mood status was the strongest clinical indicator of patients’ assessments of their health status in 125
patients one year after temporal lobe surgery. Although these
studies showed a significant association of depression with
HRQOL in individuals with epilepsy, different generic tools
were used to assess depression and HRQOL, and the diversity in methodologies and sample populations across studies
and the under-reporting of symptoms of depression by
patients and families have important clinical implications in
interpreting results or under-diagnosis by clinicians.
Personal control
Epilepsy is a disorder characterized by loss of control (Baker,
1996). The experiences of reduced control and uncertainty are
central to the subjective experience of patients with epilepsy.
This applies to seizures, the associated lack of bodily control
and substantial dependencies on medication and significant
others (Gehlert, 1994). For many, seizures can occur at any
time with little or no warning. The constant threat of a sudden unpredictable loss of control has been thought to comprise a fundamental facet of the condition responsible for significant impairments in HRQOL (Baker et al., 1998; Collings,
1990a, 1990b; Vickrey et al., 1992, 1993, 1995a, 1995b;
Wagner et al., 1995; Devinsky, Vickrey, Cramer, Parrine,
Hermann, Meador, et al., 1995). Jacoby (1992), using the term
“mastery” in the sense of predicting seizures, found that as the
feeling of mastery increased, patients worried less about their
disease. Mastery was conceptualized as a patient’s general
beliefs that he/she can control the course of his/her life in
spite of the medical condition. Two variables were chosen to
represent this dimension: locus of control and self-efficacy
(Jacoby, 1992).
Amir, Roziner, Knoll, and Neufeld (1999) investigated the role
of social support and mastery (measured by locus of control
and self-efficacy) as a major psychological mechanism determining the influence of the medical condition of 89 patients
with chronic epilepsy (as measured by perceived seizure
severity) on their QOL. Mastery was found to mediate the
relationship between disease severity and QOL. Social support acted as a mediator between disease severity and mastery. Thus, social support is influenced by disease severity
and, in turn, influences the person’s sense of mastery, which
then influences QOL. The study findings emphasize the possibility of improving QOL in persons with epilepsy by counselling and treatment aimed at reinforcing their self-efficacy
and locus of control.
DeVellis, Wallston-Strudler, and Wallston (1980) noted that
patients with epilepsy have to contend with lack of control in
their lives caused by the random occurrence of seizures and
tested the learned helplessness theory of depression in epilep-
21
sy patients. The central premise of learned helplessness is that
uncontrollability over important outcomes produces depression. A group of 289 people with epilepsy was surveyed via a
questionnaire assessing seizure-related variables, locus-ofcontrol beliefs and depression. Depression and external locusof-control variables were conceptualized as indexes of learned
helplessness. Regression analyses indicated that dimensions
of seizure disorders (perceived controllability/predictability of
seizures, severity of seizures, and extent of exposure to having
seizures) accounted for the variance in helplessness, corroborating the hypothesis that events that are as aversive as epileptic seizures contribute to feelings of uncontrollability and/or
depression.
Lack of control over the disease process is a significant stressor (Devins & Seland, 1987) that compromises self-efficacy
and contributes to learned helplessness. Reduced personal
control reduces the ability to get the “good” things in life one
desires and the ability to avoid the “bad” things one would
prefer not to encounter. However, in at least one condition,
end stage renal disease (Devins, Binik, Hutchinson, Hollomby,
Barre, & Guttmann, 1983), control over the disease itself was
not an important influence on subjective well-being or emotional distress.
Measuring quality of life in epilepsy
Traditionally, measurement of treatment outcome in epilepsy has been in the realm of the health care provider who usually assesses benefits of treatment by assessing seizure frequency and severity, adverse effects or antiepileptic drug
(AED) blood level parameters. However, patients’ perceptions of outcome usually include additional considerations
that involve the effects of epilepsy and/or its treatment on
daily life. Some of the issues that are especially relevant to the
measurement of QOL in epilepsy are loss of awareness during seizures and co-existent memory problems, both of
which may influence the accuracy of the reported data. The
length of the assessment tool (questionnaire) might also have
an impact on the responses for this patient population
because fatigue can interfere with responses. A variety of
instruments are available for evaluating QOL in the general
population.
In epilepsy, researchers and clinicians have developed and utilized various QOL measurement instruments, including
generic (Bergner, Bobbitt, Cater, & Gilson, 1981; Ware &
Sherbourne, 1992) and disease-specific instruments (Cella,
Sarafian, Snider, Yellen, & Winicour, 1993; Vickrey, Hays,
Rausch, Sutherling, Engel, & Brook, 1994). Generic HRQOL
instruments include the Sickness Impact Profile (SIP)
(Bergner et al., 1981), Nottingham Health Profile (NHP)
(Hunt, McKenna, McEwen, Backett, Williams, et al., 1985)
and Short-Form-36 (SF-36; Ware & Sherbourne, 1992). The
main advantages of generic tools are comprehensiveness,
broad applicability (allowing comparisons across patient populations), and the gained knowledge about their measurement
properties from extensive use in a variety of populations.
However, the major disadvantages are lack of emphasis on
specific aspects of patient conditions, and possible inability to
detect clinically important changes.
22
Essential for the formulation of epilepsy-specific HRQOL
instruments was the early recognition that epilepsy imposes
adaptive challenges and coping demands that, if not dealt with
effectively, can produce distress and unhappiness. As early as
1960, Lennox discussed the impact of epilepsy on the patient’s
life, family, overall behaviour and vocation. Two decades later,
Dodrill et al. (1980) developed the Washington Psychosocial
Inventory (WPSI), the first comprehensive 132-item selfadministered psychosocial instrument specific for individuals
with epilepsy. However, the WPSI is a long instrument, which
may lead to fatigue and response burden, failing to detect
small, but clinically important changes in response to therapy.
However, this instrument paved the way in developing
HRQOL instruments in epilepsy.
Over the years, the importance of measuring patient status
outcomes and overall well-being in epilepsy resulted in the
development of epilepsy-specific HRQOL instruments. A
concerted effort by the Quality of Life in Epilepsy (QOLIE)
Development Group (Vickrey, Hays, Hermann, Bladin, &
Batzel, 1993; Devinsky et al., 1995) led to the introduction of
a number of HRQOL instruments for measuring interventional outcomes in epilepsy. A number of QOL measures
assess the impact of epilepsy and its treatment, such as the
Epilepsy Surgery Inventory (ESI-55) (Vickery et al., 1992), the
widely used 89-item Quality of Life in Epilepsy (QOLIE-89)
questionnaire (Devinsky & Cramer, 1993) and its abbreviated
versions, the 31-item QOLIE-31, and the 10-item QOLIE-10
(Cramer, Perrine, Devinsky, & Meador, 1998).
All of these scales demonstrate good correlations between their
items and the source scale in QOLIE-89, which was developed
by adding epilepsy-specific items to a widely used generic
instrument, the SF-36. Their usefulness in AED trials (Wagner
et al., 1995) and epilepsy surgery has been demonstrated
(Vickrey et al., 1995a, 1995b; Wiebe, Rose, Derry, et al., 1997).
Impact of epilepsy treatment
on health-related quality of life
Research measuring the impact of epilepsy on QOL has traditionally emphasized illness-related factors, such as seizure
frequency and severity, or the evaluation of treatment effectiveness, such as pharmacological agents or surgery, adverse
effects of AEDs, or complications of surgical treatment for
intractable seizures. Despite effective treatment, epilepsy
introduces a variety of psychological and social issues that
influence HRQOL. Some studies have revealed that epilepsy
has a major impact on employment, social life and sense of
well-being of people with epilepsy (Dodrill et al., 1980; Jacoby
et al., 1996). Others have highlighted the stigmatization, a
sense of “loss of control”, fear of seizures, social isolation and
emotional difficulties that can be important problems for
people with epilepsy (Hermann, Whitman, Wyler, Anton, &
Vanderzwagg, 1990; Baker, Jacoby, & Chadwick, 1996). The
most important factor determining the self-reported QOL
appears to be the degree of seizure control (Vickrey et al.,
1995a, 1995b; Jacoby et al., 1996; Wiebe et al., 2001).
Clinicians and researchers have long recognized that seizure
frequency influences the well-being of their patients with
epilepsy. Those who are seizure-free with pharmacological
treatment report HRQOL levels similar to that observed in
the general (physically healthy) population (Leidy, Elixhauser,
Vickrey, Means, & William, 1999). The end-point used to
define efficacy in various AED trials is a ≥ 50% reduction in
seizure frequency. However, rather than complete seizure
freedom (Ben-Menachem, Henriksen, Dam, Mikkelsen,
Schmidt, Reid, et al., 1996; Gabapentin Study, 1993; Beran,
Berkovic, Dunagan, Vajda, Danta, Black et al., 1998; Loiseau,
Hardenberg, Pestre, Guyot, Schechter, & Tell, 1986).
Recognizing that complete eradication of seizures often cannot be achieved, there has been much discussion about the
degree to which partial seizure reduction may improve
HRQOL, especially when baseline seizure frequency has been
relatively high (Birbeck, Hays, Cui, & Vickrey, 2002). Some
have speculated that a 50% reduction in seizure frequency
may not reflect a clinically meaningful improvement in certain contexts (e.g., such as inability to drive a motor vehicle
(Chadwick, 1997). Individuals achieving partial seizure control continue to experience reduced personal control, inability to drive or participate in the workforce. Although seizure
frequency is the primary criterion used to evaluate the efficacy of AEDs, no consensus exists as to the magnitude of seizure
reduction that is required to produce a “clinically meaningful
change” or to produce an improvement in QOL.
Surgery for epilepsy often provides patients with significant
reductions in seizure frequency. For many patients, temporal
lobectomy, the most common form of resective surgery
(Wiebe, Blume, Grivin, & Eliasziw, 2001), may result in complete seizure freedom, or only rare, isolated seizures (Engel, Van
Ness, Rasmussen, & Ojemann, 1993; Spencer & Inserni, 1991).
Studies that have evaluated the effectiveness of temporal
lobectomy in patients with medically refractory seizures have,
in general, demonstrated improved psychological functioning
due to substantially reduced seizure frequencies or complete
seizure control (McLachlan, 1998; Dodrill, Batzel, & Fraser,
1991; Guldvog, Loyning, Hauglie-Hassen, Flood, & Bjornaes,
1991; Vickrey et al., 1995a, 1995b; Rose, Derry, & McLachlan,
1997). However, improved seizure control has not always correlated with patients’ overall well-being and improved
HRQOL (Vickrey et al., 1993; Jones, Berven, Ramirez,
Woodward, et al., 2002). Differences in practice patterns, cultural viewpoints, sample sizes, methodology, measurement
instruments, seizure measurement methods, and the various
concepts associated with QOL as it relates to epilepsy contribute to inconsistencies in observations and conclusions.
This reinforces, therefore, the need for consistent methods
and the use of validated measures in order to compare findings
and assess impact of interventions with greater confidence.
Future directions
A substantial body of research findings indicates that a
chronic physical illness, such as epilepsy, is often associated
with a variety of psychological and social issues contributing
to individual’s QOL. Measuring the impact on QOL has traditionally been in the realm of illness-related factors, such as
seizure frequency and severity, AED and adverse effects, or
in attempted evaluation of the effectiveness of treatment fac-
tors, such as pharmacological agents or surgical treatment
for intractable seizures. Improvement in psychological functioning in patients with epilepsy was demonstrated by
achieving substantial reduction of seizures or even complete
seizure control with surgical procedure. These findings
demonstrate that chronic conditions like epilepsy introduce
significant psychological challenges and adaptive demands.
Interference with lifestyles commonly occurs in chronic disease due to the influence of a variety of illness and treatmentrelated factors. Illness and treatment-related factors have
been identified as significant contributors to increased illness
intrusiveness in chronic disease, a concept described by
Devins et al. (1983). Illness intrusiveness reflects illnessinduced lifestyle disruptions that render it more difficult to
maintain involvements in valued activities and interests
(Devins et al., 1983). Illness intrusiveness, in turn, is hypothesized to compromise QOL. Illness intrusiveness is associated with decreased QOL in a number of patient populations
with different chronic diseases, including end stage renal disease (Devins, Mandin, Hons, Burgess, Klassen, Taub, et al.,
1990), multiple sclerosis (Devins, 1994; Devins, Edworthy, &
Seland, 1993), rheumatoid arthritis (Devins, Edworthy,
Guthrie, & Martin, 1992), breast cancer (Bloom, Stewart,
Johnston, & Banks, 1998), systemic lupus erythematosus
(Devins & Edworthy, 2000), psychiatric conditions (Robb,
Cooke, Devins, Young & Joffe, 1997; Antony, Roth, Swinson,
Huta, & Devins, 1998), sleep disorders (Devins, Flanagan,
Morehouse, Moscovitch, Plamondn, Reinish et al., 1995), and
for solid organ transplant recipients (Binik & Devins 1986;
Littlefield, Abbey, Fiducia, Cardella, Greig, Levy et al., 1996).
One important initiative recently undertaken (Sarkissian,
2005) involved testing the theory of illness intrusiveness in
epilepsy for the first time, and addressing the impact of illness and treatment-related factors and psychosocial factors
on overall quality of life.
About the authors
Sonia Poochikian-Sarkissian, PhD, APN, CNN(C), Assistant
Professor, University of Toronto; Clinician Scientist, Nursing,
Krembil Neuroscience Program, Toronto Western Hospital,
University Health Network, Toronto, ON.
Correspondence regarding this article should be addressed to
Dr. Sonia Sarkissian. E-mail: sonia.sarkissian@uhn.on.ca
Richard A. Wennberg, MD, FRCPC, Associate Professor of
Medicine (Neurology), University of Toronto; Director,
Epilepsy Program and Clinical Neurophysiology
Laboratory, University Health Network, Toronto, ON.
Souraya Sidani, PhD, Professor and Canada Research
Chair, School of Nursing, Ryerson University, Toronto, ON.
Gerald M. Devins, PhD, CPsych, Professor of Psychiatry and
Psychology, University of Toronto; Senior Scientist, Ontario
Cancer Institute and Toronto General Research Institute;
Head, Psychosocial Oncology and Palliative Care Research,
University Health Network, Princess Margaret Hospital;
Deputy Head, Behavioral Sciences and Health Division,
Toronto General Research Institute, Toronto, ON.
23
References
Amir, M., Roziner, I., Knoll, A., & Neufeld, M. (1999). Selfefficacy and social support as mediators in the relation between
disease severity and quality of life in patients with epilepsy.
Epilepsia, 40(2), 216-224.
Antony, M.M., Roth, D., Swinson, R.P., Huta, V., & Devins,
G.M. (1998). Illness intrusiveness in individuals with panic disorder,
obsessive compulsive disorder or social phobia. Journal of Nervous
and Mental Disease, 186, 311-315.
Aziz, H., Ali, S.M., Frances, P., Khan, M.I., & Hasan, K.Z.
(1994). Epilepsy in Pakistan: A population-based epidemiology study.
Epilepsia, 35(5), 950-958.
Baker, G.A., Smith, D.F., Dewey, M., Jacoby, A., & Chadwick,
D.W. (1993). The initial development of a health-related quality of life
model as an outcome measure for epilepsy. Epilepsy Research, 16,
65-81.
Baker, G.A., Jacoby, A., & Chadwick, D.W. (1996). The
associations of psychopathology in epilepsy: A community study.
Epilepsy Research, 25, 29-39.
Baker, G.A., Gagnon, D., & McNulty, P. (1998). The
relationship between seizure frequency, seizure type and quality of
life: findings from three European countries. Epilepsy Research, 30,
231-240.
Ben-Menachem E., Henriksen, O., Dam, M., Mikkelsen, M.,
Schmidt, D., Reid, S., et al. (1996). Double-blind, placebo-controlled
trial of topiramate as add-on therapy in patients with refractory
partial seizures. Epilepsia, 37(6), 539-543.
Beran, R.G., Berkovic, S.F., Dunagan, F.M., Vajda, F.J.E., Danta,
G., Black, A.B., et al. (1998). Double-blind, placebo-controlled,
crossover study of lamotrigine in treatment-resistant generalized
epilepsy. Epilepsia, 39(12), 1329-33.
Bergner, M., Bobbitt, R.A., Cater, W.B., & Gilson, B.S. (1981).
The sickness impact profile: Development and final revision of a
health status measure. Medical Care, 787-805.
Binik, Y.M., & Devins, G.M. (1986). Transplant failure does
not compromise quality of life in end-stage renal disease.
International Journal of Psychiatry in Medicine, 16, 281-292.
Birbeck, G.L., Hays, R.D., Cui, X., & Vickrey, B. (2002). Seizure
reduction and quality of life improvements in people with epilepsy.
Epilepsia, 43(5), 535-538.
Bloom, J.R., Stewart, S.L., Johnston, M., & Banks, P. (1998).
Intrusiveness of illness and quality of life in young women with breast
cancer. PsychoOncology, 7, 89-100.
Cella, D.F., Sarafian, B., Snider, P.R., Yellen, S.B., & Winicour, P.
(1993). Evaluation of a community-based cancer support group.
Psycho-Oncology, 2, 123-132.
Chadwick, D. (1997). Better comparisons of antiepileptic
drugs: What measures of efficacy? Pharm World Sci, 19(5), 214216.
Collings, J.A. (1990a). Epilepsy and well-being. Social Science
Med, 31, 165-170.
Collings, J.A. (1990b). Psychosocial well-being and epilepsy:
An empirical study. Epilepsia, 31, 418-42.
Cramer, J.A., Perrine, K., Devinsky, O., & Meador, K. (1998). A
brief questionnaire to screen for quality of life in epilepsy: The
QOLIE-10. Epilepsia, 37, 577-587.
DeVellis, R.F., Wallston-Strudler, B., & Wallston, K.A. (1980).
Epilepsy and learned helplessness. Basic Applied Social
Psychology, 1, 241-253.
Devins, G.M., & Edworthy, S.M. (2000). Illness
intrusiveness explains race-related quality of life differences
among women with systemic lupus erythematosus. Lupus, 9, 534541.
24
Devins, G.M., & Seland, T.P. (1987). Emotional impact of
multiple sclerosis: Recent findings and suggestions for future
research. Psychological Bulletin, 101, 363-375.
Devins, G.M., Binik, Y.M., Hutchinson, T.A., Hollomby, D.J.,
Barre, P.E., & Guttmann, R.D. (1983). The emotional impact of endstage renal disease: importance of patients’ perceptions of
intrusiveness and control. International Journal of Psychiatry in
Medicine, 13, 327-343.
Devins, G.M., Edworthy, S.M., Guthrie, N.G., & Martin, L.
(1992). Illness intrusiveness in rheumatoid arthritis: Differential
impact on depressive symptoms over the adult lifespan. Journal of
Rheumatology, 19, 709-715.
Devins, G.M., Edworthy, S.M., & Seland, T.P. (1993).
Differences in illness intrusiveness across rheumatoid arthritis, endstage renal disease, and multiple sclerosis. Nervous and Mental
Disease, 181, 377-381.
Devins, G.M., Flanagan, M., Morehouse, R., Moscovitch, A.,
Plamondn, J., Reinish, L., & Shapiro, C.M. (1995). Differential illness
intrusiveness associated with sleep-promoting medications.
European Psychiatry, 10, 153s-159s.
Devins, G.M., Mandin, H., Hons, R.B., Burgess, E.D., Klassen,
J., Taub, K., et al. (1990). Illness intrusiveness and quality of life in
end-stage renal disease: Comparison and stability across treatment
modalities. Health Psychology, 9, 117-142.
Devins, G.M. (1994). Illness intrusiveness and the
psychosocial impact of lifestyle disruptions in chronic lifethreatening disease. Advances in Renal Replacement Therapy, 1,
251-263.
Devinsky, O., & Cramer, J.A. (Eds.). (1993). Assessing quality
of life in epilepsy: Development of a new inventory. Epilepsia,
34(Suppl. 4), S1-S44.
Devinsky, O., Vickrey, B.G., Cramer, J., Parrine, K., Hermann,
B., Meador, K., et al. (1995). Development of the quality of life in
epilepsy inventory. Epilepsia, 36, 1089-1104.
Dodrill, C.B., Batzel, L.W., & Fraser, R. (1991). Psychosocial
changes after surgery for epilepsy. In H.O. Luders (Ed.), Epilepsy
surgery (pp. 661-667). New York: Raven Press.
Dodrill, D.B., Batzel, L.W., Queisser, H.R., et al. (1980). An
objective method for the assessment of psychological and social
problems among epileptics. Epilepsia, 21, 123.
Engel, J. Jr., Van Ness, P.C., Rasmussen, T.B., & Ojemann, L.M.
(1993). Outcome with respect to epileptic seizures. In J. Engel Jr.
(Ed.), Surgical treatment of epilepsies (pp. 609-621). New York:
Raven Press.
Engel, J. Jr. (2000). International classification: Implications for
neocortical epilepsies. Advanced Neurology, 84, 13-24.
Gabapentin Study. (1993). Gabapentin as add-on therapy in
refractory partial epilepsy: A double-blind, placebo-controlled,
parallel-group study. The US Gabapentin Study Group No.5.
Neurology, 43(11), 2292-2298.
Gehlert, S. (1994). Perceptions of control in adults with
epilepsy. Epilepsia, 35, 81-88.
Gilliam, F., & Kanner, A.M. (2002). Treatment of depressive
disorders in epilepsy patients. Epilepsy Behaviour, 3(55), 2-9.
Gilliam, F., Kuzniecky, R., Meador, K., et al. (1999). Patient
oriented outcome assessment after temporal lobectomy for
refractory epilepsy. Neurology, 53, 687-696.
Guldvog, B., Loyning, Y., Hauglie-Hassen, E., Flood, S., &
Bjornaes, H. (1991). Surgical versus medical treatment for epilepsy.
Outcome related to survival, seizures, and neurologic deficit.
Epilepsia, 32, 375-388.
Hermann, B.P., Whitman, S., Wyler, A.R., Anton, M.T., &
Vanderzwagg, R. (1990). Psychological predictors of
psychopathology in epilepsy. British Journal of Psychiatry, 156,
98-105.
Hunt, S.M., McKenna, S.P., McEwen, J., Backett, E.M.,
Williams, J., et al. (1985). A quantitative approach to perceived health
status: A validation study. Journal of Epidemiology and
Community Health, 34, 281-286.
Jacoby, A., Baker, G.A., Steen, N., Potts, P., & Chadwick, D.W.
(1996). The clinical course of epilepsy and its psychosocial
correlates: Findings from a UK community study. Epilepsia, 37,
148-161.
Jacoby, A. (1992). Epilepsy and the quality of everyday life:
Findings from a study of people with well-controlled epilepsy. Social
Science Medicine, 34, 657-666.
Jones, J.E., Berven, N.L., Ramirez, L., Woodward, A., et al.
(2002). Long-term psychosocial outcomes of anterior temporal
lobectomy. Epilepsia, 43(8), 896-903.
Lambert, M.V., & Robertson, M.M. (1999). Depression in
epilepsy: Etiology, phenomenology, and treatment. Epilepsia,
40(Suppl. 10), S21-S47.
Lehrner, J., Kalchmayr, R., Serles, W., Olbrich, A., Pataraia, E.,
& Aull, S. (1999). Health-related quality of life (HRQOL), activity of
daily living (ADL) and depressive mood disorder in temporal lobe
epilepsy patients. Seizure, 8, 88-92.
Leidy, N.K., Elixhauser, A., Vickrey, B., Means, E., & William,
M.K. (1999). Seizure frequency and the health-related quality of life
of adults with epilepsy. Neurology, 53(1), 162-166.
Lennox, W., & Lennox, M. (1960). Epilepsy and related
disorders (Vols.1-2). Boston: Little, Brown.
Littlefield, C., Abbey, S., Fiducia, D., Cardella, C., Greig, P.,
Levy, G., et al. (1996). Quality of life following transplantation of
the heart, liver, and lungs. General Hospital Psychiatry, 18,
36S-47S.
Loiseau, P., Hardenberg, J.P., Pestre, M., Guyot, M.,
Schechter, P.J., & Tell, G.P. (1986). Double-blind, placebocontrolled study of vigabatrin in drug-resistant epilepsy.
Epilepsia, 27(2), 115-120.
Mayou, R., & Bryant, B. (1993). Quality of life in
cardiovascular disease. British Medical Journal, 69, 460-466.
McLachlan, R.S. (1998). The Canadian Epilepsy Database
and Registry. Canadian Journal of Neurological Science, 25,
S27-S31.
Mendez, M.F., Cummings, J.L., & Benson, D.F. (1986).
Depression in epilepsy: Significance and phenomenology. Arch
Neurol, 43, 766-770.
O’Donoghue, M.F., Duncan, J.S., & Sander, J.W. (1999). The
National Hospital Seizure Severity Scale: A further development
of the Chalfont Seizure Severity Scale. Epilepsia, 37, 563-571.
O’Donoghue, M.F., Duncan, J.S., & Sander, J.W. (1998). The
subjective handicap of epilepsy. A new approach to measuring
treatment outcome. Brain, 121(2), 317-343.
Patrick, D.L., & Deyo, R.A. (1989). Generic and diseasespecific measures in assessing health status and quality of life
[Review]. Medical Care, 27(3 Suppl.), S217-232.
Peters, D.J. (1995). Human experience in disablement: the
importance of International Classification of Impairments,
Disabilities and Handicaps (ICIDH)[Review]. Disability and
Rehabilitation, 17, 135-144.
Robb, J.C., Cooke, R.G., Devins, G.M., Young, L.T., & Joffe,
R.T. (1997). Quality of life and lifestyle disruption in euthymic
bipolar disorder. Journal of Psychiatric Research, 31(5), 509517.
Rose, K.J., Derry, P.A., & McLachlan, R.S. (1997). Patient
expectations and postoperative depression, anxiety and
psychosocial adjustment after temporal lobectomy: A
prospective study. International Journal of Behavioural
Medicine, 2, 27-40.
Sarkissian, P.S. (2005). Illness intrusiveness, quality of
life and self-concept in epilepsy. PhD thesis, University of
Toronto, Canada.
Schipper, H., Clinch, J., & Powell, V. (1990). Definitions
and conceptual issues. In B. Spilker (Ed.), Quality of life
assessments in clinical trials (pp. 11-24). New York: Raven
Press.
Shidharan, R., Radhakrishnan, K., Ashok, P.P., & Mousa, M.E.
(1986). Epidemiological and clinical study of epilepsy in Benghazi,
Libya. Epilepsia, 27(1), 60-65.
Spencer, D.D., & Inserni, J. (1991). Temporal lobectomy. In
H.O. Luders (Ed.), Epilepsy surgery (pp. 533-545). New York:
Raven Press.
Vickrey, B.G., Hays, R.D., Engel, J. Jr., et al. (1995a).
Outcome assessment for epilepsy surgery: The impact of
measuring health-related quality of life. Annals of Neurology, 37,
158-166.
Vickrey, B.G., Hays, R.D., Graber, J., et al. (1992). A healthrelated quality of life instrument for patients evaluated for epilepsy
surgery. Med Care, 30, 299-319.
Vickrey, B.G., Hays, R.D., Hermann, B.P., Bladin, P.F., & Batzel,
L.W. (1993). Outcomes with respect to quality of life. In J. Engel Jr.
(Ed.), Surgical treatment of the epilepsies (2nd ed, pp. 623-635).
New York: Raven Press.
Vickrey, B.G., Hays, R.D., Rausch, R., Sutherling, W.W.,
Engel, J. Jr., & Brook, R.H. (1994). Quality of life of epilepsy
surgery patients as compared with outpatients with hypertension,
diabetes, heart disease, and/or depressive symptoms. Epilepsia,
35(3), 597-607.
Vickrey, B.G., Hays, R.D., & Rausch, R. (1995b). Outcomes in
248 patients who had diagnostic evaluations for epilepsy surgery.
Lancet, 346, 1445-1449.
Wagner, A.K., Keller, S.D., Kosinski, M., Baker, G.A.,
Jacoby, A., Hsu, M.A., et al. (1995). Advances in methods for
assessing the impact of epilepsy and antiepileptic drug therapy on
patients’ health-related quality of life. Quality Life Research, 4,
115-134.
Ware, J.E., & Sherbourne, C.D. (1992). The MOS 36-Item
Short-Form Health Survey (SF-36): I. Conceptual Framework and
Item Selection. Med Care, 30, 473-482.
Ware, J.E. (1987). Standards for validating health
measures: Definition and content. Journal of Chronic Disease,
40, 473.
Wiebe, S., Blume, W., Grivin, J.P., & Eliasziw, M. (2001). A
randomized, controlled trial of surgery for temporal-lobe epilepsy.
New England Journal of Medicine, 345(5), 311-318.
Wiebe, S., Rose, K., Derry, P.A., et al. (1997). Outcome
assessment in epilepsy: Comparative responsiveness of quality of life
and psychosocial instruments. Epilepsia, 38, 430-438.
World Health Organization (WHO). (1980). The
International classification of impairments, disabilities, and
handicaps. Geneva: World Health Organization.
25
Synapses in the city:
Making the connections
First call for abstracts: CANN Scientific Sessions
June 17-20, 2008, Victoria, British Columbia
The call for abstracts for the 39th annual meeting and scientific
sessions of the Canadian Association of Neuroscience Nurses is
now underway. This national conference provides an opportunity to share best practice experiences, research, and our knowledge and commitment to neuroscience nursing.
The British Columbia Chapter of CANN invites you to come and
experience the natural beauty and glorious coastline of the harbour city of Victoria. In Victoria, also known as the “Garden City”,
you will find the mildest climate in Canada and a colourful history with First Nations’ totem poles, heritage architecture and
afternoon tea. While you are here, you can update your professional education in neuroscience nursing, network with colleagues and take in everything that Victoria and the Pacific coast
have to offer.
The dates for abstract submission are included below. Abstract
selection is a blind review process, by the scientific committee.
Abstracts may be submitted in English or French and may be in
the categories of neuro-assessment, epilepsy, spine, stroke, brain
tumours, craniocerebral and spinal trauma, professional development or other areas of interest to neuroscience nurses. Papers
relating to neurosciences patients or neuroscience nursing in any
age group are welcome. We are accepting abstracts for both
papers and posters.
We encourage all presenters to complete written papers of their
presentations and submit them for publication in our peerreviewed, indexed journal. Please bear in mind that our neuroscience nursing journal, the Canadian Journal of Neuroscience
Nursing (formerly AXON), is one of only two such journals in
North America.
The purpose of the scientific sessions is to provide an opportunity for neuroscience nurses to enhance their knowledge
and expertise. We invite nurses and other health care professionals from all neuroscience areas to contribute to our scientific program.
The abstracts are used to assist:
a) The scientific committee in selecting those papers of the most
value and relevance to our membership and nursing specialty.
b) The registrants of the conference in choosing the
papers/sessions they would like to attend.
Requirements for preparing abstracts
1. On a single page, the abstract must, in 200 words or fewer,
describe the central theme of the paper, workshop or poster.
2. Type your name and the title of your poster or presentation or
workshop on the top of the page. The first author should be
26
the person presenting the paper, workshop or poster. Submit
a second copy of the abstract with the title only. Do not
include any names on this second abstract. A blind review
process is used for abstract selection.
3. Indicate the following on the abstract page:
• Intended level of audience (basic, advanced, or all participants).
• Intended subspecialty, if applicable (e.g. pediatrics, neurology, neurosurgery, neuro-critical care, etc.).
• Format of your session (plenary, concurrent, workshop or
poster).
4. Send the following via e-mail only:
• Microsoft Word files:
I. One file of the completed abstract with title and author
II. One file of the completed abstract with title only
III. One file with curriculum vitae for each presenter
IV. One file with authors’ information and audiovisual
requirements
V. Your return email address.
Please forward the above to:
Trudy Robertson
E-mail: Robertson3152@shaw.ca
Acknowledgement of receipt of any files or communication will
be sent via e-mail soon after receipt. If you do not receive such
acknowledgement, or if you need to communicate with Trudy,
please contact her at:
(W) (604) 777-8345
(H) (604) 944-0506
3152 Patullo Crescent
Coquitlam, BC V3E 2R3
Critical dates:
November 19, 2007 – All abstracts for paper and workshop presentations must be received. If the Codman or Brain Tumor
Foundation Award is being sought, this must be noted at the time
of abstract submission.
January 14, 2008 – All submissions for the Codman Award and
Brain Tumor Foundation Award must be received as completed
papers.
February 11, 2008 – All abstracts for poster presentations must
be received. The Canadian Journal of Neuroscience Nursing has
the first right of refusal for the publication of the Mary Glover,
Codman, and Brain Tumor Foundation papers presented at these
scientific sessions. All presenters must register for the conference
at least for the day of their presentation and pay the applicable
registration fee.
Guidelines for Brain
Tumor Foundation Award
The Brain Tumor Foundation Award is in honour of Pamela
Del Maestro, RN, BSc. It will be presented to the author or
authors of a written paper that demonstrates the achievement
of excellence in the area of neuro-oncology nursing. It is
expected the money will be used for professional development.
Eligibility
1. At least one of the authors is a voting member of the
Canadian Association of Neuroscience Nurses (CANN)
and was a voting member in the preceding year;
2. The author(s) stipulates in writing the intention to seek the
award;
3. The author(s) is prepared to present the paper at the
CANN June meeting
4. The paper contains original work by the author(s);
5. The paper may be an adaptation from a previous work by
the author(s); this must be stated;
6. The award may not be presented to the same author(s) in
two consecutive years.
Guidelines for the Codman Award
The Codman Award will be presented to the author or authors of
a written paper that demonstrates the achievement of excellence
in the area of neuroscience nursing. It is expected the money will
be used for professional development.
Eligibility
1. At least one of the authors is an active member of the Canadian
Association of Neuroscience Nurses (CANN) and was an
active member in the preceding year;
2. The author(s) stipulates in writing the intention to seek the
award;
3. The author(s) is prepared to present the paper at the CANN
June meeting;
4. The paper contains original work by the author(s);
5. The paper may be an adaptation from a previous work by the
author(s); this must be stated;
6. The award may not be presented to the same author(s) in two
consecutive years.
Content
1. The paper is approached from a nursing perspective;
2. The paper is relevant to current neuro-oncology nursing;
3. The author(s) presents a logical development of ideas
based on scientific evidence;
4. The author(s) demonstrates creativity and originality;
5. The paper has implications for neuroscience nursing practice, education, administration, or research;
6. Demonstrates comprehensive knowledge of the topic.
Content
1. The paper is approached from a nursing perspective;
2. The paper is relevant to current neuroscience nursing;
3. The author(s) presents a logical development of ideas
based on scientific evidence and a comprehensive review of
the literature;
4. The author(s) demonstrates creativity and originality;
5. The paper has implications for neuroscience nursing practice,
education, administration, or research;
6. The paper reflects current trends in nursing;
7. Demonstrates comprehensive knowledge of the topic.
Style
The paper is written according to the established guidelines
for the writing of a manuscript for the Canadian Journal of
Style
The paper is written according to the established guidelines for
the writing of a manuscript for the Canadian Journal of
Selection
1. The paper is selected by the Scientific Program
Committee;
2. The Scientific Program Committee reserves the right to
withhold the award if no paper meets the specifications;
3. Papers for consideration must be received by the Scientific
Program Committee by February 11, 2008.
Selection
1. The paper is selected by the Scientific Program Committee;
2. The Scientific Program Committee reserves the right to withhold the award if no paper meets the specifications;
3. Papers for consideration must be received by the Scientific
Program Committee by February 11, 2008.
Presentation
1. The completed paper and disk must be brought to the June
2008 meeting;
2. The paper must be submitted to the Editor of the
Canadian Journal of Neuroscience Nursing in June 2008
for peer review and publication.
Presentation
1. The completed paper and disk must be brought to the June
meeting;
2. The award is presented to the authors by a representative of
the Codman company;
3. If the paper is co-authored by a non-member, sharing of the
award is left to the discretion of the author(s) who is (are)
members.
Publication
The paper must be submitted to the Editor of the Canadian
Journal of Neuroscience Nursing in June 2008 for peer review
and publication.
27
Des synapses urbains… se formeron des liens
Premier appel de résumés: Sessions scientifiques de l’ACIISN du 17 au 20 juin, 2008
L’appel pour les résumés pour la session scientifique de la 39e
réunion annuelle de l’Association canadienne des Infirmiers et
Infimières en science neurologique est maintenant lancé. Cette
conférence nationale est une opportunité d’échanger vos connaissances et démontrer votre engagement au niveau de la recherche
et de la pratique du nursing en sciences neurologiques.
auteur inscrit devrait être la personne présentant le papier,
l’atelier ou affiche. Également, veuillez soumettre une deuxième copie de ce résumé avec le titre seulement. N’inscrivez
aucun nom sur ce deuxième exemplaire. Le comité scientifique utilise un processus préconisant un choix à l’aveugle
pour la sélection des résumés.
La division de l’ACIISN de la Colombie Britannique vous invite à
venir vivre l’expérience de la beauté naturelle et de la splendeur
de la rive qui longe le port de la ville de Victoria. Vous trouverez
à Victoria, aussi connue sous le nom de « Garden City » un des
climats les plus tempérés au Canada ainsi que des empreintes historiques des autochtones telles que les totems, en plus de
l’héritage architectural et le thé durant la pause d’après-midi.
Durant votre séjour, vous pourrez développer vos connaissances
professionnelles en sciences neurologiques, créer de nouvelles
amitiés tout en profitant de ce que la ville de Victoria et la Côte
du Pacifique ont à vous offrir.
3. Indiquez les éléments suivants suite au texte du résumé :
• L’audience visée par l’activité (de base, avancée ou tout participant).
• Sous spécialité (p.ex. : pédiatrie, neurologie, neurochirurgie, soins critiques, etc.).
• Format de la session (session plénière, simultanée, atelier ou
affiche).
Les dates limites pour la soumission de résumés sont indiquées
ci-dessous. La sélection des résumés au programme sera faite par
le comité scientifique. Veuillez soumettre votre résumé pour
présentation orale ou affiche, en français ou, en anglais. Vous
pouvez choisir l’une des catégories suivantes: évaluation neurologique, épilepsie, accident vasculaire cérébral, tumeur
cérébrale, maladies et traumatisme de la colonne vertébrale, chez
les patients de tout âge. Les articles sur le développement professionnel ou tout autre sujet intéressant dans le domaine du nursing en neurosciences seront acceptés.
Nous vous encourageons tous à participer. Vous pouvez même
faire publier vos travaux dans notre journal: Le Journal Canadien
des Infirmiers et Infirmières en sciences neurologiques. Ce journal est l’une des deux seules revues du genre en Amérique du
nord.
La raison d’être des sessions scientifiques est de donner une occasion aux infirmières d’accroître leurs connaissances et de
développer leur expertise en sciences neurologiques. Nous invitons les infirmières, ainsi que les autres professionnels de la santé
qui pratiquent dans cette spécialité, à contribuer à notre programme scientifique.
Les résumés sont utilisés pour :
a) La révision du texte par le comité scientifique dans le but faire
une sélection appropriée selon les besoins de nos membres;
b) Permettre au membres participant de choisir les sessions auxquelles ils (elles) veulent assister.
Règlements pour la
rédaction des résumés:
1. Le résumé doit être composé d’un maximum de 200 mots afin
de décrire le thème principal de l’activité, de l’atelier ou de
l’affiche.
2. Inscrire en lettres carrées votre nom et le titre de votre
présentation, activité ou affiche en haut de la page. Le premier
28
4. Envoyez le document par l’intermédiaire de courriel seulement.
• Fichiers sous le format de Microsoft Word :
I. Un dossier du résumé proposé avec le titre et les
auteurs participants
II. Un dossier du résumé proposé avec le titre seulement
III. Un dossier avec les curriculums vitaes pour chaque
présentateur
IV. Un dossier concernant le choix d’équipement audiovisuel et la logistique de l’activité
V. Votre adresse électronique de retour
Faites parvenir votre résumé à :
Trudy Robertson
Adresse courriel : Robertson3152@shaw.ca
Un accusé de réception de tous les dossiers soumis sera envoyé
par l’intermédiaire d’un courriel. Si vous ne recevez pas de
réponse dans un délai raisonnable ou si vous devez communiquer
avec Trudy, veuillez composer le:
(604) 777-8345 au travail
(604) 944-0506 à domicile
3152 Patullo Crescent
Coguitlam, BC V3E 2R3
Dates de tombée :
Le 19 novembre 2007 : Tous les résumés pour les présentations
orales ou ateliers doivent être reçus. Si vous envisagez appliquer
pour le prix Codman ou pour le prix de la Fondation des tumeurs
cérébrales, veuillez le mentionner.
Le 14 janvier 2008 : Toutes les demandes concernant
l’admissibilité au prix Codman ou au prix de la Fondation des
tumeurs cérébrales doivent être reçues sous forme d’article
rédigé.
Le 11 février 2008 : Tous les résumés pour les présentations
d’affiche doivent être reçus. Le comité administratif du Journal
Canadien des Infirmiers et Infirmières en sciences neurologiques
se réserve le droit de refuser une demande de publication d’un
travail scientifique présenté pour les concours des prix Mary
Glover, Codman ou de la Fondation des tumeurs cérébrales. Tous
les présentateurs doivent s’inscrire à la conférence et payer les
frais d’enregistrement applicables, au moins pour le jour de leur
présentation.
Réglements pour le prix de la
Fondation des tumeurs cérébrales :
Le prix de la Fondation des tumeurs cérébrales existe en
l’honneur de Pamela Del Maestro, infirmière, B.Sc. Il sera présenté à l’auteur ou aux auteurs d’un travail écrit qui démontre
l’atteinte de l’excellence dans le domaine des soins infirmiers en
neurooncologie. Il est entendu que l’argent sera utilisé à des fins
de développement professionnel.
Admissibilité
1. Au moins un des auteurs est membre de l’Association canadienne des infirmières et infirmiers en sciences neurologiques
(ACIISN) et était membre l’année précédente;
2. Le ou les auteur(s) stipule(nt) par écrit leur intention de participer;
3. Le ou les auteur(s) sont prêts à pre?senter le travail à la réunion annuelle de l’ACIISN;
4. Le travail est un ouvrage original de (des) l’auteur(s);
5. Le travail peut être l’adaptation d’un ouvrage précédent des
auteurs; ceci doit être mentionné;
6. Le prix ne sera pas présenté au(x) même(s) auteur(s) deux
années consécutives.
Contenu
1. Le sujet du travail est traité utilisant une perspective de nursing;
2. Le sujet se rapporte aux soins infirmiers en sciences
neurologiques;
3. Le ou les auteur(s) présente(nt) un développement d’idées
logiques basé sur des connaissances scientifiques;
4. Le ou les auteur(s) démontre(nt) de l’originalité et de la créativité;
5. Le travail a des implications au niveau de la pratique des soins
infirmiers en sciences neurologiques, de l’éducation, de
l’administration et de la recherche;
6. Le ou les auteur(s) démontre(nt) une grande connaissance du
sujet.
Format
Le travail est écrit en accord avec les règlements établis se rapportant à la rédaction d’un article pour fins de publications dans
le Journal canadien des infirmiers et infirmières en sciences
neurologiques.
Sélection
1. Le travail est sélectionné par le comité
du programme scientifique;
2. Le comité du programme scientifique se réserve le droit de ne
pas attribuer le prix si aucun des travaux ne rencontre les
attentes du comité;
3. Tous les participants au concours du prix de la Fondation des
tumeurs cérébrales doivent faire parvenir leur travail au
comité du programme scientifique au plus tard, le 11 février
2008.
Présentation
1. Le travail, sous forme de texte, et une disquette doivent être
apportés au congrès annuel au mois de juin, 2008.
2. Le travail sera publié dans le Journal canadien des infirmiers
et infirmières en sciences neurologiques.
Règlements du concours
de la Compagnie Codman
Le prix de la compagnie Codman sera présenté à l’auteur ou aux
auteurs d’un travail écrit qui démontre l’atteinte de l’excellence
dans le domaine des soins infirmiers en sciences neurologiques.
Il est entendu que l’argent sera utilisé à des fins de développement professionnel.
Admissibilité
1. Au moins un des auteurs est membre de l’Association canadienne des infirmères et infirmiers en sciences neurologiques
(ACIISN) et était membre l’année précédente;
2. Le ou les auteur(s) stipule(nt) par écrit son (leur) intention de
participer;
3. Le ou les auteur(s) est (sont) prêt(s) à pre?senter le travail lors
du congrès annuel de l’ACIISN;
4. Le travail est un ouvrage original de (des) l’auteur(s);
5. Le travail peut être l’adaptation d’un ouvrage précédent de
(des) l’auteur(s); ceci doit être mentionné;
6. Le prix ne sera pas présenté au(x) même(s) auteur(s) deux
années consécutives.
Contenu
1. Le sujet du travail est traité utilisant une perspective de nursing;
2. Le sujet se rapporte aux soins infirmiers en sciences
neurologiques;
3. Le ou les auteurs présente (nt) un développement d’idées
logiques basé sur des connaissances scientifiques en plus
d’avoir révisé la littérature sur le sujet;
4. Le ou les auteurs démontre(nt) de l’originalité et de la créativité;
5. Le travail a des implications au niveau de la pratique des soins
infimiers en sciences neurologiques, de l’éducation, de
l’administration et de la recherche;
6. Le travail réfète les pratiques courantes en nursing;
7. Le ou les auteurs démontre(nt) une grande connaissance du sujet.
Format
Le travail est écrit en accord avec les directives établies pour la
rédaction d’un article pour fins de publication dans le Journal canadien des infirmiers et infirmières en sciences neurologiques.
Sélection
1. Le travail est sélectionné par le comité du programme scientifique;
2. Le comité du programme scientifique se réserve le droit de ne
pas attribuer le prix si aucun des travaux ne rencontre les
attentes du comité;
3. Tous les participants au concours du prix Codman doivent
faire parvenir leur travail au comité du programme scientifique au plus tard, le 11 février 2008.
Présentation
1. L’auteur doit apporter le travail sous forme de texte et sur
diskette au congrès annuel;
2. Le prix est remis aux membres de l’ACIISN par un représentant de la compagnie Codman lors du congrès annuel;
3. Si un non-membre est co-auteur de l’article, la décision du partage
29
Canadian Journal of
Neuroscience Nursing
Manuscript Guidelines
for Publication
Le journal canadien des
infirmiers et infirmières en
sciences neurologiques
Réglements de
publication dans le JCIISN
1. The Canadian Journal of Neuroscience Nursing is a peerreviewed journal.
2. APA is used for both the body of the paper
and the references.
3. Papers must be word processed and submitted in Word
6.0 or WordPerfect format. A hard copy and disk may be
sent by mail or the paper may be submitted by e-mail
attachment to Sonia Poochikian-Sarkissian, Editor, 399
Bathurst St., MP5-311, Toronto, Ontario M5T 2S8 or
cjnn@cann.ca
4. All papers received are reviewed for content by peer
reviewers and for format by the editor. This process usually takes five to eight weeks. Papers may be accepted as submitted, returned for revisions, or returned with feedback.
5. Manuscript guidelines
• Maximum length is 6,000 words or 20 pages
• Margins 1”, double spaced, Times New Roman, 12 pt
font size
• Title page with full title, name, and institutional affiliation
• Abstract of fewer than 200 words
• Left justified, paragraphs indented 5 spaces
• Headings often include: Introduction, review of the literature (conceptual and data based), research question/objectives/hypotheses/or clinical concern, methodology and method, analysis/findings, discussion including specific clinical implications/recommendations,
summary/conclusions, and references. (Please note, not
all these headings are needed or may apply to all papers).
• Abbreviations should always be preceded by the full
term. An example would be traumatic brain injury (TBI).
• Drugs are cited using the generic name in lowercase letters and brand names in parentheses.
6. For further information, please refer to the American
Psychological Association. (2001). Publication manual of
the American Psychological Association (5th ed.).
Washington, DC: American Psychological Association.
1. Le Journal canadiendes infirmiers et infirmières en sciences neurologiques est une publication révisée par ses
propres membres.
2. APA est utilisé pour la rédaction du journal et pour les
références.
3. Les manuscrits doivent être transcrits par traitement de
texte utilisant Word 6.0 ou Word Perfect. Une copie, sur
papier et disquette, peut être envoyée par la poste ou le
manuscrit peut être envoyé par courriel à Sonia
Poochikian-Sarkissian, rédactrice en chef, 399 Bathurst St.,
MP5-311, Toronto, Ontario M5T 2S8 ou cjnn@cann.ca
4. Le contenu de tous les manuscrits reçus est révisé par
réviseurs puis adapté pour fins de publication par la rédactrice en chef. Ce processus nécessite environ 5 à 8
semaines. Les articles pourraient être acceptés tels quels,
retournés pour révision ou retournés accompagnés de
commentaires.
5. Spécifications se rapportant à la rédaction du manuscrit :
• Longueur maximale du manuscrit : 6000 mots ou 20
pages.
• Marges de 1 pouce, double interligne, « Times New
Roman », 12 lettres au pouce
• Page titre avec titre complet, le nom et le lieu d’emploi de
l’auteur
• Un résumé de moins de 200 mots doit être inclu.
• Marge de gauche, laisser 5 espaces pour les nouveaux
paragraphes
• Les entêtes peuvent inclure : introduction, revue de la
litérature, (concept et données), but de la recherche,
objectifs, hypothèses, aspect clinique, méthodologie et
méthodes, analyses et résultats, discussions avec implications d’ordre clinique, recommendations, résumé et
conclusion, références. Veuillez prendre note que toutes
ces entêtes ne s’appliquent pas nécessairement à tous les
manuscrits présentés au comité.
• Les abréviations doivent toujours être précédées du terme
complet, par exemple : Accident cérébrovasculaire
(ACV).
• Les médicaments sont nommés utilisant le terme
générique écrit en lettres minuscules et le nom commercial écrit entre parenthèses.
6. Pour de plus amples informations, veuillez consulter la
publication suivante : The American Psychological
Association. (2001) Publication Manual of the American
Psychological Association (5th ed.) Washington, DC.
30
Join us for our 4th annual
Krembil Neuroscience Symposium
Thinking Beyond the
Box
Patient Keynote Speakers:
Mr. Anthony Aquan-Assee (TBI)
Mr. Robert Murphy (SCI)
Topics of Interest:
• Clinical Trials and SCI Treatment
• Radiation Treatment in Neuro-Oncology
• Cognitive Issues in Neurosurgical Patients
• Globalization of Neurosurgery
• The OR Experience
• ICP Management
Dates: November 15-16, 2007
Conference fee: Full Conference $200, One Day $150 (Early Bird & Student Rates Available)
Membership
application
Membership year: _________________________
Membership #: ____________________________
Membership year: May 1 – April 30
Please check appropriate boxes:
❏ Renewal
Membership type: ❏ General
Correspondence requested in: ❏ English
❏ New Member
❏ Associate
❏ French
C.N.A. Certified Neuroscience Nurse?: Yes ❏ No ❏
CNN(C) Certification number: _______________
CNA member: Yes ❏ No ❏
Name: ____________________________________________________________________________________________________
(please print)
(surname)
(first)
Home address: _____________________________________________________________________________________________
(apartment #)
(street)
___________________________________________________________________________________________________________
(city)
(province)
(postal code)
Employer: _________________________________________________________________________________________________
Employer address: __________________________________________________________________________________________
(unit, clinic, etc.)
(street address)
___________________________________________________________________________________________________________
(city)
(province) (postal code)
Current position: ___________________________________________________________________________________________
Phone: (home) (_____) _____ - __________ (work) (_____) _____ - __________ (extension) ______
(fax) (_____) _____ - __________ (e-mail) ______________________________________________________________________
Background information
Total years in nursing: _______________ neurosciences: _______________ Prov. Reg. #: _______________________________
Education (Please check highest level achieved): ❏ Diploma ❏ Baccalaureate ❏ Masters ❏ Doctorate
Area of practice: ❏ Clinical Practice ❏ Education ❏ Research ❏ Administration ❏ Student
Patient population (please check): ❏ Adult ❏ Pediatrics ❏ Both ❏ None
Special interests in the neurosciences: _________________________________________________________________________
___________________________________________________________________________________________________________
Expertise (include previous positions, skills, etc.): ________________________________________________________________
___________________________________________________________________________________________________________
Regions or chapters (check the appropriate box)
❏ British Columbia
❏ Alberta
❏ Saskatchewan
❏ Manitoba
❏ Ontario (southwest)
❏ Ontario (east)
❏ Ontario (Toronto)
❏ Québec
❏ New Brunswick
❏ Nova Scotia
❏ Prince Edward Island ❏ Newfoundland
Please enclose a cheque payable to CANN for the appropriate membership fee:
General Membership Fee: $75.00 OR Associate Membership Fee: $65.00
Fee applicable to membership type:
$ ____________________________
Total Payment
$ ____________________________
A general member is a registered nurse who is licensed to practise in Canada and is working in or affiliated with neurological
and/or neurosurgical nursing. An associate member shall be another individual practising in a related discipline in the field
of neurosciences, or having an interest in the field of neurosciences.
Please mail your membership application and applicable fee to:
Jeanne Evans, Membership Chairperson, 25 Granlea Rd., North York, Ontario M2N 2Z6
For Office Use Only: ❏ Data Entry ❏ Treasurer ❏ Printer ❏ Card/Letter ❏ Councillor ❏ Package
❏ I do not wish to be included in the CANN Membership Directory.
The membership directory will include only your work address and phone number.
Canadian Journal of Neuroscience Nursing
Formulaire
d’adhésion
Année d’adhésion 1er mai au 30 avril
Année d’adhésion : ________________________
Membre no : ______________________________
Cochez les cases appropriées :
Type d’adhésion :
Langue de correspondance :
❏ Renouvellement ❏ Nouveau membre
❏ Générale
❏ Associé(e)
❏ Anglais
❏ Français
CSN(C):
CNA member:
Oui ❏
Oui ❏
Non ❏
Non ❏
Nom : _____________________________________________________________________________________________________
(écrivez en lettres moulées)
(nom)
(prénom)
Adresse personnelle : ________________________________________________________________________________________
(app. #)
(rue)
___________________________________________________________________________________________________________
(ville)
(province)
(code postal)
Employeur : ________________________________________________________________________________________________
Adresse d’employeur : _______________________________________________________________________________________
(unité de soins, département, clinique, etc.)
(adresse)
___________________________________________________________________________________________________________
(ville)
(province)
(code postal)
Titre : _____________________________________________________________________________________________________
No. de téléphone : (résidence) (_____) _____ - __________ (travail) (_____) _____ - __________ (poste) ______
(télécopieur) (_____) _____ - __________ (courriel) ______________________________________________________________
Renseignements généraux
Nombre total d’années en soins infirmiers : _______________ eu neurosciences : _______________ # Prov : ______________
Éducation (cochez le plus haut niveau d’études atteint) : ❏ Diplôme d’études collégiales ❏ Baccalauréat ❏ Maîtrise ❏ Doctorat
Domain de pratique : ❏ Pratique clinique ❏ Éducation ❏ Recherche ❏ Administration ❏ Étudiant
Clientèle (cochez une case) : ❏ Adultes ❏ Pédiatrie ❏ Les deux ❏ Aucune
Intérêts en sciences neurologiques (incluant intérêts professionnels) : ______________________________________________
___________________________________________________________________________________________________________
Expertise (postes antérieurs, compétences, etc.) : ________________________________________________________________
___________________________________________________________________________________________________________
Région/province (cochez la case appropriée)
❏ Colombie-Britannique ❏ Alberta
❏ Saskatchewan
❏ Manitoba
❏ Ontario (sud-ouest)
❏ Ontario (est)
❏ Ontario (Toronto)
❏ Québec
❏ Nouveau Brunswick ❏ Nouvelle Écosse
❏ Île-du-Prince-Édouard ❏ Terre-Neuve
S.V.P. faire votre chèque à l’ordre de l’ACIISN pour le montant approprié :
Cotisation de membre général : 75,00 $ OU Cotisation de membre associé : 65,00 $
Cotisation selon le type applicable:
$ _____________________
Montant total dû :
$ _____________________
Par membre général, on entend une infirmière ou infirmier autorisé(e) travailland activement dans le domaine des soins
infirmiers neurologiques et/ou neurochirurgicaux ou y étant activement affilié(e). Par membre associé, on entend un
personne qui exerce sa profession dans une discipline connexe aux sciences neurologiques ou qui s’intéresse au domaine des
soins infirmiers en neurologie et neurochirurgie.
Faire parvenir le tout par la poste à : Jeanne Evans, Responsable du comité de recrutemement de l’ACIISN,
25 Granlea Rd., North York, ON M2N 2Z6
Réservé à l’administration : ❏ Data Entry ❏ Treasurer ❏ Printer ❏ Card/Letter ❏ Councillor ❏ Package
Je désire que mes coordonnées paraissent dans le répertoire des membres de l’ACIISN ❏ oui ❏ non
Le journal canadien des infirmières et infirmiers en sciences neurologiques

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