Epilepsy as a Long Term Condition

In this essay, I will be discussing Epilepsy as a Long Term Condition, the impact it has on my patient Mr J and the various Healthcare Professionals that enabled Mr J to gain a better understanding of his condition through shared decision making. I will provide a rationale for my chosen patient case and provide a conclusion which will help summarise what I have learnt and discussed about the Long Term Condition. In accordance with the NMC Code (2018), Mr J is a pseudonym used in order to maintain the privacy and confidentiality of the patient. “Fear, misunderstanding, discrimination and social stigma have surrounded Epilepsy for centuries. This stigma continues in many countries today and can impact on the quality of life for people with the disease and their families” (WHO, 2019). This essay will also enable me to explore the themes of this stigma further.

Before the Traumatic Brain Injury, Mr J was a healthy 28 year old man who competed in various Iron-Man events, marathons and had no past medical history. Mr J worked as a self-employed plumber and he was living with his friends. Mr J’s family lived abroad but he has a good support network of friends living in the UK. Mr J was rushed into A&E after an axe had penetrated part of his skull. Mr J presented to A&E with hypotension, loss of consciousness and confusion. Mr J was admitted to the ward for close monitoring and he was due to have a Decompressive Craniectomy surgery that would enable him to make his full recovery. During his time at the ward, he had suffered multiple seizures. Mr J was referred and seen by an Epileptic Specialist Nurse. Doctors later diagnosed Mr J with Epilepsy a few weeks after his admission. I chose Mr J due to the extent of his brain injury, his positive outlook even through his circumstance and he was one of the first patients I looked after that was diagnosed with Epilepsy after a Traumatic Brain Injury.

Epilepsy is a common condition that affects the brain and causes frequent seizures. Since Epilepsy is a disorder which affects the Central Nervous System, the effects of Epilepsy can be felt throughout the body. This is due to the unpredictability of the seizures (Watson, 2019). In Mr J’s case, he needed close observation at the ward due to the multiple seizures he had on a weekly basis and he was anxious as he would attempt to climb out of bed all the time. Mr J was not safe to stand as he had no bone flap and his lower limbs function were severely weak. Mr J required a 1:1 HCA special due to his confusion and as part of his best interest we had to keep him in bed. Mr J was GCS (Glasgow Coma Scale) 14 at the ward as he was not aware of where he was for a few weeks but he did obey commands as the weeks had progressed. Mr J’s memory and cognitive function were severely impacted.

Along with the Occupational Therapist, we encouraged Mr J’s friends to bring in old pictures and talk about memorable events which did help with his memory and speech over time. My role as a Trainee Nursing Associate was to observe Mr J’s vital signs every four hours due to his confusion, keep him in bed to avoid the risk of injury, encourage him with his nutritional intake and support with his medication management. Also, I would raise any concerns to the appropriate Multi-disciplinary team where necessary. For example, the Speech & Language Therapists advised the nurses to speak slowly and talk in short sentences so that it would give Mr J an opportunity to understand and reply to commands. I updated the Physiotherapists and Occupational Therapists on how Mr J was progressing with his day to day exercise routine and if he would recollect what he was doing. Furthermore, I noticed that Mr J would often feel fatigued and had multiple naps during the day. Due to this concern, I asked the nurse why this was the case and she had explained that it is part of the Traumatic Brain Injury and the Anti-Epileptic drugs Mr J was taking. During meal times, I made sure Mr J was fully sat upright, alert and would not feed him if he was drowsy to avoid the risk of aspiration.

Mr J’s lifestyle had a drastic change after he was diagnosed with Epilepsy. Mr J started a Ketogenic Diet which was suggested by the Epilepsy Specialist Nurse. The Ketogenic Diet which is a high fat, low carbohydrate and controlled protein diet has been used since the 1920s to treat Epilepsy. Mr J often said that he enjoyed this diet as he felt it would keep his weight healthy. Before his brain injury, Mr J would run at least 10km a day and did weight lifting. Mr J devised his own workout routine at the gym to keep him fit for the marathons he used to participate in. Due to the extent of his brain injury, the Physiotherapists created a workout plan which would enable Mr J to go back into a similar exercise routine he used to follow. The Ketogenic diet and workout routine made a positive effect in Mr J’s lifestyle as he felt that his needs were taken into account and he felt that he was well supported by the Multi-disciplinary Team.

However, Mr J had to find a new job and he was advised by the Neurosurgeons not to drive due to the Epilepsy and the Traumatic Brain Injury. These stressful events can often change seizure patterns so Mr J had to be cautious and he found that finding a new job would be difficult due to his brain injury. Though Mr J’s friends and family supported him financially which enabled Mr J to start an online business where he would later fully work from home. All of these factors contributed to Mr J’s full recovery and helped to manage his Epilepsy. A balanced diet, keeping physically active, sleeping well and finding ways to relax and manage stress helps reduce the number of seizures an individual has (Epilepsy Society, 2019).

The Multi-disciplinary Team that devised the care plan that ensured Mr J’s discharge home was safe, effectively built a therapeutic relationship with Mr J as he did not miss any appointments and would often contact the Epilepsy Nurse Specialist for any concerns he had. Mr J created a diary where he would note down any triggers that would cause his seizures and this enabled him to learn a lot more about his Long Term Condition and effectively manage his seizures. Also, the pharmacist ensured that Mr J understood the Anti-Epileptic medications he was taking and advised him to read on the medications and how it would affect his seizures. This ensured safe self-medication management. Mr J’s overall knowledge and wellbeing improved gradually on how to manage with his Long Term Condition and this helped reduce the number of seizures he would have.

Fear, misunderstanding, discrimination and social stigma have surrounded Epilepsy for centuries. This is due to lack of education, treatment and healthcare training provided with this Long Term Condition. The World Health Organisation recognises Epilepsy as a major public health concern. The fact that it is recognised as a major public health concern shows that there is an increasing rate of individuals living with Epilepsy today and there needs to be an intervention which would enable individuals to help manage with their Epilepsy. After further research, I have found that there is a Global campaign against Epilepsy “Out of the Shadows” that helps to raise an awareness about Epilepsy and provide better information that will help to reduce the impact of Epilepsy. This intervention by WHO will help to not only educate individuals living with Epilepsy but it will also help healthcare professionals to gain a better understanding of how this Long Term Condition affects their patient enabling them to provide better care and health promotion advise. All of these factors can help to dispel the stigmas that have been surrounding Epilepsy.

In conclusion, providing a person centred care plan helped Mr J to fully understand how his Epilepsy would affect his daily life. Building an effective therapeutic relationship with Mr J by making key shared decisions about his care and utilising the Multi-disciplinary health promotion advice given to him have all contributed to help Mr J manage with his Long Term Condition effectively. As a Healthcare Professional, I have learnt about the various interventions the multi-disciplinary team provided and made a positive impact on how I could help the next individual in my care with Epilepsy. This essay helped to break down the fear, misunderstanding, discrimination and social stigma that surrounds Epilepsy today by building an effective therapeutic relationship with an individual living with Epilepsy through shared decision making.