Telementoring Program Linked With Improvement in Epilepsy Care Among School Nurses

Telementoring using the ECHO methodology was shown to be feasible for school nurse education in the management of epilepsy among students with seizures, with improvements observed for psychosocial aspects of care, comorbidities, and nonepileptic events. Findings were published recently in Epilepsy & Behavior.

As the most common childhood neurologic disorder with approximately 6 out of 1000 affected students in the United States, epilepsy is a known risk factor for comorbidities, both physical and psychosocial, which warrant specialized education services and care coordination.

In the school setting, school nurses play a critical role in delivering front-line health care services and are responsible for managing seizures and addressing seizure-related concerns, including comorbidities and academic accommodations, and training other school personnel.

“Epilepsy-focused training for school nurses has been demonstrated to increase nurses’ confidence levels in managing and supporting students with epilepsy and seizures. However, these programs have limitations,” said researchers.

“Most school nurse online seizure training modules and webinars are not interactive. Thus, opportunities are limited for nurses to ask a question about a child who has difficult to manage seizures or comorbidities or to discuss challenges with their peers.”

To address these educational gaps in epilepsy, a telementoring program for school nurses, called Managing Students with Seizures ECHO: The Importance of School Nurses (MSS ECHO), was developed by the American Academy of Pediatrics National Coordinating Center for Strategic Approaches to Improving Access to Quality Health Care for Children and Youth with Epilepsy in partnership with the Epilepsy Foundation’s (EF) National Epilepsy Education and Awareness Collaborative.

The project applies the ECHO (Extension for Community Healthcare Outcomes) model, an evidence-based telehealth and telementoring program that uses video conferencing technology to connect health care providers with specialists.

The ECHO model provides “a combination of didactic and deidentified case-based presentations to foster an ‘‘all teach, all learn” approach to strengthen health care professionals’ knowledge and self-efficacy of various health conditions,” explained the study authors.

They sought to assess the feasibility of adapting the school nurse education program to the ECHO model, as well as examine the impact of the telementoring program on school nurse knowledge and self-efficacy for managing epilepsy in students with seizures. User satisfaction, resource use, and impact on practice was also assessed.

“The EFs educational program for school nurses was adapted to the ECHO model and delivered by a team of interdisciplinary epilepsy specialists via videoconferencing,” said the study authors. “Retrospective post-program surveys were administered at program completion.”

The implementation and results for the first 2 years of the MSS ECHO model was evaluated in the analysis. In year one (Y1), 8 one-hour sessions were offered every 3 weeks starting February 2019 through June 2019, and based on the Y1 participants’ evaluation, the year 2 (Y2) program,  offered from October 2019 through April 2020, was lengthened to 10 sessions to include content requested by Y1 participants and to reflect updates in epilepsy care.

The retrospective post-program surveys comprised of items to gather participant demographics, assess program experience, and assess knowledge and confidence to manage epilepsy and associated comorbidities and use seizure training materials. Knowledge, confidence, and use of seizure training materials both prior to and at the conclusion of MSS ECHO was examined.

A total of 166 school nurses from 15 states participated in Y1 and Y2 combined, of which post-program surveys were returned by 42 participants (17 in Y1, 25 in Y2), resulting in response rates of 35.4% and 21.2%, respectively. Ten of the participants were excluded due to incomplete data leaving 32 responses for data analysis.

The majority of participants were registered nurses, female, had a bachelor’s degree or higher, had more than 15 years of experience as a school nurse, and served schools in suburban or rural areas.

Findings showed that a majority of survey responses from school nurses reported improvements in knowledge and confidence. The highest improvements in self-reported knowledge and confidence were shown to be in psychosocial aspects of care, comorbidities, and recognition of nonepileptic events.

Furthermore, over 90% of the participants (n = 32, 16 each year) agreed or strongly agreed they were satisfied with the training, that participation in this program was a valuable use of time, and that their understanding of the subject matter improved. Over two-thirds reported feeling less isolated and over 50% reported intent to change their current practice or procedures in their school.

“Findings suggest that attending the MSS ECHO provided an educational and meaningful learning experience,” concluded researchers. “The gains in knowledge and confidence in psychosocial aspects of epilepsy care and comorbidities highlight the importance of the inclusion of this content in educational programs.”

Reference

Schultz RJ, Schultz PO, Owens S, Kakacek J, Farrell K. Project ECHO telementoring program in epilepsy for school nurses. Epilepsy Behav. 2023 Feb 11;140:109114. doi:10.1016/j.yebeh.2023.109114