Abstracts

Rationale: Psychogenic non epileptic events (PNEE) are paroxysmal changes in behavior that resemble an epileptic seizure but have no electrographic correlate. PNEE are caused by psychological factors rather than an underlying medical etiology. Therefore, management of PNEE differs greatly from that of epileptic seizures. Seizure is the third most commonly reported school emergency, and school nurses are responsible for managing these events or directing other school staff in how to respond to these events. One of the greatest difficulties in the management of PNEE in children is the response to the events in the school setting. School nurses have been surveyed regarding management of epileptic seizures in school, but no studies have addressed school nurses' perceptions about the management of PNEE in schools. The aims of this study were to identify how school nurses perceive the experience of caring for a student with PNEE and to identify factors that are supportive and those that are barriers to the optimal management of PNEE in the school setting. Methods: Ten school nurses were interviewed via a phone call. Semi-structured in depth interviews were used to explore the nurses' experience with caring for a student with PNEE in their school. Interviews were recorded and transcribed. A content analysis was performed to identify themes in school nurses' experience with PNEE and factors that are supportive and those that are barriers to the optimal management of PNEE in schools Results: The nurses interviewed had a mean of 30 years of experience as a nurse and 15 years as a school nurse. Only 1 of the 10 nurses had heard of PNEE prior to having a student with the diagnosis in their school. Several themes were identified: a lack of awareness of the diagnosis by school nurses and staff leading to an initial impression that the student was "faking" the events; inadequate information provided by a health care provider about the diagnosis in general and specifically about the individual student; reliance on information from the student's family which may be limited by families' comfort levels with disclosing information about the psychological diagnosis, as well as their own understanding of how to treat the events; feelings of doubt and insecurity about the diagnosis and management of the events due to inadequate information; reliance on the school nurse to develop a response plan and to manage the events which can be very time consuming; and overall lack of information leading to high variability in management of PNEE . Conclusions: Additional resources and increased, open communication between schools and health providers regarding diagnosis and treatment recommendations are needed to increase awareness and to improve understanding and management of PNEE in the school setting. Access to a generalized response plan, which could be individualized for students, may contribute to school personnel comfort with management of PNEE, and more importantly, support student attendance. Funding: Funding was provided by a research grant from the Association of Child Neurology Nurses.