Abstracts

Rationale: Adolescents with psychogenic nonepileptic seizures (PNES) experience many school, relationship, and health care struggles as they attempt to manage their condition with PNES events that resemble epileptic seizures. The school experience has been identified as a source of predisposing, precipitating, and perpetuating factors for PNES, with adolescents reporting learning difficulties, social concerns with friends, poor relationships with teachers, and poor school attendance as triggers for PNES-inducing stress. However, little is currently known about the school experience of adolescents with PNES and the role it may play in PNES management.

Methods: To better understand the context of school-related concerns, the authors conducted a qualitative content analysis using both inductive and deductive analysis methods. Purposive sampling was used to identify adolescents who self-reported video electroencephalogram-confirmed diagnosis and had experience attending school with PNES. Participants were recruited through flyers shared with school nurses via online listservs and family members who belonged to Facebook support groups for PNES. Semi-structured interviews with adolescents were conducted via Zoom videoconferencing platform. Recorded interviews were transcribed, reviewed, and coded. A template was created for each overarching theme, and data from transcripts were decontextualized into meaning units and advanced through levels of abstraction. The authors used magnitude coding to demonstrate certain themes' presence, intensity, or frequency.

Results: Ten female adolescents 12 to 19 years of age completed interviews and reported experiencing stress, bullying, accusations of faking seizures, and feelings of isolation or exclusion. Predominantly effective proactive self-management activities included seeking protection, persevering in life despite PNES struggles, and progress monitoring through seizure tracking. Reactive activities of mixed effectiveness included coping responses to seizure warnings. School nurses, school personnel, family members, and peers served as both facilitators and barriers for PNES self-management. Adolescents also contributed information for three emerging themes—family-management, school-management, and illness representation.

Conclusions: Findings revealed adolescents’ school experience was greatly affected by poor school-management but was tempered by positive experiences resulting from school connections with caring staff and peers and effective self-, family-, and school-management strategies. School nurses and other health care professionals can and do play a role in supporting all three levels of PNES management but could benefit from a greater understanding of PNES illness representation, potential school-based interventions that can further support adolescents’ self-management proactively and reactively, and legal literacy to prevent disability related discrimination.

Funding: Please list any funding that was received in support of this abstract.: Research described in this presentation was conducted while the first author was a Robert Wood Johnson Foundation Future of Nursing Scholars Fellow. Continued research is supported by Grant Number NRSA T32NR018407 from the National Institute of Nursing Research.