Abstracts

Rationale: Patients with Psychogenic Nonepileptic spells (PNES) have generally poor outcomes and many patients fail to engage in recommended treatments. Negative healthcare provider perceptions have been implicated as a barrier to patient engagement in treatment recommendations for PNES. Illness perception of these patients has been evaluated from the perspective of physicians across multiple settings, but nursing perceptions have not previously been well-studied despite the close interactions that nurses have with these patients. Methods: The sample consisted of nurses who routinely care for patients with a diagnosis of PNES confirmed via video EEG correlation. Data were collected using voluntary sampling of inpatient neurology nurses using written surveys including the Illness Perception Questionnaire-Revised (IPQ-R) and a modified version of Shneker & Elliot's Pseudoseizure Questionnaire (PQ). Primary data points were focused upon nursing perception, knowledge, and self-perceived competence in caring for patients with PNES. A standardized intervention utilizing a Powerpoint presentation on diagnosis, communication of diagnosis, and common misconceptions in PNES followed within 30 days. Nurses were then immediately presented with the original pre-intervention questionnaires (IPQ-R and PQ) following the intervention, and gathered data were analyzed against the existing pre-intervention responses. Results: Nurses who successfully completed the pre-intervention questionnaire, structured intervention, and post-intervention questionnaire were included within the study (n = 35). Prior to intervention, 33% of nurses surveyed felt patients were voluntarily producing their symptoms, which fell to 0% post-intervention (p=0.00). Initially nurses failed to recognize the need for video EEG correlation in successful diagnosis of PNES (59%), which rose significantly (86%) following intervention (p=0.002). Nurses also better endorsed the appropriateness of discontinuing anticonvulsants once PNES was diagnosed (55% pre-Intervention vs 83% post-Intervention) (p=0.007). Self-perceived competence in caring for patients with PNES also increased significantly following structured intervention. Conclusions: The close interactions that nursing staff have with PNES patients provide an opportunity for therapeutic communication and health promotion. This study uncovered evidence of deep-seated misconceptions regarding the disease state of Psychogenic Nonepileptic spells, which may potentially impair nursing interactions with patients suffering from PNES. Significant improvements following a formal nursing staff educational intervention were noted across a wide range of attitudes and knowledge as they pertain to PNES. Self-reported competence in caring for these patients followed, potentially a reflection of improved knowledge of the PNES disease state. The results of this study suggest the need for structured educational interventions for nursing staff regarding the PNES disease state, in order to improve the care of patients with documented PNES. Funding: OhioHealth compensated staff nurses at their established hourly rate for time spent in study participation.