By Jennifer Larson, contributor
May 12, 2011 - According to a new study in the May 2011 issue of the journal Pediatrics, the school nurse’s office tends to be a haven for children who have been bullied, and for their aggressors.
Eric Vernberg, Ph.D., a professor in the child psychology program at the University of Kansas, and his fellow authors found that both groups of children tend to present to the school nurse for somatic complaints, illnesses and injuries more often than other students.
As a result, they recommended that health care providers be actively involved in screening and identification, as well as facilitating the appropriate kind of intervention.
Judith Vessey, PhD., RN, professor in nursing at Boston College, is a national expert on the issue of bullying.
Given their proximity to students, school nurses can play a particularly significant role in addressing bullying and its effects on children. They can lead prevention efforts, contribute to school-wide or district-wide anti-bullying programs, train faculty and staff members how to identify bullying and intervene, and work with individual students and their families.
“School nurses are really on the front line of being able to deal with this,” said Judith Vessey, Ph.D., RN, MBA, professor of nursing at Boston College in Massachusetts.
Students regularly designate the school nurse’s office as one of the safest spots in the school, especially when compared with places like the gym, the locker room or the playground, Vessey explained. Therefore, it makes sense that a student would feel safe turning to the nurse when they don’t feel well, for whatever reason.
Knowing there’s someone to talk to who also has the power to actually do something about the situation can be very reassuring for many children.
“The school nurse can be that person,” said Jon Lemich, program assistant for the National Association of School Nurses and a former teacher.
What does bullying look like? These three characteristics typify bullying:
1. It involves aggressive behavior that provokes negative reactions.
2. It’s repetitive over time (it doesn’t just happen once).
3. It involves a power imbalance of some sort.
The school nurse can be on the lookout for signs of those behaviors—or the effects on others--by monitoring absenteeism, logs of visits to the nurse’s office and other factors. And when addressing a student face to face, the nurse needs to make sure to ask the right questions to find out how the child is really feeling.
“I think it’s the question behind the question that you need to ask,” said Vessey, explaining that a nurse might ask a child who shows up with a playground injury why he was running and if he was running from someone or something.
It’s also important not to forget the new ways that children can target others now, using technology.
“It’s expanded in its forms of use because of the expansion of social media,” said Lemich, noting that many students carry a cell phone with them, giving them access to a wider range of online possibilities for bullying.
Mary Muscari, Ph.D., CPNP, associate professor of nursing at Binghamton University, recommends that parents monitor their children's online activities because of the rise of cyberbullying.
Mary Muscari, Ph.D., CPNP, associate professor of nursing at Binghamton University in New York, has written extensively about cyberbullying. She recommends that nurses learn about all the various communication methods used by students and ask questions about them when students demonstrate signs of being victimized.
“Determine how the [cyberbullying] is affecting them and validate their feelings,” she said.
School nurses can also teach children strategies for dealing with bullies who are using electronic forms of communication to be aggressive toward them. They can encourage students to delete unwanted emails without reading them, ignore text messages and report problems to their parents or teachers.
Additionally, Muscari said, nurses can also teach parents about ways to monitor their children’s virtual world and keep the lines of communication open with them so their children will feel comfortable telling them if they’re being bullied.
But there is a significant limitation to what a school nurse can do based on how much time the nurse actually spends in a school.
“If they’re there full time, they’ll have better opportunities” to mitigate bullying-related problems, noted Lemich.
But some states have very high student-to-nurse ratios, so many schools must share a nurse with a series of other schools. California is a notable example; the California School Nurse Organization recommends one school nurse per 750 students, or one nurse per school, but the actual ratio is three times worse than that with approximately one nurse for every 2,240 students.
Even on a part-time basis, a school nurse can still counsel students, monitor trends and work with teachers and parents. Vessey acknowledged that, by quoting an African proverb: “If you think you are too small to make a difference, try sleeping in a closed room with a mosquito.”
But given the time constraints, it’s also important that other health care providers be equipped to address bullying. A child’s regular nurse practitioner or pediatrician can also be useful when it comes to addressing bullying—or potential bullying.
“Prevention, early identification and treatment of aggressor-victim problems should be a priority for pediatric health care providers in promoting the mental and physical health of children,” wrote Vernberg, et. al.
Vessey agreed that it’s crucial for health care providers—and others—to get involved and intervene whenever bullying happens.
“We know that children who bully often grow up to be adults who bully,” she said. “And we know that children who are bullied may have difficulty reaching their full potential as adults.”
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