Frequent visitors: somatization in school-age children and implications for school nurses

Roadmap to recovery: Implemented and attitude toward school reopening strategies during the COVID-19 pandemic, a scoping review

The novel coronavirus disease 2019 (COVID-19) has had various financial and life impacts on the world's population. Schools' regular activity and function during the pandemic require balancing the repercussions of suspending in-person education versus health threats. Furthermore, children are one of the prominent victims of the restricted quarantine strategies' effects, which may make them vulnerable to various mental health problems. In this study, we reviewed previously reported strategies and roadmaps regarding the reopening of schools during the COVID-19 pandemic. The following databases were searched from October to December 2021, via multi-step search strategies for "COVID-19," "coronavirus," "school reopening," "roadmaps," "reopening," and "reopening strategies": Google Scholar, PubMed, Scopus, and Web of Science. A total of five papers with roadmaps focusing on reopening schools were included in this study. Fundamental issues and principles of these reviewed roadmaps were: 1) protecting the high-risk students and staff physically and mentally, 2) accelerating the vaccination of essential workers, staff, parents, and students, and 3) improving the COVID-19 testing capacity. Roadmaps for the reopening of the schools should describe some phases and steps for their strategies. Current roadmaps have not mentioned any phases and timelines for this process. Describing some health metrics in the roadmaps for progressing to the next step or returning to the previous ones is also necessary for all roadmaps and should be considered in further studies.

Problematic smartphone use and functional somatic symptoms among adolescents: Mediating roles of depressive symptoms and peer relationships by gender

This study explored the relationship between problematic smartphone use and depressive symptoms, peer relationships, and functional somatic symptoms with a representative sample of Korean male and female adolescents using serial multiple mediation models. The results identified the mediating effect of depressive symptoms and peer relationships for males in the association between problematic smartphone use and FSS. The serial mediating effect of the two mediators was also verified in the model for males. However, in the model for females, only depressive symptoms mediated the relationship between problematic smartphone use and FSS. The findings suggest that parents and professionals should assess adolescents with problematic smartphone use for the risk of FSS when depressive symptoms develop. Schools should also provide programs to build positive peer relationships to reduce FSS.

Time trends in treated incidence, sociodemographic risk factors and comorbidities: a Finnish nationwide study on anxiety disorders

BACKGROUND

There has been a lack of research about the time trends and socio-demographic risk factors for children and adolescents who receive treatment for anxiety disorders. This study aimed to fill these gaps in our knowledge by examining a nationwide sample of Finnish children and adolescents diagnosed in specialized healthcare settings.

METHODS

This study comprised national register data of all singleton children born in Finland from 1992-2006 who were diagnosed with anxiety disorders from 1998-2012. The changes in time trends in incidence were studied by dividing the study sample into three cohorts by birth years: 1992-1996, 1997-2001 and 2002-2006, who were followed up until the age of 20, 15 and 10 years, respectively. The 22,388 individuals with anxiety disorders were age and gender matched with 76,139 controls from the general population. Logistic regression was used to examine the socio-demographic risk factors and anxiety disorders in the entire sample. Comorbid disorders were examined in the oldest birth cohort (1992-1996 born).

RESULTS

Comparing the 1992-1996 and 2002-2006 cohorts showed that the cumulative incidence of treated anxiety disorders at the age of 10 increased from 0.3 to 1.2% among females and 0.46 to 1.9% among males. Subjects had higher likelihood for being diagnosed with an anxiety disorder if their mothers had low maternal socio-economic status class at birth (OR 1.53, 95% CI 1.45-1.61) compared to higher SES class, and marital status was single at the time of birth (OR 2.02, 95% CI 1.87-2.17) compared to married or in a relationship. They had lower risk of anxiety disorders diagnosis if born in rural (OR 0.82, 95% CI 0.79-0.86) or semi-urban areas (OR 0.79, 95% CI 0.76-0.82) when compared to urban residence. There was a wide range of psychiatric comorbidities, and unipolar depression was the most common (31.2%).

CONCLUSION

Anxiety disorders diagnosed by specialized Finnish services increased from 1998-2012 in both genders. This could indicate a real increase in overall anxiety disorders or an increase in treatment seeking. The findings on maternal socioeconomic status and single parenting improve the recognition of the environmental risk factors for anxiety disorders among children and adolescents.

Impact of Bullying and Facts on Victims in Elementary Schools

Background: Bullying is a serious problem for the mental health development of school-age children. Few studies in Indonesia have reported how the impact of bullying causes children to experience stress and difficulty in building social relationships. Aim: This study aimed to determine the impact and phenomenon of becoming victims of bullying in elementary schools in Indonesia.  Methods: This research used a mixed-method approach with a sequential explanatory design. The sampling technique used multistage random sampling. The sample population included 617 elementary school students who are in grades 4, 5, and 6. The quantitative data analysis used structural equation modeling (SEM) while the qualitative data analysis was based on the results of SEM analysis. Results: The impact of bullying on victims is stressful and symptomatic. The victims revealed they became depressed, had poor performance, had difficulty in socializing, did not dare to report fear of being ostracized, feared they would become the next victim, and was advised by the teacher not to reply, be patient, and just let it go. As a result, the victims complained they felt ugly, ashamed among friends, and reluctant to attend the class. Teachers consider bullying as ordinary delinquency because the victim can recover without help, think it is normal, or it was just a joke so there is no need for special rules. Conclusion: Bullying of elementary school students has a negative impact on their mental health and causes psychosocial problems. There is a tendency to become repeated victims, while the ambivalence of teachers makes victims more vulnerable to bullying.

The Impact of Education and Implementation Tools on Pre-Service Teachers' Attitudes About Classroom-Based Mindfulness

A growing body of research suggests that incorporating classroom-based mindfulness interventions in elementary schools can lead to improvements in student behavior, self-regulation, and measures of mental health and wellness. This quality improvement project explored the impact of an educational intervention on pre-service teachers' perceptions, attitudes, and intentions to implement mindfulness interventions in their classrooms. A brief educational intervention and website resource were provided to multidisciplinary teaching credential students. Participants completed a pre- and post-intervention survey to evaluate their intentions to implement mindfulness practices, as well as their perceptions about the acceptability, reasonableness, and effectiveness of incorporating mindfulness interventions in the classroom. Significant differences in pre- to post-intervention survey scores indicate that exposure to mindfulness concepts, practices, and resources may increase the willingness of pre-service teachers to adopt these practices in their classrooms.

A Philosophical Review of School Nursing Framed by the Holistic Nursing Theory of Barbara Dossey

This article is a philosophical review of school nursing and its constructs framed by Barbara Dossey's holistic nursing theory. The author describes the application of holistic nursing theory within the school nurse's area of activity. The review suggests that holistic nursing theory can be applied in several areas of school nursing. School nurses have a multifaceted occupation that includes meetings with students, parents, and school staff. Barbara Dossey's holistic nursing theory offers the school nurse tools to deal with people's varied experiences, feelings, and needs.

U.S. School Nursing Job Analysis

The complexity and demands of the school nurse role have changed greatly over time. Our aims included determining tasks and knowledge relevant to modern school nursing in the United States, identifying continuing education needs of school nurses, and describing anticipated changes to the professional role. A secondary analysis of a cross-sectional web-based survey of 750 school nurses was performed. The study team evaluated calculations of mean importance and frequency for school nursing task and knowledge statements. Conventional content analysis was used to analyze open-ended responses. School nurses rated most tasks and knowledge as relevant to practice, underscoring the great depth and breadth of education and training school nurses need to meet the demands of students today. The results of this secondary analysis may be leveraged to accurately describe the school nurse role, advocate for nursing services, and support school nurses as they strive to better the health of school communities.

Development of the Help Overcoming Pain Early (HOPE) Programme Built on a Person-Centred Approach to Support School Nurses in the Care of Adolescents with Chronic Pain-A Feasibility Study

Chronic pain and its consequences are major global health challenges, and the prevalence is increasing worldwide among adolescents. Adolescents spend most of their waking hours in school; however, there is limited research available on how school nurses can address chronic pain among adolescents in the Swedish school context. Therefore, we designed a person-centred intervention, known as Help Overcoming Pain Early (HOPE), to enable school nurses to offer adolescents strategies to manage their stress and pain. We used the Medical Research Council (MRC) framework for developing and designing this new complex intervention. For this study, we describe two of the four phases: (a) development and (b) feasibility and piloting. The final version of the HOPE programme consists of (i) an educational package for school nurses in the areas person-centred care, stress and pain education/management and gender perspective; and (ii) an intervention package for adolescents with chronic pain. The programme consists of four sessions during which adolescents with chronic pain have person-centred dialogues with a school nurse. The HOPE programme is based on the existing evidence of managing chronic pain and on the assumption that school nurses can support adolescents with chronic pain by using person-centred care.

Recurrent Pain and Academic Achievement in School-Aged Children: A Systematic Review

Recurrent pain and school failures are common problems in children visiting the school nurses office. The overall aim of the current study was to investigate the relationship between recurrent pain and academic achievement in school-aged children. Literature was searched in seven electronic databases and in relevant bibliographies. Study selection, data extraction, and study and evidence quality assessments were performed systematically with standardized tools. Twenty-one studies met the inclusion criteria and 13 verified an association between recurrent pain (headache, stomachache, and musculoskeletal pain) and negative academic achievement. Two longitudinal studies indicated a likely causal effect of pain on academic achievement. All studies had substantial methodological drawbacks and the overall quality of the evidence for the identified associations was low. Thus, children’s lack of success in school may be partly attributed to recurrent pain problems. However, more high-quality studies are needed, including on the direction of the association and its moderators and mediators.

The Relationship Between Reported Pain and Depressive Symptoms Among Adolescents

Pain and depressive symptoms are common reasons for adolescents to contact the school nurse. The aim was to describe the prevalence of pain (headache, abdominal pain, and back pain) and depressive symptoms among adolescents and to examine whether there is an association between pain and depressive symptoms. This cross-sectional survey included students (N = 639) in Sweden (median age: 16 years). Over half of the female participants (56%) and one third of male participants (33%) had weekly headaches, abdominal pain, or back pain. Almost every second girl (48%) and one in four boys (25%) had depressive symptoms (as measured by the Center for Epidemiological Studies Depression Scale, scores ≥ 16). There was a significant association between having pain (headache, abdominal pain, or back pain) and having depressive symptoms. It is of great importance for school nurses to adequately identify and treat the cause of pain and other factors contributing to depression.

Victimization by Bullying and Physical Symptoms Among South Korean Schoolchildren

This study examined the relationship between victimization by bullying and physical symptoms among South Korean schoolchildren. Data were analyzed from a nationally representative sample of 2006 schoolchildren across South Korea aged 9-17 years. Multiple logistic regression analysis was used to estimate the associations between victimization by bullying and physical symptoms in the children. Schoolchildren bullied 4 or more times by peers in the previous year were approximately 3 times more likely to report recurrent stomachache or dizziness and twice as likely to report headache and sleep difficulties than students who were never victimized by peers. These risk estimates were calculated by controlling for confounding variables. School nurses, teachers, and school counselors or school social workers should consider frequent physical symptoms (headache, stomachache, dizziness, and sleep difficulties) as potential indicators of victimization through bullying and then provide prompt intervention and support using a multidisciplinary approach when harm is confirmed.

Depression Screening in the School Setting: Identification of the Depressed Adolescent

Adolescent depression is a silent epidemic in this country. Untreated depression has detrimental effects on physical health, psychosocial well-being, and academic productivity. It is important for school nurses to be able to recognize depression and refer students promptly for treatment. This article and its associated learning module will provide school nurses with updated information on adolescent depression, discuss barriers in depression screening, use of the PHQ-9 (Patient Health Questionaire-9 Item) as an evidence-based depression screening tool in the educational setting, and the important role of school nurses in depression screening. It is anticipated that by increasing awareness and knowledge about adolescent depression and providing training in the use of an evidence-based screening tool, school nurses will have greater confidence in identifying and referring students in need. (A free online depression screening education module developed by the lead author is available at https://sites.google.com/view/depressionscreeningtraining .).

How school nurses experience and understand everyday pain among adolescents

Background

Pain problems are a rapidly growing health problem found among both children and adolescent, and about 15–30% have reported chronic pain problems. School nurses in Norway meet adolescents with various ailments, including pain. Yet research on how school nurses perceive the pain experienced by adolescents is limited. The aim of the present study was to explore how school nurses explain and experience the everyday pain of adolescents.

Method

A qualitative study with an explorative design comprising five focus group interviews. Each group consisted of three to five school nurses. Seventeen female school nurses in five junior high schools in Norway, age range 29–65 years participated. To cover the issues a semi structured interview guide was used. The transcribed text was analysed with qualitative content analysis.

Results

The experience of school nurses with adolescents’ pain in everyday life is mainly that pain is a social, physical, and psychological phenomenon. School nurses experienced that everyday pain is reflecting: 1) high expectations, 2) difficult relationships and traumatic experiences and 3) an unhealthy lifestyle. School nurses have ambivalent attitudes to medicalisation of pain.

Conclusion

Despite of a biopsychosocial understanding of pain, the school nurses maintained referral practice of medical examinations, with the results that many adolescents became shuttlecocks in the health system. Although the school nurses´ were sceptical of the tendency towards medicalization in society, it appears that they actually help maintain this tendency.

Clinical Presentation of Acute Gastroenteritis in Children With Functional Abdominal Pain Disorders

Visceral hypersensitivity and abnormal coping are common in children with functional abdominal pain disorders (FAPDs). Thus, it would be expected that children with visceral hypersensitivity would report more pain if their gut is acutely inflamed. The aim of the study was to compare clinical symptoms and somatization of children with and without FAPDs at time of an episode of acute gastroenteritis. Seventy children with acute gastroenteritis and their parents completed the Rome III Diagnostic Questionnaire for Pediatric Functional GI Disorders and the Children's Somatization Inventory. Twenty-one percent of children were diagnosed with an FAPD. Children with FAPDs showed significantly more nongastrointestinal somatic symptoms than children without FAPDs. There were no significant differences in abdominal pain, nausea, vomiting, or school absenteeism between both groups at time of consultation.

The effect of psychological state and social support on nail-biting in adolescents: An exploratory study

Nail-biting is one of the most common behavioral problems in children. This study aimed to examine factors affecting nail-biting among adolescents and the effects of psychological state and social support on nail-biting. This cross-sectional study was conducted between January and May of 2014 in seven schools in Istanbul ( N = 724). Data were collected using the Personal Information Form, Brief Symptom Inventory, and Child and Adolescent Social Support Scale. This study found that 48.2% of adolescents in the 11- to 17-years-old age group had a habit of nail-biting. Anxiety, depression, negative self image, somatization, hostility, and three global index scores of adolescents who bit their nails were significantly higher than in those who did not. Social support scores of those who bit their nails were significantly lower than in those who did not in the ‘mother’ and ‘classmates’ subscales and total scores. Psychological state and social support were factors affecting nail-biting among adolescents.

Arab American Adolescents’ Perceived Stress and Bullying Experiences: A Qualitative Study

In 2012, 20% of high school students were bullied in the United States. Bullying is more prevalent among minority populations. Arab American adolescents receive little research attention and are described as the invisible population. This descriptive qualitative study was conducted with 10 Arab American adolescent bullying victims to describe their bullying experiences and related stress. In addition to being bullied because of health problems or social disadvantages, Arab American adolescents reported that they were bullied because of their ethnic/racial background and religious affiliation. Victims described high stress levels and anxiety which compromised their ability to function. They reported feeling sad, angry, overwhelmed, helpless, and hurt when they were bullied. They also lost control over their lives and self-confidence. Family and friends were sources of support but school administrators and teachers were not supportive. Implications for practice and future research were discussed.

School Nurses' Experiences in Dealing With Bullying Situations Among Students

School nurses have an important role in helping students to deal with bullying. However, most of the previously undertaken studies do not have nurses as the subjects, considering their experiences around this theme. This study used a qualitative approach through in-depth interviews with 12 school nurses (SNs). The thematic analysis was employed and supported by NVivo 10 software. Five main themes arose from the analysis: (1) understanding about bullying, (2) how they identified bullying, (3) strategies, (4) support at the workplace, and (5) SNs' role. SNs have a reasonable knowledge about this issue and are capable of helping students through dialogue. However, there is a need to be trained and have more time to be able to give proper help to the students, also using other different strategies. SNs must work more actively on this issue with schools and be supported in terms of staff numbers.

Connecting Students to Mental Health Care: Pilot Findings from an Engagement Program for School Nurses

Schools function as the major provider of mental health services (MHS) for youth, but can struggle with engaging them in services. School nurses are well-positioned to facilitate referrals for MHS. This pilot study examined the feasibility, acceptability, and preliminary efficacy of an engagement protocol (EP) designed to enhance school nurses' utilization of evidence-based engagement practices when referring youth to MHS. Participants were six school nurses and twenty-five adolescents in a large, urban school district. School nurses reported positive attitudes towards the EP, suggesting that they found it feasible and acceptable. Though there were small increases in school nurses' use of engagement practices and in adolescents' readiness for services following training, due to limited sample size, differences were not statistically significant. Still, pilot results suggest preliminary efficacy of training school nurses to strategically implement evidence-based engagement practices to increase adolescents' engagement in MHS.

Characteristics of medically hospitalized pediatric patients with somatoform diagnoses

OBJECTIVES

To describe demographic, diagnostic, and psychosocial characteristics of medically admitted patients diagnosed with somatoform disorders.

METHODS

Retrospective chart reviews were performed for pediatric patients (ages 3-18 years) seen by the Psychiatry Consultation Service in 2010 and 2011 on inpatient medical/surgical units and diagnosed with somatoform disorders. Data included demographic information; patient medical history, physical symptom characteristics, and service utilization; psychiatric diagnoses, history, and comorbidities, patient temperament, and coping style; family characteristics; and academic and social characteristics.

RESULTS

Mean age for the 161 identified patients was 14.4 years. The majority of patients were female (75%) and white (73%). Chief physical symptoms were pain (58%) and neurologic symptoms (40%); 73% of patients had medical diagnoses, and 66% had a history of prior psychiatric treatment. The most common somatoform diagnoses, using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, were pain (50%) and conversion disorders (28%). Psychiatric comorbidities were predominantly mood and anxiety disorders (42% and 29%, respectively). Mean hospitalization length was 4.9 days, with 14% of patients readmitted with psychiatric reinvolvement during the study period. Patients had sensitive temperaments (80%) and internalizing coping styles (76%) and were described as "good children" (72%). School absences (55%), academic pressures (51%), and learning difficulties (36%) were reported.

CONCLUSIONS

Clarifying the prevalence and nature of such characteristics can help pediatric providers improve patient care and minimize unnecessary medical interventions with early detection of risk for somatoform processes, provision of psychoeducation for patients and families, and early referral to mental health clinicians.

Visiting again? Subjective well-being of children in elementary school and repeated visits to school health nurses

BACKGROUND

Children with vague complaints are without chronic illness, and who repeatedly visit the school nurse may be at risk for limited academic success. This study compares student reports of subjective well-being between children who do and do not repeatedly visit the school nurse with vague complaints.

METHODS

Children in grades 4 through 6 completed the School Well-Being Profile-American English (SWBP-AE), a questionnaire with 4 well-being subscales: health status, school environment, social relationships, and school as a means of self-fulfillment. School nurses extracted data on clinic visits from clinic records. Logistic regression explored associations between well-being subscales and repeated visits to the school nurse.

RESULTS

Of the 320 students participating in the study, 33 (12.04%) students made repeated visits to the school nurse. Perception of health status (OR = 2.072; 95% CI = 1.037, 4.163) was the only significant (p < .05) predictor of repeated visits to the nurse.

CONCLUSION

Children with poor perception of their health status are more likely to repeatedly visit the school nurse. Children's perceptions of their school environment, social relationships, or school as a means of self-fulfillment are not statistically significant predictors of repeated visits to the school nurse.

Neurological and biological foundations of children's social and emotional development: an integrated literature review

This article provides an integrated review of the expert literature on developmental processes that combine social, biological, and neurological pathways, and the mechanisms through which these pathways may influence school success and health. It begins with a historical overview of the current understanding of how attachment relationships and social environments influence brain development and plasticity and are, therefore, central to the physical and mental health of individuals and populations. It then expands on the effect of plasticity in relation to behavior and learning at school. This article concludes with a discussion of the role the school nurse may play in supporting health and learning by recognizing signs of relational stress and by advocating for prevention strategies.

Children's social/emotional characteristics at entry to school: implications for school nurses

Children entering school need to build healthy peer relationships; school, however, is the central place for bullying. School nurses have a growing focus on providing care for students with social, emotional and behavioural problems. We examined the relational development of children at school entry in regard to aggression and empathy, showing that teacher-reported aggression decreased between Pre-primary and Year One, while empathy increased between Year One and Year Two classes. No gender difference was found in teacher-reported total, or covert aggression. Understanding how development of empathy can be supported in children at school entry is important, thereby supporting development of pro-social behaviour and decreasing bullying. School nurses must understand the importance of surrounding children with safety in relationships as they begin school.

Identifying Symptoms of Depression and Anxiety in Students in the School Setting

Early detection of mental health problems in school-age children offers the opportunity for prompt referral to treatment which is critical to their success in school. School nurses are in a key position to screen for mental health issues in the school setting. This article discusses how school nurses began a new initiative to use two validated screening tools, the Patient Health Questionnaire–9 item for detecting depression and the 5-item Screen for Child Anxiety Related Emotional Disorders for detecting anxiety in middle school/high school-aged children in selected urban schools. Students having positive screens were referred to the multidisciplinary school-based Student Assistance Program team for further evaluation and referral. These screens improved the identification and referral for treatment of children suffering from anxiety and/or depression by expediting the connection to services.

Calming and coping strategies for the school nurse's new year: using mind-body concepts

The school nurse is often sought out by students because he or she has an ability to listen to the student, offers an intervention that focuses attention on the student, and allows the student to experience her or his symptom in a new way. Helping the student to change the way the symptom is experienced, shifting focus, and adapting to a new awareness are all ways of using mind-body concepts. Many states' Boards of Nursing Registration have developed rulings expanding the scope of practice to include mind-body interventions. This article will explain three such interventions applicable to the school nurse setting: breathing exercises, mindfulness practices, and the use of imagery.

Connecting with frequent adolescent visitors to the school nurse through the use of intentional interviewing

Nurses as accessible, helping adults within schools have daily opportunities to reach adolescents with unmet mental health needs. Understanding the relationship between frequent clinic visits or somatic complaints as a sign of underlying problems, which may be organic or psychoemotional in origin, requires the unique skill set of the school nurse. The welcoming school nurse, who cares for students with acceptance and emotional availability, nurtures the development of trust and meaningful personal connection. It is through this relationship that effective care and case finding occurs. Attachment to the school nurse as a responsive adult fosters a sense of school connectedness, which is associated with academic success. Intentional Interviewing is a person-centered, evidence-based approach that can be used by school nurses in this important work.

Understanding and identifying the child at risk for auditory processing disorders: a case method approach in examining the interdisciplinary role of the school nurse

Despite receiving increased professional and public awareness since the initial American Speech Language Hearing Association (ASHA) statement defining Auditory Processing Disorders (APDs) in 1993 and the subsequent ASHA statement (2005), many misconceptions remain regarding APDs in school-age children among health and academic professionals. While many disorders account for why a child has difficulty understanding auditory content, this article will provide an overview of the history of APDs, current clinical presentations, distinguish between the common and often coexisting disorders seen in school-age children, and discuss how an audiological evaluation is used to detect the presence of APDs. Using a case method approach, a clinical case scenario describing the elusive nature of APDs, the importance of comprehensive audiological testing, and the interdisciplinary role of health professionals, with emphasis on the distinct role of the school nurse will be highlighted.

Adolescents with depressive symptoms and their challenges with learning in school

We examine school performance among 83 adolescents at risk for major depression. Negative mood interfered with subjective measures of school performance, including ability to do well in school, homework completion, concentrate in class, interact with peers, and going to class. No significant relationships were found for mood and objective measures of school performance (school attendance, English, and Math grades). Students with a college-educated parent had stronger performance in objective measures (school attendance and Math grades), whereas males had lower English grades. In qualitative interviews, adolescents reported that negative thinking led to procrastination, which led to poor school performance, which led to more negative thinking. Adolescents with depressive symptoms that do not meet the threshold for referral report struggles in school. Understanding the specific challenges faced by adolescents with even low levels of depressive symptoms can help school nurses, teachers, and parents identify appropriate interventions to help adolescents succeed in school.