School-Based Suicide Prevention Efforts: The Impact of School Nurse Exclusivity on Moral Distress

School nurses are well-positioned to assess, identify, and refer children and adolescents who are at risk of suicide. This multiple-case study examined the personal, behavioral, and environmental factors that influence the role of the school nurse in youth suicide prevention and intervention. Purposive sampling was used to recruit two school nurses who were identified as unique cases. Data from interviews, surveys, and documents generated a cross-case analysis. Findings indicate that school-level exclusive practices, such as a lack of communication and collaboration, greatly influence the role and reach of school nurses. Further, dilemmas arising from environmental barriers hinder school nurse capacity to promote student safety and affect moral distress levels. Leveraging data to demonstrate the pivotal role of school nurses to support mental health equity and reduce disparities in youth suicide is crucial to developing inclusive and responsive suicide prevention programs.

A Qualitative Study of School Nurses' Experience of Secondary Trauma

This qualitative descriptive study explored school nurses' experiences of exposure to reports of trauma from those in their care. Online interviews of school nurses practicing in NJ, USA, were recorded and transcribed verbatim. The study found that school nurses were exposed to reports of others' trauma to varying degrees, with those serving in urban settings reporting more stories of exposure than those in suburban settings. Reports included numerous, layered traumas at the community and individual levels, including students' poverty-related adversity and psychological distress. Qualitative content analysis revealed four categories: Health Office as Safe Haven, Challenges Working Within the School Model, Things That We Hear: Reports of Trauma, and The Ripple Effect of Trauma. School-based challenges included a lack of collaboration, misunderstanding of the school nurse's role, and workload issues such as competing demands and limited time and resources. School nurses reported focusing on the individual's immediate needs and processing the experience afterward. They acknowledged they can only do so much, and shared stories of coping and resilience. Additional education, resources, and support in addressing student trauma can enhance the provision of school nursing services and support the well-being of school nurses, students, and staff. Further research is warranted with a larger and more diverse sample of school nurses, including attention to school nurse wellness and resilience strategies.

Determination of the relationship between depression and suicide in young adolescents

OBJECTIVE

This study was designed to explore the relationships between depression, and the likelihood of suicide among young adolescents by considering various factors.

DESIGN AND SAMPLES

It was conducted in a descriptive-cross-sectional format, with fieldwork spanning from November 16, 2022, to June 30, 2023. The study assessed the likelihood of depression, and suicide in young adolescents attending a university in Eastern Turkey.

MEASUREMENTS

Sociodemographic features survey form, Beck's Depression Inventory and Suicide Probability Scale were used to collect data.

RESULTS

The results from this investigation indicated that women, individuals with chronic illnesses, those with a history of psychiatric conditions, those expressing a constant desire to die, those with suicidal thoughts or plans, and those with a family member who had attempted suicide exhibited significantly higher mean scores for depression and suicide. There was a positive correlation between high depression scores and suicidal tendencies. However, no conclusive evidence of a link between depression, and suicide was established.

CONCLUSIONS

In this study, certain demographic and psychological factors were identified as correlating with elevated levels of depression and suicidal tendencies among young adolescents. It is imperative that individuals identified as being at risk be promptly referred to appropriate units for comprehensive interventions and support.

School Nurses' Perceived Role and Capacity to Support School Behavioral Health Programs in DC Public and Public Charter Schools

School nurses (SNs) practicing in DC public and public charter schools were surveyed to assess their perceived role and self-reported preparation to provide behavioral health prevention, early identification, and treatment services in schools. A total of 154 SNs completed a questionnaire about their role in the delivery of behavioral health services and supports. SNs reported they are primarily involved in the identification and referral of students to other school behavioral health professionals. Respondents also reported a lack of training in behavioral health and a desire for more information on related programs and services. This study offers recommendations for educating future SNs and highlights how the DC School Health Services Program utilized study findings to build capacity for SNs employed in practice. This study can help tailor educational opportunities for SNs to maximize their role in school behavioral healthcare process flows and ultimately improve outcomes for students and families.

School Nurse Leadership and the Implementation of School-Based Support for LGBTQ+ Students

In 2021, the National Association of School Nurses published an updated position statement affirming the unique position of school nurses to support the health and well-being of lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) students who are faced with a variety of health disparities rooted in experiences of stigma, discrimination, and bias. The 5-year cluster randomized controlled trial "Reducing LGBTQ+ Adolescent Suicide" leveraged school nurses as leaders to facilitate the uptake of six evidence-informed, LGBTQ-supportive practices in New Mexico high schools. We analyzed 5 years of interview data from 24 school nurses in 13 intervention schools to examine what factors impacted their ability to serve as an effective leader for this initiative. Several factors including job characteristics, leadership and organizational skills, relationships and reputation, and personal commitments emerged from analysis. Contextual factors, such as working in urban or rural school, and the size of the school also influenced nurses' leadership.

Adolescent suicide risk factors and the integration of social-emotional skills in school-based prevention programs

Adolescents are considered one of the most vulnerable groups affected by suicide. Rapid changes in adolescents' physical and mental states, as well as in their lives, significantly and undeniably increase the risk of suicide. Psychological, social, family, individual, and environmental factors are important risk factors for suicidal behavior among teenagers and may contribute to suicide risk through various direct, indirect, or combined pathways. Social-emotional learning is considered a powerful intervention measure for addressing the crisis of adolescent suicide. When deliberately cultivated, fostered, and enhanced, self-awareness, self-management, social awareness, interpersonal skills, and responsible decision-making, as the five core competencies of social-emotional learning, can be used to effectively target various risk factors for adolescent suicide and provide necessary mental and interpersonal support. Among numerous suicide intervention methods, school-based interventions based on social-emotional competence have shown great potential in preventing and addressing suicide risk factors in adolescents. The characteristics of school-based interventions based on social-emotional competence, including their appropriateness, necessity, cost-effectiveness, comprehensiveness, and effectiveness, make these interventions an important means of addressing the crisis of adolescent suicide. To further determine the potential of school-based interventions based on social-emotional competence and better address the issue of adolescent suicide, additional financial support should be provided, the combination of social-emotional learning and other suicide prevention programs within schools should be fully leveraged, and cooperation between schools and families, society, and other environments should be maximized. These efforts should be considered future research directions.

Hidden and unacknowledged: The mental health and psychosocial interventions delivered by school nurses in Western Australia

Schools are an important setting for the early identification, assessment and intervention of mental health problems in children and young people. Internationally, many nurses work in schools, but the role of this group with young people experiencing mental health problems has had only limited investigation. This study explored the activities school nurses undertook with young people experiencing mental health problems in Australia. Reporting was guided by the COREQ checklist. Thirty-one nurses participated in a semi-structured interview. Data were analysed using the constant comparative method of analysis as developed by Glaser and Strauss (1967). The findings identified that nurses working in schools undertake a complex and sophisticated workload to support this cohort. In addition to assessment and referral for treatment, interventions assisted young people to manage challenging life circumstances, cope with intensely difficult emotions and improve their social and occupational functioning. The work of school nurses with young people experiencing mental health problems is hidden and unacknowledged. A better understanding of the mental health work school nurses undertake can inform enhanced service provision for children, young people and their families. The research findings will be of interest to mental health nurses, education professionals, parents, policy makers and governments.

A descriptive cross-sectional study on eating disorders, suicidal thoughts, and behaviors among adolescents in the Valencian community (Spain). The pivotal role of school nurses

PURPOSE

The aims of this study were: 1) to describe the rates of risk of having an Eating Disorder (ED) and the rates of suicidal thoughts and behaviors, and 2) to examine the relationship between the risk of having an ED with suicidal thoughts and behaviors in adolescents enrolled in educational centers in the Community of Valencia (Spain).

DESIGN AND METHODS

A cross-sectional study was conducted with 718 adolescents between September 2019 and July 2020 in five schools in the Community of Valencia (Spain).

RESULTS

The adolescents studied, mostly females, are at risk of having an ED (18.6% to 30.8%) and experiencing suicidal thoughts (23% to 30.7%) and behaviors (2.2% to 6.2%). A strong association was found between EDs and suicidal thoughts and behaviors in both sexes. This association was higher in females with positive EAT-26 scores (OR: 2.09; 95% CI: 1.35-3.24) and in males with positive SCOFF scores (OR: 4.66; 95% CI: 2.40-9.02). Suicidal behaviors were positively associated with both EAT-26 (OR: 2.58; 95% CI: 1.17-5.67) and SCOFF (OR: 1.89; 95% CI: 1.21-2.26) scores in females.

CONCLUSIONS

A considerable number of adolescents, females in particular, are at risk of having an ED and of experiencing suicidal thoughts and behaviors, establishing a strong link between EDs and suicidal tendencies.

PRACTICAL IMPLICATIONS

The study highlights the importance of establishing national and regional regulations to ensure the availability of school nurses in the Community of Valencia (Spain). Collaboration between school nurses, educators, and policy makers is critical to the early detection of problems and the provision of support to both adolescents and families.

Adolescent Characteristics, Suicide, and Bullying in High School

Youth Risk Behavior Survey 2011-2017 data were examined for associations among high school population subsets who self-reported suicide risk behaviors and experiences with bullying. High-school students who reported suicidal risk behaviors were 4.64 times more likely to have experienced bullying electronically. Ninth grade and female students were more likely than others to experience suicide risk behaviors and bullying. At the interpersonal level, school nurses are able to identify students who are experiencing bullying and who exhibit suicide risk behaviors. At the systems level, bullying prevention efforts should target all students. School nurses, administrators, policy makers, and health providers should consider data-driven recommendations in bullying prevention programs.

The Evolution of the Role of U.S. School Nurses in Adolescent Mental Health at the Individual, Community, and Systems Level: An Integrative Review

School nurses are crucial to addressing adolescent mental health, yet evidence concerning their evolving role has not been synthesized to understand interventions across levels of practice (i.e., individual, community, systems). We conducted an integrative review of school nurse roles in mental health in the U.S. related to depressive symptoms, anxiety, and stress. Only 18 articles were identified, published from 1970 to 2019, and primarily described school nurses practicing interventions at the individual level, yet it was unclear whether they were always evidence-based. Although mental health concerns have increased over the years, the dearth of rigorous studies made it difficult to determine the impact of school nurse interventions on student mental health outcomes and school nurses continue to feel unprepared and under supported in this area. More research is needed to establish best practices and systems to support school nursing practice in addressing mental health at all levels of practice.

School Nurse Management of Behavioral Health, Violence, and Trauma-Related Emergencies: Findings from a Statewide Survey

School nurses are critical components of school-based interdisciplinary teams supporting student behavioral health. The purpose of the present study is to understand the extent to which school nurses in New Mexico across grade levels manage emergencies related to behavioral health, violence, and trauma. The study also seeks to identify which topics the school nurses received continuing education (CE) for, and which topics they consider to be important to their practice. Analyses of 2019 statewide survey data show a considerable number of school nurses in New Mexico provide management for behavioral health, violence, and trauma-related emergencies, and nurses in secondary schools are significantly more likely than nurses in primary schools to report managing these emergencies and to have received CE on behavioral health topics. Our findings reaffirm the essential role of school nurses in addressing emergent student health issues and underscore the need for practice- and competency-based behavioral health CE opportunities.

Preparing for the Impact of COVID-19 on the Mental Health of Youth

The COVID-19 pandemic is continuing to have long-term and global effects that the vaccine may not ease. Children and adolescents endured unprecedented periods of loneliness, social isolation, financial stressors, in-home conflicts, changes in living circumstances, and variable access to healthcare, resulting in increased mental health sequelae. Timely recognition of students’ anxiety, depression, and disruptive behaviors will allow appropriate interventions to de-escalate these feelings and prevent suicidal ideations and attempts. As youth return to school, their mental health needs will not subside. School nurses and the multidisciplinary team have a vital role in impacting this population’s already surging increase of mental and behavioral health disorders.