As a middle school nurse for Chatsworth Avenue School in Larchmont, N.Y., Terese Carey, RN, BSN, NCSN, cares daily for children who come to her office complaining of stomach aches and headaches. But once at her office, many tell her their complaints stem from a fear of being bullied or that they feigned illness to avoid a bullying situation.
Though rarely treating physical injuries from bullying, Carey says treating her patients? emotional wounds is just as important. ?Bullying affects the child emotionally and physically, so you have to take care of the whole child,? says Carey, a school nurse for more than 13 years. ?You need to have a holistic approach ... because if you don?t take care of the emotional [wounds], forget about the physical [well-being of the child].? Many times emotional wounds are contributing to their physical complaints.
According to the U.S. Department of Health and Human Services, bullying is physical harm, such as punching and shoving, spreading rumors, social isolation, teasing people in a mean way, and ganging up on others. Given the prevalence of bullying in society ? a 2005 study by the National Center for Education Statistics reported that 14% of 12- to 18-year-olds had been bullied six months before being interviewed ? Carey and other bullying-prevention advocates hope nurses become more aware of bullying and assume responsibility for tending to children who are at risk.
?Our job is to protect anyone in our care, and you can?t do that unless you?re protecting these children from bullying,? Carey says, adding she often is the first person a child confides in after a bullying incident.
The trusting relationship nurses foster with their pediatric patients gives them unique access to broach and treat an issue that historically has been left out of the medical realm.
Trust in Nurses
?I think nurses who work with children on a daily basis are in a good position to recognize things that are happening and also to talk with the kids,? says Dana Lorber, RN, MSN, CNS, a clinical nurse specialist at Maria Fareri Children's Hospital at Westchester (N.Y.) Medical Center. ?As a nurse in a facility like Westchester, you have a chance to really bond with the patients so you can forge a relationship and talk with them.?
Although nurse accounts of bullying in a hospital setting are rare, children don?t cease to be bullies or targets when receiving medical attention.
?Nurses are the eyes and ears of the unit. It?s part of the job to watch for issues with the kids and to be in tune with any type of abusive situation,? Lorber says. ?We listen to what the kids are saying and also observe the interactions they have with other children and other family members.?
Nurses can probe deeper into a child?s social situation by incorporating questions about school and feelings toward peers when completing a patient?s medical history, adds Mary Muscari, APRN-B, PhD, CPNP, CFNS, associate professor of nursing at Binghamton (N.Y.) University?s Decker School of Nursing.
?Some of these kids are being bullied outside, and you as a nurse can pick up on the psycho-social history of the patient,? Muscari explains. ?You have them as a captive audience and can get the different pieces and pick up on these issues.?
Some signs of bullying nurses can watch for are vague complaints, depression, high levels of anxiety, and being extremely introverted. Another sign is absenteeism from school or other activities.
How to Help
Andrea Fallick, LCSW, CASAC, CPP, assistant director for school-based programs of the Tarrytown, N.Y.-based Student Assistance Services Corp., says the first thing a bedside nurse can do to encourage openness about bullying is ask indirect questions. For example, a question such as, ?Have you ever worried about anybody calling you names or teasing you or forcing you to do things you don?t like?? would be followed by ?Do you wish other children called you names less?? and then ?Do you wish other people never called you names??
?That?s a way of asking, without saying, ?Does anybody bully you?? Fallick says. ?Kids don?t like to admit that, but they might say they?re worried about it.?
Asking patients about emotions can uncover reasons for bullying, Muscari says. ?A lot of kids act out because they?re afraid ? of dying or that you?re going to hurt them ? and they might not know any other way to act.?
If a nurse discovers a patient is bullied, tactics for managing the bully should be provided.
?As a nurse you could give strategies on how to deal with the bully,? says Lorber, who as a mother has seen the effects of bullying firsthand. ?You could tell them to walk away or say to the person, ?I don?t want to hear that.??
Long-term Effects of Bullying
Left unchecked, victims often become bullies themselves, Muscari says, adding 60% of bullies will have some exposure to the criminal justice system by the time they?re 30 years old. ?Ignoring it will make everything more chaotic,? Fallick says. ?We want nurses to be well aware of it and capable of assessing the kids.? Especially at risk for being bullied or becoming bullies are children who have special social challenges, Fallick says.
?New research shows that children who are recognized as having special needs have a higher likelihood of being bullied in school,? says Fallick, whose work has focused on bullying for more than seven years. In particular, children who are obese, autistic, and have ADHD are at risk for being bullied.
Fallick stressed an investigation into the incident always should be conducted. Further, parents and children should receive behavior counseling. ?And not necessarily call it bullying because when some parents hear that word they stop listening,? Fallick says. ?Tell the parent the reason we?re telling you this is because we know your child has been involved in this kind of behavior, and if it doesn?t stop you could end up with some really serious consequences.?
If a nurse is unsure how to handle the situation, Muscari says support should be sought from the facility social worker or psychiatric liaison. ?Identifying [bullying] and getting the child to the right referral source is huge,? she says.
