Contributor – Sondatre M. Thompson
In 2014, the Centers for Disease Control and Department of Education released the first federal definition of bullying. The report includes three core elements: unwanted aggressive behavior, observed or perceived power imbalance, and repetition of bullying behaviors (U.S. Department of Education, 2019). In the United States, one out of every five (20.2%) students report being bullied (Marsh, 2018). Students who are a part of the LGBTQ+ community are more likely to be targets of bullying and victimization than their heterosexual peers (Marsh, 2018). Some of the aggression includes harassment, social isolation, and stigmatization. Other students such as students of color, disabilities, or marginalized communities reported being bullied. For example, 13% were made fun of, called names, or insulted; 13% were the subject of rumors; 5% were pushed, shoved, tripped, or spit on; and 5% were excluded from activities on purpose (U.S. Department of Education, 2019).
Students who experience bullying are at increased risk for depression, anxiety, sleep difficulties, lower academic achievement, and dropping out of school (U.S. Department of Education, 2019). Furthermore, bullied students indicate that they are twice as likely as non-bullied peers to experience adverse health effects such as headaches and stomachaches (U.S. Department of Education, 2019). Through assessment, physical symptoms of violence or behaviors perceived as malicious are identified. Good clinical decision-making skills and sound judgment allow nurses to intervene when necessary and make appropriate referrals. Students who experience bullying tend to blame themselves, leading to prolonged victimization and maladjustment.
Research indicates that persistent bullying can worsen feelings of isolation, rejection, exclusion, and despair, contributing to drug abuse or suicidal behavior (Marsh, 2018). Nursing is a helping profession grounded in caring, creating space to understand the student’s experience. Caring encompasses trust, intimacy, and responsibility which are essential to maintain a nurse-patient relationship. Caring as a moral ideal of nursing is defined as an attitude, an intention, and a commitment that manifests itself in the nurse’s approach and encounter when directly involved with their patient. Wiedenbach’s nursing model defines the patient as any person receiving help of some kind from the health care system. Support can include care, teaching, and advice. In this nursing theory, a patient does not need to be ill or injured since health education qualifies such a person as a patient.
A patient’s need for help is defined as a measure desired by the patient that can potentially restore or extend the patient’s ability to cope with situations that affect health. In this nursing theory, a patient’s need for help must come from the individual patient’s perception of their case. Wiedenbach identifies four main elements of clinical nursing. They are a philosophy, a purpose, a practice, and art. The nurse’s philosophy is their attitude, belief about life, and how it affects their reality. The art of nursing includes understanding a patient’s needs and concerns, developing goals and actions intended to enhance a patient’s ability, and directing the activities related to the medical plan to improve the patient’s condition. The nurse also focuses on preventing complications that can come up due to reoccurrence or the development of new concerns. The prescriptive theory within the model is based on three factors: the central purpose, which the nurse recognizes as essential to the particular discipline, the prescription for the fulfillment of the primary goal, and the realities in the immediate situation that influence the central purpose.
Childhood bullying effects have substantial critical implications for both the target and the bully. Bullying is usually an intentional series of actions intended to disturb or hurt a victim with aggression and a perceived or real imbalance of power. Bullying has adverse effects such as legal, social, emotional, and academic problems. Consequently, anti-bullying programs have been introduced in schools and institutions to change the attitudes and behaviors of both victims and perpetrators. These advisory and educational programs address the risk factors to the individual, the family, and the community. Here, the parents, the teachers, and the healthcare professionals come in and outline the intensity of the problem. Nurses take a significant role in addressing bullying in schools and institutions. Here the victim or the bully needs help, and they, therefore, become patients. Since bullying may cause physical or mental unwellness, the nurse’s responsibility is to restore the life balance and introduce coping mechanisms towards healthier social relationships. Care, advice, and instruction are given where necessary to the bullying patient. If the bullying has affected the victim or the bully emotionally or psychologically, they are not technically ill. However, they qualify as patients once they start giving health-related advice or education.
The nurse’s philosophy towards life guides them to provide the proper care for the patient. Wiedenbach’s first element associated with nursing is philosophy. The philosophy revolves around reverence for life, respect for the dignity, worth, autonomy, and individuality of each human being, and the resolution to act on personally and professionally held beliefs. Thus, the nurse endeavors to apply this philosophy to the victim or the bully; it may involve counseling the bully on the importance of respecting fellow human beings, their sense of self-worth, dignity, and their respective personalities and perspectives. To the victim, the nurse instills a sense of self-worth that, through bullying, has been eroded. The nurse also assures the victim of the importance of their individuality, perspectives, and their personalities. There is practically nothing wrong with being different from the rest. Additionally, the victim is advised to cope with these situations and rise above the tide. Specifically, the bully is seen as having some form of compensation disorder due to the need to inflict pain (emotional or physical) to a fellow student. Therefore, the victim is only “guilty” of being different from the pack, which is good.
The nurse further understands the second element – purpose. These are the actions and activities that the nurse undertakes to ensure the patient’s overall wellness. For example, if the patient is injured, assessment and prescription of treatment are necessary, such as bandaging the injuries. More so, Psychological pain is perceived, and therapy and counseling of the patient are done to elevate emotional and psychological distress.
The nurse also observes the third element, practice. Here, the nurse considers the patient (victim or bully) in correspondence with how they perceive and feel them. The nurse’s intuition is of critical importance here as it guides the complex maze that constitutes bullying. For example, a bully behaves in a particular manner because of core psychological needs such as to prove themselves to others. This need is manifested in a show of might on victims who cannot stand up to the bully. The nurse, therefore, identifies the root of the problem and, with proper care, provides advice and counseling to the bully.
Lastly, the fourth element, art, is applied. The nurse endeavors to understand the patient’s needs, develop goals and actions intended to enhance the patient’s ability, and direct the activities related to the medical plan to improve the patient’s condition. The nurse’s focus is also on preventing complications related to reoccurrence or the development of new concerns. When addressing bullying, the nurse develops a course to deal with the present situation while preventing a similar or related bullying event. Meeting with the students can enlighten them on the harmful effects of bullying on both the bully and the victim. Morals are outlined to condemn the act of bullying as antisocial behavior. In all the above elements, the central purpose is to do away with bullying in the institution and the outside world.
When children and adolescents have unexplained psychosomatic and behavior symptoms, experience problems at school or with friends, begin to use tobacco, alcohol, and other drugs, and express thoughts of self-harm or suicide, physicians should ask about bullying (Task Force on Violence, 1999). Patients identified as bullies should be screened for conduct disorder and other psychiatric comorbidities (Connor et al., 2008). Nurses can assist with developing policies and interventions to educate students and staff on ways to address bullying and provide support to students in need. Several bullying interventions are highly effective in decreasing bullying, increasing empathy, and building self-esteem among students. Evidence-based programs have shown promise to reduce the incidence of bullying at school, including those that utilize Social and Emotional learning principles and Positive Behavioral Interventions and Supports. Teaching prosocial skills in academic classes is recommended to foster the high support indicative of positive school climates (Espelage et al., 2015). Such policies in school will encourage connectedness and trusting relationships between teachers and students. Moreover, the most effective programs involve empowering bystanders to take action. Overall, a positive school climate where students and staff work collaboratively to solve problems has alleviated bullying issues at school and online. The key to preventing bullying is to bring anti-bullying policies up regularly and consistently over the school year since having a policy is not enough but must be consistently enforced (Vitelli, 2016).
In recent years, calls for action to protect children and adolescents, including laws against bullying in some jurisdictions and “zero-tolerance policies,” have been adopted by many schools to protect students. For example, the Tennessee Model Bullying policy includes appropriate remedial actions for anyone who commits harassment or bullying. The consequences may range from positive behavioral interventions to suspension or expulsion as outlined in the Board of Education’s approved code of conduct. In addition, such policies tend to correct and prevent other occurrences of bullying behavior (Hall, 2017).
PREVnet (Promoting Relationships and Eliminating Violence Network) has been established in many safe school systems. This system uses biennial surveys to measure school climate for bullying incidents. The teams plan out anti-bullying activities and conduct a Bullying Awareness and Prevention week each year. Other programs encourage students to intervene when they see a child being bullied in school or their neighborhood (Hall, 2017).
In any form or frequency, bullying in schools represents both a public health concern and a human rights violation. Therefore, schools have a responsibility to understand, address, and prevent bullying with research-supported data, which will lead to more effective interventions. The solution to this problem lies in establishing a system to support reporting of bullying with protection from retaliation and promptly investigate and respond to reports of bullying. In addition, as members of our community, we must support school-based violence prevention programs and spread awareness regarding anti-bullying policies using multiple channels (e.g., newsletters, emails, and Facebook).
References
Connor, D. F., McLaughlin, T. J., & Jeffers-Terry, M. (2008). Randomized controlled pilot study of quetiapine in the treatment of adolescent conduct disorder. Journal of child and adolescent psychopharmacology, 18(2), 140-156.
Espelage, D., Rose, C., Polanin, C. (2015). Social-emotional learning program to reduce bullying, fighting, and victimization among middle school students with disabilities. Remedial and Special Education, 36(5), 299-31. DOI: 10.1177/0741932514564564
Hall, W. (2017). The effectiveness of policy interventions for school bullying: A systematic review. Journal of the Society for Social Work and Research, 8(1), 45-69. https://doi.org/10.1086/690565
Marsh, V. (2018). Bullying in school: Prevalence, contributing factors, and interventions. The Center for Urban Education Success at the University of Rochester’s Warner School of Education. https://www.rochester.edu/warner/cues/wp-content/uploads/2019/01bullying_FINAL.pdf
Task Force on Violence. (1999). The role of the pediatrician in youth violence prevention in clinical practice and at the community level. Pediatrics, 103(1), 173-181.
U.S. Department of Education. (2019). Student reports of bullying: Results From the 2017 School Crime Supplement to the National Crime Victimization Survey. https://nces.ed.gov/pubs2019/2019054.pdf
Vitelli, R. (2016, January 27). What makes anti-bullying programs effective? Psychology Today. https://www.psychologytoday.com/us/blog/media-spotlight/201601/what-makes-anti-bullying-programs-effective
About Sondatre M. Thompson
Sondatre M. Thompson, MSN, APRN, FNP-C, is a nurse practitioner with over 14 years of nursing experience. Sondatre is currently studying to obtain a PhD nursing degree from Texas Women’s University. She earned both a BSN and MSN from Prairie View A & M University in 2007 and 2013 respectively and held several healthcare positions. Serving as a school nurse at a local middle school, Sondatre realized that bullying was something several students faced on a daily basis. Bullying has resulted in negative physical, social, emotional, academic, and mental health issues across the nation. Depression and suicide are the worst possible outcomes which drives the need to have stronger policies and penalties in place to discourage bullying in schools. Bullying is wrong and students should not suffer in silence.