The Role of the School Nurse in Suicide Prevention: Implications for Equitable Care of Vulnerable Youth

Abstract

The rising rate of youth suicide in rural Eastern North Carolina reflects the national trend. Although school nurses have been regarded as the gateway professional for mental health services, their role in suicide prevention is not well understood. The purpose of this study was to explore school nursing practice regarding suicide prevention of school-aged children in one vulnerable region of the United States. Focus groups and surveys were collected from 35 school nurses in six school districts. Findings indicate that suicide protocols inclusive of the school nurse can facilitate their role in suicide prevention. Variation of school nursing practice existed between and within districts. These variations in school nursing practice highlight the need for school districts within the state and across the country to examine their policies and practices for mental health equity. Barriers such as higher caseloads, role disconnect, and lack of specialized training contributed to variations in practice.

Keywords

suicide prevention school nurses school nurse role vulnerable youth mental health equity qualitative research

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References

Allison

V. L.

Nativio

D. G.

Mitchell

A. M.

Ren

Yuhasz

(2014). Identifying symptoms of depression and anxiety in students in the school setting. The Journal of School Nursing, 30(3), 165–172. https://doi.org/10.1177/1059840513500076

Baur

Carpenter

D. M.

Driscoll

Fromewick

J. C.

Belden

C. M.

Thomas

K. C.

(2023). Implementing facilitative leadership to develop a school nurse research agenda in western North Carolina. Journal of School Health, 93(2), 158–161. https://doi.org/10.1111/josh.13250

Bell

(2019, January 18). Governor’s Leandro commission looks at North Carolina’s school support personnel. Education NC. https://www.ednc.org/governors-leandro-commission-looks-at-north-carolinas-school- supportpersonnel/

Bohnenkamp

J. H.

Stephan

S. H.

Bobo

(2015). Supporting student mental health: The role of the school nurse in coordinated school mental health care. Psychology in the Schools, 52(7), 714–727. https://doi.org/10.1002/pits.21851

Centers for Disease Control and Prevention [CDC]. (2023a). Leading causes of death and injury. https://www.cdc.gov/injury/wisqars/LeadingCauses.html

Centers for Disease Control and Prevention [CDC]. (2023b). Whole school, whole community, whole child (WSCC). U.S. Department of Health & Human Services. https://www.cdc.gov/healthyschools/wscc/index.htm

Cowell

J. M.

(2019). Fragmented school mental health services: Directions for research. The Journal of School Nursing, 35(2), 87. https://doi.org/10.1177/1059840519831777

Elo

Kyngäs

(2008). The qualitative content analysis process. Journal of Advanced Nursing, 62(1), 107–115. https://doi.org/10.1111/j.1365-2648.2007.04569.x

Golberstein

Wen

Miller

B. F.

(2020). Coronavirus disease 2019 (COVID-19) and mental health for children and adolescents. JAMA Pediatrics, 174(9), 819–820. https://doi.org/10.1001/jamapediatrics.2020.1456

10.

Goldman-Mellor

Allen

Kaplan

M. S.

(2018). Rural/urban disparities in adolescent nonfatal suicidal ideation and suicide attempt: A population-based study. Suicide and Life-Threatening Behavior, 48(6), 709–719. https://doi.org/10.1111/sltb.12390

11.

Granrud

M. D.

Anderzèn-Carlsson

Bisholt

Steffenak

A. K. M.

(2019). Public health nurses’ perceptions of interprofessional collaboration related to adolescents’ mental health problems in secondary schools: A phenomenographic study. Journal of Clinical Nursing, 28(15–16), 2899–2910. https://doi.org/10.1111/jocn.14881

12.

Heinz

Catunda

Duin

C. V.

Willems

(2020). Suicide prevention: Using the number of health complaints as an indirect alternative for screening suicidal adolescents. Journal of Affective Disorders, 260, 61–66. https://doi.org/10.1016/j.jad.2019.08.025

13.

Hoskote

A. R.

Croce

Johnson

K. E.

(2023). The evolution of the role of U.S. School nurses in adolescent mental health at the individual, community, and systems level: An integrative review. The Journal of School Nursing, 39(1), 51–71. https://doi.org/10.1177/10598405211068120

14.

Hoskote

A. R.

Johnson

K. E.

(2020). The role of school nurses in addressing student mental health in Texas alternative high schools. Journal of Adolescent Health, 66(2), S94–S95. https://doi.org/10.1016/j.jadohealth.2019.11.189

15.

Kaskoun

McCabe

(2022). Perceptions of school nurses in addressing student mental health concerns: An integrative review. The Journal of School Nursing, 38(1), 35–47. https://doi.org/10.1177/10598405211046223

16.

Katz

Bolton

S. L.

Katz

L. Y.

Isaak

Tilston-Jones

Sareen

, & Swampy Cree Suicide Prevention Team. (2013). A systematic review of school-based suicide prevention programs. Depression and Anxiety, 30(10), 1030–1045. https://doi.org/10.1002/da.22114

17.

Kim

Ryu

J. M.

Kim

(2020). Characteristics and trends of suicide attempt or non-suicidal self-injury in children and adolescents visiting emergency departments. Journal of Korean Medical Science, 35(33), e276–e276. https://doi.org/10.3346/jkms.2020.35.e276

18.

Lewis

T. E.

Grobe

(2011). Student services and educational leadership: The effect of student services staffing ratios on student achievement and dropout prevention in public schools. Southern Regional Council on Educational Administration 2011 Yearbook, 13–21. https://67a1ad19-c320-4f16-bd55-6e2b121299a9.filesusr.com/ugd/40dc8e_71b0c4d9ff664cd8af3b8ff1b2db30a8.pdf

19.

Markkanen

Anttila

Välimäki

(2021). Supporting student’s mental health: A cross-sectional survey for school nurses. Children, 8(2), 129. https://doi.org/10.3390/children8020129

20.

Miller

D. N.

Eckert

T. L.

Mazza

J. J.

(2009). Suicide prevention programs in the schools: A review and public health perspective. School Psychology Review, 38(2), 168–188. https://doi.org/10.1080/02796015.2009.12087830

21.

Moen

Ø. L.

Jacobsen

I. C. R.

(2022). School nurses’ experiences in dealing with adolescents having mental health problems [PDF]. SAGE Open Nursing, 8,(January-December 2022), 1–9. https://doi.org/10.1177/23779608221124411

22.

Morse

J. M.

(2017). Essentials of qualitatively-driven mixed-method designs. Routledge.

23.

National Association of School Nurses. (2019). Transition planning for students with healthcare need [Position Statement]. https://www.nasn.org/nasn-resources/professional-practice-documents/position-statements/ps-transition

24.

National Association of School Nurses. (2020). Framework for 21st century school nursing practice: Clarifications and updated definitions. NASN School Nurse, 35(4), 225–233. https://doi.org/10.1177/1942602X20928372

25.

National Association of School Nurses. (2021). The behavioral health and wellness of student [Position Statement]. https://www.nasn.org/nasn-resources/professional-practice-documents/position-statements/ps-behavioral-health

26.

National Association of School Nurses. (2022). Student access to school nursing services [Position Statement]. https://www.nasn.org/nasn-resources/professional-practice-documents/position-statements/ps-access-to-services

27.

National Association of School Nurses. (2023). IDEIA and section 504 teams—The school nurse as an essential team member [Position Statement]. https://www.nasn.org/nasn-resources/professional-practice-documents/position-statements/ps-ideia

28.

Nolta

(2014). A school-based suicide risk assessment strategy. NASN School Nurse, 29(6), 295–298. https://doi.org/10.1177/1942602X14547276

29.

North Carolina Child Fatality Task Force. (2023). Annual report to the Governor and General Assembly. https://webservices.ncleg.gov/ViewDocSiteFile/75628

30.

North Carolina Department of Health and Human Services [NCDHHS], North Carolina Division of Public Health, Injury Epidemiology and Surveillance Unit, North Carolina Violent Death, Reporting System. (2022). Suicide among school aged youth in North Carolina ages 10-28, 2020. https://injuryfreenc.dph.ncdhhs.gov/DataSurveillance/SIIED/School-Aged-Youth-Suicide.pdf

31.

North Carolina Department of Public Instruction. (2023). North Carolina school report cards. https://ncreports.ondemand.sas.com/src/

32.

North Carolina Rural Health Leadership Alliance. (2021). 2021 North Carolina rural health snapshot. https://foundationhli.org/wp-content/uploads/North-Carolina-Rural-Snapshot-Report-FINAL-WEB.pdf

33.

Patterson

(2016). Suicide risk screening tools and the youth population. Journal of Child and Adolescent Psychiatric Nursing, 29(3), 118–126. https://doi.org/10.1111/jcap.12148

34.

Pestaner

M. C.

Tyndall

D. E.

Powell

S. B.

(2021). The role of the school nurse in suicide interventions: An integrative review. The Journal of School Nursing, 37(1), 41–50. https://doi.org/10.1177/1059840519889679

35.

Price

J. H.

Khubchandani

(2019). The changing characteristics of African-American adolescent suicides, 2001-2017. Journal of Community Health, 44(4), 756–763. https://doi.org/10.1007/s10900-019-00678-x

36.

Probst

Zahnd

Breneman

(2019). Declines in pediatric mortality fall short for rural US children. Health Affairs, 38(12), 2069–2076. https://doi.org/10.1377/hithaff.2019.00892

37.

Ravenna

Cleaver

(2016). School nurses’ experiences of managing young people with mental health problems: A scoping review. The Journal of School Nursing, 32(1), 58–70. https://doi.org/10.1177/1059840515620281

38.

Robinson

Cox

Malone

Williamson

Baldwin

Fletcher

O’Brien

(2013). A systematic review of school-based interventions aimed at preventing, treating, and responding to suicide-related behavior in young people. Crisis, 34(3), 164–182. https://doi.org/10.1027/0227-5910/a000168

39.

Rural Health Information Hub. (2022). Rural Data Explorer. https://www.ruralhealthinfo.org/data-explorer?id=209&state=NC

40.

Saldaña

(2015). The coding manual for qualitative researchers (3rd ed.). Sage.

41.

Sandelowski

(2001). Real qualitative researchers do not count: The use of numbers in qualitative research. Research in Nursing & Health, 24(3), 230–240. https://doi.org/10.1002/nur.1025

42.

Shattuck

Sebastian

Zamarin

Acosta

Ramos

M. M.

(2022). School nurse management of behavioral health, violence, and trauma-related emergencies: Findings from a statewide survey. The Journal of School Nursing, 40(5), 536–546. https://doi.org/10.1177/10598405221120437

43.

Stone

D. M.

Mack

K. A.

Qualters

(2023). Notes from the Field: Recent changes in suicide rates, by race and ethnicity and age group—United States, 2021 (Morbidity and Mortality Weekly Report 72, 6). Center for Disease Control and Prevention. https://www.cdc.gov/mmwr/volumes/72/wr/mm7206a4.htm

44.

Toure

D. M.

Kumar

Walker

Turman

J. E.

(2022). Barriers to pediatric mental healthcare access: Qualitative insights from caregivers. Journal of Social Service Research, 48(4), 485–495. https://doi.org/10.1080/01488376.2022.2088949

45.

United States Census Bureau. (2022). Quick facts: United States. https://www.census.gov/quickfacts/US

46.

United States Census Bureau. (2023). Nation’s urban and rural populations shift following 2020 census [Press Release]. https://www.census.gov/newsroom/press-releases/2022/urban-rural-populations.html

47.

Vejzovic

Carlson

Löfgren

Bramhagen

(2022). Early identification of mental illness in primary school pupils by school nurses: A qualitative study [PDF]. SAGE Open Nursing, 8, (January-December 2022). https://doi.org/10.1177/23779608221081452