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American schools are no longer places where children, teachers and staff feel safe. According to a new report from the Center for American Progress, 57 percent of teenagers now fear a school shooting. The troubled youths who commit mass shootings typically have many “red flags” that fit a dangerous profile. In the wake of the Parkland, Florida tragedy, parents and school districts sought immediate deployment of security specialists and emergency response procedures. However, the most effective interventions to address school violence may be to better understand what children experience at home through trauma-informed care.

Early and persistent exposure of a child to adverse childhood experiences (ACEs) may result in toxic levels of stress which influence brain development. ACEs include abuse, neglect, divorce, the death of a parent, or living with violence. The compounded effect of ACEs throughout early childhood may expose children to harmful toxic levels of stress in their most critical period of developmental growth. A recent U.S. study found a staggering one in five children ages zero to 17 experienced two or more ACEs. This significantly places them at a higher risk for developmental, behavioral, or social delays, as well as being at greater risk for committing acts of violence compared with children who had no ACEs.

One way to address the needs of children exposed to ACEs at all levels would be to improve access to mental health support for children and their families, especially in the wake of public tragedy. Children no longer have to wait for the morning paper to read about a tragic event. They may have uninterrupted access to victims on a live stream via social media, the Internet or television.  In a national survey conducted after the September 11, 2001 attacks, it was found that children who watched the most coverage were reported to have more stress symptoms than those who watched less coverage.

High profile acts of violence, particularly in schools, may cause confusion and fear in children. Schools, once a safe haven, have become a place where children may feel that they are in danger and worry that their friends or loved-ones are at risk. Couple this with the monthly “active shooter” drills that are now as common in schools as fire-drills and we are most likely stressing our children over and over again.

Children rely on the adults around them for information and guidance on how to react. Selected strategies from the National Association of School Psychologists  include:

  1. Reassure children that they are safe, validate their feelings, and help them to express their feelings to help put them into perspective.
  2. Adults should make time to talk and to listen, and be patient because your child may not want to talk about their feelings right away
  3. Keep your explanations developmentally appropriate. To alleviate child anxiety, consider co-viewing any media coverage with your child, limiting the amount and type of media viewed at home, especially just prior to bedtime, reading newspaper articles rather than watching television, and limiting discussion in the presence of your child.

The recent tragedy in Florida is a reminder of the urgent need to implement policies to improve coordination of public health strategies, designed to prevent and respond to the impact of ACEs and toxic stress.  Funding is needed to implement evidence-based programs that promote safe, supportive learning environments. Schools are ill-equipped to work with the outliers; those complex students like the Parkland shooter. Trauma responsive schools should be the gold standard in education. We need to take the position that a trauma-sensitive environment is a “universal precaution” and will benefit the school community at large.

School nurses provide a buffering effect for students exposed to ACEs. School nurses are highly trained and well-positioned to assess individual students and gauge behavioral patterns of activity among students.  Expansion of school-based health centers (SBHC) allows pediatric or family nurse practitioners to collaborate with school nurses providing acute care health services to students, staff and families.  Research shows that mental health counseling is the leading reason for visits by students.  Seventy-five percent of SBHCs have a mental health provider available.

In the meantime, hopefully, parents across the country will keep asking the question “How was your day?,” hold their children closely, listen intently and keep doing our best to work and rebuild trust in the safety of American schools.


Sunny G. Hallowell, PhD, PPCNP-BC, IBCLC, is a Pediatric Nurse Practitioner and Assistant Professor of Health Policy at the Villanova University M. Louise Fitzpatrick College of Nursing; Elizabeth B. Dowdell, PhD, RN, FAAN, is a Professor of Pediatrics at the Villanova University M. Louise Fitzpatrick College of Nursing; Robin Cogan MEd, RN, NCSN is a School Nurse in Camden, NJ and Faculty at Rutgers-Camden School of Nursing in the School Nurse Certificate Program. She can be found on Twitter @RobinCogan and on Relentless School Nurse.

American schools are no longer places where

In 2014, the Ebola outbreak was storming through West Africa and found its way to the United States via four patients medically evacuated to the United States for treatment. Then, Thomas Eric Duncan, a Liberian man visiting family in Texas, showed early symptoms of Ebola. Initially misdiagnosed before more severe symptoms developed, Duncan then was hospitalized and eventually died at Texas Health Presbyterian Hospital. Nina Phan, a nurse who cared for Duncan, made headlines when she was diagnosed with Ebola herself.

Unless the story focused on health care workers’ potential exposure and protective equipment, American journalists rarely included nurses in their stories about Ebola before Phan came down with the disease. After that, journalists could not get enough interviews with nurses and representatives of nursing organizations. When the Ebola story receded from the headlines, press inquiries stopped. Diana Mason, a co-author of this blog, was president of the American Academy of Nursing at that time and saw the difference in media requests for interviews.

The underrepresentation of nurses in health news didn’t just occur during Ebola crises. We recently reported on the high-level preliminary findings of two phases of a study, “The Woodhull Study Revisited: Nurses Representation in Health News Stories,” about how often nurses are represented in health news stories They have significant implications for health journalists who are not diversifying their sources. While the study focuses on nurses, the findings also apply to health professionals other than physicians.

The findings were scheduled to be presented at a May 8 press conference at the National Press Club in Washington, D.C.

“Woodhull Study Revisited” replicates a 1998 study named after Nancy Woodhull a USA Today founding editor who was concerned about the underrepresentation of women in media, including nurses. The original study found that nurses were included as sources in only 4 percent of health news stories in September 1997 in two leading national newspapers and five metro dailies; and less than 1 percent of the time in four news magazines and five health industry publications. Nurses rarely were mentioned as health news sources, even though they would have been germane to the story or identified in photos accompanying the news stories.

Twenty years later, we worked with the Berkeley Media Studies Group to examine health news stories from September 2017 in the same publications (some are no longer in print but are online) and found that nothing has changed. The stories we examined included nurses as sources only 2 percent of the time, although the difference in the 20 years was not statistically significant. When used as sources, it most often was in stories about labor, the profession itself (such as the scope of practice), quality or education. Nurses seldom were included in stories on research (9 percent), policy (4 percent), or business (3 percent).

Perhaps more telling was the second phase of the study, in which we interviewed 10 health journalists about their experiences with using nurses as sources. Our preliminary findings suggest that bias exists in sourcing for health news.


This post is by Diana Mason and Barbara Glickstein and was originally published as “Underrepresentation of nurses in health care coverage continues to be a concern,” in Covering Health: Monitoring the Pulse of Health Care Journalism on May 8, 2018, and reposted here with permission. Continue reading here.

In 2014, the Ebola outbreak was storming

The George Washington University Office of Media Relations released this press advisory on May 01st.  Content of the advisory posted below.

Researchers to Present New Results of Landmark Study on Nurses in the Public Eye

Original 1997 Woodhull Study Received Second Look to Determine Progress Made
May 01, 2018

MEDIA CONTACTS:
Timothy Pierce: tpie@gwu.edu, 202-994-5647
Maralee Csellar: csellar@gwu.edu, 202-994-7564

EVENT:
Researchers will present findings from new research on the representation of nurses in the media, replicating the 21-year-old Woodhull Study on Nurses and the Media, at a press conference at the National Press Club. The original Woodhull Study found nurses were represented as sources in less than 4 percent of health news stories in leading print newspapers, newsweeklies and health care trade publications of the day.

The Center for Health Policy and Media Engagement at the George Washington University School of Nursing, in collaboration with the Berkeley Media Studies Group, replicated the original 1997 study to determine if any progress has been made. Researchers also interviewed journalists about their experiences using nurses as sources, and conducted an analysis of the use of Twitter by the top 50 schools of nursing in the country.

WHO:
The research team is comprised of:

  • Diana J. Mason, principal investigator and senior policy service professor, Center for Health Policy and Media Engagement, GW School of Nursing
  • Barbara Glickstein, director of communications and media projects for the Center for Health Policy and Media Engagement, GW School of Nursing
  • Kimberly D. Acquaviva, professor of nursing, GW School of Nursing
  • Kristi Westphaln, senior fellow at the Center for Health Policy and Media Engagement, GW School of Nursing
  • Laura Nixon, senior media researcher, Berkeley Media Studies Group

Following the presentation of high-level findings, a reaction panel will include:

  • Ivan Oransky, president, Association of Health Care Journalists
  • Cristal Williams Chancellor, director of communications, Women’s Media Center
  • Yanick Rice Lamb, associate professor and chair of the Department of Media, Journalism and Film, Howard University

WHEN:
Tuesday, May 8, 2018; 9-10 a.m.

WHERE:
The National Press Club
529 14th Street NW, 13th Floor
Washington, D.C.
Metro Center Metro (Blue, Orange, Silver and Red lines)

RSVP:
Media interested in attending must contact Timothy Pierce at tpie@gwu.edu or 202-994-5647. Media also can request a research brief under embargo. The embargo will lift on May 8, 2018, at 9 a.m. EDT.

WEBCAST:
If you are unable to attend, the event will be broadcast live at https://www.webcaster4.com/Webcast/Page/219/25375.

BACKGROUND:
The Center for Health Policy and Media Engagement at the GW School of Nursing advances policy and the health of the public through education, research, media and public forums. For more information, go to https://nursing.gwu.edu/health-policy-media-engagement.

The George Washington University Office of Media