School Nurses on the Front Lines of Healthcare: The Approach to a Student With Anxiety and Posttraumatic Stress Disorder

Abstract

Mental illness is common, and its severity ranges from subclinical to severe, where the condition affects daily social and academic functioning. Because of its ubiquity, it is necessary that school nurses have an enhanced understanding of some of the mental health conditions that children and adolescents may be facing. As will be discussed, some mental health concerns present with somatic symptoms that may bring the student into the school nurse’s office. If the nurse identifies mental health symptoms, he or she may be able to intervene, provide support, and direct the student for further management if necessary. This article will focus on anxiety in general before focusing on specific anxiety disorders, including posttraumatic stress disorder. We will begin by defining these conditions and then move into discussing potential present-day stressors, such as fear and anxiety associated with the recent coronavirus disease 2019 pandemic, and screening tools before closing with some suggestions for practice and a case wrap-up.

Narrative review: COVID-19 and pediatric anxiety

“…It has been found that social anxiety is more tightly linked to duration of loneliness, not intensity ( Loades et al, 2020 ). Inability to activate one's social network is associated with anxiety and distress ( Chardavoyne and Olympia, 2020 ; Imran et al, 2020 ). School closure-related stressors include not having access to education and food, a lack of face-to-face contact with schoolmates and teachers, and being unable to play sports ( Palacio-Ortiz et al, 2020 ; McGuine et al, 2020 ).…”

“…Confinement to home can also expose children to maltreatment and abuse in conflict-ridden families. The lockdown has exposed more women to intimate partner violence, which can traumatize children and produce anxiety ( Haleemunnissa et al, 2021 ; Guo et al, 2020 ; Palacio-Ortiz et al, 2020 ; Lo Moro et al, 2020 ; Marques de Miranda et al, 2020 ; Singh et al, 2020 ; Chardavoyne and Olympia, 2020 ).…”

“…How clinicians measure GAD during the pandemic is evolving. School nurses are well-placed to recognize new onset GAD as children return to school, particularly with tools like the Coronavirus Anxiety Scale (CAS) which has been shown to be as valid as the Generalized Anxiety Disorder Assessment (GAD-7) as a screening tool for symptoms of a variety of anxiety disorders ( Chardavoyne and Olympia, 2020 ).…”

North Carolina’s Reserve Component-connected Children: Are Our Schools Prepared to Meet Their Needs?

“…Quality of life for the military family-active, Reserve, and Guard-is heavily linked to the well-being of their children and the educational systems they attend [1]. The school environment is important in the lives of all children, but uniquely so for those who are military connected, in part because of the stability provided during parental deployment [2,3]. Schools surrounding active-duty installations are well prepared to support active-military-connected children and receive federal dollars to provide this support [1].…”