A study explored the experiences of school nurses with everyday pain in adolescents, highlighting the complexity of factors associated with everyday pain.
Chronic pain is becoming a common experience for children and adolescents. Previous studies have shown that as many as 15 to 30% of adolescents have chronic pain problems. Everyday pain among adolescents frequently affects their daily life and may also result in school absences, sleep problems, and poor overall performance in school.
Pain is a complex experience that could be related to the interaction of mind and body (psychosomatic) and therefore cannot always be treated with medication. Both parents and schools are considered to play an important role in modelling the perception and expression of pain. The school nurses specialize in public healthcare and are the main point of contact for children and adolescents having health complaints in school. It is therefore important to understand how school nurses experience and understand everyday pain among adolescents.
A recent qualitative study published in BioMed Central Nursing explored how school nurses perceived the pain experienced by adolescents. The data was collected through five focus group interviews with 17 female school nurses in five junior high schools in Norway. The participating school nurses were 29 to 65 years of age with two to 35 years of experience. Each focus group consisted of three to five school nurses. A focus group allows people with similar experiences to discuss a given topic and share insights that are normally not obtained through individual interviews. The focus group is led by a moderator and a facilitator to allow unrestrained expression of personal and possibly conflicting views. The researchers of this study participated in the focus groups as moderator and facilitator.
The research used qualitative content analysis based on a phenomenological-hermeneutic approach that concentrates on the study of consciousness as experienced from the first-person point of view and interpretation. The researchers analyzed the text obtained from focus group interviews using a four-step analytic method that comprised reading all the text to form an overall impression, identifying different aspects of participants’ experiences, condensing and abstracting meaning within each group, and summarizing the contents to generalize descriptions.
Key Factors Associated with Everyday Pain
The data analysis revealed that the school nurses perceived pain in adolescents as a complex phenomenon. Physical aspects of pain were addressed by sending adolescents for frequent medical examinations. However, obvious physical reasons are responsible for only a very small percentage of adolescent pain. The results of the qualitative analysis highlighted key factors associated with adolescent pain that was linked to psychosocial life situations- expectations, relationships, and lifestyle.
High Expectations and Low Tolerance of Stress
One of the key factors associated with adolescent pain was found to be high expectations from adolescents as well as from their surroundings. School nurses suggested that expectations related to high grades, a high degree of responsibility at home and fear of certain events such as making presentations were related to various types of physical ailments including headache, stomach pain, and sleep problems. Several nurses also emphasized that adolescents expect a life free of pain and are less robust than adolescents 20 to 30 years earlier. Too much information and too little responsibility were also cited as reasons for different types of pain.
Difficult Relationships and Traumatic Experiences
School nurses perceived that pain was a result of difficult conditions and relationships. Family issues or traumatic events such as violence, divorce, or death in the adolescent’s family could become a psychological issue that gets attached to the body and creates physical ailments. Some school nurses also pointed out problems related to bullying, dissatisfaction at school, or difficulties in adolescents’ families such as alcohol or drug abuse, as a cause of pain.
Adolescent inactivity and extensive use of social media were found to be associated with a headache, neck, back, and shoulder pain. Nurses suggested that spending too much time on their cell phones or computers led to a lack of sleep and headaches. Nurses also connected food and eating habits such as skipping breakfast and lunch or having a small portion of dinner as the cause of the adolescents’ bodily pains.
Medicalization of Pain
The analysis showed that school nurses felt responsible for referring the adolescents with pain for medical examination. Often, the medical examination results are inconclusive and adolescents come back with the same pain. Nurses admitted that adolescents with everyday pain often become shuttlecocks in the system and return with the same health problems. For managing adolescent pain, nurses believe the social situation, negative stress, or their deficient coping needs to change.
The findings of this study highlight some of the challenges school nurses face when dealing with adolescents’ everyday pains. According to nurses, it is important not to always medicalize adolescent pains but also not to miss a medical condition at the same time. Furthermore, school nurses believed that adolescents used analgesics extensively for pain relief and postulated that adolescents dealt with pain in the same way as their parents did.
This study has several strengths. The school-nurse participants had extensive experience with adolescents. The focus group methodology stimulated reflection among participants and thus enhanced the quality of findings. The inclusion of five different schools in the study ensured geographic variation from both rural and urban areas. Some of the limitations of the study are not including the adolescents themselves in the study and a small number of participants in each focus group.
In conclusion, the school nurses interpreted adolescent everyday pain to be associated with some key factors such as high expectations, difficult relations, traumatic incidents, and unhealthy lifestyle. Despite understanding the psychosocial aspects of pain, SNs maintained the medical examination referrals for these adolescents. These findings suggest a need for increased knowledge of the psychosocial aspects of pain in the education program of SNs. Further research on interventions to improve adolescent pain problems would be pertinent.
Written by Preeti Paul, MS Biochemistry
Reference: Magnhild Hoie, Kristin Haraldstad et al., How school nurses experience and understand everyday pain among adolescents. BMC Nursing, September 2017