Online and Health Risk Behaviors in High School Students

An Examination of Bullying

Meghan N. Long; Elizabeth B. Dowdell


Pediatr Nurs. 2018;44(5):223-228. 

In This Article

Nursing Implications

Nurses in pediatric settings have the opportunity to routinely screen for bullying and risk behaviors. Although often time-consuming, the first step in the screening process is to ask about experiences with bullying and to identify the adolescent who has a positive response as a bully, victim, or bully-victim. Building a rapport with the adolescent using what was shared in the history or found in the medical or school record as a foundation for asking specific risk behavior questions is the second step. When nurses are knowledgeable about bullying and risk behaviors, they can promote better communication among students, families, schools, and other professionals around this serious topic. Such conversations are the first step in designing screenings, intervention tools, and programs that help adolescents (Vessey & O'Neil, 2011).

These crucial conversations can be initiated by nurses in hospitals, schools, health clinics, and emergency room settings during a health history and physical assessment. For example, nurses can ask adolescents whether they or their friends have ever used tobacco, alcohol, or other substances. Adolescents who answer in the positive or indicate that friends smoke should be encouraged to discuss patterns of use. Reviewing the behaviors of friends and what they do can be used by adolescents as a way of testing the reaction(s) of the nurse to the information being shared. Once friends' patterns of tobacco use are discussed, it may be easier for the adolescent to then answer questions regarding his or her own current use. Special interest, understanding, and a willingness to listen are required for the nurse to coordinate or participate in a smoking education program.

Identifying those at risk for engaging in risk behaviors early on is important. Whether screening first for bullying or for risk behaviors, our research supports there is a relationship. If an adolescent shares a bullying experience, the nurse should ask about risk behaviors, and if an adolescent shares a risk behavior, they should be screened for bullying. Specifically, pediatric nurses, healthcare providers, community, and school professionals can incorporate questions about bullying and risk behaviors (e.g., drinking while driving, sexting, online harassment) when working with an adolescent.

The present research also supports effective safety education programs that target different groups, in different ways, and at different times. One suggestion is using peers in educational programs, which may be of assistance for both bullies and victims. These programs are based on shared responsibility, respect, and mutual understanding of what is helpful with peers, and provide services and content in a less threatening way. Peer leaders are effective at identifying at risk students, supporting peers to speak up about their individual issues, and working with adults to refer at-risk students (Wyman et al., 2010). Individually, questions that ask students about drinking alcohol or drinking while driving can also include their experience(s) with texting while driving, as well as riding with others who have been drinking.

Nurses are in a key position to assess, intervene, and educate about bullying, Internet safety, and health risk behaviors. Using the nursing process, which includes doing a comprehensive assessment of the adolescent, planning the care of the adolescent, implementing the plan, and evaluating the intervention, is crucial to keep children and adolescents safe. Nurses are in a pivotal position to screen, identify, and educate adolescents and parents on how to minimize risks behaviors.