As a school based nurse, the comfort of having a rapport with someone you had no idea was struggling is a bit frightening. In this regard, I dealt within ten-year old kid who attempted to commit suicide. In this school, there are no specific methods on how to handle childhood anxiety and depression. As a result, children suffer from anxiety and to a lesser extent, depression and nobody seem to care about their plight. All we rely on is the reassurances of their parents that the children are okay. However, this incidence came as a shock to both the school and the parents as well. As a nurse, I was also at fault as it I did not question the marks on her body nor did I use any method that could inform me of the level of depression and anxiety that the child was experiencing. Every attempt I made was futile, as I did not prevent the suicidal attempt in advance. The problem of depression and anxiety is a common mental health issue especially for children under the age of ten. This issue is known to be an impediment to the children's quality of life. Additionally, it contributes to poor academic performances, mental disorders and in severe cases, suicidal attempts. This paper will review the existing evidence on the best methods of addressing childhood anxiety and depression. This evidence will be used to propose a realistic project that can be applied to my school to help children suffering from depression and anxiety.
2. Synthesis of Evidence
Incidences of anxiety and depression in primary and lower classes are not new. However, the ability of the schools to devise measures to counter them is what keeps the cases anonymous. Anxiety and depression are significant impediments to the success of a child academically and in professional life. There are varieties of factors that are responsible for the fear. However, the effects of such disorders are adverse. In several cases, those children experiencing the anxiety and depression can end up committing suicide. Therefore, nurses and other medical practitioners should ensure that adequate, realistic, and practical strategies are put in place to counter the effects of childhood anxiety and depression. If the problem is not contained, children will end up abusing drugs, having mental disorders and even attempting suicides. In such cases, the community will not be at peace. Specifically, the parents of such children will not rest because of the effects of that anxiety and depression.
a) Effects of Anxiety and Depression & Methods of Intervention
There exist wide varieties of evidence that shows the effects that anxiety and depression have on the life, academic, and professional success of the child. Vast evidence proposes the various strategies that can be employed to contain such situations. According to Kosters et al. (2005), anxiety and depression are major compromises to childrens quality of life and a determinant of their life outcomes. In their research, Kosters et al. (2005) investigated whether the interventions of a school-based program for children with anxiety and depression known as Friends for Life were maintained for 12 consecutive months. In so doing, they used an intervention group of 339 children and 159 control groups of children aged 8- 13years. The intervention group fared better than the control group when the two were observed over a period of 12 weeks. A similar result was obtained by Carlyle (2014) where he conducted a pilot study on Tier 2 Child; Adolescent Mental Health Service (CAMHS) in the UK to establish whether interventions of a program titled FUN FRIENDS could lead to a decrease, and prevention of anxiety and depression in children aged 4-7 years (BsctHons, D. A. C. M., & MBACP, 2014). After 12 weeks, all the children recorded improved scores of anxiety and depression after the intervention. Knox et al. (2011) used a game based biofeedback intervention, which included the use of psychoeducation, identification of triggers and signs of anxiety, and in vivo practice. They compared this with the use of waiting list comparison group. It was their finding that the use of the intervention method reduced significantly the depression and anxiety scores thereby underpinning the importance of interventions.
b) Importance of Empowering School-Based Nurses
Marriage et al. (2012) conducted a study to establish the effects of nurse delivered behavioral therapy on the nature of life as well as changes in behavior on children with asthma and aged between 7 and ten years. After a pilot cohort study, they established that the nurse-delivered therapy increased the quality of life in such children and that the levels of anxiety dropped after such therapies. Cooper et al. (2012) further underscored the importance of empowering school-based interventions on nurses with proper strategies for prevention of anxiety and depression. In this regard, they reviewed existing literature with an aim of establishing whether students who are involved in cyberbullying and childhood bully as either perpetrators or victims were at a great risk of suicidal attempts. They established that nurse-delivered interventions are important in preventing anxiety and depression levels, which are a risk to the life of the students. Haddad & Tylee (2012) also conducted the evaluation of school-based nurses knowledge, skills and empowerment on the prevention of depression and anxiety. In this study, a 24-item knowledge test was developed based on a review of the relevant literature. After review by experts, the test was piloted to 26 nurses in different schools. A scale of depression levels was used to gauge the effects of the nurse-delivered interventions. The majority of the results showed that readability of the knowledge tests was impressive implying the lack of enough knowledge and skills for nurses to deal with depression and anxiety.
c) Support for School-Based Training and Education Programs
Fox et al. (2012) conducted a survey to establish the attitudes of parents in Minnesota regarding the screening of children in school, to establish their depression, suicide and anxiety levels. 1300 households who had children aged between 5-18 years were surveyed. Chi-square tests were the analysis methods that were used to test the differences in parents support of school-based screening of depression and fatal cases. Additionally, the tests evaluated the beliefs and knowledge of parents on depression and anxiety. An overwhelming majority of 84%-89% of the parents supported the school-based screening of children on depression and suicide. Further, the majority also supported education as one of the intervention measures. This support from the parents was defined by their increased levels of knowledge on the effects of depression and anxiety (Waite, &Shewokis, 2012). Fewer beliefs of stigmatization were also another factor that led to the high percentage of support. This study was an important one in espousing the important of school-based screening and empowerment of school-based nurses.
3. Proposal for Using Evidence in Practice
This vast wealth of proof is critical to understanding the best strategies that can be used to prevent cases of severe anxiety and depression in childhood education. From the evidence, several methods of achieving control of the effects of depression have been enumerated. As such, I will use this evidence to propose a school-based screening method for all the children so that cases like the one of suicide will not be experienced. This is informed by the success that this method of intervention has displayed in the literature. Additionally, I would propose an educational forum similar to that of Fun Friends and Friends for Life in which children will interact and be made aware of the intervention measures. Further, the evidence will help me have a proper understanding of the importance of nurse empowerment so that we could deal with incidences of depression and anxiety. Indeed, this evidence will help the children, their parents, teachers and the whole community as a whole.
The proposed project of developing a program for the interaction and education, as well as a school-based screening of children and their parents will involve all stakeholders in the society. The principal participants will be the kids and their parents. Additionally, the nurses will be able to monitor this program and ensure that all members are aware of the effects of depression and the methods of mitigating them. The teachers will also be involved as they are the ones who interact with the kids for the most hours of the day. To evaluate the effectiveness of my project, I would observe the children for ten weeks then check for any cases of depression and anxiety. Additionally, I would interview some of the children as well as their parents to evaluate how the program has helped since its inception. In any case, the effects of the program will be there to be seen, as instances of depression will be few and minimum.
To conclude, cases of depression and anxiety are not new in childhood institutions. These cases are the primary causes of substance abuse, loneliness, mental disease and event suicidal attempts among children. My experience of a suicide attempt by one of the children in the school where I act as the nurse was not only surprising but also awakening. In this regard, I was helpless, as I could not detect the signs and symptoms of the depression and anxiety that the child was going through. Through the review of the relevant literature, I have established that schools use different methods that help combat the depressive and anxious disorders that affect the academic and life quality of the child. As such, I will use this information to formulate a program for the school-based screening of children for anxiety and depression. This testing will lead to the formulation of educational programs that will help combat the effects of depression. The program will involve the children, parents, teachers and the whole community. To measure the effectiveness of the program, I will evaluate after ten weeks to establish whether cases of depression and anxiety have decreased. Additionally, I will interview parents and children on the benefits they have gained from the program.
BsctHons, D. A. C. M., & MBACP, R. (2014). With a little help from FUN FRIENDS young children can. Community Practitioner, 87(8), 26-29.
Cooper, G. D., Clements, P. T., & Holt, K. E. (2012). Examining childhood bullying and adolescent suicide implications for school nurses. The Journal of School Nursing, 28(4), 275-283.
Fox, C. K., Eisenberg, M. E., McMorris, B. J., Pettingell, S. L., & Borowsky, I. W. (2013). Survey of Minnesota Parent Attitudes Regarding School-Based Depression and Suicide Screening and Education. Maternal and child health journal, 17(3), 456-462.
Haddad, M., & Tylee, A. (2013). The development and first use of the QUEST measures to evaluate school nurses' knowledge and skills for depression recognition and management. Journal of school health, 83(1), 36-44.
Knox, M., Lentini, J., Cummings, T. S., McGrady, A., Whearty, K., & Sancrant, L. (2011). Game-based biofeedback for paediatric anxiety and depression. Mental health in family medicine, 8(3), 195.
Kosters, M. P., Chinapaw, M. J., Zwaanswijk, M., van der Wal, M. F., & Koot, H. M. (2015). Indicated prevention of childhood anxiety and depression: Results from a practice-based study up to 12 months after intervention. American journal of public health, 105(10), 2005-2013.
Marriage, D., & Henderson, J. (2012). Cognitive behaviour therapy for anxiety in children with asthma: Deborah Marriage and John He...
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