THE BELIEFS AND NEED FOR EDUCATION OF SCHOOL NURSES ON RECURRENT ABDOMINAL PAIN OF CHILDHOOD. OPPORTUNITY FOR THERAPEUTIC ALLIANCE?

Abstract

Aim: Recurrent abdominal pain (RAP) of childhood affects up to 20% of children. RAP carries significant social consequences often leading to school absence and frequent physician evaluation. Initial assessment of RAP is often made at the school nurse (SN) level. The aim of this study is to determine what knowledge and beliefs SNs have regarding RAP. Methods: 425 SNs selected from the New Jersey School Nurses Association Directory. SNs were sent a 21-item questionnaire eliciting their perceptions regarding RAP in children. The definition of RAP was 3 episodes of abdominal pain interfering with activity for 3 months in the past year. Questionnaires were coded for anonymity. SN experience, knowledge on RAP, disease perception, knowledge of medicines, and need for education were assessed. Results: There were 131 (31%) questionnaires returned and RNs accounted for 95% of respondents. Over 98% reported seeing children with RAP. More than 10 visits/month for RAP was reported by 31% of SNs. Of respondents, 77% felt that an extensive evaluation by an MD is needed but only 23% believed that medication would help RAP. Communication with MDs about RAP was considered poor by 84% of SNs. SNs reported that 70% of children with RAP were faking the pain or seeking attention. Children with RAP were considered sad (35%) or lazy (38%) by SNs. SNs recommendations for RAP included: rest (94%), go to bathroom (90%), back to class (68%) and sent home (48%). Mean total nursing experience was 26.1 ± 14 years with a mean school nurse experience of 11.1 ± 21 years. There was no significant differences found between SNs with >10 years experience vs. SNs with less experience (Table).TABLEConclusions: Despite extensive experience, SNs have negative views of children with RAP and are unclear about disease severity. SNs may inadvertently contribute to the increased social stigmata felt by children with RAP who might feel their complaints are not taken seriously. Education of SNs and better communication from MDs may allow for enhanced partnerships and implementation of strategies at the SN level to reduce the associated costs and school absenteeism seen in children with RAP.