"No One Died Today:" A Naturalistic Inquiry into the Perceptions and Experiences of School Nurses Dealing with Adolescents who Self-Harm

There is an increased incidence of self harm among middle and high school age adolescents. The school nurse (SN) is in a position to recognize this behavior (Cooke & James, 2009), but little is known about the school nurse’s perceptions and experiences related to adolescents who engage in self harming behaviors. There is a paucity of literature addressing the roles and responsibilities of the school nurse in general as well as school nurses’ responsibilities and responses to children who self-harm. The study utilized Naturalistic Inquiry (Erlandson et al., 1993; Lincoln & Guba, 1985) to explore the perceptions and experiences of school nurses who deal with middle- and high-school-age students who self harm. Fourteen school nurses were interviewed face-to-face utilizing web-based video or telephone conferencing. Study findings revealed that the responses of SNs who deal with adolescents who self harm (ASH) are multifaceted. They must triage, treat, and support the adolescent at the time of the event and in the future; they must develop creative strategies for case finding and monitoring. They must deal with their own affective responses and they must educate and support the parents to accept what is going on with the ASH and help them find appropriate treatment. The SN also must educate and support school faculty and staff as well as the community about the problem of ASH. Although the SNs found themselves frustrated and overwhelmed, their commitment to the people in their care helped to sustain them.