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Needs Assessment

To conduct a proper needs assessment, the nurse must first gather and collect data to and composite the data into a data base. The nurse can assess the data to remove biases and identify any themes. This is a crucial first step in the needs assessment because it allows for the nurse to identify strengths and resources in the population. The purpose of the needs assessment is to assess the unmet health needs of the population and provide appropriate nursing interventions to meet those needs. The aggregate population are adolescents who are at risk for becoming a victimizer or victim of cyberbullying. In completing a needs assessment, the community nurse will be able to assess the aggregate population on their knowledge of cyberbullying and educate them on preventative strategies to avoid becoming a victim or victimizer. The nurse can also asses the knowledge of cyberbullying in the community, including the families of the population. The nurse can utilize secondary and tertiary prevention strategies to screen for those who may have already been affected and provide resources such as support groups and health services. The nurse can utilize patient-centered care to provide each adolescent with resources and teaching pertaining to their individual needs, also confirming that the community is educated on how to utilize recommended services.

Evidence Based Research

As the technology advances, so does means of communication, with the internet and social media playing a huge role in its transformation. With the increasing flow of different media platforms and applications available on the internet it is hard for parents to limit what a child is seeing and hearing online. The American Academy of Pediatrics continues to be concerned by evidence about the potential harmful effects of media messages and images. (Children, Adolescents, and the Media, 2013). In western countries, it has been reported that more than 25% of teenagers have experienced cyber-bullying (Cho & Kim & Shin, 2017). Cyberbullying has the same effect on teens as other types of bullying causing depression, suicidal ideation and violent behaviors. Adolescents who self-harm appear to have higher rates of internet exposure than other adolescents, and internet use or online gaming exceeding five hours was associated with suicidal ideation (Daine et al., 2013). Media programming is now available on more modern forms such as smart phones, tablets and social media websites. TV still remains the most prominent sources of media for children and teenagers but TV programs are available on alternative sources such as smart phones and tablets. Internet and electronic access is unlimited, and has become accessible in nearly every home and school. Teenagers can practically access the internet whenever they want using a smart device, with 84% of children and teenagers having access to the internet and 88% of all teenagers using text messaging (Children, Adolescents and the Media, 2013). This creates an increase in the potential number of perpetrators of cyberbullying or victims. Health care professionals and health and science researchers are working together to find meaningful strategies to help prevent the effects of media use and cyber-bullying on adolescents.

Media use its Effects on the Brain

With the rapid progression of new technology and social media networks it has been unclear how media use has influenced the development of the brain during adolescence. Adolescents are at a time in their lives where the opinions of their peers and the need to fit-in is at its highest. During adolescence there are naturally significant changes that occur in the brain related to social experience, communication and behavior. These changes are due to the increase of white and grey matter connections in the prefrontal cortex and other areas of the brain. Studies show that media influences on the brain notably change brain activity particularly affecting the neural systems associated with behaviors important for social media use. As these neural systems are still underdeveloped and undergoing significant changes during adolescence, they may contribute to sensitivity to online rejection, acceptance, peer influence, and emotion-loaded interactions in media-environments (Crone and Konijn, 2018). Studies show there also may be positives such as more flexibility with tasks but more research needs to completed to fully understand all of the negative consequences of media use on the adolescent brain.

Barriers to Resolution

There are four primary challenges that will be discussed in this section. The four barriers to resolution are; anonymity of cyber-bullying, internet usage as a social factor, a parental knowledge deficiency of social media and smart technology, and lack of support from social network services. The internet is a vast online computerized system with various networks interconnected. It is very easy for people to create an online experience very different from one’s reality. Social media networks such as Facebook and Instagram give its users the ability to connect to many users online anywhere. This has made targeting cyber-bulling very difficult allowing victimizers to have no fear of being held accountable. Due to the anonymity of cyber bulling, user tracing is very difficult to identify in mobile phones, email and social network services, and it is very difficult to identify bullying in smartphones compared to internet caf?©’, websites or blogs (Cho et al., 2017). This sense of inconspicuousness allows the cyber victimizer to reach their victims in any remote location at times making it hard for the perpetrator to be traced down. Second, the internet and social media is used as a social factor. During the period of adolescence one may be deciding where they fit in and what social group they belong to. Co-viewing, sharing, and discussing media content with peers is common practice among adolescents in line with their developmental stage in which peers become more important than others (Crone & Konijn, 2018). Internet forums are a type of community; allowing participants to seek out support groups and information from other members. Primary objectives for internet forums are used to develop friend ships and connect with others, and to seek empathy rather than advice. This is shown to have a negative influence on internet forum users because it appeared to discuss issues self-harm in a normalizing or empathetic manner instead of a preventative manner to reduce self-harm. General internet use appears to be a source of exposure to both suicide and self-harm, with 59% of participants in one study saying they had learned about suicide from an online source (Daine et al., 2013). Third, parents of adolescents may not be as knowledgeable about new technology and popular social networks. The gap of knowledge between what the adolescent understands and what the parent comprehends can be very intimidating when trying to understand how the teen may be affected. This may create a barrier for a victim when trying to seek help or advice from a parent or school administrator. The adult may also have biases about cyber-bullying and may not perceive it as serious as traditional bullying. Lastly, social media corporations such as Facebook, Snap Chat or Instagram are not taking an active enough role in limiting what children and adolescences are seeing on their networks. Cyber-bullying has become common place on social media and not much is regulated when it comes to communication between users.

Vulnerable Populations

The majority of the population that is being effected by cyber-bullying are adolescents. Teenagers are among the most frequent users of social media, with 81% of American 12-17 year olds reporting that they use social media networking sites (Cole et al., 2016). Teenagers are more exposed to and familiar with newer technology and social networks making them more at risk for cyberbullying or victimization. Many victims do not understand why they might be bullied as cyberbullying can be anonymous. Some factors that may make an individual more susceptible to cyberbullying include sexual orientation, race, disability, economic status and even gender. Psychological factors are also correlated with cyberbullying. Those who cyberbully are more likely to have anxiety, depression, less life satisfaction, less self-esteem, and face drug and alcohol abuse (Pacer’s National Bullying Prevention Center, n.d.). Researchers claim that that cyberbullying is just another extension of traditional bullying. Others state that cyberbullying may provide a mechanism for saying and doing things to others that one would never say or do face-to-face. Studies suggest gender may play a role in cyberbullying and its effects. Although some studies state that there is no significant difference, it is more likely for boys to be perpetrators and girls to be cyberbully targets (PNBPC, n.d.) Woman are also more likely to suffer from sexual bullying. Males generally reported having more negative physical, psychological, and academic effects from cyberbullying and are more likely to be affected by different types of cyberbullying such as video games (Kowalski et al., 2013). The population that is most affected by cyber bullying is the lesbian, gay, bisexual and trans young people as nearly half have been bullied for being LGBT at school (National Society for the Prevention of Cruelty to Children, n.d.). As with race, African-Americans seem to have a higher interest in social media than other races. This is seen as a unique phenomenon amongst African Americans and may put them more at risk for cyberbullying.

Cultural Diversity and Cyberbullying

Cyberbullying effects adolescents across many countries and regions. Researcher have reported instances of cyberbullying across the globe including Japan, Scandinavia, Australia, Canada, New Zealand and England (Lerner, 2011 Cyberbullying has been reported to be very high amongst Americans and Japanese youth. Japanese are known to be heavy consumers of modern technology that may put them more at risk (Lerner et al., 2011). The Asian culture, specifically in Japan is also very focused on reputation and fear of being socially excluded, causing many not to state their opinions in public. Minority groups such as first and second generation immigrants and ethnic-cultural minorities seem to be affected by cyberbullying more than others. It is also found that if cyber-bullying is studied grouping together adolescents into one majority group, it does not show an accurate account for all adolescent minority groups. Information is very scare on the effects and amount of victims in cultural minority groups. Economic Variables An Economic variable that may affect one’s risk of cyberbullying would be poverty. The amount of time an individual spends online or on social networking determines the amount of exposure to others online. Although 95% of adolescents in America have access to the internet there are still many who do not have internet access at home ((Hinduja et al., 2018). Poverty plays a role in how likely the individual will be able to have access to the internet or a new technology such as smart phones and tablets. The less the individual uses the internet and social media platforms the less likely the individual will be exposed to cyberbullying. Although cyberbullying may be decreased depending on financial status, adolescents who come from a low socioeconomic status are still at a higher risk of traditional forms of bullying.

Continuity of Care

Bullying is very prevalent amongst the adolescent population and there has been on-going research to understand the effects on young people. As new technology emerges, cyberbullying has now been on the forefront of discussion revolving around its psychological effects. Although it is proven that cyberbullying increases the rate of suicidal ideation, depression and violent school behaviors only 33% of teens told their parents or guardians about it (Pacers National Bullying Prevention Center, n.d). The amount of adolescents and children that are being exposed to cyberbullying is increasing with some studies showing statistics as high as almost half of adolescents. There must be a multidisciplinary approach when dealing with victims of cyberbullying. Health care professionals are at the forefront when providing care for the pediatric community. During doctors’ visits it is the job of the health care professional combined to asses for signs of cyberbullying and also use that time to provide education to the child and parents. Other institutions such as school nurses also have a role in teaching prevention strategies to adolescents about cyberbullying. Utilizing a multidisciplinary approach to report possible cyberbullying has been show to stop potential threats of violence or suicide.

Nursing Interventions

Interventions are performed at different levels of prevention; primary, secondary and tertiary. On a primary level the job of the nurse is educating the population about the risks of cyberbullying and how to preventing it from happening to the individual. On a primary level, the nurse can begin by educating the community on what cyberbullying is and who is at risk. The nurse can educate the population on strategies on preventing cyberbullying such as not posting any personal information or images online and not opening or responding to strange messages. The nurse should also educate the community that cyberbullying can occur anonymously so utilization of privacy settings on accounts would be helpful in achieving safer use of technology. Parents should be educated in the same way as adolescent about internet safety, this will facilitate a better understanding of cyberbullying so parents will be able to be more proactive monitoring their child’s use of technology. The school nurse can include these strategies in a safety education session on how to avoid becoming affected by cyberbullying and also can demonstrate how to access privacy settings online. The nurse can evaluate the teaching by asking the individual what they learned and what was helpful, the nurse can do this by utilizing the teach-back method by having the individual reiterate one to two ideas that were discussed. Secondary interventions include screening for who are already at risk for perpetration or cyber victimization. Studies show that both victimization and perpetration can go hand in hand and many who are victims may also be doing the bullying as well. Although an individual may only be a victim of cyberbullying, by screening the individual this may stop them from also becoming a victimizer. The nurse can also address concerns of those at risk, this may a time for the individual to state their anxieties about a situation that may be arising in their own lives and how to prevent it from occurring. The nurse can evaluate the response by noting how many people utilize the time to actually communicate a problem that they may be having. Tertiary prevention includes maximizing of recovery after one has already been affected. It is the nurses job to provide resources to care for that individuals specific need. The nurse can provide information on support groups for those who have been affected by cyberbullying. The nurse can also provide resources for health services if the individual feels that they need medical services. The nurse can evaluate the progress of the adolescents who reported being exposed to cyberbullying and received support or health services.

Nurse Advocacy and Cyberbullying

A Client advocate is one role of the community nurse. The nurse plays the role of informer, supporter, and mediator (Sommer, 2013). Being an advocate is a principal that every nurse understands as a duty when taking care of a population. With more than 25% adolescents being exposed to cyberbullying and only 33% reporting it to parents and guardians, there is certainly a need for nurses to step up and advocate for the population. Violence in schools seems to be increasing with numerous deaths linked to gun violence. Many sources are shifting blame on bullying and its involvement in student to student violence. The community school nurse plays a huge part in providing support for students who feel personally victimized or excluded from their peers. Adolescence is a time when one is just beginning to think about who they are and challenge to break free from their parents. Understanding the sensitivity of the matter, the nurse should make it imperative to provide proper education and recourses on a daily basis to all individuals.

Learning Theories

The learning theory being applied is the Social Learning Theory founded by Albert Bandura in 1977. This theory focuses on observational learning, implying that an individual, specifically children, observe models or others whom provide examples of behaviors the individual can observe or imitate. Observational learning implies that the more an individual pays attention to that model the more likely they are to imitate the behaviors of that model. The child or adolescent in this case, will be more likely to imitate those who seems more like oneself such as their peers, although the action reproduced may not be positive (McLeod, 2016). The nurse can provide interventions such as education about cyberbullying and also teaching safe internet strategies to adolescents expecting that they will be able to model these behaviors to their peers. The nurse can also utilize The Health Belief Model which describes the likelihood of one taking action based the perceived threat, modifying factors (e.g demographics & knowledge level), family, friends, the media and the perceived benefits minus perceived barriers to taking action (Sommer, 2013). One similarity of both of these theories is the fact that an individual will most likely demonstrate actions that will benefit their selves. The learning style that can be applied to this population is a tactile-kinesthetic learning style. This would be most helpful for learning because it includes methods such as trial and error, hands-on approach and return demonstration. These learners will gain meaning through exploration (Sommer et al., 2013) A barrier to using auditory and visual learning styles would be the adolescent will most likely do what is socially accepted by their peers so a more hands on approach would be useful. In social situations it may be useful to learn by doing something new or seeing the results of a new approach. The nurse can demonstrate to the community how to utilize safety measure on smart devices or on the internet and social networks and the adolescent can then utilize that in their own lives and demonstrate what was learned to others. Americans are entering time where cyberbullying has shown many adverse effects on the actions of its youth. Many Americans are stepping forward to announce need for change in their schools and communities. Adolescents can try to implement change by reporting suspicion of cyberbullying, being more socially and culturally inclusive of others, and implementing internet safety strategies.

ANA Standards of Practice

The American Nurses Association is a professional nursing organization that has assumed the responsibility of developing a scope and standard of its professional practice. The Scope of Nursing practice describes the who, what, where, why and how of nursing practice. The ANA standards of practice is comprised of standards of practice and standards of professional performance. Included in the standards of practice is the critical thinking model referred to as the nursing process allowing the nurse to provide competent and safe care by demonstrating critical thinking. The nursing process includes the component of assessment, diagnosis, outcome identification, planning, implementation and evaluation. In utilizing this process, the nurse will be able to properly care for the aggregate population and its needs. The nurse will also be able to provide a diagnosis centered around the need of the community (ANA, 2010). A community nursing diagnosis for cyberbullying may be: Risk of negative stressors among adolescents related to increased exposure to internet and social media use.

Quality and Safety Education for Nurses

Quality and Safety Education for Nurses competencies are integral components of the curriculum of nursing programs in the United States (Cherry & Jacob, 1999). The competencies associated with this aggregate problem include Team Work and Collaboration, Safety and Patient Centered Care. It is very crucial when providing care to foster open communication with the client, family and health care professionals. Using a team approach allows for better decision making and it allows for each member to feel that they are included in the care. Using this approach is especially helpful when communicating important client details to other health care providers so that there is no hesitation of care and resources. Safety is also extremely important with this population. Adolescents may feel that they are very knowledgeable when it comes to new technology but technology is vast and every changing. One should be extremely cautious about what is put online and what is communicated online to others. Patient centered care should always be utilized to advocate for that client being the source of their own care, providing respect for their preferences, values and needs. (QSEN, 2012)

Healthy People 2020

Healthy People 2020 provides a comprehensive set of 10-year, national goals and objectives for improving the health of all Americans. Mental health has always been a matter of importance and discussion listed as one of the leading health indicators. Healthy People 2020 Lists suicide and adolescents with major depressive disorders as the most crucial in mental health. Cyberbullying is known to be linked to suicidal ideation, depression and suicide. Increased internet use has been show to expose many adolescents to suicide. The current baseline is 11.3 suicides per 100,000 population occurred in 2007. The goal is a 10% decrease changing that statistic to 10.2 suicides per 100,000 populations. Healthy People plans on reaching its goals by providing screening for children under the age of 11 for depression, screening children and adults for risk for suicide, and also researching the effectiveness of anti-bullying policies in schools. (Healthy People 2020, 2010).

Ethical Principals

The Public Health Code of Ethics identifies the ethical practice of public health nursing. The ethical considerations are centered around promoting good and preventing harm all while respecting the autonomy and rights of the individual and community (Sommer, 2013). The nurse can abide by this code of ethics to provide the best quality of care for the patient. Since the issue of cyberbullying effects those of all backgrounds it is crucial to provide distributive justice to all patients making sure to provide the same level of medical care to each member of the community based upon their needs. The nurse should also understand the importance of privacy and confidentiality when discussing matters pertaining to the adolescent population as privacy is a very important factor in one’s life.

Leadership Principals

Being a leader is can come with much responsibility but has proven to be an extremely valued trait. Nurses can have many leadership and management roles providing their knowledge and expertise to help lead a community in health promotion. Adolescents are every focused on identity and many times will emulate a role model to frame the type of adult they would like to become. Knowing this it is imperative for the nurse to be a strong leader. Leaders working with adolescents should focus on being a transformational leader. Transformational leaders are very vision oriented and are committed to reaching the set goals. This leader likes to empower members of the community in a way to impart meaning and challenge to work (Cherry & Jacob, 1999). A nurse who is a transformational leader can fill the gap for adolescents who feel that they have no adult who they emulate or admire. If the nurse is able to receive a positive response from the community, it will help to create a better atmosphere for learning and communication. With the trust of the community the nurse can better implement new initiatives and changes to reach set visions and goals.

National Patient Safety Goals

The purpose of National Patient Safety Goals is to improve patient safety. The goals listed focus on problems in health care of the steps to solve them. One of the 2018 Behavioral Health Care National Patient Safety Goals is to: Identify individuals served safety risks. The intervention listed is to find out which individuals are most likely to try to commit suicide (The Joint Commission, 2017). It is known that adolescents are one of the groups that are at a high risk of suicide. Adolescents are also at a high risk for cyberbullying and traditional bullying. Knowing this, it is vital for the nurse to use primary and secondary prevention strategies to reduce risk and to screen for those who may already be at risk. It is the nurses job to keep in mind the safety goals that are related to the aggregate population to better meet heath care needs.

Technological Advances

Some advancements have been made to help educate adolescents about the internet the risk of cyberbullying or victimization. Since cyberbullying can only be completed through technology it is important to be educated on how to properly manage the internet and modern technology in one’s life. I-SAFE founded in 1988, is a non-profit foundation whose mission is to empower and education youth to make their internet experiences safe and responsible (About i-SAFE inc, 1998). I-SAFE is not only for adolescents but also extends into the community to provide parents, educators and law enforcement with programs to increase their knowledge of cybersecurity. Having a multidisciplinary approach has been proven to be effective when tacking problems that effect a large population or people. There are also other avenues for resources including the STOMP Out Bulling live chat line where victims can speak to trained volunteers who specialize in assisting youth who feel distressed from bullying and who are at risk for suicide. This is extremely helpful because it is very convenient to access when needed and the help can occur privately online with trained volunteers. Social media networks have also worked on providing better security features to help limit the sharing and posting of inappropriate or personal information among users.

Legislation on Cyberbullying

There are no anti-bullying federal laws, bullying falls under laws of harassment in which schools are legally obligated to address. Federal civil laws protect those from being discriminated against related to their race and national origin, sex, disability and age. States have their own specific anti-bullying laws and policies and many states are beginning implement more laws and policies to help protect the community from bullying. Most states have both laws and policies against bullying, some states have only laws. States that are law only include Texas, Arizona, Arkansas, Colorado, Hawaii, Mississippi, Missouri, North Carolina and Texas. One Territory is policy only and that includes the Northern Mariana Islands. In 2010 the U.S Department of Education reviewed states laws and identified 11 key components. The Key components include purpose statement, statement of scope, specification of prohibited conduct, enumeration of specific characteristics (e.g discrimination against races, religion, origin), development and implementation of LEA Policies, review of local policies, communication plan, training and preventative education, transparency and monitoring, statement of rights to other legal resource and model policy (Stop Bullying: Laws and Policies, 2017). These components summarize and highlight what initiatives states plan to take to lower the risk of cyberbullying.

The Global Impact of Cyberbullying

Internet use has increased globally by 566.4% between December of 2000 and June 2012. (Daine et al., 2013). As stated earlier cyberbullying has had very high prevalence in many different countries. It is possible for one person to be cyberbullied by another although they may live in totally different countries or continents. Research has shown the cyberbullying has even worsening effects when combined with social rejection and mental illness. Although it is very widespread in America, it has been found that Asian countries actually have a higher prevalence of cyberbullying.