Menstruation, Menarche, and Sexuality in the Public School Curriculum: School Nurses' Perceptions

Article excerpt

Recommendations from research about education related to menstruation and menarche include matters related to the physiological aspects of human reproductive development, the hygienic management of menstruation, as well as the emotional context of this developmental milestone (Anastoasiow, Grimmett, Eggleston, & O'Shaughnessey 1988; McNab, 1985; Reirdan, Koff, & Flaherty, 1983). Pre-adolescence is deemed the most desirable time to introduce information about menstruation and other aspects of human sexual development (Soeffer, Scholl, Sobel, Tanfer, & Levy, 1985); however, the time of menarche has also been described as ideal to reinforce sex education (Soeffer et al., 1985).

The impact of other sources of information on menstruation, sexual development, and reproduction necessitate that school-based educational programs on these topics provide an opportunity for students to raise questions about myths and other inaccurate information (Greenberg, Perry, & Covert, 1983; Thornberg, 1981). Parental and adolescent perceptions of family dynamics may change at menarche, and adolescents' perceptions of relationships with other family members need to be included in educational programs related to menarche, menstruation, and sexual development (Hill, Holmeck, Marlow, Green, & Lynch 1985; Reirdan, Koff, & Flaherty; 1983).

The literature on education about these subjects in the schools has focused primarily on the role of the teacher in providing instruction and instituting discussion. One study examined school nurses' attitudes and perceived teaching responsibilities about menarche in the severely disabled adolescent (Tse & Oppie, 1986). The roles and responsibilities of school health nurses working with pregnant adolescents, parenting adolescents, and contracepting adolescents have not always been apparent (Oda, 1991). However, strategies that adapt to adolescent client needs have greater success (Chen, Fitzgerald, DeStefano, & Chen, 1991; Holt & Johnson, 1991; Bulloch, McFarlane, & Maloney, 1990; Washburn, 1989; Jackson, 1989). School nurses have responded to the need for AIDS education (Brainerd, 1989; Nauman, 1989a, 1989b; Glennister, Castiglia, Karski, & Haughey, 1990). The variation in school nurses' roles and responsibilities related to content on these subjects has been attributed to priorities set by schools (Kobokovich & Bonovich, 1992), and strategies of nurses (Chen, Telleer, Mitchell, & Chen, 1992). The present survey examined the involvement of nurses in the school curricula.


A convenience sample of 39 school nurses attending an annual statewide continuing education workshop completed a self-administered questionnaire at the beginning of the workshop. Copies had been made available at the registration table, and announcement was made at the beginning of the conference explaining the questionnaire's purpose and requesting the voluntary participation of all attendees.

Most items on the questionnaire were closed-ended with a minimum of open-ended questions to allow respondents the opportunity to elaborate on issues addressed. Items included content of the nurse's role in school health nursing; involvement in teaching or consulting with teachers about content related to menstruation, menarche, and other reproductive health topics including contraception; and teaching techniques and strategies employed in the classroom setting.

All 39 nurses were currently employed in public schools; 75% were employed exclusively in the schools; 25% had other assignments in addition to school nursing. The mean amount of time spent in schools per week was 27 hours (SD = 13). While 46% were employed by the schools, 54% percent were employed by the local public health department. Most nurses worked at all three school levels (elementary, middle, and high schools). Only three worked exclusively in elementary schools and two exclusively in middle schools (Table 1). …


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