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.

METHOD

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).

Ninety-two percent reported that content on menstruation was taught at these schools; 5% noted that it was not taught: and 3% were unsure. Seventy-four percent said there was no variation in the content taught at specific grades between the schools, while 26% said the content varied among the schools.

Table 1

Although the majority of respondents stated that the content taught to boys and girls was similar, a majority also said that boys and girls received their instruction separately. A third of the respondents indicated that some of the instructional sessions included boys and girls together, but no data were obtained as to the rationale for the different strategies. Further evaluation of the advantages and disadvantages of teaching boys and girls together may yield more conclusive recommendations as to the most advantageous strategy.

Another area that warrants further investigation is the inclusion of parents in the teaching of these subjects. In this study only a quarter of the nurses indicated any parental involvement. No data were obtained as to the rationale for the general lack of parental involvement or why there was parental involvement in the minority of instances.

Strategies for classroom teaching were predominantly lecture and discussion with audiovisual aids. Less than a quarter of the respondents indicated use of small-group discussion. A determination of how and when small groups might be advantageous would be essential before recommendations could be made about the use of this particular strategy.

The nurses who responded in this study are assuming considerable responsibility for teaching about menstruation and other related topics. Since they are assuming this responsibility, more attention needs to be paid to the resources they have available and the rationale that guides their decisions in selecting content and employing specific teaching strategies. These questions deserve additional exploration in order to make productive recommendations to school health nurses in this important aspect of their expanding role.

REFERENCES

Anastoasiow, N.J., Grimmett, S.A., Eggleston, P.J., & O'Shaughnessy, T.E. (1988). Educational implications of earlier sexual maturation. Phi Delta Kappan, November, 198-201.

Brainerd, E.F. (1989) HIV in the school setting: The school nurse's role. Journal of School Health, Sept., 59(7), 316-317.

Bullock, L., McFarlane, J., & Maloney, E.F. (1990). Preventing violence during teen pregnancy. School Nurse, Feb., 6(1), 10-12.

Chen, S.C., Fitzgerald, M.C., DeStefano, L.M., & Chen, E.H. (1991). Effects of a school nurse prenatal counseling program. Public Health Nurse, Dec., 8(4), 212-218.

Chen, S.C., Telleen, S., Michell, D.R., & Chen, E.H. (1992). Factors influencing visits to school nurses by pregnant adolescents. Pediatric Nursing, July-Aug., 18(4), 355-360.

Glennister, A.M., Castiglia, P., Kanski, G., & Haughey, B. (1990). AIDS knowledge and attitudes of primary grade teachers and students. Journal of Pediatric Health Care, Mar.-Apr., 4(2), 77-85.

Greenberg, B.S., Perry, K.L., & Covert, A.M. (1983). The body human: Sex education, politics and television. Family Relations, 32, 419-425.

Hill, J.P., Holmeck, G.N., Marlow, L., Green, T.M., & Lynch, M.E. (1985). Menarcheal status and parent-child relations in families of seventh-grade girls. Journal of Youth and Adolescence, 14(4), 381-316.

Holt, J.L., & Johnson, S.D. (1991). Developmental tasks: A key to reducing teenage pregnancy. Survival of Pediatric Nursing, June, 6(3), 191-196.

Jackson, D. (1989). Sex education in Haitian secondary schools, Health Visitor, July, 62(7), 219-21.

Kobokovich, L.J., & Bonovich, L.K., (1992). Adolescent pregnancy prevention strategies used by school nurses. Journal of School Health, Jan., 62(1) 11-14.

Nauman, L. (1989a). School nursing and AIDS education. Kansas Nurse, Jan., 64(1), 6.

Nauman, L. (1989b). School nursing and AIDS education. Journal of School Health, Sept., 59(7), 312-13.

McNab, W. (1985). What they should know about menstruation. The Science Teacher, Feb., 27-32.

Oda, D.S. (1991) The invisible nursing practice. Nursing Outlook, Jan.-Feb., 39(10), 28-29.

Reirdan, J., Koff, E., & Flaherty, J. (1983). Clinical experience: Guidelines for preparing girls for menstruation. Journal of the American Academy of Child Psychiatry, 22(5), 480-486.

Soeffer, E., Scholl, T., Sobel, E., Tanfer, K., & Levy, D. (1985). Menarche: Target age for reinforcing sex education for adolescence. Journal of Adolescent Health Care, Sept., 6, 383-386.

Thornburg, H.D. (1981). Adolescent sources of information on sex. The Journal of School Health, April, 54(1), 274-277.

Tse, A.M., & Opie, N. (1986). Menarche in the severely disabled adolescent: School nurses' attitudes, perceptions, and perceived teaching responsibilities. Journal of School Health, Dec., 56(10), 443-447.

Washburn, D (1989). "Mom, I'm pregnant!" The crisis in teen pregnancy. School Nurse, Jan.-Feb., 5(1), 8-13.

Beverly Foster, Clinical Assistant Professor, University of North Carolina, School of Nursing, Chapel Hill, NC 27599-7460