According to the Centers for Disease Control and Prevention (CDC; 2008a, 2008b), the phenomenon of school violence has evolved into a pervasive public health problem contributing to the morbidity and mortality of American youth ages 5–18 years. School violence behaviors, such as bullying, physical fighting, weapon carrying, and street gang presence on school property, are disruptive processes identified as nonconducive to the school learning environment. For example, according to the Office of Juvenile Justice and Delinquency Prevention (OJJDP, 2009) the alarming magnitude of school violence can be demonstrated within the documented 457,700 cases of youths, ages 12–18 years, who were victims of serious crimes, such as sexual assault, robbery, and aggravated assault; specifically, 34% of these crimes occurred on school grounds or on the way to school. Nansel et al. (2001) measured the prevalence of bullying behavior and reported that 13.0% of students reported moderate or frequent experiences as the perpetrator, where 10.6% reported being the victim of bullying, and 6.3% reported experiencing a combination of perpetuating and victimization. Later, in 2007 the Youth Risk Behavior Survey (YRBS) reported that while on school property at least 1 day during the 30 days before the survey, 5.9% of students reported carrying a weapon (e.g., a gun, knife, or club), and 12.4% of students reported having been in a physical fight (CDC, 2008b). Furthermore, direct and indirect costs of youth violence are estimated at an annual cost of $158 billion (CDC, 2008c).
The primary purpose of this evolutionary concept analysis is to identify the current, state-of-art usage of the concept school violence. Rodgers and Knafl's (1993, 2000) evolutionary concept analysis method is used to determine the contemporary trends and issues relative to the concept of school violence. Second, implications for forensic nurses are provided related to the concept of school violence.
Rodgers and Knafl's evolutionary concept analysis method
Rodgers and Knafl's (1993, 2000) evolutionary concept analysis method serves as the theoretical framework for this study. According to Rodgers and Knafl (1993, 2000) an evolutionary concept analysis is viewed as a rigorous, dynamic, systematic, inductive approach to knowledge development that uses the processes of concept definition, evaluation, and refinement. These conceptual processes are used to clarify the attributes of a concept, to identify the current usage of a concept, and to serve as a foundation for further development of the concept. Additionally, Rodgers and Knafl (1993, 2000) identify concepts as contextually dependent and containing “pragmatic utility rather than inherent truth” as compared to the historically accepted essentialism view of a concept as a “static … finite … universal … inherent truth” (p. 73).
Major activities or tasks found in Rodgers and Knafl's (1993, 2000) evolutionary concept analysis method include: (1) identifying the concept of interest; (2) choosing the setting and sample; (3) collecting and managing the data; (4) analyzing the data; (5) identifying an exemplar; (6) interpreting the results; and (7) identifying implications. Key to the conduction of this evolutionary concept analysis of school violence is Rodgers and Knafl's (1993, 2000) position that the “identification of change over time … is not always necessary to clarify the current status and applications of a concept” (p. 91). Based upon Rodgers and Knafl's (1993, 2000) evolutionary concept analysis method, the results of the current state-of-art usage of the concept, school violence, are presented.
Activity: Identifying the concept of interest
Identifying the concept of interest is an important initial activity in evolutionary concept analysis, including identification of surrogate terms that express similar ideas. From Rodgers and Knafl's (1993, 2000) point of view, concepts are articulated through spoken or written language. The concept of school violence has been identified by the CDC (2008a) as:
a subset of youth violence [within] a broader public health problem. Youth violence refers to bullying, slapping, punching, weapon use, and rape. Victims can suffer serious injury, significant social and emotional damage, or even death. The young person can be a victim, an offender, or a witness to the violence-or a combination of these (para 1).
In this evolutionary concept analysis, the terms violence, youth violence, and violent crimes are identified as surrogate terms of school violence. Violence is legally defined as, “the abuse of force … that force which is employed against common right, against the laws, and against public liberty” (Lectric Law Library, n.d., para 1). The OJJDP (2009) defines serious violent crimes as sexual assault, robbery, and aggravated assault. From an environmental perspective, school violence has been additionally defined as occurring on school property, on the way to/from school, or during or on the way to/from a school-sponsored event (CDC, 2008a). The concept of school violence is identified as the concept of interest for this evolutionary concept analysis.
Activity: Choosing the setting and sample
In the task of choosing the setting and sample, Rodgers and Knafl (1993, 2000) define the setting as “the time period to be examined and the disciplines or types of literature to be included” (p. 87). For this concept analysis, inclusion criteria consisted of: (1) English language publications, (2) literature that focused on adolescents 12–18 years old, (3) reports of school violence occurring in the USA, and (4) time frame 2000–2010. Rogers and Knafl (2000) later refer to the “identification of change over time” as “this developmental perspective is not always necessary to clarify the current status and applications of a concept” (p. 91) which is the primary focus of this evolutionary concept analysis.
Activity: Collecting and managing the data
Databases selected for examination included MEDLINE, PsychINFO, Cumulative Index to Nursing and Allied Health (CINAHL), Education Resources Information, and Social Work Search. In each database the key word school violence is crossed referenced with the key words youth violence, youth substance use, adolescence, and alcohol and substance use on school property. Cross-referencing generated the following number of relevant articles from the time frame 2000–2010: MEDLINE (n= 110); PsychINFO (n= 456); CINAHL (n= 8); and Social Work Search (n= 5). Next, all relevant titles and abstracts were reviewed, labeled according to the applicable database, and numbered 1 through the size of sample; for example, relevant articles retrieved from MEDLINE sample size = 110 were numbered sequentially 1 through 110. A brief discussion of the random sampling strategy employed in this study follows.
Distinguishing feature: Random sampling procedure
Rogers and Knafl (2000, 1993) method of evolutionary concept analysis calls for the random sampling of articles or literature items designated for inclusion in the analysis. According to Creswell (2009), random sampling is a procedure that states “each individual has the equal probability of being selected from the population, ensuring that the sample will be representative of the population” (p. 233). In this study, the random sampling procedure for selecting articles and literature-based items is viewed as a strength for objectivity in the literature-based selection process is increased, and each relevant literature-based item has the equal chance of being selected for inclusion in the concept analysis. Although Rodgers and Knafl (2000) call for the random sampling of articles or literature-based items, exceptions can be made for the inclusion of articles or items deemed seminal in nature (Rodgers & Knafl, 1993, 2000). As a result, in this study, exceptions were made for selected governmental reports that served as guiding frameworks in the problem of school violence and for six very recent articles that illustrated the rapidly emerging trend of cyberbullying/Internet bullying or other forms of electronic aggression.
In this concept analysis, based on the sample size of articles from each database, random numbers were generated using a computerized random integer generator program (, 2008). Articles whose number corresponded with the generated random number then became the selected article for inclusion in the concept analysis. Based on inclusion criteria, the random sampling procedure produced 34 randomly selected articles for inclusion in the concept analysis. Seven articles were added to the analysis that were deemed seminal in nature bringing the total to 41 articles selected to examine the current, state-of-art usage of the concept school violence.
Congruent with Rodgers and Knafl's (2000) framework, each article or item included in the literature sample was read for understanding and to initiate the process of submersion into the literature. From the primary author's perspective as a clinical scientist whose life work is committed to school violence and adolescent substance abuse, the term “submersion into the literature” signifies the author's initial exploration of the literature, for “concept development” is an on-going and evolutionary process (Rodgers & Knafl, 2000). As the data were reviewed, recurring patterns and subthemes and the associated verbatim passages were organized and reorganized, labeled and grouped into categories as attributes, antecedents, consequences, surrogate terms, and related concepts. Table 1 lists the attributes, antecedents, and consequences of school violence from this evolutionary concept analysis.
Activity: Analyzing the data by identifying major themes and attributes
Based on this evolutionary concept analysis, seven major attributes emerged that defined the state-of-art usage of the concept school violence: (1) bullying, (2) physical fighting/weapon carrying, (3) alcohol/substance related school violence, (4) street gang presence on school property, (5) safe school legislation, (6) school-associated violent death, and (7) school violence prevention strategies (see Figure 1).
Bullying is identified as a significant component of school violence that takes on many forms: psychological, physical, financial, sexual, and includes the evolving phenomenon of cyber/media bullying (Nansel et al., 2001; Sampson, 2002; Synder, 1999, 2006). Nansel et al. (2001) initially defined bullying as:
A specific type of aggression in which (1) the behavior is intended to harm or disturb, (2) the behavior occurs repeatedly over time, and (3) there is an imbalance of power, with a more powerful person or group attacking a less powerful one. This asymmetry of power may be physical or psychological, and the aggressive behavior may be verbal (e.g., name-calling, threats), physical (e.g., hitting), or psychological (e.g., rumors, shunning/exclusion) (p. 2094).
Further, Nansel et al. (2001) measured the prevalence of bullying behaviors in their study of 15,686, US 6th to 9th graders from public, Catholic, and private schools. They found that 13.0% of students reported moderate or frequent experiences as the perpetuator, with 10.6% reporting having been the victim of bullying, and 6.3% reporting having experienced a combination of perpetuators of violent behaviors and victimization. Sampson (2002) expanded the definition of bullying to include elements of financial abuse and property damage, such as, “demands for money, destruction of property, theft of valued possessions, and destruction of another's work” (p. 2). Finally, Sampson included the behaviors of sexual harassment, sexual propositioning, sexual abuse, and ostracism based on perceived sexual orientation, and hazing as forms of bullying that occur on school property.
Media technology, such as computers used for Internet access, cell phones, and personal assistant devices provide the student with valuable information and access to social interaction (David-Ferdon & Hertz, 2007). Nonetheless, access to the emerging electronic media places the student at risk to exposure of cyberbullying/Internet bullying or other forms of electronic aggression (Williams & Guerra, 2007; Worthen, 2007; Ybarra, Diener-West, & Leaf, 2007). Williams and Guerra (2007) define Internet bullying as, “the willful use of the internet as a technological medium through which harm or discomfort is intentionally and repeatedly inflicted through indirect aggression that targets a specific person or groups of persons” (p. 15). Kowalski and Limber (2007) describe methods of electronic bullying as the use of “e-mail, instant messaging, in a chat room, on a website, or through digital messages or images sent to a cell phone” (p. 22). They further assessed the scope of electronic bullying among 3767 middle school students and reported students were most often bullied through instant messages, chat rooms, e-mails, and websites.
Physical fighting/weapon carrying
Physical fighting/weapon carrying on school property are found to be disruptive processes that are not conducive to the school learning environment. Beliefs and attitudes play a role in school violence. Seminal research conducted by Malek, Chang, and Davis (1998) found among 7th graders (N= 567) an association p= 0.001, between increased physical fighting and students who believed their parents would be displeased if they did not fight when insulted by others. Almost a decade later, the 2007 Youth Risk Behavior Survey (YRBS) (CDC, 2008b) examined self-reports of 9th to 12th grade students nationwide in private and public schools. Results revealed that while on school property at least 1 day during the 30 days before the survey, 5.9% of students carried a weapon (e.g., a gun, knife, or club), 12.4% of students had been in a physical fight, and 27.1% of students had their property stolen or deliberately damaged. Additionally, 5.5% of students had not gone to school for at least 1 day because they felt they would be unsafe at school or on their way to or from school.
Alcohol and drug use
Alcohol and drug use while on school property is not a well-studied phenomenon, yet it is counterproductive to the school learning environment. Foundational research conducted by Durant, Krowchuk, Kreitier, Sinal, and Woods (1999) surveyed 2227 randomly selected 8th graders in a southern school system to examine the association between weapon carrying on school property and the onset of substance use and other variables. Their study found that the odds ratios (ORs) for gun carrying were associated with increased age (OR, 1.57); male gender (OR, 5.62); minority ethnicity (OR, 3.30); and earlier age of onset of cigarette smoking (OR, 0.85) (Durant et al., 1999). All associations were at the 95% confidence level.
Kuntsche, Knibbe, Engels, and Gmel (2007) found that violent males had a higher level of alcohol consumption than females and they drank more often to be part of a group in which both alcohol consumption and violent behaviors were the norm. Alcohol use has also been highly correlated with alcohol-related fighting compared to other physical fighting (Swahn & Donovan, 2006). Additionally, results from the 2007 YRBS indicated that while on school property, 4.1% of students drank at least one drink of alcohol; 3% of students had been offered, sold, or given an illegal drug by someone; and 4.5% of students had used marijuana (CDC, 2008b). To further illustrate the magnitude of youth alcohol/substance use on school property, Rudatsikira, Muula, and Siziya (2008) analyzed 2227 self-reports from participants of the 2005 YRBS. Findings revealed that while on school property, physical fighting was associated with alcohol consumption (OR = 1.45) and the use of illicit substances (OR = 1.73). All results were at the 95% confidence level.
Street gang presence on school property
The term street gang has been defined by DeVoe et al. (2004) as, “organized groups that are often involved in drugs, weapons trafficking, and violence” (p. 46). The US Department of Justice surveyed 2551 police departments nationwide in 2006. Results from this survey revealed approximately 785,000 gang members and 26,500 gangs were in operation across the nation (Egley & O'Donnell, 2008). Gang presence on school property is s viewed as nonconducive to academic achievement and places the student and staff at risk to exposure of violence (DeVoe et al., 2004; Egley & O'Donnell, 2008; Federal Bureau of Investigation, 2008; Knox, 2009; Myers, 2007; Office of the Attorney General, n.d.; Office of Safe and Drug-Free Schools, n.d.). Alarmingly DeVoe et al. (2004) reported data from the 2003 National Crime Victimization Survey that indicated that 21% of students ages 12–18 reported the presence of gangs in their schools, 31% of urban school students reported gang presence, followed by 18% of suburban school students, and 12% of rural students.
School-associated violent death
According to the CDC (2008d) school-associated violent death is defined as
a fatal injury (e.g., homicide, suicide, or legal intervention) that occurs on property, on the way to/from school, or during or on the way to/from a school-sponsored event. Only violent deaths associated with U.S. elementary and secondary schools are included (Case definition section, para 1).
Findings from the School Associated Violent Death Study (N= 204) conducted by Anderson et al. (2001) revealed that 102 school-associated violent deaths were the result of interpersonal disputes, 52 were gang-related, and 8 were due to drug-related activities. This study also identified antecedents of school-associated deaths (N= 204) revealed 54.5% of cases did not leave a note, did not make threats, nor did they make journal entries, or display other actions (e.g., arguments, fights) and that homicide perpetrators were twice as likely as homicide victims to have been bullied by peers (Anderson et al., 2001).
Safe schools legislation
Title IV Part A Safe Schools and Drug Free Communities section of the No Child Left Behind Act of 2001 (U.S.C. Public Law 107–110, 2002) provides funding to “support programs that prevent violence in and around schools; that prevent the illegal use of alcohol, tobacco, and drugs; that involve parents and communities … to foster a safe and drug-free learning environment that supports student academic achievement” (Title IV, Sec. 401, Part A, Sec. 4002). The Office of Elementary and Secondary Education's Department of Safe and Drug-Free Schools Program functions at all levels of government to administer financial assistance for drug and violence prevention activities, to administer violence and drug-related national policies, and to participate in setting the agenda for drug and youth violence prevention at the individual, family, peer/school, and community levels.
School violence: Problem identification, prevention, and intervention strategies
School violence prevention practices are as multifaceted and as complex as the problem of school violence. The CDC (2008c) advocates a four-step approach to address the problem of school violence: (1) define the problem; (2) identify risk and protective factors; (3) develop and test prevention strategies, and (4) ensure widespread use of evidence-based prevention strategies. The CDC (2008c) publication Understanding School Violence Fact Sheet provides a detailed discussion of this guiding framework. School violence identification, prevention, and intervention strategies range from universal school-based curricular programs that target all students and address self-social and emotional competency (Greene, 2008), anger management, and conflict resolution (Botvin, Griffin, & Nichols, 2006) to the implementation of mental health referrals for problem students. In addition, to deter weapon-carrying/concealment on school property, a number of a protocols have been developed, such as, weapon-reporting procedures, installation of metal detectors, and mandatory school dress code (Mulvey & Cauffman, 2001).
Contemporary clinical studies examined the relationships between school violence and other risk factors (Bryan, 2009; Chen and Astor, 2010; Jones et al., 2009; Langman, 2009; Theriot, 2008). For example, Jones et al. (2009) surveyed 219 middle school students in schools designated “persistently dangerous” to examine fighting behavior among students (p. 284). The schools are designated “persistently dangerous” because of the schools' high rates of suspension and expulsion. Study findings characterized students who were more likely to fight as, students who perceived parental approval of fighting and students who lacked adult supervision. From a financial perspective in view of recent funding cuts, Bryan (2009) examined the relationship between school safety funding and school violence in 108 public high schools. Findings revealed no significant relationship between school safety funding and school violence. From a global perspective, Chen and Astor (2010) examined the phenomenon of school violence in Taiwan by surveying 7th to 9th grade students (N= 3058). Findings revealed characteristics of school violence among Taiwanese students that were similar characteristics of school violence seen in students in western countries (e.g., student's perceptions of violence, lack of impulse control).
In terms youth violence, screening in the emergency department for the problem of adolescent firearm carrying serves as a valuable intervention and educational opportunity. Larkin (2003) calls for physicians to conduct firearm carrying screening in the Emergency Department using the firearms-carrying FIGHTS screening tool: Fi = fighting; G = gender; H = hurt while fighting; T = threatened; S = smoker. According to Larkin (2003), “one point is assigned for each positive response, and a score of 2 or more is considered positive for adolescent firearms-carrying” (p. 808). Larkin also asserts that the screening for adolescent firearms carrying is an opportunity to provide needed counseling and referrals.
In sum, seven major themes emerged identifying the state-of-art usage of the concept school violence: (1) bullying, (2) physical fighting/weapon carrying, (3) alcohol/substance related school violence, (4) street gang presence on school property, (5) safe school legislation, (6) school-associated violent death, and (7) school violence prevention strategies.
Activity: Interpreting the results to reflect current usage of the concept school violence
The current, state-of-art usage of the concept school violence revealed a general multidisciplinary consensus that of a multifaceted phenomenon comprised of complex intertwined processes that are human-bound, dynamic in nature, contextually dependent, and contain practical utility. Major themes reflect the destructive nature of school violence—bullying, physical fighting/weapon carrying, alcohol/substance use, gang presence, and school associated violent death. The negative consequences of school violence may be a physical force and/or psychological in nature (see Table 1). The rise of electronic media bullying/aggression and the growing presence of street gangs on school property further compounds the problem of school violence. Due to the magnitude of the problem of school violence, monumental efforts by government and private enterprises have led to the design of safe schools legislation and school violence prevention strategies to serve as far-reaching protective and remediating factors.
Implications for forensic nursing
What does school violence, as a major public health problem, mean for forensic nursing? Forensic nurses are a significant line of defense, at all levels of prevention, for at-risk individuals, groups, agencies, and communities. Congruent with the foundational facets of forensic nursing—specifically, the provision of direct services to individual clients; consultation services to nursing, medical, and law-related agencies; adequacy of services delivery; and specialized diagnoses of specific conditions as related to nursing (International Association of Forensic Nurses [IAFN], 2006), forensic nurses across practice settings are uniquely positioned to address school health issues. These concerns can be addressed through collaboration with school nurses, teachers, and administration regarding the use of primary and secondary prevention interventions. Many schools across the nation are instituting “Zero Tolerance for Violence” policies yet this approach is still in the preliminary phases and not necessarily completely understood or uniformly implemented. Specific consultation from forensic nurses to local and state school policy makers can provide expanded awareness of the underlying evidence-based research that can be translated into school policy and enhancing safety-related practices. Such consultation can include information dissemination, methods for problem identification, approaches for screening and reporting, and subsequent referral and counseling. Further, stemming from the principle of beneficence within the American Nurses Association's Code of Ethics (2001, Provision 8.2), nurses have an obligation to become knowledgeable about the health issues that place their clients at risk (Jones & Lachman, 2011). Yet, school agencies are ill-prepared to screen for potential school violence and to subsequently intervene effectively. Examples of barriers that hinder agencies and interfere with intervention include an inadequate awareness of the scope of the problem, a lack of clarity of their role in screening and intervening, and myths/stereotypes about socioeconomic status, ethnicity, and nationality or culture of perpetrators of school violence. In this light, school nurses, administrators, teachers, and concerned family/community members can benefit from consultation and collaboration from forensic nurses who can directly respond to these issues through curricular and experiential education, clarification of school policy, enhancing risk assessment, and establishing antiviolence interventions.
Forensic nurses can work closely with schools to examine and utilize prevention efforts already established from a variety of contemporary agencies (see Table 2). For example, according to the Consortium to Prevent School Violence (2008), the following approaches are foundational in prevention efforts:
- responding to risk factors across ecological levels: individual, peer, family, school, and neighborhood;
- providing a balanced approach that improves students' investment and bonding to school, while also providing a school-wide system of rules and behavioral expectations that are communicated and implemented in a firm, fair, and consistent manner;
- offering general supports for all students as well as several levels of more specialized and intensive supports for a smaller percentage of students with greater needs; and
- collecting and analyzing data to identify needs areas and drive responsive school practices. (Online source para 2).
Forensic nurses could provide guidance and support to local schools surrounding such recommendations and further provide unique feedback and evaluation.
Rodgers and Knafl's (1993, 2000) evolutionary concept analysis method proved to be an effective contemporary approach to knowledge development. Employing Rodgers and Knafl's (1993, 2000) evolutionary concept analysis method revealed the enormous scope and complexity of the concept of school violence and determined the current usage of the concept. Findings from this approach assisted in identifying the major attributes of school violence which provided guidance for the role of forensic nursing relative to the problem of school violence.
As demonstrated through the literature review, there are gaps in the school violence knowledge base that beg for further understanding: following rapidly developing electronic media and developing quick turnaround survey methods to measure student substance use (Worthen, 2007); continuing the focus on youth interpersonal violence prevention (Pratt & Graydanus, 2003); examining potential causes of youth violence; and designing effective intervention strategies (Williams Rivera, Neighbours & Reznik, 2007). The authors noted that in comparison to the volume of underage drinking studies and youth violence studies, the phenomenon of alcohol, tobacco, and other drug use while on school property also warrants empirical study.
Nurses across all practice settings could benefit from enhancing their knowledge and skills given that many are on the frontline of the healthcare arena and could conduct primary prevention strategies in the problem of school violence.
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