FIELD ATTACHMENT REPORT

Introduction

The general goal of the field attachment was to gain experience/exposure through application of
theory into practice in the prevention and management of mental health problems. This include
tackling child, adolescent and adult mental health problems using the nursing process and
incorporating their families in the process.

The Schools Health Programme is a health care department which provides holistical heath care
services to school going children, both children and adolescents. This encompass children from
pre-schools up to Form 5. Incorporated are sometimes teachers that are in need and families of
individuals whereby the assistance of one pupil requires family involvement and support.
Staffing incudes a variety of nurses with different qualifications, nutritionist, dental hygienist and
an environmentalist which work in collaboration in providing health services in schools.

Week 1

Objectives

 To provide psycho-education to visited schools.

 Identify those in need of mental health care services.
 To make follow up care on pupils that had been identified during the de-worming
campaign.
 Apply the nursing process in assessment and management of mental health problems and
disorders.

Activities

Conducted group psycho-education to pupils and teachers on various topics which include ways
to cope with stress, substance abuse, gender based violence, rape and the protocols to be
followed when one has been raped. The pupils in visited schools were also assessed from head to
toe and comprehensive psychiatric history was taken. Most of the pupils had physical problems
and commonly were flue, ringworms and diarrhoea. Came up with nursing diagnoses from
current chief complaints of the pupils, made a plan of how to manage the conditions and current
chief complaints, implemented planned interventions, pupils were given treatment and those with

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serious illnesses were refereed for further management in nearby hospital. Schools that were
visited are Nkwalini primary school, Mangwaneni primary school, Fundukuwela high school and
Beaconkomp primary school. Management for previously identified pupils (those that were
identified during the de-worming campaign) was done and this included counselling of one of
the pupils from Motshane high school whom had a problem of substance abuse and an
appointment was made at the Psychiatric centre to which they agreed to take over as he now
required admission due the fact that he had dropped out of school. Other pupils were identified
with conditions of low mood, depression and anger management issues and these were scheduled
to be reviewed and managed the following week.

Week 2

Objectives

 Review and manage previous week’s cases of low mood, depression and anger
management.
 Conduct psycho-education on anger management and bullying in schools.
 Socialize with pupils during their break and sports time for better assessment.

Activities

We also interacted with the pupils during school break and sports time to socialize, provide
education on various topics which include anger management, bullying and its consequences.
Counseling and psychosocial support was provided where needed. During this time it was when
assessment was done based on how the identified pupils interacted with each other during break
and in sports as they had been identified of having problems to deal with anger, some with low
mood and others being bully. Families were involved in such a way that each pupil would come
with their mother for further history, counselling and psycho-education on ways of dealing with
the problems. Other schools were visited and routine of conducting health education prior to
head to toe examination of pupils was done. Schools visited were Maryward primary school,
Mpumalanga primary school, Motshane high school, and Ka-Schiele high school. It was
discovered that most pupils were interested in sexual health related topics, pregnancy and
growing up changes in the body

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Week 3

Objectives

 To conduct health education sexual and reproductive health related topics.

 Equip students on the various changes that takes place in growing up.
 Enlighten pupils on general life coping skills including self-esteem and peer pressure.

Activities

After observing that most children were in the puberty stage and were now interested in sexual
relationships, sexual and reproductive health education was given to the pupils in simpler
language for easy understanding and they all seem to be interested in this subject. This included
counselling of the girls about managing and understanding the whole concept of menstruation
cycle and ways of dealing with it. Various life coping skills and strategies were covered which
included modalities of building confidence to achieve high self-esteem as well as ways of
dealing with peer pressure.

Week 4

Objectives

 To conduct family psychotherapy as needed.

 Referral of clients with severe mental disorders.
 Counselling of identified/referred pupils with mental conditions.

Activities

This week basically had been allocated for pre-school visits. Activities conducted were similar to
those for the higher grades with the addition of examining whether the immunizations were up to
date as per the standard schedule in the children’s welfare cards. Health education was conducted
as per routine with topics chosen according to the ages of the children and amongst them all
topics included were personal hygiene, mouth care and hand washing. Pre-schools visited were
Evangelical pre-school at Zulwini, Mbikwakhe pre-school and St Mary’s pre-school. Amongst
other conditions that were discovered during assessments is that some of the children had
delayed developmental milestones (were still not yet talking) and they were referred for speech

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therapy as well as occupational therapy. We also received a case of major depression brought by
parent from the St Marks high school and the case was complicated, counselling couldn’t be
done at all since the girl couldn’t talk at all instead she started presenting with psychotic
symptoms and was very insultive. She was then booked for referral to psychiatric centre where
further management could be done. On Friday we also visited Kadvokolwako high school where
we had been called as psych nurses to give psycho-education on substance abuse.

Strengths and limitations

The Schools health programme provides good services to the public especially school going
children mostly through health promotion. This is done by giving health talks in various classes
which the topics are allocated based on the age differences of the pupils in each class e.g. for the
higher grades, it encompasses aspects of teenage pregnancy, substance abuse and growing up life
skills. Because of all this, schools mental health nurses are trying to assist teachers in dealing
with problems that interfere with schooling. Prominent examples are seen in the range of
counselling, psychological, and social service activities the team provides.

As a result the team addresses a range of mental health and psychosocial concerns (e.g., school
adjustment and attendance problems, dropouts, physical and sexual abuse, substance abuse,
relationship difficulties, emotional upset, misbehavior, violence.) Most common disorders found
in the schools are as follows: anxiety, low mood, eating disorders, personality disorders, some
self-harming behaviour and depression.

However, there is lack of an organized schedule as to where and when each school will be visited
and the various activities/services to be provided. Another shortcoming is that sometimes the
teachers are not involved yet they are the ones that spend most time with the pupils.

Recommendations

For the faculty

 There is a need to allocate students for school health as the school is primary center for
health promotion and there is a lot to learn as various pupils go unnoticed with serious
health problems.

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  I recommend that the students may be placed in primary settings which include clinics
and school heath where the clients are first seen before being referred in order to get a
clear picture of the acute onsets of the disorders as the hospital come into play when there
disorder has complicated, requires admission or when it’s a relapse.

For the facility

 I recommend that the programme may try look for support groups where they can refer
the patients for psychosocial support.
 Students be allowed to continue to practice in the programme and be given maximum
exposure to gain more experience with pupils having undiagnosed mental problems.
 Clear lines of referral should be created to enable proper referral of those in need and
follow up care.
 Involvement of teachers and their education so they can be able to identify cases for early
intervention.