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School Health Nursing
Ceelin T. Robles Nr-32
Ben de Paz, RN, MAN
The practice of school nursing began in the United States on October 1, 1902 when the initial role of the school nurse was to reduce absenteeism by intervening with students and families regarding health care needs related to communicable diseases. While the nurse‟s role has expanded greatly from its original focus, the essence of the practice remains the same. The school nurse supports student success by providing health care assessment, intervention, and followup for all children within the school setting.
In 1999, the National Association of School Nurses Board of Directors defined school nursing as: A specialized practice of professional nursing that advances the well-being, academic success, and life-long achievement of students. To that end, school nurses facilitate positive student responses to normal development; promote health and safety; intervene with actual and potential health problems; provide case management services; and actively collaborate with others to build student and family capacity for adaptation, self management, self advocacy, and learning. Inherent in this definition is the framework that school nurses engage in professional nursing practice, use the nursing process for decision-making, document the care they provide, and assure confidentiality. Professional nurses address the physical, mental, emotional, and social health of their clients. In addition, professional school nurses have as the ultimate outcome of their practice, the support of student success in the learning process. In this context the school nurse provides services to the entire school population, which may include infants, toddlers, pre-schoolers, children with special needs, traditional school populations, and, to a limited degree, adults within the school community. DOH defined School Nursing, a type of public health nursing that focuses on the promotion of health and wellness of the pupils/students, teaching and non-teaching personnel of the schools. School nurses also assist young people in making choices for a healthy lifestyle, reduce risk taking behavior and focus on issues such as prevention of drug and substance abuse, teenage pregnancy, sexually transmitted infection, malnutrition and communicable and non- communicable diseases.
Objectives of School Nursing
General: To Promote and maintain the health of the school populace by providing comprehensive and quality nursing care. Specific: 1. Provide quality nursing service to the school population; 2. Create awareness among school children personnel and administrators the importance of the promotive and preventive aspects of health through health education; 3. Encourage the provision of standard functional facilities; 4. Provide nursing personnel with opportunities for continuing education and training; 5. Conduct and participate in researchers related to nursing care; and 6. Establish/strengthen linkages with government and non-government organization/agencies for school community health work.
Duties and Responsibilities of the School Nurses
Health advocacy Health and nutrition assessment including other screening procedures such as vision and hearing Supervision of the health and safety of the school plant Treatment of common ailments and attending to emergency cases Referrals and follow-up of pupils and personnel Home visits Community outreach like attending community assembles and organizing school community health councils Recording and reporting of accomplishments Monitoring and evaluation of programs and projects
Functions of the School Nurse
School Health and Nutrition Survey This should be done initially to provide data for evaluation for planning process. The survey shall include among others the current health and nutritional status of the children, situation on health facilities as well as actual status of health education activities undertaken by the teachers and health personnel.
Putting up a Functional Clinic R.A. 124 mandates that all schools are to provide school clinics for the treatment of minor ailments and attendance to emergency cases. The school nurse encourages the provision of the facility. Health Assessment
It aims to discover the signs of illness and physical defects in order to correct them check on health habits of
pupils and prevent the progress of those which cannot be corrected. In order to attain the purpose, the examination must be thorough. Standard Vision Testing
Vision is very important sensory skill that affects learning and general development. Early detection and
treatment of eye and vision problems can prevent childhood blindness and visual disorder. The student‟s visual status must be 20/20 for him to perform his visual task demand clearly and comfortably at far and near distances. Ear Examination Children who do not see or hear will often experience difficulty in the educational environment. The early recognition of hearing loss is extremely important not only because it may interfere with the teaching-learning process as well as school achievement but also because the development of clear speech and social skills is facilitated by good hearing. This will also help in attaining effective treatment and rehabilitation.
Height and Weight Measurement and Nutritional Status Determination Height and weight measurement is a procedure for evaluating the tallness or the shortness and the heaviness of a pupil. It offers the most acceptable parameter and is the simplest way to determine the nutritional status of the school children. Medical Referrals Whenever necessary, the school nurse may recommend that a student with an existing condition be referred for further assessment and intervention by the appropriate professional/agency. Attendance to Emergency Cases It is incumbent upon the nurse to attend to emergency cases while they are in school. However, majority of the nurses are assigned to several schools. In their absences, the school authorities and the clinic teacher have the responsibility of attending and referring them promptly. Parents must be informed of the occurrence of the emergency as soon as possible. Student Health Counseling School nurses welcome the opportunity to help concerned parents and guardians of students in any form of individual health counselling. The school nurse also help to make appropriate referrals either to school-provided or outside counselling services whenever necessary.
Health and Nutrition Education Activities The school nurse takes every opportunity to talk on health related topics both in formal and informal settings. She would be willing to use her ability, knowledge and background to influence the school and community in a healthy and positive way. Organization of School-Community Health and Nutrition Councils The school nurse shall initiate/encourage the organization/reactivation of School-Community Health Council, the membership of which shall come from both school and community. The school shall conduct school-community assemblies to interpret the school health problems/programs in the community.
Communicable Disease Control Prevention and control of communicable disease is a responsibility shared by parents, school personnel, community and the DOH. If a child is suffering from a recognized contagious or infectious disease, he/she should be referred and sent home and not be permitted to return until school authorities are satisfied that any contagious and infectious disease does not exist. The school nurse encourages immunization requirements, aids in early detection, helps to provide parental notification and information, and makes any medical referrals necessary. Establishment of Data Bank on School Health and Nutrition Activities Accurate and up-to-date health records are essential in helping monitor the health of students while they are in schools. Findings are recorded in the health examination card and reviewed and updated annually.
School Plant Inspection for Healthy Environment The school plant shall be inspected in order to provide healthful environment and safety in schools. Aside from the minimum standards for schools in relation to school site, area, location, space and sanitation, classroom and other rooms and facilities shall be inspected for size, lighting, ventilation, and arrangement of seats. Particular attention shall focus on the provision and maintenance of toilets, school clinics, water supplies, sanitation of school canteen, and safety and nutritional value of foods being served.
Rapid Classroom Inspection It is done as a routine procedure when frequent and regular visits can be made to a school during the year, in addition to the individual health assessment. Home Visitation It is necessary in the effective implementation of the total service program particularly the Integrated School Health and Nutrition Program. Home visitation is a social, educational and preventive work and should not be regarded as remedial or curative.
Legal Bases of the School Health Program
PD 603 Child and Youth Welfare Code Article I- General Principles “The child is one of the most important assets of the nation. Every effort should be enacted to promote his welfare and enhance his happy opportunities for a useful happy life.” “Other institutions like the school, the church, the guild, and the community in general should assist the home and the state in their endeavour to prepare the child for the responsibilities of the adulthood.”
Article II- Promotion of Health “It should be the responsibility of the health, welfare and education entities to assist the parents in looking after the health of the child.”
Article III-Rights of the Child
“Every child has the right to a balanced diet, adequate clothing, sufficient shelter, proper medical
attention, and all the basic physical requirements of a healthy and vigorous life.”
1936 Constitution of the Philippines- Article VIII, Sec. 11,12, and 13 Article VIII- Social Justice and Human Rights Section 11 – “ The state shall adopt an integrated and comprehensive approach to health development which shall endeavour to make essential goods, health and other social services available to the people at affordable cost. There shall be priority for the needs of the underprivileged, sick, elderly, disabled, women and children. The state shall endeavour to provide for free medical care to paupers.”
Section 12- “The State shall provide and maintain an effective food and drug regulatory system and undertake appropriate health, manpower, development and research responsibilities to the country‟s health needs and problems.”
Section 13- “The State shall establish a special agency for disabled persons for their rehabilitation, self-development and self-reliance and their integration into the mainstream of society.
Executive Order No.14 s. 1946 Creation of the Medical and Dental Services granting authority for the voluntary contribution of 50 centavos per pupil for the maintenance of the service
RA No. 951 s. 1947 Medical inspection of school children, enrolled in private schools, colleges and universities in the Philippines.
RA No. 847 s. 1953 Return of the Medical and Dental Services from the Department of Health to the Department of Education
RA No. 1082 s. 1954 An act strengthening health and dental service in the rural areas and providing funds thereof
RA No. 2620 s. 1961 Nationalization of the Medical and Dental Services of the Bureau of Public Schools, Department of Education
Presidential proclamation No. 225 s. 1967 Observance of National Health Education Week on October 10-16 of every year
Article V sec. 29 s. 1972 Dangerous Drug Act- Integration of Drug Education concept in the School Curriculum
PD No. 491 s. 1974 Designated July as Nutrition Month for the purpose of creating greater awareness among the people on the importance of nutrition
PD No. 491 s. 1974 Nutrition Act of the Philippines- Creation of National Nutrition Council with DECS as a member
RA No. 856 s. 1976 Code of Sanitation of the Philippines
LOI No. 441 s. 1976 Mandated the Integration of Nutrition Education in the school curriculum
LOI No. 764 s. 1977 Creation of School health Guardian Program. Its concept was focused on the training of the teachers to assume responsibilities in providing school health services in the absence of the school health personnel.
LOI No. 764 s. 1978 Declaring the School Health Program , a priority program of the national government with the aim of educating teachers and school children in the use of medicinal plants as simple remedies for common ailments.
Section 938 of the Revise Administrative Code Provides that the Bureau of Public Schools shall have specified powers regarding health teaching physical education and to prescribe rules on personal hygiene within the public school premises
E.O. No. 234 s. 1987 Reorganizing the National Nutrition Council- “The revised function of member agencies like DECS have been effected.”
P.P. No. 335, s. 1988 Observance of Drug Abuse Prevention and Control Week every 3rd week of November
Republic Act 7624, s. 1992 „An act Integrating Drug Prevention and Control in the Intermediate and Secondary Curricula a s well as in Non-Formal, Informal and Indigenous Learning Strategies and for other purposes.”