Global Journal on Advances

in Pure & Applied Sciences

Vol 4 (2014) 383-388

Selected Paper of 1st World Conference on Health Sciences (H-SCI 2014), 24-26 April 2014,
Zeynep Sentido Hotel Convention Center, Antalya, Turkey
Healthy schools and healthy generations
Birsen Bilgen Sivri*, Mevlana University School of Health Services, Nursing, Konya 42003, Turkey.

Suggested Citation:
Sivri, B., B. Healthy schools and healthy generations, Global Journal on Advances in Pure & Applied Sciences
[Online]. 2014, 04, pp 383-388. Available from: http://www.world-education-center.org/index.php/paas

Received October 03, 2013; revised December 04, 2013; accepted March 04, 2014.
Selection and peer review under responsibility of Prof. Dr. Haluk Soran, Near East University, Cyprus.
©2014 SPROC LTD. Academic World Education & Research Center. All rights reserved.

Abstract

Because school is generally the first place where children enter into society after leaving the family circle; it is
important in terms of not only developing health related knowledge, attitudes and behaviors but also gathering
those who are sensitive to infectious diseases and accidents together. Health services related to school-
environment include the following issues:
- Location, building and inner parts of the schools
-Infrastructure facilities of the schools
-Lighting Equipment, ventilation system, paint-color of the classrooms
- School playgrounds,
-Healthy water supply of the schools,
-Garbage disposal and garbage preserving at the schools
-Toilets of school (hygiene and sufficient number of toilets)
-Heating and air conditioning at the schools
-School ergonomics,
-Size of the classrooms in proportion to student population
-Appropriate school desks, school chairs and tables in line with children’s developmental characteristics
-Not allowing students to carry daily heavy objects (such as books, notebooks, …) that may distort their musculo-
skeletal systems
-Hygiene of the school canteens and the effect of the products sold on health
-Availability and function of the traffic signs around the school

* ADDRESS FOR CORRESPONDENCE: Birsen Bilgen Sivri, Mevlana University School of Health Services, Nursing, Konya 42003,
Turkey. E-mail address: bbsivri@mevlana.edu.tr
Sivri, B., B. Healthy schools and healthy generations, Global Journal on Advances in Pure & Applied Sciences [Online]. 2014, 04, pp 383-388.
Available from: http://www.world-education-center.org/index.php/paas

-Investigation of physical, chemical, psycho-social and biologic fouling and taking the due measures.
A large team consisting of school physician, school nurse, school principal and staff, parents, school psychologist
performs school health services –from planning to execution- together with state policies. School health nurse is
also important in the team. Therefore; nurses working at schools have big responsibilities.

Keywords: school health, student, school health nurse.

1. Introduction
In later years, the school after making its place in society was established with a full of service
dedicated young generation. Taking care of physical, societal and mental health of a generation that
will lead to future generations is to ensure a happy and healthy society [1, 4]. The school period is a
very crucial period for creating a healthy society [4]. During this period for ensuring continuous growth
and development of children cooperation between school health services, individuals, families,
communities and health professionals is required. One of the primary objectives of health services is
to ensure comfort and safety of students and teachers at school and creating favourable environment
for continued education. In broad sense; School Health and Safety concept is to ensure transport
security for students and employees for their departure from their homes in order to go to school and
their arrival at home at the end of the day from the school [2, 5+. In this context, school’s health
studies form fundamentals and priorities of primary care services [2, 4].
Schools provide an opportunity for the development of children's health. Since schools serve as the
first entry place of children into the society, it holds importance as it brings together necessary health-
related knowledge, development of attitudes and behaviours, as well as many kinds of infectious
diseases and various accident sensitive people [5, 6]. Also; it is known that health problems related
with sight and auditory skills which are necessary and often used in school life in order to improve
reading, writing, listening and participation are detected more during this period. Therefore; school
health period during which children encounter many new health risks is significant [7].
World Health Organization (WHO) promotes school health programs among youths to avoid major
health risks and risks affecting the educational, social, economic and political conditions [6]. When we
talk about the objectives of school health; it is meant to enable the school-age children to obtain and
to maintain optimum physical, psychological and social health/wellness in the society; to make them
develop in a healthy environment and to increase the children’s, their families’ and society’s
health/wellness levels [8].
In this review; school health services about school health were examined in Turkey and across the
world and the aim was to make recommendations to improve school health services implemented
today.

2. What are the steps of the school health?

There are four aspects of school health: student-health; school environment, health education and
health of school personnel [9]. Student-health includes protection and improvement of health,
prevention of diseases, making exact diagnosis by detecting health problems, treating these problems
if necessary, providing emergent care to sudden diseases and injuries and health related education
and counseling. Within the context of student-health; there are such activities as medical examination
at the time of school enrollment, periodical physical examinations, health screenings, fight against
infectious diseases, prevention of accidents and first aid, psychological health services, detection-
treatment and monitoring of students with acute and chronic diseases, physical education and
sportive activities, health education and immunization [8, 10].

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Sivri, B., B. Healthy schools and healthy generations, Global Journal on Advances in Pure & Applied Sciences [Online]. 2014, 04, pp 383-388.
Available from: http://www.world-education-center.org/index.php/paas

Environmental health services at the school include:

 School’s location, building and internal environment
 School’s infrastructure
 Classroom’s light, ventilation and colours of walls and furniture
 School’s playgrounds
 Healthy water supply in school
 Garbage disposal and storage facility
 School’s toilets (hygiene, adequacy)
 School’s heating and ventilation facilities
 School’s ergonomics
 Capacity of classrooms according to the number of students
 Arrangement of school’s desks, tables and chairs according to children’s requirements
 Not allowing daily carrying of heavyweights (books, copies) by children which can result in
musculoskeletal problems
 Hygiene of school’s canteen and health impact of food sold there
 Existence and functioning of traffic lights around the school
 Research conducted by school on factors like physical, chemical, psychosocial and biological
contamination [5, 6, 9, 13].
Health of school personnel includes mainly teachers and other school personnel. That teachers
work in a safe place and are satisfied and are happy, comfortable, peaceful and healthy not only
increases students’ school success but also have a positive effect upon their psychological
development. The objective of health education is to improve the desired health, knowledge, attitude,
behavior and values by using various educational techniques in the target group. The aim is to provide
the students with the ability to change behavior for a lifetime healthy life. It is the environment that
affects the children most after school and home. With the health education given at the school; it is
aimed to obtaine individuals with healthy life knowledge and skills and thus to create a healthy society
[5, 10].
The school health services’ health check-ups at the beginning of school and during school age,
medical examination, detection and diagnosis of some diseases at the early stage and availability of
treatment facilities play an important role in laying the groundwork of a healthy future society [13].
Despite the lack of current and reliable data, the studies show high figures of growth retardation in
school-age children, visual disturbances, parasitic diseases, oral and dental health issues, chronic and
acute health problems, psychological problems and nutrition-related problems [4, 5, 10, 14]. For the
implementation of the state health policies, the school health services engages school physician,
school nurse, school principals and staff, parents, school psychologists as a crowded team [15].
One of the problematic areas of the school health services is either absence of school health team
or ineffective school health team. School health services cannot be carried out only by health care
personnel. School health cannot be considered as physical examination, vaccination programs and
health screenings. Of modern school health services; there are student health services, school
ergonomics, school environment health, health trainings provided for students, teachers, other school
personnel and parents and school personnel health. Student health considered as a part of school
health includes medical examination at the time of school enrollment, periodical physical
examinations, health screenings, fight against infectious diseases, prevention of accidents and first aid,
psychological health services, detection-treatment-and-monitoring of students with acute and chronic
diseases, physical education and sportive activities, health education and immunization [8, 16].
Although nurses are members of the school health team; they are the ideal personnel to conduct
coordinator ship-tasks. There is a defined relation between health and education and presence of
school nurses directly affect wellness and school success of the students [7, 9, 10, 17]. Nurses play a
key role in school health team. A nurse who is always available at school can conduct medical

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Sivri, B., B. Healthy schools and healthy generations, Global Journal on Advances in Pure & Applied Sciences [Online]. 2014, 04, pp 383-388.
Available from: http://www.world-education-center.org/index.php/paas

screenings and follow-ups, provide health education, help health coordinator, implement school
vaccinations and intervene in case of emergency [8, 17, 18].

3. What is being done for school health?

In the world; school health programs began to be provide in the 19th century and became a routine
service during the first half of the 20th century particularly in developed countries [9]. Today; WHO
initiated global healthy schools project [10, 19]. Also, WHO provides support for local health
promoting school projects. In European countries and the USA; such models as coordinated school
health, national healthy school standards and comprehensive school health have been designed in
order to improve school health [17, 18]. In countries where health care services are advanced such as
the USA, Canada, Sweden, Norway; training, tasks and responsibilities to be adopted by school nurse
have legally been regulated [6, 19, 20, 21].
In our country; Ministry of Health is responsible for conducting school health services. With the
“School Health Cooperation Protocol” signed between Ministry of Health and Ministry of National
Education; programs are planned and conducted. In Turkey; the following programs have been used as
a part of school health: health improving schools in Europe, school white flag projects, first aid
trainings, prevention of school violence, screening programs, screening and consciousness-raising
programs for mouth and dental health, fight against substance abuse (smoking-alcohol use and drugs),
national tobacco committee studies, development of health consciousness among adolescents, ERDEP
(Change during adolescence project), health encouraging and improving studies, consciousness-raising
programs for school age children about nutrition and obesity, studies for meal centers at schools,
studies for school canteens, studies for hygiene and hand washing, environmental health studies for
the school and school environment, potable water studies at schools, use of iodized salt, training for
thalassemia, training and preventive studies for HIV/AIDS, studies for special days and weeks on
health, immunization studies (school vaccinations), health training studies for school personnel and
students, medical check-ups for student health, controlling the schools and workplaces around the
schools [9, 22, 23]. According to the regulation published in official gazette on 08.03.2010 and with the
issue number of 27515 and amendment to the regulation made on 19.04.2011; tasks, power and
responsibility of school health nurses are defined [24]. Besides; it is seen that studies done by
academician nurses on the importance of school health nurses make contributions; too.
National Association of School Nurses (NASN) uses the intellectual potential of school nurses,
children and young generation to increase their talent, and to positively affect their current and future
physical, social, personal and emotional growth. American School Health Association (ASHA) has
recognized school nurses, caregivers, educators, counsellors, case managers, advocates and
researchers as the responsible professional members [1, 25]. Health school nurses hold important
position as they determine children’s health-related barriers in learning, ascertain and help in
overcoming their health problems and helps in maintaining their health at their school-age and adult
life [26]. Indeed the school health nurse team has a vital role to play in the protection of health of
students on every step of the planned activities in a school. Therefore, the nurses serving in the
schools have a big responsibility on them.
Although there are differences; all of the countries try to do their best in order to take more
tangible and constructive steps for an advanced school health. As for our country; because Turkey
doesn't have sufficient capacities and possibilities, we cannot use the available capacities and
possibilities effectively and productively and the number of the employed nurses is limited; successful
steps to form a healthy society fall short or the desired outcomes are not obtained.

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Sivri, B., B. Healthy schools and healthy generations, Global Journal on Advances in Pure & Applied Sciences [Online]. 2014, 04, pp 383-388.
Available from: http://www.world-education-center.org/index.php/paas

4. Conclusions and Recommendations

Healthy children are the guarantee of the future of the societies. It is an inevitable obligation to
improve school health services for the achievement of a healthier youth and more productive society.
School health nurses have the ability to explore the potential and the existing problems in this field.
Provision of a quality school health is possible with a professional team in which nurses participate;
too.
For the provision of a quality school health; it may be recommended that school health nursing
should be certified through short-term courses after graduate education and the nurses who work as
school nurses should continue their work after taking short-time courses on school health. Child and
parent education should be combined with school health studies and teacher cooperation should
absolutely be achieved. On nationwide; the necessary legal regulation should be made and
responsibilities should be made explicit. Also; establishment of school health team should be legal
obligation and presence of the school health nurses in the system should be backed with legal
regulations.
If school health services which constitute an important part of the preventive health services are
planned, implemented and continued in a systemized way; a big step to achieve the objective of
designing healthier society will have been taken.

References

[1]Bahar, Z. (2010). School health nursing Journal of Dokuz Eylul University School of Nursing, 3 (4), 195-200,
[Online]. Received December, 02, 2014 from: www.deuhyoedergi.org/
nd
[2]Tekbas, O., F. (2012). Public health days, in 2 Symposium Proceedings of the national school health, 17-18
May Adana/Turkey, p. 40-41.
*3+Akın, A., Hodoglugil, N., Koçoglu, G., Supramaniam, D., Aydin, Y., & Bacanli A. (2000). Altındağ centers in
health centers in five elementary schools to evaluate the implementation of school health, Hacettepe
Public Health Bulletin, 21(3). Received March 04, 2014 from:
http://www.thb.hacettepe.edu.tr/arsiv/2000/sayi_ 3/baslik3.pdf
[4]Cagatay, G. (2007). Children's environmental health action plan and the general plan intersectoral, Publisher:
Ministry of Health General Directorate of Primary Health Care, Ankara.
[5]Ministry of Education and Ministry of Health of the white flag projects, Available: Received March 04, 2014
from: http://www.toplumsagligi.com/PageContentsPopup.aspx?ld=25kriter
[6]Ertop, N., G. (2012). The importance of health promotion in schools, in 2 National School of Public Health
Days Health Symposium Proceedings 17-18 May Adana/Turkey, p. 69-70.
[7]Cekem, K., Basat, O., Ucak, S., & İkizler, C. (2009). School health and medico social activities, Sisli Etfal
Education and Research Hospital Medical Bulletin, 43, 117-122.
[8]Gunduz, S., & Albayrak, H.M. (2014). Where are we in school health? Ankara Medical Journal, 14(1), 29-33.
[9]Ozcebe, H., Ulukol, B., Mollahaliloglu, S., Yardim, N., & Kahraman, F. T. C. (2008). Ministry of Health in Health
Services School Health Book. Health Protection and Development, Yücel Offset Publishers, Ankara.
[10]Committee on School Health. (2001). School health centers and other integrated school health services,
Pediatrics, 107(1), 198-201. Available: DOI: 10.1542/peds.107.1.198. [Accessed Jul. 14, 2014].
[11]Ceylan, S., & Turan, T. (2009). The evaluation of school-health nursing practices in a primary school, Firat
Journal of Health Services, 4(12), 35-49.
[12]Kalyoncu, C., Metintas, S., Baliz, S., & Arikan, I. (2011). Education in research area elementary school
students and school health screening level evaluation of inspection results, TAF Preventive Medicine
Bulletin, 10(5), 511-518.
[13]Neyzi O. (2005). School health in the Western World and in Turkey, Journal of Clinical Child Forum, 5(5), 1-5.
[14]Secginli, S., Erdogan, S., & Demirezen, E. (2004). School health screening program: a pilot study sample, Sted,
13(12), 462-465.

387
Sivri, B., B. Healthy schools and healthy generations, Global Journal on Advances in Pure & Applied Sciences [Online]. 2014, 04, pp 383-388.
Available from: http://www.world-education-center.org/index.php/paas

[15]Pala, K., Aytekin, N., & Aytekin, H. (2003). Gemlik in the area of overweight and obesity prevalence in
children, 6-12 years of age, Sted, 12(12), 448-450.
[16]Ozcan, C., Kılınc, S., & Gülmez, H. (2013). School health and legal status in Turkey, Ankara Medical Journal, 13
(2), 71-81.
[17]Whitehead, D. (2006). The health-promoting school: What role for nursing?, Journal of Clinical Nursing, 15,
264-271.
[18]Council on School Health. (2008). Role of the school nurse in providing school health services, Pediatrics,
121, 1052-1056. Available: DOI: 10.1542/peds.2008-0382. [Accessed Jul. 14, 2014].
[19]Lohrmann, DKA. (2010). Complementary ecological model of the coordinated school health program,
Journal of School Health, 80(1), 1-9.
[20]Cihangir, O., Kilinc, S., & Gulmez, H. (2013). School health and legal status ın Turkey, Ankara Medical Journal,
13(2), 71-81.
[21]Child Health of Istanbul University Institute, The Istanbul Provincial Directorate of National Education,
Children's Health Association, In Turkey. (2004). Suggestions for the Development of School Health
Services, Expert Committee Report, May 2004, Istanbul.
[22]TR Ministry of Education, Department of Health Affairs. Received Jun. 30, 2014 from:
http://sdb.meb.gov.tr/okulsagligi.html
[23]Health Promoting Schools Project. Received Jun. 30, 2014 from:
http://iogm.meb.gov.tr/pages.php?page=projects&id=15
[24]Regulation Published in Official Gazette on 08.03.2010 and With the Issue Number of 27515 and
Amendment to The Regulation Made on 19.04.2011. Received Jul. 3, 2014 from:
www.ttb.org.tr/mevzuat/index.php?option=com
[25]Bulduk, S., & Pek, H. (2005). A Study on the roles and functions of the nurses working at private primary
schools in Istanbul, Journal of Cumhuriyet University School of Nursing, 9(2), 40-48.
[26]Guler, G., & Kubilay, G. (2004). Determination of the physical care problems of students in a primary school”,
Journal of Cumhuriyet University School of Medicine, 26(2), 60-65.

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