CHAPTER 16 – SCHOOL HEALTH

I. HISTORICAL DEVELOPMENT OF SCHOOL HEALTH PROGRAMS


School Health Programs – School Health Services, School Health Education, Healthy school
environment (Tradition definition of School Health Program.
 Health Promoting School: (Redefinition of School Health program year 1980)
1. School Health Services
2. School Health education
3. Healthy School Environment
4. Health promotion for school health personnel
5. School Community Projects and outreach
6. Nutrition and food safety
7. Physical education and recreation
8. Mental Health, counselling, and social supports
 School nursing – specialized practice of professional nursing that advances the well-being, academic
success, and lifelong achievement of students. (National Association of School Nurses United States)
 Role of School Nurse:
1. Facilitate positive student responses to normal development
2. Promote Health and safety
3. Intervene with actual and potential health problems
4. Provide case management services
5. Actively collaborate with others to build student and family capacity (for adaptation, self-
management, self-advocacy, and learning.)
 Redesigned Approach in School Health Nursing (RASHN) Philosophy – Academic performance of
the pupils and the instructional outcomes are determined by the quality of health of the school
population and the community where they come from.
 Integrated School Health and Nutrition Program (ISHNP) – designed to maintain and improve the
health of school children by preventing disease and by promoting health related knowledge, skills, and
practices.

Activities of the ISHNP:

1. To expand early childhood care and education.

2. To improve the quality of education
3. To provide learning and life skills to young people and adult

SHNP also intended to address MDG goals:

 To eradicate extreme poverty and hunger

 To reduce child mortality
 To combat HIV/AIDS, malaria, and other disease
 To ensure environmental sustainability
II. SCHOOL HEALTH SERVICES

1. HEALTH EDUCATION
 The target of health education may be Children in the preschool, primary, or secondary level,
teachers and/or school personnel.
 Health education is culture sensitive and based on the identified educational needs of the target
population.
 Health Education concepts:
1. Nutrition
2. Personal and oral hygiene including WASH (Water, Sanitation and Hygiene)
3. Prevention of soil-borne helmintiasis, mosquito-borne disease, and other prevalent
communicable diseases like acute respiratory infection, diarrheal disorders, and tuberculosis.
4. Use of traditional and alternative health care management of common health conditions.
 Other concern for health education:
1. Oral Hygiene – Oral care program – 7 o’clock Toothbrushing Habit Activity.
2. Injury Prevention and Developing Safety Conscious Behavior- in the use of playground,
while engaging in sports, and the like.
⃰MAPEH Period – good time for the school nurse or teacher to talk with or counsel students
about the risk of developing health problem related to physical activity.
3. Tobacco use – Prevention should be emphasized in young people.
4. Substance abuse – the use of alcohol and other drugs associated with school problems, injuries,
violence, and motor vehicle deaths.
⃰National Drug Education Program – directed toward raising the consciousness of primary
and secondary students regarding the perils of the use of the illicit drugs.
5. HIV/AIDS and other Sexually Transmitted Infections – an information dissemination
campaign to educate the general population on the risk of HIV/AIDS.

2. PHYSICAL EDUCATION
 Regular physical activity – helps build and maintain healthy bones and muscles.
 Physical education should be focus on activities that children can continue into their adult years
(examples: swimming, walking, biking, and jogging)
 Educational content may change as the child ages (example: what may appeal to a young children
such as playing in the playground is different from what motivates an adolescent such as
competitive sports)

3. HEALTH SERVICES
 Health screening
- Such as screening for completeness of immunization (measles vaccine)
- Detect early signs and symptoms of illness, disabilities, and deviation from normal.

Health screening Activities:

- Annual Individual Assessment – eyes, ears, nose, throat, neck, mouth, skin, extremeties, posture,
nutritional status, heart and lungs.
 ⃰Snellen’s chart, E-chart, or symbol chart - Visual acuity test
⃰Ballpen Click test – done for hearing acuity test.

- Height and Weight Measurement – done at the beginning and at the end of the school year.
- Rapid Classroom Inspection – done to detect illness, particularly when there is an outbreak in the
community and the condition is characterized by easily observable signs and symptoms.

 Emergency care - Basic first aid equipment should be available in all schools.
-School nurse and school health guardians must be knowledgeable about
standard first aid and certified in cardiopulmonary resuscitation (CPR).
- Procedures in activating an emergency management system including referral
system should be in place.

 Care of the ill Child – school nurse is responsible for monitoring the health of all students.
- School nurse often required to assess an ill child to determine the type of illness
of health problem, identify the source of illness, and determine how to manage
the illness.

 Student records – health record should be maintained for students according to the policies of
DepEd.
- Student health record should be afforded the same level of confidentiality as that
given to clients and patients in other setting.

4. NUTRITION
 School-Based Feeding Program (SBfP) (previously known as Breakfast Feeding Program)
- Aims to rehabilitate at least 70% of the more than 560,000 identified severely
wasted school children to normal nutritional status at the end of 100-120 feeding
days.
- Aims to increase classroom attendance by 85-100%
- Schools are encouraged to develop vegetables gardens within the school
grounds.
 Eating Disorders – prevention should concentrate on eliminating misconceptions surrounding
nutrition, dieting, and body composition, and it should stress optimal health and personal
performance.
- Nurse must also be aware of eating disorders as they frequently co-occur
with other mental disorder.
1. Binge eating - recurrent, out of control eating of large amount of food
whether a person is hungry or not.
2. Anorexia – severely restricted intake of food based on an extreme fear of
weight gain.
 3. Bulimia – chaotic eating pattern with recurrent episodes of binge eating
followed by purging.

⃰Female Athlete Triad - syndrome consisting of eating disorder, amenorrhea, and osteoporosis.

 Obesity – obesity and prevention of it or treatment must be concerned to the school nurse.
Contributing factors in obesity:
- Reduced access and affordability of the nutritious food.
- Decreased physical activity
- Cultural and Genetic influence.
 Nutritional Education Program – must include parents, teachers, and the child.
- Children need to know and understand what a food pyramid is.
- All adolescent and school-aged children should receive counselling
regarding the intake of saturated fat.

5. COUNSELLING, PSYCHOLOGICAL, AND SOCIAL SERVICES

- One of the important roles of school nurse is act as an counselor or confidante.

- It is important for the school nurse to be cognizant of the warning signs associated with suicide and
to recognize and refer at risk adolescents to appropriate mental health professionals.
- School nurse may help the child learn how solve problems, how to cope, and how to build self-
esteem.
- The school nurse may need to work closely with families to develop an appropriate health plan for
particular child.
- Psychosocial Intervention Project – intended to enhance knowledge and skills of school health
personnel in providing psychosocial intervention.
- Truths about adolescent suicide:
1. Most adolescent who attempt suicide are ambivalent and torn between wanting to die and
wanting to live.
2. Any threat of suicide should be taken seriously.
3. Usual warning signs of suicide attempt: depression, substance abuse, decreased activity,
isolation, appetite and sleep changes.
4. Suicide is more common in adolescent that homicide.
5. Education concerning suicide does not lead to an increase number of attempts.
 6. Females are more likely to consider or attempt suicide, and males are more likely to complete a
suicide attempt.
7. One suicide attempt is more likely to result in a subsequent attempt.
8. Firearms and strangulation are the predominant modalities completed suicide in children and
adolescents.
9. Most adolescents who have attempted or completed suicide have not been diagnosed as
having mental disorder.
10. All socioeconomic groups are affected by suicide.

6. HEALTHY SCHOOL ENVIRONMENT – a healthy environment should consist of:

 Physical and psychological, and social environment that is developmentally appropriate, and
enables students to achieve their potentials.
 A healthy organizational culture within the school
 Productive interaction between the school and the community

7. HEALTH PROMOTION FOR SCHOOL STAFF

- School nurse can assist the faculty and staff by giving workshops on exercise and nutrition,
screening for increased blood pressure, and establishing weight management programs.
- Teachers’ Welfare Health Enhancement Program - through this program, school health
personnel conduct health examination and health profiling of all teachers and nonteaching
personnel.

8. FAMILY AND COMMUNITY INVOLVEMENT

- School nurse are a ready resource to the community whenever health-related problem arises.
- School nurse can help parent develop healthy eating habits in home that will directly affect their
family.
- The nurse can also help develop physical activity programs in the community that include both the
child and the family.

III. SCHOOL NURSING PRACTICE

- School nurse’s practice is relatively independent and autonomous.
- For entry into school nursing, it is recommended that the nurse hold a minimum of a bachelor’s
degree.
- School nurse must be able to identify and access professional development to maintain competency
in the care of children and adolescents.
- Student function in many roles including: care provider, student advocate, educator, community
liaison, and case manager.

IV.FUTURE ISSUES AFFECTING THE SCHOOL NURSE

- The School nurse must be constantly evolving to meet the demands of the future.
- Issues that will face the school nurse in the future includes:
1. Ethical dilemmas
2. Use of Information and Communication Technology (ICT)
3. Environmental change brought by climate change
4. Threat of new emerging infectious disease
5. Increase in antibiotic resistance disease