School Health PDF

# School Health ## Learning Objectives: At the end of this lecture, the student should be able to: - Define common terms related to school health - Identify common health problems of school age children - Define a coordinated health program - List objectives of the school health program - Explain...

# School Health ## Learning Objectives: At the end of this lecture, the student should be able to: - Define common terms related to school health - Identify common health problems of school age children - Define a coordinated health program - List objectives of the school health program - Explain components of a coordinated school health program - Apply the roles of a community health nurse in a school health program according to the three levels of prevention ## Outlines - Introduction - Definition of some terms - Definition of school nursing - Definition of a coordinated school health program - Definition of school health - Goals and objectives of a school health program. - Components of a school health program. - School age health problems in Egypt. - Roles of a community health nurse in a school health program according to the three levels of prevention. ## Introduction School children are an important group because they often form a high proportion. The child spends most of the time in school between the ages of 6 to 15 years. The school is an ideal place for learning and growing up for the school child. The school health is an important aspect of the community health. The reasons for giving school age special consideration are they constitute a big sector of the population, about 1/6. They are easily reached through school. School pupils are considered a vulnerable group. They are growing and exposed to physiological, mental, and emotional stress at home or school. School pupils are very active and curious so liable to accidents. Pupils are affected by school environment. School years are the best opportunity for health education. ## Definition of some terms: ### Definition of school nursing School nursing is a specialized practice of professional nursing that advances the wellbeing, academic success, and lifelong achievement, and health of students. ### Definition of school health School health refers to all activities that contribute to improve and maintain the health of children. ### Definition of a coordinated school health program - An organized set of policies, procedures, and activities designed to protect, promote, and improve the health and well-being of students and staff, thus improving the student's ability to learn. ## Reasons for giving school age special consideration: 1. School children form a big sector of a population. 2. School children are a vulnerable group as they demonstrate low immunity to infection especially diarrheal disease and respiratory infection. 3. They are over active, and therefore susceptible to accidents. 4. They are growing, which necessitates special measures to ensure optimal health. 5. Good health is necessary for successful education. 6. School years present the best opportunity for health education as children can learn healthful habits and understand their responsibility for their own health. 7. Through children we can reach parents, so we can access to all community. 8. School children may expose to different stress and strains imposed by the competitive atmosphere in schools, and their reaction differs, this call for attention from all whom work at schools. ## Objectives of a school health program - Early detection and care of students with health problems. - To develop health attitude and behavior. - Ensure healthy environment. - Prevention of communicable diseases. ## Components of a coordinated school health program. ### Healthful School Environment 1. **Physical Environment:** - Site: - Central to the community. - Far from dangerous areas such as railways, truck routes. - Quiet and attractive environment. - Sufficiently away from sources of noise, smoke or fumes. - Building: - It requires a special building design such as T-shaped or U-shaped. - Soil: dry unpolluted area, porous soil is the best. - External Ventilation: Sufficient open space to ensure perfect external ventilation. - Size: It should be sufficiently wide and with suitable playground. - Classroom: - Size: Usually 6x8 or 5x7 m². - Ventilation: The windows are arranged on both side walls to allow cross ventilation. The window area is at least one sixth of the flower areas. - Light: - Natural lighting by adequate window area. - Artificial lighting for cloudy days or evening schools should be in a good power and distribution. - Desks and Seats: - It should be properly designed for the body of the students. Unsuitable desks and seats may cause discomfort, deformities and optical errors. - School Sanitation: - Water Supply: - Piped water supply in urban and underground water in rural areas or areas with no public water supply. - Refuse Disposal: - It should be collected and disposed daily. Small baskets in the playground and classroom to collect paper and waste material to keep the school clean. - Sewage Disposal: - In towns where running water is present, the water carried system is used, while in rural areas and areas with no running water a permeable cesspit is used. - Insect Control: - The school environment should be free from any breeding places. Application of insecticides is given to the canteen and avoiding the food handlers scattered around the school. 2. **Non-physical environment (Social and Emotional Environment)** - Good relationship between students and the teachers and parents. - Good relationship between the children themselves. - The school day and the homework are properly arranged to prevent fatigue. - Opportunities for developing talents and skills. ### Health Services 1. **Preventive Services:** - Health appraisal - Health counseling - Prevention and control of communicable diseases - Emergency care - Care of handicapped children 2. **Curative Services:** - Treatment of any diseases. - Referral to the school health units or hospital. #### **Preventive Services: ** - **Health Appraisal:** - This is the organized activity to assess the health status of the students from the physical, mental, social and emotional condition. - Components of health appraisal include the following: - **History**: - Past history of diseases: Measles, Chicken pox. - Past history of allergy, accidents, and surgical operation. - **Observation:** - The observation is done by teachers and health visitors. - **Screening:** - Simple tests that can be carried out frequently. - Weight - Height - Test for vision acuity - Hearing Test - Color Vision Test - **Laboratory Test:** - Urine analysis, Stool analysis, Blood analysis, X-ray. - **Comprehensive Medical Examination:** - Conducted by physicians and dentists. - The physician uses all of the previous screening and laboratory tests. - In Egypt, the examination is done on entry and every three years. - Availability of reporting system in the school. - **Special Survey Study:** - Required for investigation of a particular disease or health problem, especially when precise data are not available. - Example: nutritional deficiency and parasitic disease and handicapped. - **Health Counselling:** - A process of guiding a student or group faced with health problems in order to overcome it. - **Prevention and control of communicable diseases:** - Most common infectious diseases in school children are: - Respiratory diseases. - Diseases spread through droplet infections such as Measles, German Measles, Chicken Pox, Common Cold. - Parasitic diseases such as Ascaris and Oxyuris. - Eye diseases such as Trachoma and Conjunctivitis. - Skin diseases such as Scabies, ring worm and impetigo. - Food and Milk born infections as diarrheal diseases such as dysentery and amebic dysentery, enteritis, food poising and hepatitis A. #### **Measures for prevention of communicable diseases**: **A. Immunization:** | Immunization | Grade | Does | Route | |---|---|---|---| | Meningitis | 1st grade of baby garden, 1st grade of primary school, 6th grade of primary school, 1st grade of secondary school | 0.5 ml | S.C | | DT | 1st grade of primary school, 4th grade of primary school | 0.5 ml | IM | | MMR | First grade of primary school | 0.5 ml | S.C | **B. Healthful School Environment:** - Proper ventilation, prevention of overcrowding, safe water supply, sanitary refuse, and sewage disposal. **C. Daily Observation of the students and separation of suspected cases.** ### **Teacher observations**: - Teachers should observe the pupils at the beginning of the school day and throughout the day for any manifestation that may develop, for example: pallor, flushing of face, irritability, sneezing, etc. ### **Readmission to school after sickness:** - The student should be re-examined by a nurse, for example, Diphtheria and Typhoid. Three negative samples are needed before readmission (three days in between and no antibiotic should be used for 24 hours before sampling). ### **Care of contacts: ** - Certain measures are needed for home or class contact such as: - Observation. - Immunization or chemoprophylaxis. - Health education. ### **Care of absence:** - During epidemics, it is important to search for the cause of absence among pupils. ### **Searching for the source of infection.** - Such as, a teacher carrier of diphtheria or teachers having open TB or the Typhoid carrier among food handlers. ### **Food handlers in schools:** - Food handlers in schools should be examined yearly for any communicable diseases on carrier conditions and observed the whole year. They should be treated for any intestinal worms or amebiasis that could spread to others. ### **Health education for communicable disease control:** - Communicable disease is often called contagious disease or infectious diseases. - These are diseases that can be transmitted from person to another or from animal to man. - Teachers, parents, food handlers and pupils should be exposed to a program of health education on communicable disease prevention. - Physicians and nurses should be responsible for this health education program and apply measures for controlling communicable diseases by improving the standard of hygiene at schools and health education at schools and mass immunizations for the students and staff if needed. ### **Early detection and correction of non-communicable disease.** - Early detection of eye defects, speech defects, dental problems, deficiency diseases...etc, to speed to non-medical short-term solutions. ### **Emergency Care:** - It is care of urgently diseased or injured pupils and staff members to prevent further damage & complication. - It is the responsibility of the school to arrange transportation, notify parents, and should have an emergency plan, supplies, and facilities. - Medical emergencies such as appendicitis, fracture, bleeding, gastroenteritis, asthmatic attack. ### **Care of handicapped children:** - Handicapped children need medical, social, and educational care. - Most specialists prefer education of handicapped children in the ordinary school with other children. - Children with minor or mild cases of disability can attend regular schools. - Severe forms, e.g., the deaf, blind, or mentally retarded, may be sent to special institutes. ## Curative Services - Treatment of any diseases. - Referral to the school health units or hospital. ## School Health Education - Health education is the process of providing a learning experience for the purpose of influencing knowledge, attitude, and changing behavior into a healthful one. ### Methods of health education: 1. **Formal Health Education:** - Is a planned health information in specific periods in the timetable with a formal curriculum, for example, nutrition, pollution. 2. **Incidental health teaching:** - Indirect/unintentional/unplanned learning within an informal or formal learning situation that might occur at anytime, anywhere at school, for example, injury of a pupil, a pupil has a communicable disease. ### **Courses of health education:** 1. **Methods of prevention of spread of contagious disease.** 2. **Health promotion and the effects of individual behavior on health status including:** - Poor eating - Physical activity - Injury prevention - Alcohol and other drug use and abuse - Sexuality education - Mental health 3. **Training children for first aid and practice health habits.** 4. **Special health education when infectious disease appears in the school.** 5. **Physical Education:** - Taking part in physical activity during the school day is recommended for all children. - It provides regular exercise, as well as sports programs outside the normal school day. 6. **Nutrition Services** - **Definition:** Access to a variety of nutritious meals that meet the health and nutrition needs of students. - **Functions** - To provide adequate access to culturally and nutritionally appropriate food. - To provide nutrition education to empower students as consumers. - To access and intervene when nutritional problems are identified. 7. **Counseling and psychological, social services:** - These services promote the health of children who receive special education services as well as children who have mental health needs. - Working with families at risk because of socioeconomic needs is also a part of this area. 8. **Health promotion for the staff :** - Nurses can help in providing health care for teachers and other staff members in the schools. - Staff can ask nurses about their health and obtain health education at school to improve their health status through activities such as a health assessment and health education. - **The rationale for staff health promotion:** Keeping employees healthy will result in: - Decreased health care costs for staff - Decreased absenteeism - Increased job satisfaction - Increased community involvement. 9. **Families and community members influence the growth and development of students and share responsibility for nurturing students in to becoming healthy and productive adults.** ### **Barriers to coordinated school health programs:** - Lack of local administrative commitment. - Lack of adequate prepared teachers. - Lack of funds. - Lack of community/parent support. ### **Personnel of school health services and their duties:** - Teacher - Administrator (principal) - Physical educator - Physician - School nurse - Psychologist - Health educator - Health coordinator - Counselor - Dentist - Social workers - Health aids ### **Common health problem among school age children in Egypt:** 1. **Respiratory diseases:** - Asthma in childhood is strongly associated with allergy, especially in developed countries. - Common exposures, such as tobacco smoke, air pollution, and respiratory infection, may trigger symptoms and contribute to the morbidity and occasional mortality. - The prevalence of asthma among Egyptian students was 7.2%. - Among asthmatic students, males constituted 53.6% and females 46.4%. 2. **Parasitic infection and anemia:** - Anemia is considered a serious public health problem in Egypt. - Also, infection with intestinal parasites, which are considered one possible cause of anemia. - The prevalence of anemia among school age children is high, but very few serve forms (<2 per cent). - Prevalence of intestinal parasites among school age children is 40%. 3. **Rheumatic heart diseases:** - RHD cases (with an estimated prevalence of 6.2/1000 students) were diagnosed with RHD. - Low socioeconomic status, chronic tonsillitis, positive family history of acute rheumatic fever/RHD, and paternal consanguinity were significantly associated with the occurrence of RHD. 4. **Chronic diseases:** - **Epilepsy:** - The most common neurological disorders affecting school age children. - Epilepsy increases the risk for a number of psychosocial problems, including learning disabilities, academic underachievement, emotional problems, and difficulties with social interactions. - Two recent surveys found a prevalence rate of approximately 0.7% for epilepsy among school age children. - **Food Allergy:** - Allergic reactions to foods have become the most common cause of anaphylaxis among school age children. - Research suggests that approximately 4% of school age children are affected by food allergies. ## **Roles of a community health nurse according to three levels of prevention** **1. Primary Prevention:** - **Aim:** Health Promotion. - **Component:** - Prevent occurrence of the disease. - **Non-specific Measures:** Environmental sanitation and Health promotion. - **Specific Measures:** - **Environmental Sanitation:** - Good ventilation. - Proper disposal of waste and garbage. - Insect & rodent control. - Proper food and water sanitation. - **Health Promotion:** - Ways to improve and maintain the health of students: - Proper nutrition: students have special nutritional needs that should be satisfied. - Performing regular exercises several times a week. - Adequate sleeping period (6-8 hours/day) - General personal hygiene. - Periodic medical checkup every 6 months. - Maintaining ideal body and avoid obesity. - Managing stress effectively promotes good mental health and provides early intervention and specialized treatment. **2. Secondary Prevention:** - **Aim:** Early case finding, proper treatment, and prevention of complication. - **Components:** - **Early case finding through:** History taking, observation, screening, lab tests, comprehensive medical examination, special survey study. - **Proper treatment.** - **Management of ill and injured children, school employees, and proper management of infectious chronic diseases.** - **Management of the students with chronic diseases: ** - **Children with Allergies:** - Food and insect allergies that result in anaphylaxis is being diagnosed more frequently, so: - The school nurse must develop a plan for preventing exposure to a known allergens and responding to an allergy emergency. - Allow students to carry emergency medication, if developmentally appropriate. - **Children with Asthma:** - Asthma is the leading cause of children being absent from school because of chronic illness. - Asthma can also be caused by allergic triggers such as dust. - The school nurse must keep track of the indoor air quality of the school and other sources of air pollution. - The school nurses administer or help them use their inhaler or other asthma rescue medication. - The school nurses instruct teachers, children's parents about asthma and ways to reduce allergens. - **Management of communicable diseases:** - **Control of cases:** - Notification to the local health office. - Isolation of the student. - Concurrent disinfection. - **Control of Contacts:** - Through the following: - Observation. - Immunization or chemoprophylaxis is required in some diseases. - Health Education: about good hand washing techniques, good preparation of food, disinfection, and washing tools for food, properly. **3. Tertiary Prevention:** - **Aim:** To provide rehabilitation, disability limitation, and treatment of complications. - The school nurses give nursing care related to tertiary prevention when working with children who have long-term or chronic illness, or special needs. - **Components:** - **Physical Rehabilitation:** - Encourage the compliance with medication. - Maintain follow up and comply with the healthy habits. - Provide prostitutes for the handicapped students. - **Psychological Rehabilitation:** - Encourage the patient to express his feelings. - Provide emotional support to help the patient to accept the already existing complication. - Provide measures to promote self-esteem. - **Social rehabilitation:** - Assess the patient's economic level. - Provide financial support.