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Family health/ Community Health Nursing I


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Referenced note on Family health

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Family health/ Community Health Nursing I

  1. 1. School Health Programme Pratiksha Rai
  2. 2. Introduction Children between the age of 5-17 years are school age children.
  3. 3. School School is defined as an educational institution where groups of pupils pursue defined studies at defined levels, receive instructions from one or more teachers, frequently interact with other officers and employees such as principal, various supervisors/ instructors, and maintenance staff etc., usually housed in a single building.
  4. 4. School health School health refers to a state of complete physical, mental, social and spiritual well being and not merely the absence of disease or infirmity among pupils, teachers and other school personnel
  5. 5. School health service Ideally School health services refer to need based comprehensive services rendered to pupils, teachers and other personnel in the school to promote and protect their health, prevent and control diseases and maintain their health. But practically, it refers to providing need based comprehensive services to pupils to promote and protect their health, control diseases and maintain their health.
  6. 6. Philosophy 1. A healthy child is mentally alert, receptive, will not miss school due to minor sickness and will have better performance in his/her studies. 2. Health is not just freedom from sickness or infirmity but the realization of the full potential of the child which has physical, mental, social and spiritual component
  7. 7. Contd.. 3. Prevention is better than cure; interventions when health breaks down are costly and time consuming. 4. School health services will help identify any deviations from normal growth and development, any health problem so that timely, therapeutic, corrective and rehabilitative actions can be taken to im-prove and maintain health and continue studies.
  8. 8. Contd.. 5. While early diagnosis and prompt and adequate treatment is of great importance, follow up care is equally important for effective school health services. 6. Rehabilitation of physically and mentally handicapped children can be done and must receive ad-equate attention. 7. Health knowledge and skills learnt not only will benefit the child but also it will benefit the school, the parents, family and community
  9. 9. Introduction to School Health Programme It is that phase of community health and family health service that promotes the well being of the child and his education for healthful living. School health programmes can be a powerful influence for shaping health behavior.
  10. 10. Contd.. The school health programme refers to all school activities/procedures that contribute to initiation, understanding, maintanence and improvement of the health of pupils and school personnel, including health services, health education and healthful school living.
  11. 11. Contd.. Healthful habits as regards personal hygiene, clean surroundings, nutritious diet, exercise, rest and recreation if formed at an early stage will remain with person throughout life and will help to develop healthy citizens in the full and positive sense of the term. So the school is the best place for giving health education on health subjects.
  12. 12. Health Problems of the school child The health problems of school children vary from one place to another, surveys carried out depicts following problems: 1. Malnutrition 2. Infectious diseases 3. Intestinal parasites 4. Diseases of skin, eye and ear and 5. Dental caries.
  13. 13. Objectives • Promotion of positive health including awakening of health consciousness in school children. • Early detection and prompt treatment and follow-up/ referral. • Prevention and control of communicable and non-communicable diseases. • To make provision and provide a healthy and safe environment for the all round development of child. • Awakening health conciousness in children.
  14. 14. Aim The aim of the school health programme is to promote healthy children so that they can reach optimum growth and development which will enable them to lead study. This will be achieved by emphasizing the: • Protection from disease • Appropriate medical and dental care including emergency services of injury and sudden sickness.
  15. 15. Contd.. On the basis of these above mentioned aims and objectives three efferents of the school health programme are identified. • Health education in schools • Healthful school living • School health services
  16. 16. Aspects of School Health Service • Health appraisal of school children and school personnel • Remedial measures and follow-up • Prevention of communicable diseases • Healthful school environment • Nutritional services
  17. 17. Contd.. • First aid and emergency care • Mental health • Dental health • Eye health • Health education • Education of handicapped children • Proper maintainence and use of school health records.
  18. 18. 1. Health appraisal The health appraisal should cover not only the students but also the teachers and other school personnel. Health appraisal consists of periodic medical examinations and observation of children by the class teacher.
  19. 19. Contd.. A. Periodic medical examination: The initial examination should be thorough and unhastened and should include a careful history and physical examination of the child, with tests for vision, hearing and speech. A routine examination of blood and urine should be carried out. Clinical examination for nutritional deficiency and examination of faeces for intestinal parasitosis.
  20. 20. Contd.. Parents should be persuaded to be present at these examinations. The teacher should help in the medical inspection by recording the medical history, regular recording of height and weight, annual testing of vision, and preparing children for the medical examination by helping them understand the “how” and “why” of the health appraisal.
  21. 21. Contd.. B. School personnel: Medical examination should be given to teachers and other school personnel as they form part of the environment to which the child is exposed. C. Daily morning inspection: The teacher is in a unique position to carry out the “daily inspection”, as he is familiar with the children and can detect changes in the child’s appearance or behavior that suggest illness or improper growth and development.
  22. 22. Contd.. The following clues will help the school teacher in suspecting children who need medical attention: Unusually flushed face, Any rash or spots, Symptoms of acute cold, Coughing and sneezing, Sore throat, Rigid neck, Nausea and vomiting, Red or watery eyes, Headache, Chills or fever, Listlessness or sleepiness, Disinclination to play , Diarrhea, Pains in the body, Skin conditions like scabies and ringworm, Pediculosis.
  23. 23. Contd.. Children showing any such signs or symptoms should be reffered to the school medical officer. Teacher observation of school children is of particular importance. For this work, the teachers should be adequately trained during Teacher Training courses and subsequently by short In-service Training courses.
  24. 24. 2. REMEDIAL MEASURES& FOLLOW UP Special clinics should be conducted exclusively for school children at the primary health centres in the rural areas, and in one of the selected schools or dispensaries for a group of about 5000 children in urban areas.
  25. 25. Contd.. The clinic days and time should be intimated to all the concerned schools. Considering the high prevalence of dental, eye, ear, nose and throat defects in the school children, special clinics should be secured or provided for the exclusive use of school children for examination and treatment of such defects.
  26. 26. Contd.. In the big cities, the required no of specialists should be employed in the School health service. There should be provision for beds in the existing referral hospitals for the children to be admitted for investigation and treatment as and when required.
  27. 27. 3.PREVENTION OF COMMUNICABLE DISEASES Communicable diseases control through immunization is the most emphasized school health service function. A well planned immunization programme should be drawn up against the common communicable disease. A record of all immunizations should be maintained as part of the school health records. When the child leaves the school, the health record should accompany him.
  28. 28. 4. HEALTHFUL SCHOOL ENVIRONMENT The school building, site and equipment are part of the environment in which the child grows and develops. A healthful school environment therefore is necessary for the best emotional, social and personal health of the pupils. Schools should serve as demonstration centres of good sanitation to the community.
  29. 29. Contd.. The following minimum standards for sanitation of the school and its environs has been suggested: Location: the school should normally be centrally situated with proper approach roads and at a fair distance from busy places and roads, cinema house, factories, railway tracks and market places. The school premises should be properly fenced and kept free from all the hazards.
  30. 30. Contd.. Site: the site should be on suitable high land, and not subject to inundation or dampness and can be properly drained. The school health committee recommended that 10 acres of land be provided for higher elementary schools and 5 acres for primary schools with an additional one acre of land per 1000 students. In congested areas, the nearest public park or playground should be made available to the students.
  31. 31. Contd.. Structure: Nursery and secondary schools, as far as possible, be single storied. Exterior walls should have a minimum thickness of 10 inches and should be heat resistant. Classroom: verandhas should be attached to classrooms. No classroom should accommodate more than 40 students. Per capita space for students in classroom should not be less than 10 sq ft.
  32. 32. Contd.. Furniture: Furniture should suit the age group of students. It is desirable to provide single desks and chairs. Desks should be of minus type. Chairs should be provided with proper back-rests, with facilities for desk-work. Doors and windows: the windows should be broad with the bottom sill, at a height of 2’-6” from the floor level; combined door and window area should be placed on different walls for cross ventilation; the ventillators should not be less than 2% of the floor area.
  33. 33. Contd.. • Colour: inside colour of the classroom should be white and should be periodically white-washed. • Lighting: classrooms should have sufficient natural light, preferably from the left, and should not be from the front. • Water supply: there should be an independent source of safe and portable water supply, which should be continuous, and distributed from the taps.
  34. 34. Contd.. • Eating facilities: vendors other than those approved by the school authorities should not be allowed inside school premises; there should be a separate room provided for mid-day meals. • Lavatory: privies and urinals should be provided- one urinal for 60 students and one latrine for 100 students. Arrangements should be separately made for boys and girls.
  35. 35. 5. NUTRITIONAL SERVICES A child who is physically weak will be mentally weak, and cannot be expected to take full advantage of schooling. The diet of the school child should, therefore receive first attention. The diet should contain all the nutrients in proper proportion, adequate for the maintainence of optimum health. Nutritional disorders are widely prevalent among school children, particularly deficiencies relating to proteins; vitamins A, C, thiamine and riboflavine, calcium and iron.
  36. 36. Contd.. Mid-day school meal: In order to combat malnutrition and improve the health of school children. It is now an accepted procedure in all advanced countries to provide a good nourishing meal to school children.
  37. 37. Contd.. The School Health Committee recommended that school children should be assured of at least one nourishing meal. Those who can afford it may bring their lunch packets from home, and during lunch hours take their meals in school. Otherwise, school should have some arrangement for providing mid-day meals through their own cafeteria on a “no profit no loss” basis.
  38. 38. Contd.. Applied nutrition Programme: UNICEF is assisting in the implementation of the Applied Nutrition Programme in the form of implements, seeds, manure and water supply equipment. Wherever land is available, the facilities provided by the UNICEF should be utilized in developing school gardens. The produce may be utilized in the school feeding programmes as well as for nutrition education.
  39. 39. Contd.. Specific nutrients: advances in the knowledge of nutrition have revealed that specific nutrients may be necessary for the prevention of some nutrient disorders. Dental caries, endemic goiter, nightblindness, protein malnutrition, anaemias and a host of other nutrient disorders are eminently preventable. Use of specific nutrients is indicated where such nutrient disorders are problems in a community.
  40. 40. 6. FIRST AID & EMERGENCY CARE The responsibility of giving first-aid and emergency care to pupils who become sick or injured on school premises rests with the teacher and therefore all teachers should receive adequate training during “Teacher Training Programme” or “In-service Training programmes” to prepare them to carry out this obligation.
  41. 41. Contd.. The emergencies commonly met within schools are a)accidents leading to minor or serious injuries, and b) medical emergencies such as gastroenteritis, colic, epileptic fits, fainting etc.
  42. 42. 7.MENTAL HEALTH The mental health of the child affects his physical health and the learning process. Juvenile delinquency, maladjustment and drug addiction are becoming problems among school children. The school is the most strategic place for shaping the child’s behavior and promoting mental health.
  43. 43. Contd.. The school teacher has both a positive and preventive role- he should be concerned with helping all children attain mental health, so that they may develop into mature, responsible and well adjusted adults.
  44. 44. Contd.. The school routine should be so planned that there is enough relaxation between periods of intense work, and every effort should be made to relieve the tedium of the class room. No distinction should be made between race, religion, caste or community; between the rich and poor; and between the clever and dull.
  45. 45. Contd.. It is now increasingly realized that there is a great need for vocational counsellors and psychologists in schools for guiding the children into careers for which they are suited.
  46. 46. 8. DENTAL HEALTH Children frequently suffer from dental diseases and defects. A school health programme should have provision for dental examination, at least once a year. In the developed countries, dental hygienists are employed in schools to assist the school dentist with the examination of the teeth.
  47. 47. Contd.. They make preliminary inspection of the teeth and do prophylactic cleansing which is of great value in preventing gum troubles and in improving personal appearance. They take part in the teaching of dental hygiene as they work with the children
  48. 48. Contd.. Schools should be responsible for the early detection of refractive errors, treatment of squint and amblyopia, and detection and treatment of eye infections such as trachoma. Administration of vitamin A to children A to children at risk, has shown gratifying results. In other words, basic eye health services should be provided in schools
  49. 49. 9. EYE HEALTH SERVICE Schools should be responsible for the early detection of refractive errors, treatment of squint and amblyopia, and detection and treatment of eye infections such as trachoma. Administration of vitamin A to children at risk, has shown gratifying results. In other words, basic eye health services should be provided in schools.
  50. 50. 10. HEALTH EDUCATION The most important element of the school health programme is health education. The goal of health education should be to bring about desirable changes in health knowledge, in attitudes and in practice, and not merely to teach the children a set of rules of hygiene.
  51. 51. Contd.. Health education in schools should cover the following areas: 1. Personal hygiene 2. Environmental health 3. Family life
  52. 52. Contd.. Health education in schools is a function of the school teacher. The health officer and the public health nurse/health worker/health assistant may furnish teaching materials and advice, but the teacher is the key person in the presentation of material to the children. To do this important work, the teacher should be well versed in health education techniques, and sincerely interested in the welfare of the pupils.
  53. 53. 11. EDUCATION OF HANDICAPPED CHILDREN The ultimate goal is to assist the handicapped child and his family so that the child will be able to reach his maximum potential, to lead as normal a life as possible, to become as independent as possible, and to become a productive and self-supporting member of society. The resources for managing handicapped child vary from country to country. It requires the cooperation of health, welfare, social and educational agencies.
  54. 54. 12. SCHOOL HEALTH RECORDS A cumulative health record of each student should be maintained. Such records should contain • Identifying data – name, date of birth, parent’s name and address, etc • Past health history • Record of findings of physical examination and screening tests and record of services provided.
  55. 55. Contd.. The purpose of maintaining school health records is to have cumulative information on the health aspects of school children in order to give continuing intelligent health supervision. These records will also be useful in analyzing and evaluating school health programmes and providing a useful link between the home, school and the community
  56. 56. ROLE OF NURSE IN SCHOOL HEALTH PROGRAMME A school health nurse assumes a major part of the health programme responsibilities and works in collaboration with others in the school and community. Nursing services in school ordinarily consist of three interwining and overlapping areas – health supervision, health counseling and health education.
  57. 57. Contd.. • Health supervision includes such activities as health assessments, vision and hearing screening and health deficit identification. • Health counseling involves providing interpretation of health information, guidance and counseling regarding health behavior and recommendations regarding individual and group health conditions. • Health education refers to planning, promoting and implementing health instructions as well as providing consultation services in health related matter.
  58. 58. Contd.. In general, the functions of the school health nurse are associated with: • The establishment and enforcement of the schools policies and programs for the protection and promotion of health of pupils. • The maintenance of a school environment which is conducive to healthful living.
  59. 59. Contd.. • The building of those components of the curriculum which have significance for health. • The management of the health service including screening programs and emergency care services. • The handling of special problems • Relating the health programme to those of the community.
  60. 60. Contd.. Thus, the functions of nurses in schools include using the nursing process with the school-age population to maintain or improve the health by nursing actions including health teaching, creating an environment conducive to good health, and relating the health of the school population to families and the community.
  61. 61. Contd.. Actually, the school health programme is carried out by the school medical officer with the help of school health nurse and other paramedical staff and also with the help of trained teachers in the school.
  62. 62. Table1 : School Health Nursing Service flow Health Education Health Supervision Health Counselling Emergency care Follow-up Prevention Health deficit Consultation, referral Adaptation, prevention Vision, hearing testing Follow-up consultation referral Conservation, prevention Health appriasals Nursing diagnosis and action Maintainence promotion, self decision making.
  63. 63. Thank you