nursing

1. School health service
INTRODUCTION: Child spends more time at school than anywhere else except
home.School havea major effect on children’s health.Childrenbetween the age of 5-
14 years are school age children.About 15 percent of the populationis comprised of
this age group. School Health Service is the most important aspect[branch]of
communityhealth .
DEFINITION:
SCHOOL: School is defined as an educationalinstitution where groups of pupils
pursue defined studies at defined levels,receive instructions from one or more
teachers,frequentlyinteract with other officers and employees such as principal,
various supervisors/ instructors,and maintenance staffetc., usuallyhoused in a
single building.
SCHOOL HEALTH: School health refers to a state of complete physical,mental,social
and spiritual well-beingand not merelythe absence of disease or Infirmityamong
pupils,teachers and other school personnel.
SCHOL HEALTH SERVICES: IdeallySchool health services refer to need based
comprehensiveservices rendered to pupils,teachers and other personnel in the
school to promote and protect theirhealth,prevent and control diseases and
maintain theirhealth.But practically,it refers to providingneed based
comprehensiveservices to pupils to promote and protect their health,control
diseases and maintain theirhealth.
SCHOOL HEALTH SERVICES IN INDIA
• Before Independence Era
• 1909, when for the first time medical examinationofschool children was done in
Baroda city.
 The school health services were taken after the Bhore committee report in
1946 .
Post independence Era
• 1957 when Child Education -Nutrition EducationCommittee and WHO assisted
School Health Education project were set up.
• 1960 the Ministryof Health, Government ofIndia,set up a School Health
Committee under the chairmanship ofSmt. Renuka Ray, the then member of

2. parliament to assess the standard ofHealth and Nutrition ofschool children and also
to suggest ways and means of improvingthese.
• 1977 when a CentrallySponsored NationalSchool Health Scheme was started.
• 1979, the National School Health scheme was handed overto State Governments.
• 1981, a Task Force was establishedbythe Government ofIndia,Ministryof Health
and Family Welfare to studythe progress of School Health programme functioningin
various states of the country.
• 1984-85Delhi had its own comprehensiveschool Health Scheme which is
continuing.
• 1988, a proposal forthe comprehensiveschool health service.
• 1989, the Central Health Education Bureau,Directorate General ofHealth Services,
had launched an intensiveSchool Health Education Project.
• At present "child to child” and "Youth to child” approaches.
AIM OF SCHOOL HEALTH SERVICES: The ultimate aim of School Health Services is to
promote, protect and maintain health ofschool children and reduce morbidityand
mortalityin them.
COMMON HEALTH PROBLEMS OF THE SCHOOLCHILDREN: The prevalence of
morbidityconditions in developingcountries is very high.
 Health problems :-
1. Malnutrition-Anaemia, PEM, Vitamin deficiencies
2. Respiratory-Tuberculosis,pneumonia, asthma
3. Gastrointestinal -Intestinal parasites,diarrheal diseases
4. Skin Conditions-scabies,lice, eczema,dermatitis
5.Eye Diseases- Refractivedefects,squint , conjunctivitis
6. Dental Problems- Dental caries , bleedinggums ,irregularteeth.
 Behaviourproblem:-
1. Antisocial problem: -stealing,lying, gambling,destructiveness,sexual offence.
2. Habit disorders: - nail biting,thumb sucking, bed wetting.
3. Personalitydisorders: -temper tantrum, shyness,daydreaming,and jealousy.
4. Educational difficulties: -backwardness in study,school fear, school failure, etc.

3. OBJECTIVES OF SCHOOL HEALTH SERVICES:
1. The promotion ofpositivehealth.
2. The prevention and control ofcommunicable diseases.
3. Earlydiagnosis,treatment and followup of defects.
4. Awakeninghealth consciousness in children.
5. The provision ofhealthful environment
GOALS OF SCHOOL HEALTH SERVICES:
1) To prepare the younger generation to adopt measures to remain healthyso as to
help them to make the best use of educationalfacilities,to utilize leisure in
productiveand constructivemanner, to enjoy recreation and to develop concern for
others.
2) To help the younger generation become healthyand useful citizens who will be
able to perform theirrole effectively for the welfare of themselves,their families,and
the communityat large and countryas a whole.
NEED FOR SCHOOL HEALTH SERVICES:
1. School children constitute a vital and substantial segment ofpopulation.
2. School children are vulnerable section ofpopulation byvirtue of theirphysical,
mental,emotional and social growth and development duringthis period.
3. School children are exposed to various stressful situations.
4. Children comingto school belongto different socio-economicand cultural
backgrounds which affect theirhealth and nutritionstatus and require help and
guidance in promoting,protectingand maintainingtheirhealth and nutritional status.
5. Children in school age are prone to get specific health problems.
PHILOSOPHY OF SCHOOL HEALTH SERVICES
1. A healthychild is mentallyalert,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 infirmitybut the realization ofthe full
potential ofthe child which has physical,mental,social and spiritualcomponents.
3. Prevention is better than cure; interventions when health breaks down are costly
and time consuming.

4. 4. School health services will help identifyanydeviations from normal growth and
development,anyhealth problem so that timely,therapeutic,correctiveand
rehabilitativeactions can be taken to improve and maintain healthand continue
studies.
5. While earlydiagnosis and prompt and adequate treatmentis of great importance,
followup care is equallyimportant foreffective school health services.
6. Rehabilitationofphysicallyand mentallyhandicapped children can be done and
must receive adequate attention.
7. Health knowledge and skills learnt not onlywill benefit the child but also it will
benefit the school,the parents,familyand community.
PRINCIPLES OF SCHOOL HEALTH SERVICES
1. Be based on health needs ofschool children.
2. Be planned in coordinationwith school,health personnel,parents and community
people.
3. Be part of communityhealth services.
4. Emphasize on promotiveand preventiveaspects.
5. Emphasize on health educationto promote, protect,improveand maintain health
of children and Staff.
6. Emphasize on learningthrough activeand desirable participation.
7. Be ongoingand continuous programme.
8. Have an effective system of record keeping and reporting.
SCHOOL HEALTH TEAM
1. The school principal
2. The school teacher
3. The parents
4. The community
5. The children
6. The medical officer
7. The school health nurse/communityhealthnurse

5. SCHOOL HEALTH ADMINISTRATION 1. School Health Committees 2. Primary health
centres
SCHOOL HEALTH POLICY 1. Health centre staff is responsible forimplementationof
school health programme.
2. The school health programme is carried out in schools by the health centre staff
working together with school’s administrators/teachers,local government,parents
and communityincludingboth agencies and students.
3. Priorityshould be given to school health programme at primaryschool levels.
ASPECTS / COMPONENTS/ ACTIVITIES OF SCHOOL HEALTH PROGRAMME
1. HEALTH APPRAISAL : Children should be medicallyexamined first – at the time
of admission in the school then every 4th
year after admission and then at the
time of leaving.
 Height , weight , teeth , eyes , speech and hearingshould be examined as a part
of physical examination.
 In school health services: dailyhealth check-up of children is conducted by
teacher.
2. TREATMENT AND FOLLOW-UP : Treatment and follow-up ofchildren should be
done by school health nurse and follow-up visits must be given to maintain the
health of the children.
3. IMMUNISATION : Communicable disease control throughimmunisation .
 Proper record of all immunisations shouldbe maintainedand this shouldbe
given to child , when the child leaves the school.
4. NUTRITIONAL SERVICES : MiddaySchool Meal - In order to prevent malnutrition
and improvethe health of school children the middaymeal is needed .
 Due to malnutrition children suffer from vitamin deficiency blindness ,
anaemia,beri-beri , low resistance.
 Malnutrition can be corrected by proper and adequate diet.
5. FIRST AID : First aid box should be always be available in school to handle
accidents and expected situations like sports accidents , pain in abdomen ,
epilepticconvulsions,diarrhea etc.
 Teacher should be skilled in providingfirst aid kits and list of drugadvised .
6. HEALTH EDUCATION : It is one of the crucial and key element of school health
services , it creates awareness , makes them knowledgeable regarding health
matter .

6.  Areas included personal hygiene, environmental health,nutrition, prevention
and control of communicable and non-communicable diseases ,first aid and
emergency care .
 Teachers should demonstrate healthfulenvironmentand motivates students to
practice healthful habits .
7. MENTAL HEALTH : The burden orstress of studycan lead to mental illness.
Juvenile delinquency,maladjustment ,drug addiction, etc.are common
problems amongschoolchildren .
8. DENTAL HEALTH : Children frequentlysuffer from dental disease and defects .
Make inspection ofteeth and do cleaningwhich help in preventinggum
troubles .
9. EYE HEALTH SERVICES : Early detection ofrefraction errors , treatment of squint
and myopia , detection and treatment of eye infection , administration of
vitamin A .
10. HEALTHFUL SCHOOL ENVIRONMENT : School should be away from
railwaystations , railwaylines,bus stands , market places and cinema .
 One toilet for every 25 students up to strength of 300 students , separately
made for boys and girls.
 Windowsize should be 25% of floorarea .
 Direct glare from electric bulbs and filaments shouldbe avoided.
 Classrooms shouldhavesufficient natural light.
 Safe and portable water supply
11. SCHOOL HEALTH RECORDS : Health record of each student must be
maintained properly.
 Health record should contain-name , DOB and address . Past health history.
Record of services provided .
ROLE OF NURSE IN SCHOOL HEALTH SERVICES: 1. General physical examination
2. Identifyanyabnormalities/ defects / diseases
3. Health education
4. First aid services
5. Periodicvisit
6. Immunisationrecords
7. School environment
8. Health records

7. BIBLIOGRAPHY
1. The Short Textbook Of Community Health Nursing , By Veerbhadrappa
Gm, Volume 2nd
, Jaypee Publications , First Edition , Page No. 187-202.
2. Textbook Of Community Health Nursing 2nd
, By Ravi Prakash Saxena, Lotus
Publication, Page No. 181-194.
3. Community Health Nursing , By Bt Basvanthappa , Page No. 824-8311