Health

1. School Health Services
Prepared by:-
Dr. Mohamed Mustafa
Assistant Professor in Community Health
Nursing

2. Objectives:-
By the end of this lecture the students should be able to:
1. Describe the major components of school health services.
2. Analyze potential stressors of the school population as a client
subsystem.
3. Describe the assessment and strategies used by the nurse in
intervening at the three levels of prevention.
4. Discuss the organization and expectations of the school health nurse
as described by the Ministry of Health in Saudi.
5. Explain common emergencies that occur in the school.
6. Describe how the school nurse could use algorithms to aid in
decision making during emergency situations.
7. Anticipate future trends in school nursing.
2

3. Introduction:-
 School children as an aggregate need health
care services during their school day.
 School nurses are there to put bandages on the
wound and provide comprehensive nursing
care to both children and the staff and
coordinate health services to improve students'
scholastic achievement.
3

4. Healthy People 2010 Goal in relation to
School Health:-
 Reduce adolescents absence due to illness or injury.
 Increase the educational achievement of adolescents and
young adults.
 Reduce adolescent and young adult victimization by,
crimes.
 Increase the proportion of adolescents who have had a
wellness checkup in the past 12 months.
• Reduce violence exposure in schools.
4

5. Obj:1
8 elements of the School Health program
5

6. 1- School Health Services:-
• School Health Services is described as a
coordinated system that ensures a continuum
of care from school to home to community
health care provider and back.
• School health services are different from one
place to another according to the needs of the
students, community resources, funding
sources, and school leadership preferences.
6

7. • All school maintain health record on every
student and at a minimum monitor
immunization status.
• Health services include:
Health screening (lice, violence, abuse, suicide,
neglect, health problems.
Basic care for minor complaints.
Administration of medication.
Immunization.
Case finding for early identification.
Counselling.
Care for the students with special needs.
7

8. Preventive services such as immunizations.
Screenings for vision, hearing, and obesity.
Emergency care.
Management of acute and chronic health
 (diabetic child, autistic, hypertensive,
asthmatic).
8

9. 2- Health Education:
An objective from Healthy people 2010 has set a
goal that students in middle and junior high
school will take at least one health education
course.
Six behavioural topics should be the primary
focus of health education geared to
adolescents.
The following are negative behaviours that often
start in childhood or adolescence and persists
into adulthood. 9

10. 1- Behaviors that result in intentional and
unintentional injuries.
2- Tobacco use.
3- Substance abuse including alcohol and other
drugs.
4- Sexual behaviours that result in STDs or
unwanted pregnancies.
5- Poor nutritional habits.
6- Lack of adequate physical activity.
10

11. 3-Physical Education:
A sedentary /inactive lifestyle has long been
associated with obesity, heart disease
hypertension, and diabetes. (WHO,2007).
Studies have shown that people who are active
have a better quality of life.
Habits in childhood are more likely to be
continued into adulthood.
Studies have also shown that children and
adolescents who are physically active tend to
have greater self–confidence and self-esteem.
11

12. • Physical activity education should focus on
activities that children can perform into their
adult years such as walking, swimming,
biking, riding.
12

13. 4- Nutrition:
School-age children are undergoing periods of
rapid growth and development and
consequently have high nutritional needs.
Diets should include a proper balance of
carbohydrate, protein, and fat with a sufficient
intake of vitamins and minerals.
Poor nutritional status is closely associated with
poverty.
13

14. School nurse should assess:
Eating disorders (bulimia, anorexia).
- Nutritional education program:
It is essential and must include parents and teachers
and the child.
Children need to know and understand:
1-The food pyramid.
2- How to make healthy choices for snacks.
3- The importance of balancing physical activity
with food intake.
4- Obesity, dental caries, anaemia and heart disease
can be reduced or prevented with proper education
and lifestyle changes. 14

15. 5- Counseling, psychological, and social
services:-
The mental health of a child or adolescent is
affected by physical, economic, social,
psychological and environmental factors.
Children like adults often hide problems from
themselves and from others.
They may see problems as a sign of weakness or
as a lack of control or they try to protect
someone they love.
15

16. • The nurse or teacher may be the only stable
adult in the child’s life who will listen without
being judgmental.
• Children may come to the school nurse with
various vague complaints such as recurrent
stomachaches, headaches, or sexual behaviour
and the nurse must look beyond the initial
complaint to identify underlying problems.
• The school nurse may help teach the child how
to solve the problem, how to cope, and how to
build self-esteem.
16

17. 6- Healthy school environment:
A healthy school environment means that the
school is free from physical hazards and
psychological threats.
All students and staff have a right to learn and
work in a healthy school environment.
The school nurse as an advocate for students,
staff and community will be actively involved
in the development and maintenance of a plan
for a healthy school environment.
17

18. 7- Health promotion for school staff:
• Health promotion program should have the
following fourlevel of prevention: screening
and assessment, risk factor reduction
education, organizational policies, and
employee assistance programs.
• School nurses play an important role in all
levels of prevention through assessment,
planning, intervention and evaluation.
18

19. 8- Family and Community involvement:
School nurses are often asked to provide health
content to family, parents and the community
on a variety of topics such as sexuality, STDs,
HIV, communicable diseases and substance
abuse.
Health education in the community should
consist of programs that are designed to
positively influence parents, staff and others in
matters related to health.
19

20. Obj:2
Potential stressors of the school population as a
client subsystem.
A- Intrapersonal stressors.
B- Interpersonal stressors.
C- Extra personal stressors.
20

21. Potential stressors of the school population:-
intrapersonal interpersonal Extrapersonal
Physiological Poor nutrition
Unrecognized h. problems
Birth defects.
Repeated infection and accidents.
Multiple, closely spaced children.
Family violence.
Repeated hospitalization
Psychological Behavior disturbance
Self-concept
Signs of stress/coping
Severe mood changes
Suicidal ideation
Low self-esteem.
Abuse and neglect.
Strong beliefs about physical
punishment for obedience.
Lack of support from
community organization.
Developmental Genetic abnormalities
Developmental disabilities
Sports injuries
Immature parents and unable to
handle responsibility.
Parent education.
Parental age, previous
experience and knowledge
deficit.
Excessive/inadequate
stimuli to children.
Sociocultural Siblings, marital status,
cultural/ethnic backgrounds.
Toxic substances unprotected at
home.
Unsafe home.
Decreased verbal communication
Poor environment
Lack of contact with
community
organizations.
Spiritual Lack of Religious education. Religious beliefs that may
influence child health as female
circumcision, conflicts with
religious beliefs.
Inability to practice
Spiritual activities safely.
Terrorism 21

22. Obj:3:-
Strategies used in applying levels of prevention in school (discussion)
• 1- Primary level of prevention includes:
 Health promotion activities.
 Teaching healthy lifestyles.
 Immunization of the children.
• 2- Secondary level of prevention includes:
 Screening program.
 Caring for ill or injuries child or staff.
• 3- Tertiary level of prevention includes:
 Caring for children with chronic health conditions.
 Health referrals.
 Continuity of care.
22

23. Obj:4: Role of the School Health Nurse:-
• Health Services.
• Screening.
• Case-Finding.
• Surveillance of Immunization Status.
• Managing Minor Complaints.
• Administration of Medications.
• Counselling.
• Case Management.
• Health Education.
• Servicing Students with Special Needs.
• Health Education.
• Environmental Health.

24. Obj:5: Common emergencies in the school:-
1. Aggressive behaviours.
2. Nose bleeding.
3. Minor injuries.
4. Seizure.
5. Tooth knocked out.
6. Fall down and Fractures.
7. Diarrhea and Vomiting.
8. Incontinence.
9. Asthma attack.
10. Insects bites.

25. Family Related Health Problems in School
Aged Children:-
 Acne.
 Impetigo.
 Cellulitis.
 Streptococcal pharyngitis.
 Tuberculosis.
 Urinary Tract Infection
(UTI).
 Osteomyelitis.
 Scabies.
 Tinea capitis.
 Pediculosis capitis (head
lice).
 Insect bites.
 Caries.
 Enuresis.
 Anorexia.
 Bulimia.
 Obesity.

26. Obj: 6: Use of algorithms (procedures, process,
rules)to aid in decision making during an
emergency situation:-
• Set clear disaster plan with corresponding teachers in case of
emergency and train students on this plan
• Paint coloured line ( red line) that reaches the school clinic
to help students reach clinic easily.
• Write and distribute to each class leader the evacuation plan
in case of emergency.
• Encourage students to participate in “ School clinic’s
Friends) and teach them first aid measures
• What else……

27. Role of the nurse in promoting health and
wellness through primary health care
nursing:-
Discussion: three levels of prevention:
a. The Primary level of prevention.
b. Secondary level of prevention.
c. Tertiary level of prevention. 27

28. The Levels of Prevention in Schools:-
Primary prevention:
Use the nursing process.
Children need continued health services in the schools.
The school nurse sees them on an almost daily basis and is the
person who is usually given the role of teaching them about
and promoting their health.
The school nurse may have the opportunity to go into the
classroom to teach health promotion concepts.
They may spend time with the teachers, giving them the latest
information on healthy lifestyles for children, or how to spot
a child who may be ill or in need of counselling.
Teach healthy food.
Initiate team nutrition.

29. • Prevention of childhood injuries.
• Substance Abuse prevention education.
• Required vaccinations for school children.
The school nurse must keep a complete file of
all of the children’s vaccination records.

30. Teach young children in a school:-
• When teaching for elementary and primary
schools, keep the lesson to no more than 10
minutes in length.
• Use a lot of examples, pictures, and stuffed
animals in the talk.
• Always remember the developmental stage of
the children when teaching them.

31. Secondary prevention:
This includes caring for ill or injured students and school employees.
It also involves screening and assessing children.
Referral to appropriate health agencies or providers.
The school nurse uses the nursing process.
Children seek out the school nurse for a variety of different needs:
Headaches.
Stomachaches.
Diarrhoea.
Anxiety over being separated from the parents.
Cuts, bruises, or other injuries.
Need for emergency equipment.

32. • Screening children for lice.
• Identification of child abuse or neglect.
• Communicating with health care providers.
• Violence at school.

33. Tertiary prevention:
Use the nursing process for chronically ill children as:
Children with asthma.
Children who are autistic and have Attention Deficit
Hyperactivity Disorder.
Children with special needs e.g. catheterization,
tracheostomy, gastrostomy ………….etc.
Diabetes.
Children with terminal diseases.
Homebound children (children with disability in
institutions).
Pregnant teenagers and teenage mothers at school.

34. Future trends in school nursing:-
• The future of school nursing is strong.
• In the future school, nursing will entail
telehealth and teleconsulting to teach health
education.
• The internet will be used by school nurses to
work with parents and children.

35. Questions:-
1- Enumerate five elements of the school health program?
2- Mention five school health services?
3- As a school health nurse you should assess the nutritional health status
of school-aged child and adolescent, which one of the following
represents eating disorder among school adolescent?
A- Headache.
B- Stomached.
C- Bulimia.
D- Constipation.
4- List five rules of the school health nurse?
5- Discuss the role of the nurse in promoting health and wellness through
primary health care nursing?

36. Questions:-
6- Mention five common emergencies in the
school?
7- Which one of the following should be an
extra personal potential stressor of the school
population as a client subsystem?
A- Repeated hospitalization.
B- Suicidal ideation.
C- Low self-esteem.
D- Developmental disabilities. 36

37. Thanks