The School Health Nursing Program

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Provide quality nursing service and education to develop the child

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THE SCHOOL HEALTH NURSING PROGRAM
The holistic approach to strengthen health and nutrition is attained through the Redesigned Approach in School Health Nursing (RASHN) officially adopted through DECS Memorandum No. 37, series 1991. This is restricted procedure in providing school health nursing services with a considerable length of time spent for the activities done in a package during the school visits of the nurse. The RASHN is based on the philosophy that the 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. General Objective: Provide quality nursing service and education to develop the child physically, mentally, socially and spiritually healthy to become a productive, self-reliant and responsible member of society. Specific Objectives: Detect early signs and symptoms of illness/disabilities and deviations from normal; Provide preventive and remedial measure, for simple and common ailments among the school population; Coordinate with other health personnel, the translation of scientific knowledge to desirable health behavior; Participate in the dissemination of health messages to teachers and pupils; Create awareness among school children, personnel and administrators on the importance of health and safety. Monitor the implementation of the standards of school health nursing program relative to the school plant; Establish/Strengthen linkages with government and non-government organization for school-community health work; Encourage the provision of needed health facilities; Utilize tried and tested medicinal plants for the treatment of common ailments; Provide opportunities for research and studies on health related concerns. Policies and Guidelines: All newly appointed school nurses shall undergo orientation/ in-service training The Nurse-in-charge shall conduct the orientation/in-service training with practicum at the regional/division level in coordination with the regional and the division medical officer from one to two weeks. Vacancies for the school nurses shall be immediately filled up. Applicants must satisfactorily meet the requirements contained in the Qualification Standards Manual. Regional/Division Medical Officer/Nurse-In-Charge shall assist the Schools Division Superintendent in the selection of the applicants. Position of school nurses who are on leave without pay shall be filled up as soon as possible until incumbent reinstates. School nurses shall upgrade their professional preparation They shall be encouraged to take Graduate Studies in public health/school nursing education/public administration and management/health education and to attend seminars, workshops, conferences related to health and nursing. Regular in-service training for school nurses shall be provided. Scholarship grants shall be made available to deserving/qualified school nurses who have been in the service for two years or more. School nurses who have teaching load shall be required to take 18 units of education units School nurses shall participate in health and nutrition activities by: Training teachers as health guardians as well as helping other groups with related functions at different level.

Giving lectures/health talks to different classes at different grade levels and other audiences about health/nutrition topics. Scientifically tried and tested medicinal plants shall be utilized for the treatment of common ailments. (Bayabas, Bawang, Lagundini, Sambong, Acepulco, Herba-Buena, Ampalaya, Niyog-Niyogan, TsaangGubat, mangosteen, etc.) Teachers/pupils/students/ hall be trained in the preparation and utilization of tried and tested 10 medicinal plants. All divisions/school shall maintain functional school clinics. School nurses shall establish/strengthen coordination with government and non-government agencies for support/resource generation and involvement in school community health activities. A Nurse-In-Charge shall be designated from among the public health nurses in the division. The selection shall be based on management skills, work performance, leadership qualities, full knowledge on the health and nutrition programs and projects, dedication and commitment. Monthly statistical reports shall be submitted to the Nurse-In-Charge for consolidation. And shall be submitted on the 5th working day of the succeeding month to the regional office, copy furnished the Health and Nutrition Center, DECS Complex, Pasig City. Regional quarterly report shall be sub mitted on the 10th of every quarter (April, July, November , and January) to the Health and Nutrition Center, DECS Complex, Pasig City. Performance Appraisal Report and Civil Service Form 48 of school nurses shall be initialed by the Nurse-InCharge and duly signed by the Division Medical Officer or the Head of the Health and Nutrition Section. Data bank shall be established in every school clinic to include records of the current health and nutritional status of the school children, situation on the health care delivery, school environment, health facilities, the status of the health education activities, etc. that are properly filed for planning, research and other purposes. Medicines and medical supplies shall be made available. 10% of the quarterly cash disbursement ceiling (CDC) shall be provided for the procurement of medicine (DECS Order No. 69 s. 1978 and DECS Memo No. 342, S. 1995). The Nurse-In-Charge should coordinate with the Medical Officer in the procurement of medicines and medical supplies. School nurses shall have the following targets: School visits ----------------------- 4-6 schools/nurse/month. Health assessment/ - - - - -------1000 puplis/nurse/month or 90-98% of examination pupil/student population Classroom health talk ----------- 20 lectures/nurse/month Organization/reorganization--- one per school/nurse/ of school-community Conduct of community --------- one per nurse/month assemblies School nurses shall be required to report to the division clinic regularly, i.e. weekly or on rotation basis to prepare reports, attend to the needs of the school personnel and other related activities. School nurses shall bring their own instrument which could be either be personal or provided by the Division or Regional Office like: sphygmomanometer, stethoscope, thermometer, etc. contained in a nurses kit/bag. 1. The school nurse should wear the prescribed uniform with cap, and white shoes when in the division clinic and schools. When on travel white blazer, dark pants may be worn. Black attire is not allowed even when in mourn. Wearing of slippers/step-ins are strictly prohibited.

Nurses in vocaatinal/secondary school teaching 2 classes of health subjects shall render 6 hours of nursing service. For school nurses teaching more than 2 classes of health subjects, they shall be paid honoraria. Health examinations of Grade I enrollees shall start during the National School Enrollment Day (NSED) up to September 30 of every year. School nurses shall be allowed to attend annual congress/conventions/seminars/workshops based on memorandum issued for the purpose.

Scope of Work The school nurses with their experience and knowledge of the changing growth and behavioral patterns of children are in a unique position in the school setting assist the children in acquiring health knowledge, in developing attitudes and practices conducive to healthful living. The duties and functions of the School nurse can be well stated through the fours components of the school health and nutrition program. A. Health and Nutrition Education 1. Gives health lectures/talks to classes or pupils before and after any health activity or procedure and on different levels, on different health and nutrition topics. 2. Confers with the teachers about the kind of follow-up needed by the pupils. 3. Demonstrates to teacher the different screening procedures and their implication to the learning process. 4. Conduct the different screening procedures like vision test, hearing test, height and weight measurement, health examination/assessment of pupils. 5. Assist teachers in the selection of appropriate health and nutrition instructional materials. 6. Acts as resource person in health classes and other health related activities. 7. Initiates/assists in planning in-service trainings and seminars for teachers on current health and nutrition problems. 8. Initiates/conducts training of teachers as school health guardians. 9. Assists the administrators in providing the school with adequate health education references for pupils and teachers. B. Healthful School Living 1. Helps supervise the maintenance of safe, healthful and sanitary conditions of the school plant. 2. Looks into the sanitation of the lunch counter, in the selection, preparation and serving of food. 3. Encourages the promotion of wholesome interpersonal relationship. 4. Assists the administrator in the organization of a healthful school day. 5. Encourages the school administrator to provide safe and sanitary health facilities. C. Health and Nutrition Services 1. Helps organize a functional school clinic. 2. Conducts individual health and nutrition assessment/examination. 3. Treats common ailment identified. 4. Provide health guidance and counseling to pupils found with defects. 5. Render first aid treatment. 6. Utilizes tried and tested medicinal plants.

7. Isolates cases of communicable diseases and refers them to the medical officer or any health agencies for proper diagnosis and management. 8. Identifies, refers and follow through exceptional and physically handicapped children. D. School-Community Coordination for Health and Nutrition 1. Follows-up cases of sick children, teachers and other school personnel through home/hospital visits. 2. Confers with parents/teachers concerning the health status of pupils/students. 3. Initiates/reactivates the organization of the school-community health council. 4. Coordinates with the community health agencies regarding proper management and referrals and other health and nutrition projects. 5. Coordinates with the community health agencies regarding proper management and referrals and other health and nutrition projects. 6. Acts as resource person in school-community health related activities. 7. Conducts school-community assemblies. E. Other Related Health and Nutrition Activities 1. Participates in meetings/conferences and other health and nutrition related activities. 2. Initiates projects related to health and nutrition education/service. 3. Conducts school health and nutrition survey and utilizes results for planning research and other purposes. 4. Conducts action research in relation to school health and health education. 5. Participates in the evaluation of the school health and nutrition programs and projects. 6. Consolidates, prepares and submits required promptly and regularly. 7. Establish health and nutrition data bank. Duties and Functions of the Division Nurse-In-Charge in Addition to their Regular Duties as Nurse. 1. Monitors the work of the school nurses as regards their monthly and yearly schedule of visits, school nursing techniques and accomplishments of records and reports. 2. Orients new nurses on the School Health Nursing Program and the redesigned Approach in School Health Nursing in order to provide comprehensive quality nursing care to school population. 3. Provides regular feedback related to school nursing to the Chief of the Health and Nutrition Section. 4. Initiates/Conducts staff development activities to upgrade the competencies of the school nurses and first aid teachers. 5. Plans and prepares the annual Division Action Plan of the School Health Nursing Program in coordination with the Head, Health and Nutrition Section. 6. Assists the Head of the Health and Nutrition Section in the recruitment, placement and promotion of school nurses and other health workers. 7. Monitors and evaluates the implementation of health and nutrition programs and projects. 8. Prepares drafts of memoranda/communications to the field. 9. Coordinates/collaborates with government and non-government agencies regarding the implementation of health and nutrition programs and projects. 10. Cooperates with other agencies in emergency and relief works during epidemics, disaster calamities and other health-related activities. 11. Prepares/consolidates the school nurses health and nutrition accomplishment reports. 12. Recommends medicines and other medical supplies for school health nursing services. Plan of Work: For effective implementation of School Health Nursing Program, the school nurse should carefully plan her work.

A. School Visit Generally, the school nurse visits four to six schools a month. The length of the visit may vary from 3 days or more depending upon the school population/distance and means of transportation. Revisits may be done after all the schools have been visited, for follow-up purposes or as the need arises and shall be prioritized. Revisit should not affect the regular schedule for other schools. The schedule of visits shall be prepared in advance, and in close coordination with other members of the school health and nutrition team. B. Activities 1. School Health and Nutrition Survey. This shall be done initially to provide date for evaluation and for planning purposes. The survey shall include among others the current health and nutritional status of school children, situation on health facilities as well as actual status of health education activities undertaken by the teachers and health personnel. A survey form is available for this purpose. Actual survey should be done during the first visit of the nurse to the school and every three years thereafter. Results of the survey should be discussed with other members of the health team in order that identified health needs maybe addressed. 2. Putting up of a functional school clinic R.A. 124 mandates that all schools are to provide school clinics for the treatment of minor ailments and emergency cases. 3. Pupils/Students health and nutrition assessment/examination. To detect cases of ailments and deviations from normal among the school children, nurses shall perform health and nutrition assessment/examination. This activity is aligned with the expanded role of the school nurses. 4. Referral of cases Cases discovered during health and nutrition assessment/examination that need further management shall be referred to appropriate health personnel/agencies. When medical officers are not available, cases may be referred to any of the following: a. Public health agencies 1. Municipal/provincial health officer 2. Provincial/community/district hospitals 3. Social welfare service b. Private entities 1. Private or family physicians 2. Civic organization The school and community should recognize the need to provide treatment and other social services for children whose parents are financially unable to secure such services. The teacher and school nurse who notice a pupil with any sign of social, emotional maladjustment, mental or physical diseases/ailments should refer him/her to medical officer, voluntary health or welfare agencies. 5. School Plant Inspection

The school plant shall be inspected in order to provide a healthful environment and safety in schools. Aside from the minimum standard for schools in relation, to school site, area, location, space, school building, sanitation, classrooms and other rooms and facilities, schools shall be inspected for size, lighting, ventilation and arrangement of seats. Particular attention shall focus on the provision and maintenance of toilets, school clinics, water supplies, sanitation of school canteen and safety of foods being served. 6. Attendance to emergency cases It is incumbent upon the nurse to attend to emergency cases while he/she is in school. However, in his/her absence, the school has the responsibility of attending to emergency cases at all times. The teacher as school health guardian shall assume such responsibility. 7. Organizing/reactivating/reorganizing School Community Health Council The school nurse shall initiate/encourage the organization/reactivation of School-Community Health Council, the membership of which shall come from both school and community. A set of officers shall be elected to manage the Council. Each set of officers shall be encouraged to put up one school-community project during their term. Members of the community should be motivated to take active participation in the solution of school-community health-related problems and concerns. The school nurse shall conduct school-community assemblies to interpret the school health problems/programs to the community. 8. Establish data bank on school health activities The following records and reports shall form part of the data bank: a. Daily treatment in the school clinic b. Records of the school visits (RHU and school health personnel) c. Inspection Report of the School Health Personnel d. Health and Nutritional Status of School Children e. Records of emergency cases attended to and referrals made f. Inventory of clinic equipment and supplies g. Health education activities in school h. School health service records of accomplishments i. Records of officers/officials of the School-Community Health Council and their accomplishments. 9. Health Education Activities Each school nurse shall plan a training program and conducts conferences/workshops on health and nutrition for the teachers as school health guardians. The school nurse shall serve as resource person on any related activity. She shall prepare health communication messages/materials on the prevention and control of commonly found ailments among children which shall be communicated to the teachers during district/staff meetings. Standard School Clinic The School clinic should be located in a strategic area that is accessible to the school children. It should be functional, well-lighted and properly ventilated. It should have the following facilities: an examination room; treatment room, dental treatment room, drinking, handwashing and toilet facilities. There should be a comfortable waiting area for the school children to rest as they wait for their turns to be treated or attended to. The school clinic should contain the following basic equipment, supplies and materials, to wit: A. Equipment 1. Sphygmomanometer

2. Stethoscope 3. Weighing Scale 4. Sterilizer/boiler 5. Examination bed 36” X 75” X 30” 6. Medicine/treatment cabinet 7. Water jar/jug 8. Dressing cart 9. Clinic furnitures a. Office/writing table b. Stock cabinet c. Chairs d. Footstool (half moon shaped) 22” wide, 12” long and 11” high e. Stools for pupils/students patient and nurse first aid teacher 10. Waste cans with cover for solid and liquid waste. Liquid wastes shall be placed under the footstool. During the treatment, the cover shall be removed. 11. Clinic linens like bedsheets, bath towels, hand/face towels, pillow cases, mattress. B. Machines and Uses 1. Ophthalmic Ointment Eye infection 2. Eye Drops Eye wash 3. Otic Drops Ear infection 4. Cough syrup/tablets Cough 5. Nasal Decongestants Colds 6. Antispasmodics Abdominal Pain 7. Antacids Hyperacidity 8. Antidiarrhea/Oral hydration tablet Loose bowel movement 9. Analgesic /Antipyretic Headache/fever 10. Aromatic Spirit of Amonia Fainting, dizziness 11. Tincture of Arnica Hematoma, sprain 12. Anti-allergy tablets Allergy 13. Caladryl Lotion/Ointment Urticaria, Alleregy 14. Ap-ap Solution/Salicydic Acid 10% Tinea Flava 15. Whitfield Ointment Ringworm 16. Topical Ointment Infected Wounds 17. Antiseptics Disinfectant 18. Zinc Oxide Ointment Scabies 19. Benzyl/Benzoate Solution Scabies, pediculosis 20. Ichthyol of Belladona Ointment Carbuncle, boil 21. Lysol 10%/Zephiran 1:10,000 For disinfecting forceps, other instruments C. Supplies and other equipment 1. Cotton, cotton balls, cotton pledgets 2. Gauze bandages 3. Plaster/adhesive tape 4. Band-aid strips 5. Soap dish with soap 6. Medicine glasses 7. Pair of scissors 8. Pair of forceps 9. Medicine Droppers 10. Applicators, tongue depressors, splints 11. Basin, round

12. Kidney basin 13. Drinking galsses 14. Tray 15. Clinical Thermometer 16. Ice cap 17. Hot water bag 18. Bottles/jars for cotton balls, cotton pledgets, tablets 19. Elastic Bandage The medicines/medical supplies in the treatment cabinet shall be arranged in the following manner: 1. First upper shelf – from left to right – Eye and ear medicines, internal medicines 2. Second middle shelf – external medicines like ap-ap solution, Whitfield Ointment, antiseptics 3. Lower shelf a. Jar for gauze dressing b. Jar for cotton balls c. Jar for cotton pledgets d. Bottle of Antiseptics (for washing of wound like Hydrogen Peroxide, Lysol 1%, others) e. Adhesive tape/plaster f. Pair of scissors g. Kidney basin h. A pair of forceps i. Container for Lysol Solution 10% or Zephiran solution for disinfecting the forceps in between treatments. Remove and dry the pair of forceps at the end of the day. The school medicinal garden should be located near the clinic, as much as possible. It must have the ten recommended medicinal plants. Potted medicinal plants may be provided inside the clinic for aesthetic and medicinal uses. HEALTH APPRAISAL ACTIVITIES TO BE PERFORMED BY THE SCHOOL NURSE I. Health Assessment – It is the examination of the eyes, ears, nose, throat, neck, mouth, skin, Extremities, posture, nutritional status, heart and lungs. It differs from health inspection in that it is more complete and extensive. A. Frequency: 1. Health assessment should be done once a year. Priority should be given to Grade I enrollees on the National School Enrollment Day (NSED) which falls on the last Monday of January up to September 30 of every year. The first year students should likewise be given priority. 2. Pupils/students in other grades/year levels shall be examined once a year too. B. Aims 1. To discover signs of illness, physical or behavioral defects or abnormality; 2. To check on the habits of pupils on cleanliness; 3. To treat common ailments needing treatment; 4. To help parents determine ways of correcting defects; 5. To find ways and means of preventing the progress of defects and ailments which cannot be corrected. C. Materials Needed: 1. A well-lighted room 2. Tray with towel lining containing tongue depressors, penlight, oral thermometer, alcohol, stethoscopes etc. 3. Tables and chairs 4. School Health Examination Card

D. Procedure 1. Before the examination is conducted, the nurse should explain to the pupils in simple terms, the aims of the procedure and how this will benefit them. 2. Explain the different steps in the procedure-that the different parts of their body shall be inspected and examined for cleanliness and abnormal conditions. 3. Pupils should be assessed one by one, observing their gait, posture, odor, general appearance and state of health. 4. Findings should be recorded during the examination. 5. After the examination, the nurse should tell the class her general findings like-how clean and healthy they are and the pupils can see her in the clinic if necessary. E. Follow-up; 1. The results of the health assessment should be discussed with the teacher so that she will understand her pupils better. 2. If necessary, parents should be called for a conference, for proper guidance and advice. 3. Home visits should be made for follow up cases, if necessary. 4. Referrals should be done for pupils who need to be referred. II. Rapid Classroom Inspection – It is a fast inspection of the pupils in the classroom or while the pupils are in their lines outside of the classroom noting their general cleanliness, signs and symptoms of illness and treatment or corrections made. A. Frequency 1. It should be done after a long vacation, between health examination, or when there is an impending or actual epidemic. B. Aims 1. To detect early signs of symptoms of a disease especially communicable diseases. 2. To note corrections and have been made. 3. To note the general cleanliness of the pupils. C. Needed Facility and Material 1. A well-lighted place like the entrance of a room, corridor 2. HNC Revised Form 58 used during consolidation of health assessment. D. Procedures: 1. Instruct the children to file past the nurse, showing their hands or fingers, or ant part of the body to look into. 2. If rapid classroom inspection is done during an epidemic, special attention should be given to signs and symptoms peculiar to the disease. 3. Record new findings. E. Follow-up 1. Discuss the findings with the classroom teacher as soon as possible. 2. Any case found which requires more careful inspection should be examined in the clinic.

III. Vision Testing
– It concerns with the examination of the visual acuity of pupils. The appraisal of Visual is accomplished through continuous observation by the teacher and screening examinations’ of both eyes which are necessary for the continual and satisfactory appraisal of the school children vision.

A. Frequency: 1. Test for visual acuity should be done once a year, preferably at the beginning of the school year. B. Aim: 1. To test the visual acuity of the school children. C. Materials Needed: 1. Snellen’s Chart - E. Chart or symbol chart - Letter chart or literate chart or alphabet chart 2. Black cardboard / eye cover 3. Letter E symbol 4. Pointer or a piece of stick 5. Ruler D. Procedure Preparation for Testing 1. Post the chart at the eye level of the child in a place with sufficient space and light without glare. 2. Using a ruler, measure 20 feet from the chart, at the end of which a line shall be drawn where the pupils shall stand during the testing. 3. If the child has eyeglasses, test vision with eyeglasses first, then without glasses. 4. The children should be tested one by one. Techniques of Testing 1. Test the right eye first. Instruct the child to cover the left eye with a cardboard, taking care not to press the eyeball. 2. Tell the child that as you point to each letter, he must show you, using his three fingers or letter E symbol the direction of the “E”. 3. Point to the letters at random for each line, starting from the top line down to the last line. Use a pointer, not a pen or pencil. 4. Note the last line in which the child can read without error and record the fraction printed at the end of this line. This is the visual acuity of the eye. 5. Repeat the same procedure with the left eye. 6. If the child cannot see the biggest letter on the chart, record this as “less than 20/200”. 7. There must be only one reading per eye. Reminders: 1. Vision testing should only be done during the early part of the schoolyear. 2. It may be done inside the classroom. 3. The symbol chart can be used for all grades. The letter chart may be used if it is available in higher grades. 4. The chart should be removed when not in used so that the children will not memorize the letters. 5. Do not allow the pointer to cast a shadow on the chart. 6. More than two (2) errors show inability to read that line. 7. Do not obscure the letter with the pointer. 8. Findings should be recorded immediately. 9. The teachers should watch for the signs of: a. Impaired vision - Holding head in a peculiar position - Watery eyes - Loss of line reading - Confusion in reading - Complaints of the child like headache, dizziness, discomfort in reading and confusion in recognition of letters. b. Disease

- Redness - Swelling - Scaling - Loss of lashes - Discharge E. Follow-up 1. Any child with a vision worse than 20/30 should be given immediate attention. 2. Refer to the child physician or hospital for proper diagnosis and management. 3. Pupils with defective vision should be seated in front. 4. Parents should be informed of the defective vision of their children. IV. Height and Weight Measurement – It is a procedure of evaluating the tallness or the shortness of a pupil. It is the simplest, easy to accomplish and acceptable parameters’ in determining the nutritional status of any given population. A. Frequency: 1. Measurement of height and weight is done at the beginning and end of the school year. 2. Pupils who are recipients of participant in any rehabilitative supplementary feeding program should be weighted every quarter. B. Aim: 1. The determine the nutritional status of the school children C. Materials Needed: 1. Weighing scale, preferable beam balance 2. Tape measure 3. Triangular board or chalk board 4. Revised HNC Form 58 / School Health Examination Card 5. Thumb tacks D. Preparations: 1. Any footwear should be removed, pockets emptied and minimum clothing be worn. 2. Urinary bladder should be emptied prior to weight taking. 3. Weighing should not be done after a full meal. 4. The height and weight of the child should be taken at the same time and day to provide a common basis for the computation of the child’s age. 5. If tape measure is being used to measure the height, it should be placed against a flay wall. 6. If the children to be measured vary in height, measure 20 centimeters from the floor before fastening the tape measure on the wall and add 20 centimeters to the actual reading. 7. Care must be taken to get an accurate weight. The beam must not cling to the upper or lower bar, but must swing freely. Always place the sliding weight to the zero. 8. The weight must be read to the tenth of a kilo and the height in centimeter. E. Procedures: Measurement in Height 1. Instruct the child to stand erect with heels together against the wall, that he straighten his spine so that his heels, buttocks, back and head touches the tape measure. 2. Bring the triangular board or chalk box down on the child’s head not too tightly and being sure that it is flat against the wall. 3. Read the height to the nearest 0.5 centimeter. 4. Record the weight. F. How to compute the age of the school child. 1. Long Method

Age of the child in years and months (as of last birthdate) Compute the child’s age to nearest month using the formula: - Date when measurements were taken minus his birthdate. Use corresponding numbers for the months, e.g. 1 for January, 2 for February, 3 for March, etc. - For example – Juan a Grade 1 pupil was born on January 3, 1971. His height and weight measurement were taken on June 21, 1977.

Formula: Year Month Day Date when measurements Were taken 77 6 21 Minus birthday 71 1 03 Juan’s age is 6 years 06 5 18 And five months Disregard the extra Numbers of days

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