school Health Services Learning Objectives this unit, the student should be able to: after reading ee uae the objectives of school health services «+ Explain Initiation. an ‘ = shoal hath Sees pan nition al pring of shea hn + Recall Health problems of school children. + Recognize school health programme unde g ore Components ‘of school health services. Ayushman Bharat. + Review Maintenance of school health records. + Explore Role of 2 school health nurse. Be # umprk t Schoo! tnuinenns 587jl Cisse es ee | es SS ee bi Health Nursing -! 588 Community INTRODUCTION n important branch of preventive and social medicine. During the last 70 yearg tries, It comprises the medical examination of school chitd;, al service with supervision of the health and wellbeing of Schogf en to school School health health has developed in many coun preventive and soci comprehensive, children throughout the school yea HISTORICAL DEVELOPMENT The beginning of schoo! fhalth service in India dated to 1909 when for the frst time; the medio examination of school children was carried out in Baroda City. The Bhore Committe, 1946 rp thatthe school food health services were practically non-existent in India. In 1953, the ccm tducation commission emphasized the need for medical inspection of pupils and school jas?) programme. Daring the second five year plan many state governments provided for school fn) Programmes In 1960, the Government of India constituted a school Health Committee to assea | present standards of health nutrition of school children and suggest ways and means to improve then The Committee recommended certain measures for the improvement of school health service, Gov of India has emphasized the importance of the medical check-up of primary and secondary class's sha going children. Keeping in the importance of the programme of medical check-up of school gong | children the programme was launched all over the Stale with the available existing medical and medical staff of PHCs, SHCs and CHCs since 1993-1994. The Programme thrust is based on gener health of the School going children and to take remedial measures and follow up. ee DEFINITION OF SCHOOL HEALTH SERVICE The school health service is defined as “the school procedures that contribute to the maintenance and improvement of the health of pupils and school personnel including health services healthful living and hea education”. OBJECTIVES SCHOOL HEALTH SERVICES 1, To reduce morbidity amongst school children by preventing them from falling prey to the preventable diseases and thus help to reduce the drop-out rate amongst school children. 2. Early detection of health related problems in children and their proper treatment through referral services. 3. To impart health education to the school children and the teachers. j . To advice the school authorities on safe drinking water supply, good environmental sanitation and cleanliness etc. . To provide curative, referral and follow-up services to the students of primary, middle and senior secondary classes of the schools through medical check-ups. To prepare younger generation to adopt measures to remain healthy. To help the youngster to make the best use of educational facilities, utilize in a productive and constructive manner, enjoy recreation and develop concern for others. 8. Tohelp the younger generations to become healthy and useful citizens who will be able to perform their role effectively for the welfare of themselves, their families, the community at large and the country as a whole, 2UNIT-11 Schoo! Health Services 589 h of school children t/follow up/ referral ‘joUsNeSS. itive health te promot nosis /treatmen' ly Ai health cons thal environment. ere) problem in school going children which is classified under two ind behavior related problem: Seats ee eso ogee: The health problem ofthe shoo! health children vary from one place to another 1 Health Petition: ‘Anemia, PEM, vitamin deficiency, etc. a Maltjous disease: ‘testinal parasites, diartheal disease, constipation, etc b, Infe ‘condition: Scabies lice, acne, dermatitis, ete. i ye disorders ‘Conjunctivitis, refractory defect, et: | Eve jratory disease: TB, pneumonia, asthma, etc. ries problems in children are due to various regions like mental {, Dental ca Ibenavior proviems: The behavior 2 ¥r isease and failure to the intemal and extemal environment, the behavior se some comin mere ated problems sealing, lying, gambling, destructiveness and sexval offence thumb sucking and bedwetting, shyness, day dreaming, and jealousy school fear and school failure. Pt Anti social proble 1) Habit disorder: Nail biting, 2 personality disorder: Temper tantrum, 4 educational difficety: Backwardness in study, ‘Poe OF SCHOOL HEALTH Baie Health appraisal Healthful schoo! environment ae First aid and emergency care ‘Components of schoo! he Seren siete enue KGnn) FIGURE 11.1 lth services.590 Community Health Nursing - Health Appraisal Generally, itis seen that most ofthe students in the school suffer from many preventable dig as defective teeth, bad sight, deafness, anemia, etc, but such diseases adversely ation ne tS capacity ofthe students andl cause ill health. Medical inspection is only the intial stop 8 heme of progress which involves the improvement of not only the physical but the ment ig rea development of the children, However, for making the medical inspection meaningful ine Rileers factors should be taken into account: wing 1. A thorough medical examination of all pupils and necessary follow-up and teatmen wth necessary, should be carried out in all schools. 2, Pupils with serious defects and those who suffer from severe illness should be examine a frequently. ore 3. Medical examination should be given to teachers and other school personnel as they form, of the environment to which the child is exposed. 4. The teacher is in a unique position to carry out the “daily inspection’ as he is familar yp th children and can detect changes in the child appearance or behavior that suggest ing improper growth or development. or Part Healthful School Environment The site of school, the building, the lighting and ventilation, the school furniture and equipmeny he curriculum and the time table should be arranged in such a manner that it should not interfere with health of the pupils, The school atmosphere, the school environment should be healthy. There shog be good physical condition prevailing in the school consisting of proper sanitation, supply of pu drinking water, provision for mid-day meal and play ground of reasonable dimension. For the mes emotional, social and personal health of the pupils, a healthful school environment is necessary asa following factors should be taken into account for making the school environment healthful 1. Location: The school should be centrally situated with proper approach roads and at a fair distance from busy places and roads, cinema houses, factories, railway tracks and market places The school premises should be properly fenced and kept free from all hazards. 2. Site: The most important factor of the school is the selection of site. So, careful attention should be paid to this important aspect the site should be dry; well drained, free from foul smells, smoke and dust and away from noise of all kinds. The School Health Committee, 1961, recommends that 10 actes of land be provided for higher elementary schools and 5 acres for primary schools with an additional one acre of land per 100 students. In congested areas, the nearest public park or play ground should be made available to the students. Other important points for careful examination in selecting sites are; the surroundings, the conditions as to natural drainage and ordinary level of the ground, the nature of the soil and sub soil and the play ground. 3. Structure: This will depend of course, upon the number of scholars for whom accommodation his to be provided and expert advice should be sought with regard to the present and future needs ofthe school. At the time of constructing school building the following factors should be taken in to account a. Number of class rooms b. Equipment and furniture ¢. Arrangements of light and ventilation d. Arrangements for water supply e. Washing and lavatory arrangements 4, Class rooms: Verandah should be attached to classrooms. There should be provision in the class room to accommodate more than 20 students. Classroom should not be less than 10 square feet ER OE eeeUNIT-11 School Health Services 591 spure: To avoid strain in children, equipment and furniture should be provided to the children a Form dance with their growth and should suit the age group of students. It is desirable to Jn ace single desks and chairs. Desks should be of ‘minus’ type. Chairs should be provided with ck est, with facilites for desk work Fighting: Class room should have sufficient natural light, preferably from the left and should not 6 front wm the j ee apply; There should beanindependent source safe and portable water supply arrangement. 1 watory: Privies and urine’s should be provided one urinal for 60 students and one latrine for 100 8 ae nts, arrangements should be separately made for boys and girls. i 5 communicable Diseases apreventive measure, the headmaster or principal of school should arrange for timely vaccination einoculation against some common ‘communicable diseases such as Typhoid. Small pox, Cholera, ithelia, Whoop ns ‘cough, etc. and necessary steps should be taken in case some boys suffer from dane contagious diseases like Ring-worm, Eczema, Scabies and Leprosy, etc nutritional Services Tala who is physically weak also will be mentally weak, and cannot be expected to take full anage of schooling. The dict of school child should therefore, recive first attention, The diet sera eontain all the nutrients in proper proportion adequate forthe maintenance of optimum health. {Integrated child development scheme: The Government of India has started a program called Integrated Child Development Services ICDS) in the year 1975, ICDS has been instrumental in proving the health of mothers and children under age 6 by providing health and nutrition srhcation, health services, supplementary food, and pre-school education. The ICDS national evelopment program is one of the largest in the world. It reaches more than 34 million children aged 0-6 years and 7 million pregnant and lactating, mothers Other programs impacting on under-nutrition include the National Mid-day Meal Scheme, the National Rural Health Mission, ‘nd the Public Distribution System (PDS). 2. Midday meal scheme: National Programme of Nutritional Support to Primary Education popularly known as the Mid-Day Meal Scheme (MDM) was started in 1995 in an attempt {0 Enhance enrolment, retention and attendance while simultaneously improving nutritional lev els among children in school. In October 2007 the scheme was revised to cover children in the upper primary section as well, ic. classes VI to VII. The ‘Scheme estimates a cooked mid-day meal with a Frinimum of 300 calories and 8-12 grams of protein to al children studying in classes I to V. Upper Primary meals consist of 700 calories and 20 grams of protein by providing 150 grams of food grains (rice/wheat) per child/school day. The central government supplies state and union territory government with free food grains (wheat/rice) at 100 grams per child per school day From the nearest Food Corporation of India (FCI) go-down and compensation of the cost of transporting, the food grains from the nearest FCI to the Primary school First Aid and Emergency Care In each school a fully equipped first aid box should be provided as per regulations of St. John ambulance association of India and one member of the teaching staff should be trained in first aid and should be in charge ofthat first aid. The teacher must know the fundamental principle of health, so that he can play a valuable part in bringing to the notice of the school medical officer or other authorities ‘concerned any cases of deviation from the normal at a fairly early stage.592 Community Health Nursing - 1 Mental Health Services al health of the child affects his physical health and the learning. process, and maladjustment are becoming problems among school children. The Schoo! havior and promoting mental health. The community 9. The ment jelinquency ‘ cane fits for shaping the child’s behavior ot nurse has both a postive and preventive role. She should be concerned with helping al childnoy mental health, The school routine should be so planned that there is enough relaxation between na of intense work and every effort should be made to relieve the tedium of the class room, 1.5. increasingly realized that there isa great need for vocational counselors and psychologists ns for guiding the children in to careers for which they are suited. School Health Records In order to indicate all the medical examination results of a child at a glance, a separate card shoul maintained for each child. One copy of the health care should be kept by the school medical niin another copy should go to the parent in cases requiring medical or parental attention and a third «., with the teacher in charge of a particular group of students. It should be the duty of the seh physician to study the reports of health examinations and to select those cases for which remedisi corrective treatment is indicated. Thus, the health and safety of students will become an important concern of the entire school and activities for promoting and safeguarding the health of the studens. | Such records should contain: 1. Identifying data: Name, date of birth, Parent's name, address, etc. 2. Past health history 3. Records of the findings of physical examination and screening tests | 4. Records of services provided The records will provide cumulative information on the health aspects of school children and also; for analyzing and evaluating school health programmes and providing a useful link between the home school and community. Remedial Measures and Follow Up Medical examined are not an end in themselves they should be followed by appropriate treatment and 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 5,000 children in the urban areas. Considering the high prevalence of dental, eye, ear, nose and throat defects in the school children in India, special clinics should be provided for the exclusive use of school children for examination and treatment of such defects Health Instruction Health instruction should enable the child to achieve perfect as far as possible with regard to their physical and mental health, through imparting class room instruction and information by promoting good health habits and developing in them a sense of health conscience. By imparting adequate health knowledge the children of the school can be guided to live in a healthful manner, to establish certain habits and the principles of living which will provide a basis for the greatest possible happiness. But these things cannot be possible, if the right kind of environment will not be provided for building uP real consciousness in children.UNIT-11 School Health Services 593 ently suffer from dental disease and defects, Dental care Frsdtental disease in India, School health must have provision for deneay oan ease are i Bain dental exami ena yet Health education must be given regarding dental hygiene lental examination at least on eHealth Services unity health nurse should observe symptoms of visual difficulty. Visu Bein a year. al acuity test should redone equcation of Handicap Children ity health nurse should educate the parent e community heal Parents and teacher about various agencies. Tenses ultimate goal is to assist the handicapped children and his family so thatthe celdven wile io reach maximum potential. It helps to become independent, productive and self support : frember of the society ae mM bea suse OF SCHOOL HEALTH RECORDS 4 clinic records and reports are given below. Because of the importance of maintaining Grate, up-to-date health information on each child, it is suggested that records be consistently maintained including the following: : 4, Referral slip: All children should bring a referral slip to the clinic before being admitted for care The referral slip is the school nurse’s assurance that the teacher knows where the child is, >, Daily log: This is a running account of those who visited the clinic during the school day. 4, Clinic report to parents (optional): This is a form letter used to advise parents of a visit to the clinic by their child. This letter describes the nature of the complaint and action taken. This is particularly useful when the school has been unable to reach the parent(s) via the telephone concerning non-emergency situations. 4, Student medication record: This is a form used to record each dose of medication administered to a student, including both over the counter and prescription medications. SCHOOL HEALTH PROGRAMME UNDER AYUSHMAN BHARAT Healthy children are the foundation for a healthy nation and nation’s future depends on the status of the children. Leaders around the world have acknowledged schools as an important setting where children develop behavior skills for physical, emotional and social wellbeing. Thus, the Department of School Education, Ministry of Human Resource Development and Ministry of Health and Family Welfare have ajoint initiative to improve the health of school children under AYUSHIMAN BHARAT. is initiative will aim to strengthen the existing programs: Rashtriya Bal Swasthya Karyakram (RBSK) and Rashtriya Kishor Swasthya Karyakram (RKSK) by strengthening the preventive and promotive spe of health in environment of schools in line with the overall approach of Ayushman Bharat. 1. To provide age appropriate information about health and nutrition to the children in schools. 2. To promote healthy behaviors among the children that they will inculcate for life. oe —| | | | | | 594 Community Health Nursing -1 To detect and treat diseases early in children and adolescents including malnourished and anemic children with appropriate referrals to PHCs and ho: To promote use of safe drinking water in schools; To promote safe menstrual hygiene practices by girls. ‘To promote yoga and meditation through Health and Wellness Ambassadors, To encourage research on health, wellness and nutrition for children. identification spitals, Package of Services under School Health “Age appropriate incremental leaming for promotion of healthy behavior ang prevention of various + Delvered through schoo! teachers/Health and Wellness Ambassadors trainag each school in Bobo eaeeue cid ~The screening of children for 30 identified health conditions for early detection jae) treatment and management through dedicated RESK mobile health teams | 7 Provision of IFA and Albendazole tablets by teachers through WIFS a > programme respectively + Provision of sanitary napkins + Age appropriate vaccination Bend eee il tees 3 a aca Electronic health record for each child Imparting skills of “Training of teachers on basic first aid Cera aeis FIGURE 11.2 Package of Services under School Health under AYUSHMAN BHARAT SCHOOL HEALTH PROMOTION ACTIVITIES The trained teachers/ Health and Wellness Ambassadors will conduct weekly sessions and complete the modules in the academic year as per the proposed schedule. The health promotion activites wil be given a special focus. Age appropriate health education for the students will be taken up to influence behavior and enhance skills. The framework developed pays special attention to physical, psycho social and mental aspects based on the developmental stages of the child. The broad components a: TABLE 11.1 School health promotion activities j eS ‘Age Appropriate Health Promotion eee feelers | High school + Health, growth and development | + Puberty and related changes + Prevention of substance abuse + Personal safety + Eye care, oral hygiene + Sexual and Reproductive Health + Nutrition and physical activity | + Nutrition + Violence Prevention + Hygiene practices + Bullying prevention + Unintentional Injury + Prevention of Diseases like: + Meditation and Yoga + Road safety | Malaria, Dengue, TB, worms | « internet safety and media titeracy | + Nutrition infestation, diarrhea and vaccine |. prevention of sub: . a nd Yooa prevantaolecicenees revention of substance abuse + Meditation and Yoo + HIV/AIDS + Mental Health ueUNIT-11. School Health Services 595 nin serene sthya Karyakram (RBSK) is pal Swasthya Baty is an important initiati es fpati)2 Be on for children from birth to 18 years to ec See ee eects s at birth, Deficiencies, Rime jopment delays inchading disability, Th yin y sability. The 0-6 years’ age gro piseasess District Early neers Centre (DEI) level while for 618 = a eo im F eonditions will be done through FUE A aRCROHICE ee gh existing public he a eae public health facilites, DEIC will act as ni provision of Services clic Acid Supplementation through 6-19 years of age will follow the existing guidelines eekly Iron Fe ippleme jnshe schools: These services will continue to be delivered through school teachers. apie 112 ‘Age grouP 6-10 years |, Regime ee creas sas Ec Mrablets of 5 mg elementaliron and | Weeky throughout the period 400 mcg of folic acid 6 Reet age £ 70-19 years rpc irr Weekly throughout the period | Throughteachers | 500 meg of folic aci 10-19 years of age. | gees | aienctne ss eae =) ——— Through teachers | 1, Deworming: To combat parasitic worm infections, Government of India has declared 10th August and 10th February as fixed days to provide ‘Albendazole tablets for deworming school-age children. During NDD, Albendazole 400 mg P rewable tablets will be administered to children at govers ments rmment aided, and private schools. This will continve 0 follow the current NDD guidelines >, Menstrual hygiene management: Sanitary napkins may ie provided in the schools for adolescent girls as per MHS guidelines. B fiealth screening: Under RBSK, identification of 3 diseases including malnutritior with appropriate referrals. Identification of children with refractive errors may spectacles provided. 4 Physical and mental fitness: Classes on YOR! and meditation through Health and Wellness ‘Ambassadors may be promoted on the lines of international Yoga Day” to inculcate the habits of yoga and meditation among children since their childhood. 5. Research: Provisions may be made for research and studies on health, wellness and nutrition for ' children to assess the impact of the programme. Other preventive services in the form of regular age appropriate vaccination of children through local health staff are being considered. yn and anemia be done and NOTE: + Refer Annexure O: For Eval thool children sation of health counseling for $2 MCN UP Lee feu eakuose vices, these steps can be followed: Sesement of the health needs of the students and To initiate or organize school health se data analysis to identify the most 1. Assess the needs: Conduct a comprehensive as 4 the school community. This can include surveys, interviews, and pressing health issues.ki 2 S96 Community Heath Nursing <1! 2. Form a health committee: Establish 2 health committee consisting of key ctakeh, school administrators teachers, parents, healthcare professionals, and community sa This committee will be responsible for planning and implementing the schoo! he Develop a health policy: Create a health policy that outlines the goals, objectives for the school health services. This policy should address areas such as health promar.,* prevention, first aid, mental health support, and nutrition. Secure resources: Identify and secure the necessary resources to su local healthcare providers or organizations. Establish partnerships: Collaborate with local healthcare providers, community i and (government agencies to enhance the effectiveness of the school health cena partnerships can provide additional expertise, resources, and support. address the identified health needs of the students. These programs can focus on =, Physical activity, healthy eating mental health promotion, substance abuse prevent sexual health education. Monitor and evaluate: Regularly monitor and evaluate the effectiveness of the Long Essay Questions 1, Discuss the primary objectives of School Health Services and explain why they are essential for the overall wellbeing of students. 2, Describe some common health problems that school children may face and the impact of these issues on their education and development. Explain the various components that make up School. Health Services, such as health education, health screenings, and preventive interventions How are health records maintained in a school setting? Discuss the importance of keeping accurate health records for students, '5. What steps should be taken to initiate and plan School Health Services in a school or educational institution? Outline a basic implementation strategy, 3, 4. |. What is a primary objective of School Health Services? a. To increase school enrolment b. To promote student wellbeing and learning . To reduce teacher workloads d. To provide free textbooks to students 2. Which of the following is NOT a common health problem among school children? a, Obesity b. Hearing loss Retirement planning d. Dental cavities 3. Which component of School Health Services focuses on educating students about healthy lifestyle choices? ‘a, Health screenings b Immunization programs © Health education d. Emergency response 4, What is the purpose of health screenings in schools? a. To assign grades to students b. To identify health issues in students early € To select students for sports teams d. To assess academic performance 5. What role does a school health nurse typically play in School Health Services? a. Preparing schoo! lunches b. Conducting parent-teacher conferences ee 6, Describe the role and responsibilities of health nurse in promoting the heath an si students ae 7. How can health education programs in sen S400 help students develop lifelong healt habits) » examples of topics covered in schoo, (or education, heath 8, Explain the purpose of health screenings in «ry and provide examples of common health seca conducted for students es Discuss the importance of immunization prog, within School Health Services and the le tha a in preventing infectious diseases among student,” 10. Outline the protocols and procedures that shoulg in place for responding to medical emecgencics , 5 school setting. My Multiple Choice Questions © Promoting student health and providing basic healthcare d. Managing the school library 6. What is one of the key benefits of maintaining accurate health records for students within School Health Services? 4, It reduces the workload of school staft b. It helps identify students with the highest grades . It allows for targeted health education programs d. It increases the school’ budget. 7. Which of the following is NOT a common component of School Health Services? a. Physical fitness programs b. Health counseling Nutritional assessments d. First aid and emergency care 8. In the context of School Health Services, what & the primary purpose of immunization programs? a. To provide physical education classes b, To promote healthy eating habits To prevent the spread of infectious diseases among students d. To enhance academic performance What is the main goal of health education programs in schools? a, To assign homework to students b, To teach students advanced mathematics ¢. To promote healthy behaviors and lifestyles d_ To increase the school's revenue«mesa emergency in 2 school, what I statt prioritize fst? spond Se ographs of the incident king Fg the media i he Mediate medical assistance and c rofessional help aang 1 dia profes Mhe primary objective of School Health a1, What is the PTagard to health problems of vinices with children? shot lately eliminate all health issues among students p10 identity and address heath problems early to promote students wellbeing « Roprowide medica treatment t0 a students § fo ncrase school envaliment rates ta. which of ee flowing is» common component wrsanoot Health Services that focuses on keeping ot of students’ health and medical Nstory? b Heath education programs bb Health screenings t Maintenance of schoo! health records & Physical education classes What is the first step in the initiation and Fanning of School Health Services in 2 new school? ‘a. Hiring a school nurse . Conducting health screenings © identifying ey stakeholders end forming 2 committee 4. Providing immunizations to all students In the context of School Health Services, what is the role of a school health nurse in health promotion? a, Providing counseling to teachers, b. Managing the school cafeteria © Promoting health education and providing healthcare to students d Conducting parent-teacher conferences Which of the following is NOT typically covered in health education programs as part of School Health Services? 2. Nutrition and healthy eating b. Physical fitness and exercise Answer Key f.: Die 5. c 15. ¢ 4d 4c 2c cra Be 13.¢ UNIT-11, School Health Services 599 © Retirement planning d. Substance abuse prevention 16. What is the primary focus of School Health Services in addressing the he heath problems school children? — 3 a. Preventing all health problems b. Providing immediate medical treatment for all students Promoting early detection and intervention for health issues 6. Offering specialized healthcare services 17. Which of the following &s a key component of School Health Services that helps ensure the well-being of students by offering guidance on healthy lifestyles? a, Health screenings . School lunch programs Cc. Phrsical education classes d. Health education programs 18, What is the primary purpose of maintaining health records for students in School Health Services? 2, To track students’ academic performance . To identify potential candidates for student leadership roles ¢ To provide documentation for school budgets To monitor and address students’ health end medical needs 19, What is the typical role of a school health nurse during health screenings conducted in schools? a. Performing surgeries, i needed bi. Administering vaccinations to all students © Collecting and recording health data, such as height and weight . Teaching physical education classes 20. In case of a medical emergency involving = Radent in a school setting, who should be contacted first? ‘a The student’ parents b. The school principal © Local emergency services d. The school janitor Ge EO Ge Ce hem Patriots dS PS