Community Health Care Nursing

Week 16 Lecture Notes

The use of tobacco, alcohol and drugs, poor nutritional habits, inadequate physical
activity, irresponsible sexual behaviour, violence, suicide and reckless driving are
examples of behaviour that often begin during youth and increase the risk of serious
health problems.
 The school nurse visits four to six schools per month, with each visit lasting
for 3 days or more, depending on the type of school and school location and
population.
 Revisits may be done within the month in a particular school.
 Teachers who also serve as school guardians, provide primary care as
necessary. Such as detection of obvious health problems and administration of
first aid.
 The school nurse is responsible for planning and conducting training programs
for teachers on health and nutrition.
 Poverty is associated with decreased or inferior health care and has been
linked to serious health problems that result in absenteeism and failure in
school.
 The school nurse and in the absence of the school nurse, the well-prepared
school teacher, serving as school health guardian, can effectively manage
minor complaints of illnesses, helping these children to return to or remain in
class.
 There is a need for mental and physical health services for student of all ages
in an effort to improve both academic performance and the sense of well-
being.
 School health program were defined as :
1. School health services
2. School health education
3. A healthy school environment to include both physical and
psychosocial aspects of environment( WHO, 1997)

 RA 124 in 1947- an act to provide for Medical Inspection of Children

Enrolled in Private Schools, Colleges and Universities in the
Philippines. This law stated that it was the duty of the school heads of
private schools with a total enrolment of 300 or more to provide for a
part-or full time physician for the annual medical examination of pupils
and students.
 The physicians were to render of their school health activities at the end
of every quarter of each school year to the Director of Health.
  SCHOOL HEALTH SERVICES:
 Health Education- these are culture sensitive and based on the
identified educational needs of the target population.
Areas of concern for health education:
1. Oral Hygiene- the oral health care program involves the 7 o‘clock
toothbrushing habit activity.
2. Injury prevention and developing safety conscious behaviour in the use of
the school playground, while engaging in sports, and the like. MAPEH
period is a good time for the school nurse or teacher to talk with and
counsel students about risk of developing health problems related too
physical acivity.
3. Tobacco Use- Smoking is a major problem in this country.
- Prevention should be emphasized in young people.
4. Substance Abuse- The use of alcohol and other drugs is associated with
problems in schools, injuries, violence and motor vehicle deaths.
- National Drug Education Program- designed to promote collaboration of
other sectors with the school system by establishing linkages among
government, private and sociocivic organizations.
- Random drug testing is also carried as part of this program.
5. HIV, AIDS- School-base HIV and AIDS Education and prevention
program is an information dissemination campaign to educate the general
population on the risks of HIV and AIDS.
EIGHT COMPONENTS OF SCHOOL HEALTH RPOGRAMS

Health Physical Health Nutrition

education Education Services Services
Family and
Counseling , Healthy Health community
psychological school promotion for involvement
and social environment staff
services
 Physical Education - Sedentary lifestyle is associated with obesity,
hypertension, heart disease and diabetes
- Regular Physical activity helps build and maintain healthy bones and
muscles.

 Health services
1. Health Screening- one of the objective of the school health nursing program
in the Philippines is to detect early signs and symptoms of illness,
disabilities and deviations from normal.
1.1 Annual Individual health assessment- examination of the eyes, ears,
nose, throat, neck, mouth, skin, extremities, posture, nutritional status,
heart and lungs.
- Visual acuity test is done with the use of snellen‘s chart, E-chart or
symbol chart.
- Ballpen click test(auditory screening)- test for hearing acuity.

1.2 Height and weight measurement- done at the beginning and at the end of
the school year.
1.3 Rapid Classroom Inspection- inspection of the pupils in the classroom or
while they are in line formation outside the classroom.
- Done to detect illness, particularly when there is outbreak in the
community.
 Emergency Care- emergencies can include natural events such as
typhoons, floods, and earthquake and man-made disasters, such as
hazardous material spills, fires and civil disobedience.
- Basic first aid equipment should be available in all schools.
- The school nurse and school health guardians must be knowledgeable
about standard first aid.
- EMS activation and Referral system should be in place.
 Nutrition- a variety of foods must be ingested to meet their daily
requirement.
- Diets should include a proper balance of carbohydrates, proteins, and
fats with sufficient intake of vitamins and minerals. S
- Skipping meals, especially breakfast and eating unhealthy snacks
contribute to poor childhood nutrition.
- Food preparation is expected to be undertaken by the home economics,
feeding teachers, homeroom Parent-Teachers Association on a rotation
basis or both.
 Obesity – not considered as an eating disorder
- must be of concern to the school nurse
- 3 most common eating disorder:
1. Anorexia- severely restricted intake of food
based on an extreme fear of weight gain.
 2. Bulimia- chaotic eating pattern with recurrent
episodes of binge eating.
3. Binge eating-out-of control eating of large
amounts of food whether hungry or not.
 Counseling, Psychological and social services- children and teens
struggle with depression, substance abuse, conduct disorders, self-
esteem, suicide ideation, eating disorders and under or
overachievement.
- One of the most important roles of the nurse with various vague
complaints, such as recurrent stomachaches, headaches, or
sexually promiscuous behaviour.
- early dtetction and treatment may prevent untoward
consequences.
- It is important for the nurse to be cognizant of the warning signs
associated with suicide and to recognize and refer at-risk
adolescents to appropriate mental health professionals.
 Healthy School Environment- the healthy school environment should consist of
(WHO, 1997)
1. A Physical, psychological and social environment
2. A healthy organizational culture within the school
3. Productive interaction between the school and community.
 Health Promotion for school staff- staff that participate in health promotion
increase their health knowledge and positively change their attitudes and
behaviors relative to smoking practices, nutrition, physical activity, stress and
emotional health.

Truths about adolescent suicide

1. Most adolescent who attempt suicide are torn between wanting to die and wanting to
live
2. Any threat of suicide should be taken seriously
3. There are usually warning signs preceding an attempt(depression, isolation, sleep
changes)
4. Suicide is more common in adolescents than Homicide
5. Education concerning suicide
does not lead to an increased number of attempts.
6. Females are more likely to attempt suicide. Males are more likely to suicide
7. One attempt can result in a subsequent attempt
8. Firearms and strangulation are predominant modalities of completed suicides in
children and adolescents.
9. Most adolescents who attempted suicide have not been diagnoses as having mental
disorder.
10. All socioeconomic groups are affected by suicide.

Warning Signs Of Stress

 Difficulty eating or sleeping

  Use of alcohol or other substances(sedatives, sleep enhancer)
 Difficulty in making decisions
 Persistent angry or hostile feelings
 Inability to concentrate
 Increased boredom
 Frequent headaches and ailments
 Inconsistent school attendance

 Healthy School Environment- the healthy school environment should consist of (WHO,
1997)
4. A Physical, psychological and social environment
5. A healthy organizational culture within the school
6. Productive interaction between the school and community.
 Health Promotion for school staff- staff that participate in health promotion increase
their health knowledge and positively change their attitudes and behaviors relative to
smoking practices, nutrition, physical activity, stress and emotional health.

Standards of school nursing practice

Standards Of Practice
Standard 1. Assessment Nurse collects comprehensive data
pertinent to the clients health or the
situation
Standard 2. Diagnosis Nurse analyzes the assessment data to
determine the diagnoses or issues
Standard 3. Outcomes identification Nurse identifies expected outcome for a
plan individualized to the client or the
situation
Standard 4. Planning School nurse develops a plan that
prescribes strategies and alternatives to
attain expecte outcome.
Standard 5 A. Coordination of care Nurse provides health education and
employs strategies to promote health and
a safe environment.
Standard 5 B. health teaching and health Nurse provides health education and
promotion employs strategies to promote health and
a safe environment.
Standard 6. Evaluation School nurse evaluates the clients
progress towards attainment of outcomes.
Standards of professional performance
Standard 7. Quality of practice School nurse systematically enhances the
quality and effectiveness of nursing
practice
Standard 8. Education School nurse attains knowledge and
competency that reflects current school
nursing practice.
Standard 9. Profession practice Nurse evaluates ones own nursing
evaluation practice
Standard 10. Collegiality Nurse interacts with to the professional
 development of peers and school
personnel as colleagues.
Standard 11. Collaboration School collaborates with the client,
family, school, staff
Standard 12. Ethics School nurse integrates ethical provision
in all areas of practice.
Standard 13. Research School nurse integrates research findings
into practice.
Standard 14. Resource utilization School nurse considers factors related to
safety, effectiveness, cost and impact.
Standard 15. Leadership School nurse provides leadership in the
professional practice setting and the
profession
Standard 16. Program Management Manages school health services.

School Nursing Practice- is a specialty unto itself. School nurses need education in
specific areas, such as growth and development, public health, mental health nursing,
case management, family theory, leadership and cultural sensitivity to effectively
perform their roles.