School Health Services

1. School Health Services Lecture #2 CHS 485

2. School Health Services School health services must be considered to be an important component of the coordinated school health program. • Generally, the school health services programs include numerous services that are designed to: • Appraise the health status of the school children. • Prevent and control communicable diseases. • Providing care for school-children who become sick or injured while at school.

3. Models For Providing HEALTH SERVICES: school-linked center school based center Objectives : To improve the student's access to primary care. They are designed to overcome such barriers to obtaining health care as time scheduling, lack of transportation, and apprehension which often keep school-age children from getting proper care during the school day.

4. The Professional Roles

5. School Nurse The role of the school nurse: • Can be a valuable help to the classroom teachers by providing instructional support and serving as a recourse person. • Administer first aid instructions. • Assess student health complaints. • Carry out screening procedures. • Maintain school health records.

6. School Nurse • Provide help to the child who becomes sick or injured while at school. • Manage the medical needs of the medically fragile child. • Manage students' medications during the school day. • Identifies and refers cases of child abuse, neglect, and sexual abuse to the proper authorities.

7. School Nurse • Participates in the activities which is designed to identify children with medical problems and working with teachers, school administrators, and child's parents to develop an individualized educational plan. • Participates in developing the school health curriculum. • Works with the school administration to establish policy for all matters relating to the health.

8. School Nurse • Effective and timely delivery of such services is influenced by the number of nurses available at the school site to respond to the students’ needs. • The maximum ratio of nurse to student should be: one school health nurse to no more than 750 students in the general school population.

9. Classroom Teacher The role of classroom teacher: • Using health service activities as an opportunity to educate students. • Prepares the students for screening and appraising activities through organized instructional units. • Acts as an advocate for child health.

10. Classroom Teacher As an advocate for child health, the classroom teacher can play 4 roles: • Observation:Teachers can observe student's physical, cognitive, social, emotional, and language performance in comparison to age cohort peers. While a problem might not be noticed when the child is alone, developmentally consistence peers can provide a valuable frame of reference.

11. Classroom Teacher 2. Referral: if the teachers suspect that a health problem may be a learning impediment, their responsibility extends to making an appropriate referral. 3. Gathering information: about the condition as observed over a period of time. 4. Follow up the referrals:teachers must be patient and persistent in their follow up activities. This includes continuing observation and documentation to support the work of intervention specialists who are working with the child.

12. Break ! Walk & Stretch Alternate sitting with standing ! (4 minutes per hour is all it takes)

13. Health Appraisal Activities • Appraisal for the health status of an individual is important for identifying deviations from normal, and conditions that may have a negative effect on the learning and everyday functioning . • The classroom teacher should use the various activities involved in school health appraisal activities as an educational motivation for students.

14. Health Appraisal Activities Health appraisal activities include: ❖ Health examination:head, neck, chest, abdomen, legs as well History of the health status. ❖ Screening programs which include: ✓ physical growth and development. ✓ vision screening. ✓ hearing screening. ✓ scoliosis screening. ❖ Disease control and immunizations.

15. Health examination • School districts should adopt policies requiring that children have health examinations before enrolling in school for first time. • The health examination should provide a history of the health status of the child and identify any health problems or allergies that child might have.

16. Screening programs A ) Physical growth & development ❖ Height and weight measurements are helpful in ascertaining if the children are experiencing appropriate physiological growth and development patterns. ❖ School programs enable a variety of growth disorders to be identified i.e. malnutrition-related problems, hypothyroidism.

17. Screening programs B ) Vision Screening ❖ Poor vision can lead to various behavioral problems that can have negative effects on academic performance. Visual defects/problems: Inflammations , injuries, and refractive error, which is an error in the focusing of light by the eye and frequent reasons for reduced visual acuity.

18. Visual defects: The inflammations Conjunctivitis (pink eye): • An inflammation of the conjunctiva caused by bacteria and viruses. • It can be easily transmitted to others by rubbing the inflamed eye or by reusing a washcloth or towel used by the infected individual. • There are effective antibiotic ointments or drops for bacterial infection.

19. Visual defects: The inflammations Sty: • A red, swollen inflammation of the sebaceous gland on the edge of the eyelid. • Apply hot compresses , ointment or surgery.

20. Visual defects: Injuries to the eye • Direct blows to the eyeball or penetration of the eye with sharp foreign objects. • Chemical injuries by strong acids or alkalis. While prevention is the important factor, the teacher must be familiar with appropriate emergency care measures.

21. Visual defects: Refractive errors Three basic types of refractive errors: • Nearsightedness (myopia). • Farsightedness (hyperopia) • Astigmatism

22. Visual defects: Refractive errors ❖ Objects at a distance appear to be fuzzy and blurry , but nearby objects are clear . ❖ In this case, the light rays are bent so that they meet short of the retina, ❖ This may be caused by an eyeball that is too longer or by a sharply curved cornea. ❖ It can be corrected by wearing prescription glasses or contacts lenses. ❖ Corrected by concave lenses • Myopia

23. Visual defects: Refractive errors ❖ The eyeball may be shorter from front to back and the light rays cannot be bent enough to focus on the retina, ❖ It may also be caused by an insufficiently curved cornea. • The hyperopic individual has difficulty seeing objects that are nearby clearly. ❖ Corrected by convex lenses • Hyperopia

24. Visual defects: Refractive errors • Astigmatism ❖ in this case there is an imperfectly shape cornea, the light rays focus at different points short of the retina. As a result , there are various forms of blurring or misshapes. ❖ This error often accompanies myopia or hyperopia. Corrected by cylindrical lenses.

25. School Vision Screening Procedures ❖ Visual acuity refers to how well an individual sees an object at a specific distance. ❖ The screening environment should be in a quiet room with normal light without glare or shadows. ❖ The Snellen eye chart is the most commonly used, the least expensive and the easiest screening test to perform. ❖ With this procedure , the eye chart should be placed at eye level at a distance of 20 feet from where the individual is standing or sitting.

26. School vision screening procedures The student is then asked to identify the line on the chart at which the student can read at least 50% of the letters correctly. Both eyes should be checked individually. The acuteness of vision is reported in the form of a fraction in which the denominator indicates the smallest letters that the individual can see. The numerator indicates the distance at which the test was giving . for example , for a reporting of 20/40 ,the 20 indicates that the individual was tested at 20 feet from the chart and the 40 indicates the value of the smallest line of the letters that could be read. A child with the reading of less than 20/25 should be referred to the physician.

27. Screening for color deficiency ❖ the individual being tested must identify a number or figure made of colored dots within a background of other colors. Screening for Eye muscle imbalance ❖ Involves having the student look at a small target object held about 15 inches from the face. the individual giving the test moves the object alternately from eye to eye about ten times. The screener watches the eye for horizontal and vertical movement.

28. Screening programs C ) Hearing Screening: Hearing is important during all stages of life, but has particular impact during the elementary school years when speech patterns are developing and adaptations first occur outside the home. Hearing loss can interfere with normal speech and language development .

29. What are the indicators for hearing loss problems? ❖ Failure to hear questions posed by the teacher, inattention, excessive loudness by the child when talking and responding to others, and turning the head to one side to hear. ❖ Distortion in children's speech is another important early observation clue for hearing problems.

30. School Hearing screening procedures They are subjective, unscientific appraisal procedures but they do assist first hand hearing screening. There is two types of hearing loss: 1) A sensorineural loss: Results from damage to the sensory cells in the cochlea or the neural pathway between the cochlea and the brain, it is most likely permanent. 2) A conductive hearing loss : ❖ it may be the result of a buildup of earwax in the ear canal or the presence of a foreign body in the ear canal. Otitis media, a common cause of conductive hearing loss. ❖It is usually correctable.

31. Screening programs D ) Scoliosis Screening: ❖Scoliosis is a sidewise (lateral) curvature of the spine that usually begins in the pre-pubertal and adolescent growth years. ❖In some cases, the cause may be congenital or the result of trauma, but in most instance the cause is unknown.

32. Types of Scoliosis ❖Postural scoliosis: In this type the spine is structurally normal, but looks curved because of another condition such as differing leg length or muscle spasm in the back muscles. The curve is usually mild and it changes or goes away when the person bends sideways or forwards. ❖Structural scoliosis:Cannot be corrected actively by individual, If left untreated it can become extremely severe and can result in permanent disability.

33. Disease Control - immunizations • Seven major childhood infectious diseases that in some cases could cause permanent disability or death have been significantly reduced or eliminate today. All of these diseases are preventable by immunization with safe and effective vaccines. Today , immunization is required by law for admission to school in the world. • The required immunizations prior enrollment in school include: diphtheria, pertussis, tetanus, polio, measles, rubella and mumps.

34. Emergency care for sick and injured students ❖ Acute onset medical conditions such as asthmatic attack, diabetic coma, or epileptic seizures, often occurs unexpectedly, as do unintentional injuries. ❖ School districts should develop written policies that indicate the specific measures to be taken in such circumstances so that school personnel know what actions to take to assist their students. In order for this to occur, school staff members must be educated about the policies and understand their responsibilities.

35. School health records ❖ There should be a school health record on a file for every elementary and middle level school child. These records should be kept in an appropriate location that assure confidentiality & makes them accessible to those who need access to them. ❖ The record should be large enough to provide space for health history information, immunization records, the student's measurements during the school years.

36. Extra Shots References • Telljohann, Susan Kay, Cynthia Wolford Symons, and Beth Pateman. (2001) Health education: Elementary and middle school applications.New York: McGraw-Hill. • The Centre of Disease Control (CDC) • Journal of School Health. Suggested Readings Karen Cheung, Catherine A. Lesesne, Catherine N. Rasberry, Elizabeth Kroupa, Deborah Fisher, Leah Robin and Seraphine Pitt Barnes, Barriers and Facilitators to Sustaining School Health Teams in Coordinated School Health Programs, Health Promotion Practice, 18, 3, (418), (2017). https://www.healthcareers.nhs.uk/explore-roles/public-health/roles-public-health/school-nurse

37. Best! “ Your true success in life begins only when you make the commitment to become excellent at what you do. “ — Brian Tracy