School Health Services

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School Health Services

• Activities to protect and promote the health of
  the students

CHS 485 2nd lecture
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• 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.

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MODEL FOR PROVIDING HEALTH SERVICRS Objecti
ves Is 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.
school based center
school-linked center
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The professional roles
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The school nurse The role

• Can be a valuable help to the classroom teachers
  by providing instructional support and serving
  as a recourse persons
• Administering first aid instructions.
• Assessing student health complaints.
• Carrying out screening procedures.
• Maintain school health records.

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The role of the school nurse

• Provides help to the child who becomes sick or
  injured while at school.
• Managing the medical needs of the medically
  fragile child.
• Managing students' medications during the school
  day.
• Identifying and referring cases of child abuse
  and neglect, and sexual abuse to the proper
  authorities.

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The role of the school nurse

• Participates in the activities which is
  designed to identify children with medical
  problems and to be involved in the development of
  educational programs for these individuals. This
  often involves 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.

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• 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.

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classroom teacher
The role

• Using health service activities as an opportunity
  to educate students.
• Prepares the students for screening and
  appraising activities through organized
  instructional units.

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The role of the 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 an
• a valuable frame of reference.

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the role of the classroom teacher

• Referral if the teachers suspect that a health
  problem may be a learning impediment, their
  responsibility extends to making an appropriate
  referral .
• Gathering information about the condition as
  observed over a period of time.
• 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.

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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.

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• 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.

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• 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.

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• Screening programs
• The health screening activities most commonly
  carried out within the school are inexpensive,
  can be conducted on a routine basis, and provide
  important early information about potential
  deviations from normal that may needed medical
  attention.
• The most commonly found screening activities are
  height weight, vision and hearing screening,
  and screening for scoliosis.

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• A ) Physical growth and 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.

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• Vision screening
• Poor vision can lead to various behavioral
  problems that can have negative effects on
  academic performance.

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• Visual defects/problems
• Inflammations , injuries, and refractive error,
  which keeps the light rays from focusing on the
  retina

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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.
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Sty A red, swollen inflammation of the
sebaceous gland on the edge of the eyelid. Apply
hot compresses , ointment or surgery
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• 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.

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Refractive errors three basic types of
refractive errors Nearsightedness(myopia). Fars
ightedness (hyperopia) Astigmatism.
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• Myopia
• 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

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• Hyperopia
• 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

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• 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

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• School vision screening procedures
• Visual acuity refers to how well an individual
  sees an object at a specific distance (20 feet
  6 meters). What is meant by VA 6/18 (Distance
  /the smallest size of the letter read).
• 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.

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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. 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.
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The acuteness of vision is reported in the form
of a fraction in which the denominator indicates
the smallest letters, or symbols, that the
individual being tested 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.
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• 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.
• Screening for color deficiency
• the individual being tested must identify a
  number or figure made of colored dots within a
  background of other colors.

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• 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 .
• 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 cue for hearing
  problems.

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School hearing loss problems and 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.
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• 2) A conductive hearing loss
• it may be the result of a buildup of ear wax 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.

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• 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.

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• There are two different types of scoliosis
  Postural and structural.
• 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.

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• 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.

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• 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.

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• School health records
• There should be a school health record on a
  file for every elementary and middle level
  schoolchild. 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.

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Thank you