BARRIERS TO

EFFECTIVE
SCHOOL
NURSING
PRACTICE
JY LLEVA, RM, RN
 " School nursing is a specialized
practice of nursing that protects
WHAT IS and promotes student health,

SCHOOL facilitates optimal development,

and advances academic
NURSING? success."
- National Association of School Nurses,
2017
School nurses are:

• grounded in ethical and evidence-based practice,

• the leaders who bridge health care and education,

• provide care coordination,

• advocate for quality student-centered care and;

• collaborate to design systems that allow individuals and

communities to develop their full potential

 1
HEALTH STATUS AND
CHARACTERISTICS OF
STUDENT POPULATION
IMPERATIVE ISSUES

2
AFFECTING SCHOOL MANDATES, ROLES AND
COMPETENCIES OF SCHOOL
NURSING PRACTICE NURSES

Fleming, R. (2011)

3 WORK ENVIRONMENT AND

STANDARDS OF PRACTICE
1 HEALTH STATUS OF STUDENT POPULATION
(Philippine context)

Schoolchildren in the Philippines suffer from a high burden of preventable

diseases, with hygiene deficiencies as a common cause, i.e. lack of basic
personal hygiene and poor access to sanitation. The main diseases are:

• Hygiene-related infectious diseases: diarrhea, acute respiratory infections, and

pneumonia are the top three killer diseases for children in the Philippines;

• Soil-transmitted helminth (STH) infections: more than 66% of children are infested

with intestinal worms;

• Dental infections and toothache: 80-90% of children have caries, and toothache is

the most common reason for children missing days from school
1 HEALTH STATUS OF STUDENT POPULATION
(Philippine context)

Immunization of children and communicable disease prevention

• Expanded Program on Immunization for vaccine-preventable diseases

• COVID - 19 Vaccination of pediatric population:

Adolescents: 9.8 million are fully vaccinated

Children: 4.3 million are fully vaccinated

• A major responsibility of school nurses is to increase immunization compliance rates

especially to the vaccines that may be given to school-age children and adolescents such as,

but not limited to, influenza vaccines and HPV vaccines, among others. School nurses have

unparalleled access and opportunity not only to increase overall immunization compliance

rates, but also to reduce communicable disease disparities among populations

UNMANAGED POOR
CHRONIC
PREVENTABLE SCHOOL
ABSENTEEISM
PERFORMANCE
DISEASE
THE BARRIERS

School health often falls between the remits of the health and
education sector administrations, so that problems of
coordination and mutual understanding hinder large-scale
program implementation.

• There is a limited capacity of schools to promote and strengthen child and

community health due to difficulties of intersectoral collaboration between the
health and education sectors (from national to local level).

• There is also limited funding for the programs and health commodities to be
maintained.
THE BARRIERS

There is a lack of facilities to provide health services to the

students
• Only 13,081 of some 47,000 public schools have school clinics. In terms of basic
hand washing facilities, only 44,043 schools have access to them. (Rappler,
2022)

Most of students also disregarded basic health protocols, such

as observing physical distancing and limiting interactions with
their peers, and basic handwashing due to lack of knowledge
about the importance of these protocols.
THE BARRIERS

There are perceived lack of information of the parents about

vaccines leading to hesitancy

Limited resources for the inocculation of vaccines given to school-

age children.
• Most of the vaccines (i.e. flu, hpv) are not free and publicly available
thus it may not be affordable to everyone.
2 MANDATES AND THE ROLES OF SCHOOL NURSES
(Philippine context)

Duties and responsibilities of the School Nurses*

• Health Advocacy
• Health and nutrition assessment including other screening procedures such as vision
and hearing
• Supervision of health and safety of school plants
• Treatment of common ailments and attending to emergency cases
• Referrals and follow-up of pupils and personnel
• Home Visits
• Community outreach
• Recording and reporting of accomplishments
• Monitoring and evaluation of programs and projects
*Based on Public Health Nursing in the Philippines 10th edition (2007)
2 MANDATES AND THE ROLES OF SCHOOL NURSES
(Philippine context)

Nurse to student ratio of 1:5000*

School nurses shall have the following targets:

SCHOOL VISITS 4 - 6 SCHOOLS/ NURSE/ MONTH

HEALTH ASSESSMENT/ 1000 PUPILS/NURSE/ MONTH OR 90% - 98% OF PUPIL POPULATION

POPULATION EXAMINED

CLASSROOM HEALTH TALK 20 LECTURES/ NURSE/ MONTH

ORGANIZATION/ ONE PER SCHOOL/ NURSE/ SCHOOL-COMMUNITY

REORGANIZATION

CONDUCT OF COMMUNITY ONE PER NURSE/ MONTH ASSEMBLIES

2 MANDATES AND THE ROLES OF SCHOOL NURSES
(Philippine context)

Proposed House Bill 7874 of the 18th Congress

• Establishment of School Health and Safety Office in every public

schools in the country
• Whereas the bill will provide two nurses for schools with up to
3,000 students and three nurses for schools with more than
3,000 enrolled and provision of other health personnel such as
dentists and medical doctors
THE BARRIERS
Inefficient number of school nurses hired/ in the plantilla position
• Data from the DepEd showed that there were only 3,657 public school nurses
for 21,741,049 public school students in 2019. This means a school nurse
would have to attend to an average of 5,945 students. (Rappler, 2022)
• School nurses nationwide are not assigned by school but by city and province
across the various DepEd school division office (Philippine Institute for
Development Studies, 2018)
• The PIDS (2013), discovered that back then: (a) only 28 percent (generally the
large schools) had a doctor, dentist and nurse; (b) only 18 percent had a nurse
only; and (c) only 10 percent had a doctor and dentist in various SUCs
nationwide.
3 WORK ENVIRONMENT AND EDUCATIONAL CULTURE
(Philippine context)

Public School Health Nurses generally have a high-

quality work life

• The study conducted by Macarain, Oducado, Minsalan, et. al. (2019),

indicated that public school nurses generally appreciate their job
and are contented with the different aspects of their work life.
THE BARRIERS
Risk of exposure to health, environmental and safety hazards
• School nurses are also exposed to hazards especially during visitations to far-flung
schools that are identified as vector – infested with malaria (26 highly endemic
provinces) filaria (17 affected provinces and 23 suspected provinces), schistosoma (28
provinces) and capillaria, to name a few. In times of calamities or emergencies, these
personnel are in the forefront rendering basic health and nutrition services, and their
direct contact with the children, teachers and non-teaching personnel, not to mention
their interface with the parents during home visitation, highly exposes them to risks
(DO 82 S. 2007)
• In the Philippines, nurses are not unionized and therefore do not have a formal
mechanism to identify workplace hazards and advocate for improved working
conditions.
DISCUSSIONS

There are still issues and factors affecting the practice of school
nursing, and nursing in general that require further study or research so
that it may be promptly addressed.

The government and other stakeholder agencies should address health

concerns of the students and boost morale of school nurses by giving
proper compensation and appropriate delegation and staffing.

Strengthen trainings/ orientations of school regarding proper

management of emerging and re-emerging diseases (such as of COVID-
19 and Monkeypox) that may affect the health of the students.
DISCUSSIONS

Proper funding on health programs should be addressed by the

legislators

The Department of Education should decrease workloads of teachers by

hiring more staff to handle areas such as in health .

Nursing organizations/ labor unions should be proactive in defending

the rights of the nurses in our country.
REFERENCES