Journal of Clinical Research & Bioethics

The Role and Future of School Nurse in Pakistan

Amir Sultan^1*, Sheraz Khan^2* and Afrooz Bibi^{1 1}Department of Nursing, Saidu Group of Teaching Hospital, Swat, KPK, Pakistan
²Department of Nursing, Bacha Khan Medical Complex Swabi, KPK, Pakistan
^*Correspondence: Amir Sultan, Department of Nursing, Saidu Group of Teaching Hospital, Swat, KPK, Pakistan, Email: Sheraz Khan, Pakistan,

Received: 07-Feb-2022, Manuscript No. JCRB-22-15083; Editor assigned: 09-Feb-2022, Pre QC No. JCRB-22-15083 (PQ); Reviewed: 23-Feb-2022, QC No. JCRB-22-15083; Revised: 28-Feb-2022, Manuscript No. JCRB-22-15083(R); Published: 07-Mar-2022, DOI: 10.35248/2155-9627.22.13.401

Introduction

Nursing is important in every part of the world, but in developing countries like Pakistan, it doesn’t take a proper consideration and acknowledgment. Nurses are considered the backbone of the health sector, and currently, in the pandemic of COVID-19 nurses prove that they are an important part of health care system; many nurses have sacrificed their lives to save humanity. In Pakistan 16.76% of the total population is less than 5 years, which means that they start their early schooling within the age of 5 years [1]. School nursing focuses entirely on the students and staff of a public or private school, this type of nurse not only helps keep the child's health but also contributes to their lifelong academic success and achievement. The role of School nurses is considered essential for providing care for children and youths. Knowledge of the school nurse’s role is important to confirm reliable care because there is a direct relationship between health and learning.

Pakistan have put their right steps on the track during the last one decade in nursing, due to the leaderships present in provincial level, the support of regulatory authorities and the interest taken by the government officials. The quality care hospitals have always a clear understanding regards the role of nurses, but in more than 90% of the government hospitals the nurses are still struggling for their rights and they face lot of a problems from the hospitals administrations and sometime from their own hierarchy due to partial role. In this situation introducing the school nurse in the education system seems difficult on government level but the Pakistan nursing council authorities have a very positive and guided role for school nurses as they have advise the government through notification.

We clearly realize that the government of Pakistan faces economic challenges, and it is very difficult to start the school nurses recruitment on national level, initially they can start the school nurses appointment in private schools as a key requirement for the registration regards the safety of their students and the private school collect a huge amount of fees from the students. Later then government can start the recruitment of school nurses in different phases at national level.g

History of School Nurse

The practice of school nursing began in the United States on October 1, 1902, when Lina Rogers, the first school nurse, was hired to reduce absenteeism by intervening with students and families regarding healthcare needs related to communicable diseases, from many decades, nurses especially in Anglo- American and Scandinavian countries have operated as «School (Health) Nurses» and have supervised children and teenagers in all health-related matters[2], but unfortunately the concept of the school nurse is new in Pakistan. The health of students is linked with their learning abilities. The students with challenging health face difficulties in their education programs. The school nurse supports student success by providing health care through assessment, intervention, and follow-up for all children within the school setting. The school nurse addresses the physical, mental, emotional, and social health needs of students and supports their achievement in the learning process [3].

Health challenges at school Level

Students enrolled in government school is need more Attention and monitoring regards their health compared to public schools, because the nutritional assessment and awareness related to their health are low compared to public schools. The rich and strong background people send their children’s to private schools because they can afford the fee and expenses of that schools. According to UNICEF Pakistan 44% of the population represent the age 5-16 years, Nearly 10.7 million boys and 8.6 million girls are enrolled at the primary level and this drops to 3.6 million boys and 2.8 million girls at the lower secondary level [4]. The basic purpose to place school nurse at the foundation level is based to assess for physical, social and emotional health needs. Here are some of the issues:

Lack of knowledge regards immunization and inadequate vaccination coverage to prevent diseases.

Four out of ten children are suffering from malnutrition.

Inadequate information

Cloudiness water

Bad hygiene

Poor socio-economic situations (Poor quality of life)

Awareness regards hygiene.

Water borne and food borne diseases

Bacterial, fungal and viral infections

Exposure to domestic violence

Obesity and overweight

Injury or violence

Poor environmental quality

School Nurse

In Pakistan there is less awareness regards the health education, as a part of school system the nurse has to prevent and maintained the health of the students, but also to provide health education to students as an important subject in the school. The national school association defines that a school nurse as “A specialized practice of professional nursing that advances the well-being, academic success, and lifelong achievement of students. To that end, school nurses facilitate positive student responses to normal development; promote health and safety; intervene with actual and potential health problems; provide case management services; and actively collaborate with others to build student and family capacity for adaptation, selfmanagement, self-advocacy, and learning” [5]. According to national health services: “School nurses are Specialist Community Public Health Nurses (SCPHN) who work with school-aged children and young people and their families to improve health and wellbeing outcomes and reduce inequalities and vulnerabilities”[6]. School nurses are responsible for providing care to a wide range of students, including those with physical and mental disabilities or chronic medical conditions, School nurses continue to perform valuable services to schools, individual students and the community.

Role of School Nurse

Explain school nurse role could be difficult for most people and administration due to their work in variety of setting. The role will definitely explained but first it should be clear that the working force in school will be nurses, there will be a proper degree or diploma of nursing with the practicing license from Pakistan nursing council having a good clinical experience to handover the health of students to a responsible and qualified school nurse. In most of hospital specially the students of medical or allied technologist working under the label “nurse” in most of the hospitals which is a risk for the image of nursing.

In Pakistan, the school nurse can provide intervention in emergencies, also prevent communicable diseases and can promote health awareness on the school level, which can ease the burden on health care system. Student faces problems like native issues, insufficient sources, and forcefulness which affects the physical and psychological performance of the student, to address these issues of students every private and public school requires having a full time nurse for the wellbeing of their students.

The National Association of School Nurses identifies 7 core roles that the school nurse fulfills to foster child and adolescent health and educational success, the roles are overarching and are applicable to school nurses at all levels of practice, in all geographic settings, and with all clients [7].

In case of any injury or acute illness the school nurse provide special health care to the student, which include objective and subjective assessment and management under the boundary of nursing and also communicate with their parent’s.

Health education, diseases prevention and promotion of health is important role in every community, communicating and demonstrating health promotion and diseases prevention programs and educational lectures to the school students individually and in groups will bring awareness among the students, and the spread of communicable and noncommunicable diseases will be decrease which can reduce the burden on our health system.

As a part of health team, the school nurse can prepare a health plan for the school in case of any emergency which are the preparation of strategies in case of emergencies and catastrophes and documentation of those events.

The school nurse can screen school student during their admission or later to detect any health problem which can affect negative the student education. The screening may involve immunization, labs investigation, vision, hearing and their body mass index. Early identification of health problem could be referred to the medical facility to treat it on time.

The school nurses have to plan the prevention and management of the situations which affect physically and psychologically the students like violence, stress and drugs, any affected student could be counsel or refer to the specialist. School nurse could assess the environment and identify to remove the hazards for the students in the environment, indoor air ventilation and in the playgrounds.

The school nurse will also make a policy for the health management of students as a leader for the promotion and protection of school students: The policy will clearly guide the administration of the school and students, the future plan for those students which are suffering from chronic illness, disability, surgery, acute illness, injuries and having infectious disease.

If a student suffering from a long term illness physically or psychologically the nurse will be a work as a bridge between the family and the administration of school.

Future of school nurse in Pakistan

The profession of nursing in Pakistan is gradually moving toward betterment; like evidence based practices, working on research and upgrading the quality of academic and practice skills, the nurses prove their competency during the all three waves of COVID-19. The professional growth of nursing in Pakistan have taken many decays, the most unpleasant truth that 90% of nurses had retired after 25 to 30 years’ service on the same scale appointed by government without service rules and service structure, which shows the interest of government in nursing profession.

To bring change on the foundation the school nurses will be needed. The campaign of school nursing will be promoted day by day in Pakistan. First to understand that it is the need of time to provide the basic care on immediate bases in the school and provide awareness in the age group which will play a vital role in the future of the country and will provide us better youth health outcomes. Pakistan has limited resources but through this program we can connect every school to our health care system and that can obtain statistical data. School nurses are responsible for students from 4 to 21 years students so we will have to excess to our 16.7% population under 5 years and 44% of population 5-16 years old.

School nurses are expert in immunization and parents education, so the health system will have been boots on group in case of any outbreak, which will minimize the ratio of patients in hospitals. The student who is going to enroll in schools will also be screened for height, weight, and vision, hearing and oral health so identification of any problem will help the nurse to manage it and bring in knowledge of the family to work up on it in the initial stages.

It is very necessary that the local government provide an opportunity for school nurse to collaborate will community care centers to make it safe for the children’s and pediatrics that if problem require treatment.

In the future school nurses will be play a vital and important role in the advancing health care and education health system. They will be front line health providers like the clinical nurses have fight against COVID-19 in Pakistan. The government will clarify and will provide a road map for the recruitment of school nurses that will be on the basis of tehsil, districts, health departments or educational department.

How to Hire

The hiring is a vital role later on the performance of has health team of school, for school nurse there should be qualification and experience.

In government schools the school nurses will be probably be recruited by health departments of governments and in private schools it will be hired by school authorities. This will require a diploma, degree of nursing, valid Pakistan nursing council registration card and clinical practice in health care setting. The process should be very clear about nursing profession, because in most of the private secondary hospitals of Pakistan quacks practice with a nursing title, which affect the progressive image of nursing and in case of any error the blame will come on nursing profession which is a serious thread for the nurses.

Conclusion

Nursing is a profession which makes attention day by day and some countries has the shortage so they recruited from other countries. Pakistan is among those countries which produce nurses per year above from its need, so there should be a close monitoring of age group in schools which need more attention. Health for all is primary goal of WHO, so approach to every person the school nurses have the capability to reach every student for the promotion of their health and from the prevention from diseases. The developed world have already set a framework for the school nurses and its now the time that Pakistan should focus on the development and framework of school nursing, which will provide them basic statistical data and a health force in every school that they will be present in every outbreak.

Recommendation

In my opinion the direction given by Pakistan nursing council is a very good and productive step for the betterment of our health and educational health system. I will suggest that the nursing regularity authority of Pakistan have to start a specialty program of one or half year for school nursing to trained the nurses that they perform well with school students. I will also suggest that appointment of a school nurse should not only be limited to first aid or basic medication but they should also teach the students from the primary school about the health education, disease and prevention from health diseases, the school nurse should also collaborate with the faculty and management of school about the awareness of health. There should be a regulatory authority that will monitor the nurses of every school and upgrade their education on monthly or yearly basis.

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