School area records

1
 School environment assessment sheet
School name: …………………………………………………………………..
Type of school Primary ( ) Preparatory ( ) Secondary ( )
School address: …………………………………………
School Homes ( ) Schools ( ) Farms( ) Factories( ) Waste dump( )
surrounding: Away from transportation Yes ( ) No ( )
Building
Number of floors: ………………………………………………………..
Stairs are Maintained Yes ( ) No ( )
There are side rails for stairs Yes ( ) No ( )
Level of stairs steps is suitable Yes ( ) No ( )
Playground Dusty ( ) Sandy ( ) Concrete ( ) Mixed ( )

Classrooms
Number of Classrooms …………………………………………..
Size of classroom(m ) 2
…………………………………………..
Walls of class were painted with light colors Yes ( ) No ( )
Disk condition is maintained Yes ( ) No ( )
Height of disk is suitable to student size Yes ( ) No ( )
Number of pupils suitable to number of disks:……………………………………
(Ratio= Number of disks/ Number of students)
Space between first row and blackboard …………………..cm
Ventilation
There is enough ventilation Yes ( ) No ( )
Area/m2 of windows and doors = ….…………………. m2
Area /m2 of class
Source of ventilation Natural ( ) Artificial ( )
Lighting:
There is enough lighting Yes ( ) No ( )
Source of lighting Natural ( ) Artificial ( )

Cleanliness and waste disposal in classrooms:

Walls and Ceilings are clean Yes ( ) No ( )
Number of classroom cleanliness………………………………………..
Baskets are present Yes ( ) No ( )
Number of Baskets………………………………………………………
Baskets clean Yes ( ) No ( )

2
Baskets covered Yes ( ) No ( )
Wastes are around the basket Yes ( ) No ( )

Toilet/Bathroom:
Number of toilets…………………………………………………………..
Presence of WC sign on door Yes ( ) No ( )
Presence of soap in bathroom Yes ( ) No ( )
Number of cleaning bathroom……………………………………………..
Cleaning by using brush and soaps Yes ( ) No ( )
Cleaning by using disinfectant Yes ( ) No ( )
There are paper tissues Yes ( ) No ( )
Presence of clean baskets Yes ( ) No ( )

Water supply
Source of water Running water ( Tanks (
Number of taps ………………………………………………………………..
Number of taps are adequate to number of Yes ( ) No ( )
students in school
Tapes are Maintained Yes ( ) No ( )
Water tanks is cleaned regular under Yes ( ) No ( )
supervision

Collection of waste disposal

Time of collection………………………………………………………………..
The waste disposal is collected in locked boxes Yes ( ) No ( )

Food shop in school

There is school canteen Yes ( ) No ( )
Food handlers has a certificate Yes ( ) No ( )
Type of food………………………………………………………………….

3
 Role of school health nurse
Not Reason of
Items Don
done undoing
I- Administrative role
1- Record all students who have specific health needs
and/or problems
2-Categorize health needs and/or problems according
types, chronic.
3-Record all students who receive treatment and nursing
care for health needs and/or problems.
4- Check health insurance card before referral to school
health unit or hospital.
5-Review the immunization record and notify any
additional requirements.
6-Indicate infectious status for all registered students at
the time of enrollment.
7-Recording emergency sheets if the student has a new
medical concern or starting a new medication.
8- Maintaining and updating cumulative health records.
9-develop/revise school health policies, procedures and
standing orders.
10- Prepares the budget for school health supplies.
11- Reviews, revises and implements emergency
policies, including in-service health and safety programs
for personnel.
12- Prepares first aid kits for each building.
13- Reports regularly in writing to the principal and
superintendent on school health activities
14- All students who request to see the school nurse must
have their agenda signed by their teacher except in
emergency.
15- Prepares statistical reports.
16- Implements the school medication policy and
procedure.
II- Monitoring and assessor role
1- Daily inspection of students for detection of any
abnormality.
2- Observing their behavior regarding healthy behavior
2- Daily round on classrooms for inspection of proper
ventilation, maintenance and cleanliness.
3- If student has excessive visits or recurrent complaints
discuss with parent
4- Observing absenteeism because of health problems

4
 1- Reporting and follow up for any repairing needs.

III- Preventive role

1- Providing health education for students about
preventive measures of common health problems
2- Assist in planning curriculum for health instruction
3- Providing education for staff on relevant health issues
including infectious diseases, respiratory disorders and
emergency procedures.
4-Using screening programs and first aid procedures as
learning experiences for the student.
5-Assisting the classroom teacher by presenting health
concepts in science, biology, home and family living,
child development, physical education, and health
classes.
6-Supplementing the regular classroom encompassing
the health education content areas.
7-Serving as a resource to health teachers.
10-Providing safety programs.
11-Practicing good health behaviors.
11-Acting as a health advocate.
12-Isolation of student with infection.
IV- Curative role
1- Performing a comprehensive health assessment for
early detection.
2-Assessing in health assessment
3- Performing a periodic screening test
4- Referral of student health problems.
5- Provide and monitor the treatment of student with health
problems.
6- Provide first aid measures during distress attacks
and/or accidents
7- Interpret the finding of clinical assessment and
diagnostic measures.
8- Diagnose and categorize the health problems and
needs.
9- Contribute the health problems to their factors.

5
Recommended Facilities and Supplies for the School Health Services Office
Facilities Yes No
1-The nursing office should be conducive to the privacy and
confidentiality of school nursing practice
2- Telephone in the Nurses’ Office.
3- Bed.
4- Lavatory facilities with soap dispenser and disposable towels.
5- Proper lighting and ventilation.
6- Locked storage for medication.
7- Screening environment.
8- Locked file cabinets or drawers for storage of health records.
9- The nursing office must be fully handicapped accessible
Health office supplies
1-Adhesive tape (1 in. & ½ in.)
3-Cotton Balls.
4-CPR Mask (children).
5-Emesis Basin.
6-Eye pads.
7-Gloves (latex & vinyl disposable).
8-Medication cups.
9-Pen light.
10-Pillow covers.
11-Scissors.
12-Splints (finger and arm/leg).
13-Sterile gauze rolls (2 in. & 3 in.)
14-Equipment/clean-up kit.
15-Alcohol.
16-Band Aids (regular & butterfly).
17-Blood Pressure Instrument and Stethoscope.
18-Cotton Swabs.
19-Disinfectant spray for cleaning surfaces.
20-Eye cup.
21-Gauze pads (4 x 4 & 2 x 2).
22-Ice packs (reusable).
23-Paper cups.
24-Peroxide
25-“Red” Standard precaution bags for contaminated materials.
26-“Sharps” dispenser.
27-Thermometers
28-Tongue depressors.
29-Triangle bandage.

6
 School health record

Pupil name …………… Age ………… Sex …………

Date of attendance to clinic: ……………………………………………
Reason of attendance to clinic: …………………………………………….
Socio-economic characteristics
Father Illiterate or read and write ( ) Primary ( )
Education Preparatory ( ) Secondary ( ) University ( )
Mother Illiterate or read and write ( ) Primary ( )
Education Preparatory ( ) Secondary ( ) University ( )
Father occupation Don’t work ( ) Worker ( ) Clerk ( ) other ( )
Mother occupation House wife ( ) Worker ( ) Clerk ( ) other ( )
Income / month Not enough ( ) Enough ( ) Enough and save ( )
Number of sisters &brothers Males ( ) Females ( )
Total number of household members= …………………………….
Number of household bedrooms=…………………………………….
Crowded ratio= ………………………… Interpretation:………………
Present health history
Chief complaints ………………………………………………………………
Onset:… ………..Frequency:……….. Duration:…………
Date of starting medical treatment:……………………………….
Current Name:…………. Dose:…… Route of administration:……
medication
Associated signs & symptoms:…………………………………………
Past health history:
Accident ( ) Allergy ( ) Blood transfusion ( ) Kidney disease( )
Heart disease ( ) Diabetes mellitus ( ) Respiratory disease ( ) Others ( )

Physical assessment:
Vital signs Temp: …………… Pulse:……… Resp: ………
Anthropometric measurements
Wt:…… Ht:…… Body mass index (BMI):… Interpretation:….
General appearance
Eye: Redness ( ) Squinting ( ) Discharge ( ) Wear eye glasses ( )
Ear: Impaired hearing ( ) Discharge ( ) Ear ache ( )
Nose and throat: Nasal discharge ( ) Epistaxis ( ) Sore throat ( )
Oral cavity: Lips: Dryness ( ) Pale ( )
Gum: Inflammation ( ) Bleeding ( ).

7
Dental problem: Decayed ( ) Missed ( ) Filled ( ) Malocclusion ( )
Lab investigations:…… ………………………………………………
Radiological examination:……………………………………… …………….
Nursing Diagnosis

8
 Nursing care plan
Date of visit Health problem Assessment Nursing intervention Health education Progress Follow up

Nursing Diagnosis

9
 Nursing care plan
Date of visit Health need Assessment Nursing intervention Health education Progress Follow up

Nursing Diagnosis

10
11