The Role of School Nurses in Beijing, China. (Health Service Applications)
Yu, Xiaoming, Journal of School Health
Since the 1970s, the Chinese government has placed emphasis on prevention and control of common diseases among students, mainly including vision impairment, trachoma, caries, ascariasis, anemia, and malnutrition. In recent years, the incidence of some of these common diseases among students, such as anemia, ascariasis, and trachoma significantly decreased. Malnutrition also declined in Beijing because of improvements in nutrition and environment. However, by contrast, obesity has shown an increasing trend. Unintentional injuries and some health problems related to smoking and lack of exercise also are becoming more frequent.
School provides one of the main settings for children and adolescents to learn and to live. It also offers a resource for promoting their health and development. School can transmit prevalent cultural values to children and adolescents through organized learning experiences. School also serves as an agent of cultural change by providing instruction in line with changing knowledge, social needs, and values. (1) A report from the WHO Expert Committee on Comprehensive School Education and Promotion suggested schools should constantly strengthen their capacity as a healthy setting for living, learning, and working. (2) School nurses, as health care providers, play a crucial role in assisting children and adolescents to form positive health values, to develop skills, and to share resources for solving health problems.
In China, primary health care for children aged 6 to 15 years in full-time compulsory education is provided mainly by school nurses under the guidance and coordination of the government departments of education and health at the national and local levels. In 1990, the National Education Commission and Ministry of Health of China jointly issued the document Regulations on School Health, (3) which stipulated that the tasks of school nurses should include supervising student health status, providing health education, improving the school environment, and controlling common diseases among students.
The principal of a school can decide how many nurses the school can hire in keeping with local education authorities regulations on personnel, and the number of students in the school. According to Regulations on School Health, at least one nurse should be employed in schools with more than 600 students.
At present, the system of service provision by school health workers, including both full-time school nurses and other, part-time health workers, has been established in middle schools throughout China. An estimated 60,000 school health workers currently are employed.
The project sought to ascertain school nurses' perceptions about their existing responsibilities and scope of services, to investigate attitudes of school nurses toward health care services for students for whom they are responsible, and to understand barriers they encounter in providing these services in school. The project also examined the strengths and weaknesses of existing training provided to school nurses as part of their career development.
The project used in-depth interviews for data collection, conducted in two different kinds of middle schools: key schools and nonkey schools. The former have better resources, such as more experienced teachers and better teaching appliances. Schools were selected in urban districts in Beijing, and 30 full-time school nurses from these schools were selected randomly as interviewees. Each interview was conducted by two trained interviewers and lasted one hour on average.
The interview guide included background information on school nurses, scope of their daily work, training prior to taking up work, and perceptions of and attitudes toward student health care. Observations of medical equipment used in the school clinic were done after each interview to understand working conditions of the nurses. …