School health nursing applies community health nursing to learners, teachers, and school personnel. Schools gather a large, reachable population at an age when health habits form, so they are one of the most efficient settings for prevention.

Components of a school health program (classic three)

Many programs also add community and family involvement and staff wellness.

Aims: protect and promote the health of learners so they can learn well; detect health problems early; prevent the spread of communicable disease in school; and build lifelong healthy behavior.

Common health problems of Filipino school-age children include undernutrition (wasting and stunting) alongside rising overweight, dental caries, soil-transmitted helminth infections, vision problems, skin infections, acute respiratory and diarrheal illness, and increasingly mental health concerns and early tobacco or vape use.

Department of Education (DepEd) school health and nutrition programs

• Oplan Kalusugan sa DepEd (OK sa DepEd) — the convergence of DepEd health programs at the school level with partner agencies. Its major programs are the School-Based Feeding Program (SBFP), the National Drug Education Program, Adolescent Reproductive Health education, Water, Sanitation and Hygiene in Schools (WinS), and medical, dental, and nursing services.
• RA 11037 — Masustansyang Pagkain para sa Batang Pilipino Act institutionalizes a national feeding program for undernourished children in public day care, kindergarten, and elementary schools. The SBFP gives at least one fortified meal to undernourished public elementary learners (kindergarten to grade 6) for not less than 120 days a year.
• School-based deworming — with the DOH, DepEd gives albendazole or mebendazole twice a year (national deworming months in January and July for children 1–19 years).
• School-based immunization — the DOH National Immunization Program gives school-based measles–rubella (MR), tetanus–diphtheria (Td), and HPV vaccination.
• WinS — daily group handwashing with soap, daily group toothbrushing with fluoride toothpaste, and functional toilets and water supply.

Other laws affecting school health

Timing principle: health appraisal (assessment and health history) is done at the start of the school year so that problems are identified early and the year's health plan can be built on the results.

School health assessment (start of the school year)

1. Health history from parents or guardians — past illnesses, allergies, medicines, immunizations, and special needs.
2. Nutritional status — weight and height; classify by BMI-for-age (and height-for-age for stunting); list undernourished learners for the feeding program.
3. Vision screening — Snellen or tumbling-E chart at the standard distance; refer those who fail.
4. Hearing screening, oral examination, skin and scalp inspection.
5. Record findings, inform parents, refer as needed, and follow up referrals.

First aid and emergencies

• Collapsed or unresponsive learner: check responsiveness and breathing first, shout for help, and start CPR with an AED if the learner is not breathing normally; activate emergency services.
• Keep a stocked clinic, a list of learners with asthma, allergies (with epinephrine autoinjector plans where available), seizures, and diabetes, and written emergency plans signed by parents.
• Conduct fire, earthquake, and other disaster drills with the school disaster risk reduction team.

Communicable disease control in school

• Daily observation for illness by teachers; the nurse assesses and sends sick learners home with advice.
• Exclusion rules follow the infectious period, for example:
  • Chickenpox: keep the learner home until all lesions have crusted.
  • Measles: until 4 days after the rash appears.
  • Influenza-like illness: until fever-free for at least 24 hours without antipyretics.
  • Conjunctivitis and skin infections (impetigo, scabies): until treatment has started and per the physician's advice.
• Notify the local health office of notifiable diseases and clusters (for example, many absences with the same symptoms); check the vaccination status of contacts.

Oral health

• The school nurse promotes daily toothbrushing, fluoride use, healthy snacks, and oral screening, and refers learners with caries to the dentist. Diagnosing and treating dental caries is the dentist's role, not the nurse's.

Food safety in the canteen and feeding program

• Apply HACCP principles — identify biological, chemical, and physical hazards at each step from purchase to serving, and control the critical points (cooking temperature, cold holding, cross-contamination).
• Food handlers wear clean clothing and hair covers, wash hands, and stay off work when ill with diarrhea, vomiting, or skin infections.
• Healthy canteen policy: limit sugary drinks and salty, fatty snacks.

Mental health and protection

• Promote life skills, coping, and help-seeking; screen and refer learners in distress; know the referral pathway to guidance counselors and mental health services.
• School mental health programs focus on promotion, prevention, early detection, counseling, and referral — not on prescribing psychiatric medicines, which is a medical act.
• Recognize signs of abuse and bullying, and follow the school's child protection policy.

1. Health care provider — first aid, emergency response, screening, immunization and deworming (with the DOH), and care of minor illness.
2. Health educator — classroom sessions, WinS activities, puberty and reproductive health education appropriate to age, substance use prevention.
3. Case finder and referral agent — identify learners with vision, hearing, dental, nutrition, or emotional problems and ensure follow-up.
4. Environmental health monitor — inspect water, toilets, handwashing stations, canteens, and classrooms.
5. Record keeper — maintain accurate and confidential learner health records.
6. Coordinator — link teachers, parents, the DOH, barangay health workers, and referral facilities; support the feeding and deworming programs.
7. Advocate — for healthy school policies (smoke-free and vape-free campus, healthy canteen, anti-bullying).

• Consent: parents or guardians consent to immunization, deworming, and treatment of minors; explain benefits and side effects and document refusals.
• Confidentiality: health records are released only to authorized persons; learners and their parents or guardians have the right to access their own records. Do not discuss a learner's condition with other learners or unauthorized staff.
• Non-discrimination: learners with HIV, disabilities, or chronic illness cannot be excluded because of their condition.
• Child protection: suspected abuse or bullying must be reported through school child protection procedures and to the appropriate authorities.
• Scope of practice: the nurse does not diagnose or treat conditions outside nursing scope (for example, dental caries, prescribing psychiatric medicines); refer instead.

Case 1. A grade 3 learner develops chickenpox; the parent wants to send her back once the fever is gone.

Action: Advise that she stay home until all lesions have crusted, and check the varicella immunization status of classmates. Why: varicella remains contagious until the lesions crust.

Case 2. A learner suddenly collapses in the gym.

Action: Check responsiveness and breathing, call for help and an AED, and start CPR if the learner is not breathing normally. Why: rapid recognition and CPR decide survival in cardiac arrest.

Case 3. At the start of the school year, the nurse plans the year's health program.

Action: Conduct the health assessment and nutritional status survey first. Why: baseline data identify learners for feeding, referral, and follow-up.

Case 4. A father asks to see his son's school health record.

Action: Allow access after verifying identity and following school procedure. Why: the learner and his parent or guardian have the right to access his own health information.

• Delaying the school health assessment until problems appear — it is done at the start of the school year.
• Allowing a child with chickenpox back when the fever is gone but lesions are still fresh.
• Believing the school nurse treats dental caries or prescribes medicines for mental disorders.
• Thinking HACCP covers only germs — it covers biological, chemical, and physical hazards.
• Refusing parents access to their child's health records, or sharing records with unauthorized staff.
• Ignoring vape use because "it is not tobacco" — vapes are regulated and banned near schools.

• School health program = health services + health education + healthful school environment.
• OK sa DepEd covers SBFP, drug education, adolescent reproductive health, WinS, and medical, dental, and nursing services.
• RA 11037: feeding for undernourished learners (K–6), at least one fortified meal for 120 days or more a year.
• Deworming twice a year (January and July); school-based MR, Td, and HPV vaccination.
• Health assessment at the start of the school year; nutritional status by BMI-for-age.
• Collapsed learner: responsiveness and breathing first, then CPR and AED.
• Chickenpox exclusion until all lesions crust.
• HACCP: biological, chemical, physical hazards at critical control points.
• RA 10627 anti-bullying policies; RA 11900 no vape sales within 100 m of schools.
• Learners and guardians may access their health records; confidentiality otherwise protected.