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The Nurse's Office As A Refuge 5

Source: Monograph vol.55 edited by Educational Research Center, Benesse Corporation
(Supervising Editor : Dr. Masashi Fukaya, professor, Tokyo Seitoku Junior College)

5. CASE STUDIES OF EACH SCHOOL

The junior high schools that we studied are located in Tokyo. We interviewed school nurses at five schools and in this chapter, we analyze data on these five schools to supplement the results of the survey data.

1. Characteristics of each school

1) Profiles of each school

There are considerable differences in the roles played by the nurse's office in each school. The following introduces some of the conditions of the junior high schools that cooperated in this study(Table 57).

a. School A
This school is located in an area where household incomes are slightly below average and there are many one-parent households. Many of the students in this area tend to have irregular lifestyle habits, stay up late, and skip breakfast. As such, most of the students visit the nurse's office because of physical problems or to avoid attending class. The school nurse is busy giving each student individual care and coping with frequent visits.

The school nurse is involved with several grades. School nurses try to communicate with other teachers. However, they spend too much time with teachers, they worry that they spend less time with students. Nevertheless, in spite of her busy schedule, her caring attitude is apparent in her relations with students. To ensure that the nurse's office functions properly, the nurse's office should be well-integrated in the organization of the school.

b. School B
This is an ordinary school integrated into the local community. Junior high school is considered to be the last step in compulsory education. In this school, the nurse's office is intended to function as a place where students can visit whenever they need some time for self-reflection and a sympathetic ear.

As such, students regard the nurse's office as a place they can visit whenever they wish and it is also a place to receive first aid for accidental injuries and treatment when they do not feel well.

The school nurse is always calm and full of curiosity and her personal touch is apparent everywhere. She is actively involved with several grades and makes an effort to understand the entire school. According to the school nurse, the nurse's office is meant to educate students to help them understand themselves. She keeps the nurse's office open and wants to keep it impartial and available for anyone who needs to visit.

c. School C
The number of students in this area tends to increase year by year because this is a new, developing residential area. Since this area has not been completely developed, parents have strong expectations and desires for the school.

Students freely make use of the nurse's office as a multipurpose room. School staffs and parents visit whenever they need to.

In this school, the school nurse values meetings with students and tries to look for anything that signals a problem. On the other hand, she manages the nurse's office without giving too much thought to her role as a coordinator.

Since students enter puberty at this time, the school also tries to systematically address relevant health issues during the three years of junior high school. Because the school nurse and staff have a mutual understanding, the school nurse has a sense of fulfillment and approaches her work in an energetic manner.

d. School D
There appears to be many problems due to the large number of students at this school. Students have to go to the teachers' room to get a card to visit the nurse's office. Students frequently visit the nurse's office for injuries or illness.

The nurse's office stresses emotional and psychological health and the nurse tries to the communicate with each student individually. However, the nurse's office tends to accept so many students that it becomes a meeting place for students.

There is little trust between the school nurse and teachers. For this reason, it is difficult for them to share common ground and a sense of solidarity.

Ideally, the school nurse and teachers should understand each other and systematically cooperate on issues by making the best use of the school nurse's role and the functions of the nurse's office.

e. School E
This is a quiet school with ties to the local community. However, both parents and students tend to think that school grades are most important and students tend to show poor physical strength, flexibility, and psychological health. Students visit the nurse's office when they are injured or ill.

The school nurse is experienced enough to understand what is happening at school and she can fully communicate with the school staff. The nurse's office functions as a place to communicate and receive various kinds of information and is also a reassuring place.

The teachers are positive and systematically cooperate. It appears that the school nurse will be able to use her abilities to manage the nurse's office and conduct health education.


2) Expectations to the nurse's office

Every school has a separate room called the nurse's office. The issues that each school faces can be seen when we examine the incidents that take place there in the nurse's office.

The role of the nurse's office is prescribed by the School Education Law which states that "the school nurse is in charge of protecting students".

Students think of the nurse's office as a place where they are not evaluated by school grades and where the school nurse values them as individuals. They disclose their troubles, worries, conflicts and the pains of adolescence to the school nurse. However, each year, the problems and issues they face are becoming increasingly complex and school nurses worry about how to give them advice. Above all, it is hard for school nurses to deal with the complex psychological and emotional problems. It is necessary for them to share their responsibility in the school and in a more systematic manner. School nurses should also work with school counselors in the future.

Additionally, we hope to see an improvement in the quality of school nurses, as well as in health education with an emphasis on preventing hurt and illness, by increasing the number of school nurses.

The nurse's office is increasingly utilized as a multipurpose room and the school nurse is expected to support the emotional health of students in addition to functioning as a specialist on health education to encourage students to be more positive and independent.


2. Diversity of Nurse's Offices: Looking at Each School

Conditions at the nurse's office vary according to each nurse's way of thinking, the teachers' views, and the circumstances at each school. This section examines each school by 1) functions of the nurse's office, 2) relationship with the school nurse and the nurse's office, and 3) images of the school nurse and the nurse's office.

Characteristics of each sample are shown in Table 58. Studies were conducted under the same conditions in each school from the seventh to the ninth grades, and we can see there was not a great disparity among the grades. As for working mothers, there were not many full-time housewives among mothers in School A.

1) How the nurse's office functions

Before examining the extent to which the nurse's room is used, we examined background conditions such as the health of students and whether or not students had problems. Students visited the nurse's office mainly for treatment of an injury. The frequency of use is affected by their physical condition.

Table 59 shows the percentage of students who answered that they did not suffer any of the symptoms at all. On the whole, it appears that most of the symptoms that students cite, such as not being able to get up in the morning, feeling sleepy, and being unable to concentrate are caused by lack of adequate sleep hours. There was little variation among schools, but many students at School B enjoyed physical health while students at School A had many students who were not physically healthy.

Under such conditions, the nurse's office has recently become a place to solve student problems and schools are now considering the introduction of school counselors. The problems faced by students are factors that influence the frequency of the visits to the nurse's office. Table 60 shows the percentage of students who are very worried or a little worried about each of the items listed after entering junior high school. In general, a higher percentage of students are worried about classes, how to study, and their future rather than about personal relationships. We also compared the conditions of students in each of the schools. In School A, students had poor physical health and many problems about not understanding their classes or knowing how to study. In School B, many students enjoyed good physical health, but were worried about entrance examinations, about their grades not improving no matter how hard they studied, and about entering the school of their choice. In the case of School C, a medium-sized school, students indicated many problems with group relationships, such as not being able to get accustomed to the atmosphere of the class and a stressful atmosphere at home. At School D, a large school, students indicated many problems with relationships, such as not being able to get along with teachers and not being able to get accustomed to the atmosphere of the class. At School E, students have relatively few problems, but did feel that their parents did not understand them.

To what extent do students actually visit the nurse's office? Table 61 shows that frequency of visits by each school. School B had the highest percentage(76.8%) of students who do not visit the nurse's office, followed by School E, School C, School D, and School A. As seen in Table 59, students at School B have the best physical health and the lowest use of the nurse's office. In contrast, students at School A are in poor physical condition and tend to visit the nurse's office most often. At School A, 5.1% of the students visit the nurse's office at least once a week; at School B, 0.2%; at School C, 7.1%; at School D, 8.6%; and at School E, 1.0%.

In actuality, how does the nurse's office function? Table 62 shows the reasons for visits by students. In each school, more than 90% of the students visit when they are hurt or ill. At School D, where students have many problems with personal relationships, they visit the nurse's office when they are troubled or when they want to avoid their classes. At School C, where students indicated relatively few problems, students rarely visit the nurse's office except when they are injured as in School B.

Summarizing the characteristics of the nurse's office by school, we see that in School B and School E, the nurse's office functions as a place to receive treatment for injury, and at these schools, few students visit once a week or more. In School A, students use it as a refuge when they feel sleepy, or when they do not want to attend class. In School C and School D, students visit the school nurse when they have a problem, and for them, the nurse's office is a place to receive counseling. Furthermore, in these schools, there are many students who visit the nurse's office at least once a week.

2) Relationship with the school nurse and the nurse's office

Whether or not students visit the nurse's office depends on the physical health of students and whether they have problems. However, when students use the nurse's office as a place to receive counseling, they seem to be influenced by the relationship with the school nurse. Here we examine their attitude toward the school nurse through their feelings of psychological closeness and trust in her.

Table 63 asks students if they think the school nurse knows them and to what extent. In School A, a high percentage of students, 19.5%, think that the school nurse probably does not know them. In contrast, in the four other schools, this percentage is below 10%. In terms of the size of each school, School A has 300 students, the smallest number of schools. In contrast, School D has 650 students, but the percentage answering that the school nurse probably does not know them is the lowest at 5.8%. In School C with 500 students, 57.8% of the students think that the school nurse knows them, and School D with 650 students has the highest percentage of 58.0%.

At both of these schools(School C and School D), which are large, the nurse's office functions as a counseling center. Apart from the question of whether the school nurse actually knows the students or not, we can see that the size of the school does not determine how the students perceive their relationship with the school nurse.

Students tend to choose the school nurse as a counselor depending on whether they think she will keep their secrets. In School A, 15.9% believe that the school nurse will keep their secrets; in School B, 13.8%; in School C, 31.7%, and in School D, 34.0%; in School E, 17.5%. In School C and School D, a high percentage of students use the nurse's office as a place for counseling in practice. Whether the nurse's office functions as a place for counseling is influenced by closeness to the school nurse and the students' trust in her, irrespective of the size of the school(Table 64).

Even if students do not want to visit the nurse's office at present, when do they think they want to visit? Table 65 shows when they want to visit the nurse's office. According to this table, besides when they were injured or ill, students want to visit the nurse's office when they lack sleep and when they do not feel like attending classes. By school, students in School C and School D generally feel inclined to visit the nurse's office.

Also, for students who do not currently visit the nurse's office, the nurse's office has become a place for various activities such as counseling, gathering information, and taking a rest.

3) Images of the school nurse and the nurse's office

What is the image of the school nurse and the nurse's office and how does it change according to the type of school nurse? Table 66 shows what students think of the types of school nurses. Students think of the school nurse as a person who is knowledgeable about health issues, is cheerful, and does not scold students about their studies.

At School A, where students frequently visit the nurse's office and where it functions as a refuge, 70% see the school nurse as a person who is knowledgeable about health issues, is cheerful, and who does not scold them about their studies. At School D, where students frequently visit the nurse's office and use it as a place for counseling, students see the school nurse as someone who is cheerful, knows a lot about health, is someone they can easily talk to and does not scold them about their studies and who is good at listening to their problems. At School B, where students do not often visit the nurse's office, and functions as a place for medical treatment, more than 70% see the school nurse as someone who is only knowledgeable about health issues. In conclusion, when the nurse's office functions as a place to receive counseling, the school nurse is regarded as a person whom they can easily talk to about many issues.

Lastly, Table 67 indicates the image that students have of the nurse's office. Generally, the nurse's office is perceived to be clean and quiet. By school, School A where the school functions as a refuge, students tend to see the nurse's office as clean and quiet. At School D, where the nurse's office functions as a place to receive counseling, they also see it as a cheerful and comfortable place in addition to being clean. On the other hand, at School B, where the nurse's office is not visited much and where it functions as a place mainly for medical treatment, students see it as a clean and quiet place. Compared with the four other schools, a higher percentage of students see it as a hospital.

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