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The Nurse's Office As A Refuge 2

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



In recent years, refusal to attend school and bullying have become serious issues in school education. Under these circumstances, some students think of the school nurse's office not only as a place to rest when they do not feel well or are hurt but also as a place where they can get away and take refuge. These students say they feel they can go to school if it is possible to visit the school nurse when they cannot attend class. They also claim to take refuge in the nurse's office when they feel they are likely to be bullied. There are, in fact, many students who visit the nurse's office because they don't want to attend class, need someone to listen to their problems, and because they did not sleep well the night before. Many students have a favorable image of the school nurse and consider her to be a person who is warm, who always listens to their problems, and who makes them feel relaxed. Above all, the school nurse appears to give them a different sense of security from the homeroom teacher because they are not evaluated on the basis of scores and exam results.

Generally, the nurse's office is operated by one school nurse. The purpose served by the nurse's office varies according to the school because it reflects each school nurse's particular way of thinking. Some school nurses firmly consider the nurse's office to be a place where they give first aid to students who don't feel well or are hurt. They do not look favorably upon students visiting the nurse's office for other reasons. In addition, some homeroom teachers do not approve of students visiting the nurse's office because they believe students will not be able to keep up with classes and this will contribute to difficulties in their studies. In addition to the usual treatment for physical illness and injury, the school nurse has come to play a larger role in the emotional care of students and to function as a counselor. On the other hand, homeroom teachers are critical of school nurses, saying they spoil students and make it difficult to give students guidance since school nurses do not discuss a student's problems with them. This indicates that there is a disparity in the views of homeroom teachers and school nurses who are in charge of the one place in the school that is always open to students.

In recent years, while problem behavior by children has increased and become more complex, the nurse's office is seen to be a comfortable and secure place for junior high school students to talk about their problems. As such, we focused our study on the nurse's office and analyzed what it means for students, the actual conditions of its use, and the problems of junior high students.

2.Profile of Students

The survey targeted school nurses and 1,991 junior high school students (1,027 boys and 964 girls) in six public schools in Tokyo. (Table 1)

Let us introduce a profile of the junior high school students that we studied. Table 2 shows participation in club activities. 94.3% of the students take part in club activities. 64.3% students are actively involved in the activities of sports or cultural clubs with a high percentage of boys involved in sports and girls in cultural clubs.

Table 3 indicates attendance at cram schools. 46.7% do not attend cram schools. 40.5% attend two to three times a week. Among ninth graders, attendance increases to 69.6% and this shows that junior high school students are very busy with both club activities and cram school. Table 4 indicates the number of friends. Only 1.0% of the students do not have friends or have only one friend while more than 50% answer that they have more than 20 friends.

According to their future plans in Table 5, 32.4% of the students hope to go on to university. 22.0% would like to attend a vocational school or junior college. This shows that about 50% of junior high school students hope to receive higher education after graduating from senior high school.

Next, we studied the daily lives of junior high school students. Table 6 shows their bedtimes. 29.5% of the students go to bed around midnight, and there are even 12.6% who go to bed after 1 AM. There is a difference between boys and girls, but by grade, more than 20% of the ninth graders go to bed after 1 AM and this seems to indicate that they stay up late studying for senior high school entrance exams.

Tables 7, 8 and 9 show the family situation of junior high school students. 36.6% have mothers who work part-time, 17.1% have mothers who work full-time, and 10.1% of their mothers are self-employed. In total, more than 60% of their mothers are engaged in some form of work. (Table 7)

When we asked about dinnertime, we found that 34.1% dine with the entire family, 37.2% dine with everyone in the family excluding the father, indicating that more than 70% of the students have dinner with someone as seen in Table 8. When the students who have dinner alone (7.5%) and students who answered "other" are combined, the percentage exceeds 20%. This result leads one to wonder if they are eating at the cram school, with grandparents, or with the brothers and sisters. Regarding the number of siblings in the family, there are 2 siblings in 52.5% of the families of students, and there are 3 siblings in 32.1% of the families, indicating that more than 80% of the students have 1 or 2 brother(s) or sister(s). (Table 9)

Table 10 shows how junior high school students evaluate themselves. More than 50% of the students see themselves as having many friends, conversant on a large variety of topics or are optimistic. However, a high percentage of students indicate that they do not have confidence in themselves when it comes to being good at studies, having the confidence of teachers, having leadership, having good taste or giving advice to someone.

3.Daily Life and Health

In conducting a study of the nurse's office, we must first consider the health of the students and their daily lives.

First, we surveyed the amount of exercise that junior high school students get. About half (47.7%) of the students exercise vigorously 4 or more times a week outside physical education class. In contrast, one fourth (26.3%) exercise less than once a week. The higher the grade, the less frequently students exercise. For example, more ninth graders exercise less than once a week (42.5%) than those who exercise 4 times a week or more (29.5%). These findings can be attributed to the period from July to September during which this study was conducted since ninth graders had already quit their school clubs and had few opportunities for exercise. In addition, we found that girls exercise fewer times than boys. (Table 11)

Table 12 shows that 53.3% of the students attend cram school and this percentage increases in the higher grades. In the ninth grade, 69.6% of students go to cram school and 50.0% go more than 3 days a week. This is more than double the percentage in the seventh and eighth grades and indicates that ninth graders are very busy after school.

With such busy lives, with whom do they have dinner on weekdays? In Table 13, 37.2% eat without the father and only one third (34.1%) report that they have dinner with the entire family. The number of students who eat alone increases in the higher grades and we can infer that fathers with junior high school children are in the prime of their careers and are very busy. By gender, more girls than boys report having dinner with everyone in the family excluding the father.

Dinner should be a pleasant time when family members can talk about how they spent their day, but for junior high school students, it appears difficult for all members of the family to gather around the dinner table.

A further look at bedtimes in Table 14 shows that more than 80% (82.5%) of the students go to bed after 11 PM, 42.1% go to bed after midnight and this percentage rises in the higher grades, increasing from 22.4% in the seventh grade and 40.0% in the eighth grade to 65.8% in the ninth grade. Girls stay up later than boys. Staying up late has an adverse effect on the physical growth of junior high school students and their activities the following day. In order to be alert the next day, junior high school students should ideally go to bed between 10 to 11 PM, sleep for about 8 hours and get up at 6:30, 2 hours before class begins. However, in practice, there are few students who do this.

We have seen that junior high school students exercise infrequently and are very busy attending cram school. What do they think of their health?

According to Table 15, 66.6% of the students always or often find it difficult to get up in the morning and 55.3% suffer from lack of adequate sleep hours. These findings are quite understandable considering the fact that so many students go to bed late. Surprisingly, 42.3% of the students are unable to fall asleep easily. At the same time, 22.3% have a poor appetite and this is a cause for concern given that junior high school students should have a good appetite. In the higher grades, more students report always or often having the symptoms listed. In particular, more ninth graders than seventh graders reported frequent incidences of the following.

(1) have stiff shoulders +13.6%
(2) lack of adequate sleep hours +10.7%
(3) cannot concentrate easily +10.3%
(4) cannot easily get up in the morning +9.6%

In the higher grades, students have more stress in their daily lives. Girls tend to feel more stress than boys, and report having stiff shoulders, being too busy every day, and suffering from lack of sleep.

4.Self-evaluation and Satisfaction with Life

What do students think about themselves as human beings? How do they feel about their present circumstances?

In Table 16, many students see themselves as having many friends, conversant on the large number of topics or optimistic (percentage answering "very much" or "somewhat"). However, a high percentage of students indicate that they do not have confidence in themselves when it comes to being good at studies, having the confidence of teachers, having leadership, having good taste, or giving advice to others.

It appears that students lose self-confidence in the higher grades. The difference between seventh and ninth graders is as follows.

(1) like my present self -13.4%
(2) have many friends -10.4%
(3) skilled at sports -9.8%
(4) conversant on large variety of topics -8.7%
(5) can accomplish whatever I try to do -5.6%
(6) good at studies -4.5%

For these items, there is a greater difference between the seventh and the eighth grades than between the eighth and ninth grades. This indicates that a dramatic change takes place not only physically, but also mentally between the seventh and eighth grades.

However, students in the higher grades report that teachers have more confidence in them. This can be attributed to closer relations between students and teachers.

On the other hand, boys tend to think that they are skilled at sports (+13.2%), can do what they try to do (+9.8%), and are good at their studies (8.7%). As for girls, they tend to think of themselves as someone to whom others come for advice (+29.6%), are optimistic (+10.6%), are conversant on a large variety of topics (+7.4%), and have good taste (+7.3%). Many boys feel they cannot ask others for advice and are physically weak.

In Table 16, 70.5% of the students think they have very many friends or rather many friends. Table 17 shows the number of friends by grade. About 70% answer that they have 11 friends or more and half answer that they have 21 or more which is rather many. However, the percentage tends to decrease from the seventh to the eighth grade. In the seventh grade, they spend time with many friends and their social lives are an extension of elementary school, but upon reaching puberty, they begin to become conscious of the opposite sex and tend to form cliques. In particular, the eighth grade is a time to make friends and many students seem to be uneasy about life and people around them.

Table 18 shows the type of friends they have. Many students answer that they have 6 to 10 friends with whom they enjoy spending time and 2 to 3 other friends. However, because 24.4% of the students do not have friends they can consult with about serious problems, 17.1% do not have friendly rivals in sports and studies, and 15.7% do not have friends whom they consider to be life-long friends, we can imagine that they do not have real friends, however many they have.

How do students feel about school life? Table 19 compares junior high school life with elementary school life. First of all, more students think that school rules become stricter, they cannot easily play with friends, they have more problems and their teacher becomes stricter. At the same time, they do not find it difficult to talk with teachers or to go to the nurse's office. They do not think the school nurse has become strict or that it is difficult to make friends. Relatively speaking, students seem to have a good image of the nurse's office.

Table 20 shows differences by grade and gender. Many seventh graders find that school rules have become stricter. In the higher grades, students increasingly report having problems and anxieties. More eighth graders find that teachers have become stricter, that school has become boring, that they do not feel free to visit the nurse's office, and that the school nurse has become stricter. This tendency was also seen in their self-evaluations.

By gender, more girls than boys agree very much or somewhat that junior high school is different from elementary school and this indicates that they are rather negative about school life. In particular, many girls feel that school rules have become stricter and that they have more problems. When asked whether they enjoyed daily life or not in Table 21, more students report finding each day very or somewhat enjoyable than not very enjoyable or not at all. Students tend to find school less enjoyable in the higher grades with one-third of ninth graders reporting that they do not find it enjoyable.

In Table 22, 27.0% of the students often think they do not want to go to school and this percentage increases to 60% when those who sometimes think so are included, and more students in the higher grades report feeling this way. This may be an indication of the various pressures and problems they feel.

5.Characteristics of Students who visit the Nurse's Office

After considering the lifestyle and health of junior high school students and character types, it is necessary to study the characteristics of students who visit the nurse's office. We compared students who visit the nurse's office more than once a week with those who do not visit the nurse's office in Table 23, 24, 25, 26 and 27.

First, according to Table 23, compared with students who do not visit the nurse's office, students who visit the nurse's office feel more anxious about their health and are unable to control their physical condition. A high percentage are irritable, have poor appetite and lack adequate hours of sleep, all symptoms that derive from poor sleep habits. They never get enough sleep and go to school the next day without having gotten rid of their stress from the previous day. They come to school in less than good mental condition and visit the nurse's office to sleep for a while.

Looking at the relation to self-image in Table 24, students who frequently visit the nurse's office tend to be the type whom others go to for advice and who have leadership qualities. Generally, students who go to the nurse's office are thought of as having a weak character, however even students who have leadership qualities and are trusted by friends sometimes visit the nurse's office because they do not know how to cope with their various problems. A high percentage of students who are conversant on a variety of topics feel stress because they become tired of conforming with people around them. Furthermore, a low percentage of students who frequently use the nurse's office tend to think they cannot seek advice from others and this indicates the nurse's office is used as a place to receive counseling.

Regarding what has changed about their school life compared with elementary school in Table 25, many students who frequently visit the nurse's office think that school has become boring, teachers have become stricter and that they cannot easily talk with teachers. In contrast, few students think that the school nurse has become stricter and they often go the nurse's office to talk about their frustration with school life and teachers.

Table 26 shows the relation of frequency of visiting the nurse's office to daily enjoyment. Students who frequently visit the nurse's office tend not to enjoy daily life very much or not at all. However, there are also many students who enjoy themselves daily which shows that the nurse's office is not only a place to have one's physical condition checked and to receive counseling, but also a place for socializing. Students often go there to measure their height and weight or chat with the school nurse.

Apparently, students who are frustrated and feel stressed about school life frequently visit the nurse's office. 55.0% of the students who do not often visit the nurse's office report that they sometimes do not want to go to school in contrast to 71.0% of the students who frequently visit the nurse's office.

As can be seen, students frequently make use of the nurse's office not only when they are hurt or do not feel well, but for various reasons. This indicates that the nurse's office functions as an overall health center for the care of the mind and body.

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