보건교사의 학교보건업무 실태분석

Abstract

The school health has for its object to prevent diseases, to take care of health, and to promote it so that the students and the teaching staffs may live in health and safety. Today the aspect of diseases changes from the acute diseases to the chronic degenerative diseases, hereupon the school health is emphasized to take the health education for forming the students healthful living habits and to promote their health. Therefore the school nurse's affairs of school health should be established rightly according to the current situation and should be systematized. So this study was progressed with the object of supplying the basic data to grasp the problems of school nurse's affairs as of today by investigating her affairs to perform at the scene of school and also with the object of concretizing her affairs suited to 21 century school health. This study sampling was used the ratio stratified sampling to select the random sampling by stratifying each school of elementary, middle, and high schools each in the 26% of 1236 schools that the school nurses were disposed in Kyunggi Province. The questionnaires were sent by post to 308 school nurses selected as sample of them and the replied 193 questionnaires (reply rate 62.6% of them) from Oct.4, 2002 to Oct.28, 2002 were used in statistical analyses. The questionnaires, measuring means of this study, were consisted of 52 questions all which were made by this researcher's amendments and supplements on the bases of the books related to the local community nursing science, of the school nurse's duties regulated at Article 3 of Enforcement Ordinance in School Health Law, of the 2002 school year's school health guiding principle and the preceding dissertations (Jeong Ja, Park;1994, Gi Ju, Kim;1999, Nam Hee, Km;1992, Hyang Sook, Choi;2001), and of the research for the actual condition of national school nurses that was carried out by the National Health Committee in September, 2000. The data were calculated at the frequency and the percentage in using SPSS statistics program and were analyzed into the school grade differences through the X2-verification and ANOVA verification The results of this study, carrying out the above method, were summarized as follows: In the aspect of the school health room management, 95% (192 schools) of total schools were secured the school health room. The school health rooms were sized to "half-classroom" in 61.6% and "more than one-classroom" in 17.6%. Observing school levels, elementary and middle schools health rooms were sized to "half-classroom" in 70.7% and 63.9% each, and high school health rooms were sized to "more than one-classroom" in 50.0% as showing the attentive difference (p=0.000*) according to school level. School health room's facilities and equipments were showed more than 90% in security of 'refrigerator' (95.3%), 'sterilizer' (97.4%), 'heater'(95.3%), 'computer'(99.5%), 'printer'(92.7%), and 'private internet wire'(96.9%) while were showed less than 50% in security of 'hot-water supply'(34.7%), 'water purifier' (42.0% ), 'foot- washer' (4.1 %), 'humidifier' (28.4%), 'television' (36.8%), and 'video'(23.3%). School level was showed its difference to 'water purifier'(p=0.000*), 'foot-washer'(p=0.037), and 'auto measuring instrument of obesity index'(p=0.051%). First-aid treatment students in daily average were showed the most rate in '10-29 students'(45.l%) and '30-49 students'(31.1%). Patient students to visit school health room were shown their diseases the most in order of 'external wound'(41.1%) and 'bellyache' (33.6%). Yearly purchase cost of first-aid medicine was showed elementary schools to be '300,000-490,000 won' in 33.3% , middle and high schools to be 'more than 700,000 won' in 61.1% and 61.8% each as showing the attentive difference (p=0.000) according to school level. Special medicine holding status was showed as 'non' in 92.2%. Monthly average students to be counselled were showed 'below 3 students' and '4-6 students' to be the same 28.5%, '7-9 students' to be 19.7%, and 'more than 10 students' to be 20.2%. And the emergence patient carrying system was showed elementary schools to be 'prepared' 50.4% while middle and high schools were only showed to be 'prepared' in 47.2% and 26.5% each as showing the attentive difference (p=0.045) according to school level. In the aspect of health education status, the health education was carried out 'never practice' in 14.5%, 'irregular practice' in 59.1%, and 'regular practice' in 26.4%. In the view of school level, elementary schools were carried out 'irregular practice' in 64.2%, 'regular practice' in 34.1%, and 'never practice' in 1.6% while middle and high schools were carried out 'never practice' in 22.2% and 52.9% each as showing the attentive difference(p=0.000) statistically. Weekly health education hours were showed elementary schools to be 'more than 2 hours' in 50.5% and middle and high schools to be in 32.1% and 18.8% each in the low rate as showing the attentive difference(p=0,001) according to school level. And health lesson themes were showed 'sex education'(49.2%) and 'drug misuse'(27.6%) in the most rate. The problems in health lesson hours were showed 'difficulty caused by not having regular lesson hours' to be 35.3% and were showed 'lack of facilities and materials for teaching' and 'less lesson hours by other affairs' to be 21.1% each in the same rate. Other health education methods were showed 'health education bulletin notice' to be 74.2% in the most rate and next 'publishing health news paper' to be 57.4%, 'educational broadcasting' and 'special lecture' to be 54.7% and 49.5% each. Yearly health education times for the teaching staffs were '1-2 times' on the average in 51.3% and 'more than 3 times' in 41.5%. The health edu! cation budget rate of the whole budget for school health was showed 'less than 5%' to be 74.1%. In the case of oral hygiene, elementary schools were showed 'carry out both the fluorine brushing teeth project and the brushing teeth education' to be 64.2% and 'only the brushing teeth education' to be 24.4% while middle and high schools showed 'never carry out' to be 63.9% and 73.5% each in the most large rate as showing the attentive difference (p=0.000) statistically. And the obesity management was showed 'to operate the adults diseases examination' to be 93.2% in the highest rate, next 'asking parents cooperation for teacher's letter' to be 70.7%, and 'health education and counselling' to be 56.5%. The lumbago management was showed 'to practice health education and counselling' to be 43.5%, 'asking parents cooperation for teacher's letter' to be 36.8%, and 'never to practice' to be 34.2%. The eyesight management was showed 'asking parents cooperation for teacher's letter' to be 72.4% in the highest rate, next 'health education and counselling' to be 32.3%, an! d 'never to practice' to be 16.7% in order. In the aspect of regular health evaluation status, the security rate of school health manpower was showed 'school doctor' to be 99.0%, and 'school pharmacist' and 'school dentist' to be 82.4% and 86.5% each. School doctors major, who were performing the constitutional examination, of elementary and middle schools were showed 'and others' to be 33.3% and 38.9% each in the highest rate while high schools were showed 'internal medicine' to be 50.0% in the highest rate. Especially 'pediatrics' was showed elementary schools as 12.2%, and middle and high schools as 5.6% and 0% each as showing the attentive difference (p=0.005) according to school level. School doctors , at the case of elementary schools, were belonged to 'private hospital' in 40.7% and 'public health center and others' in 32.5% , but they ,at the case of middle and high schools, were belonged to 'private hospital' in 50.0% and 38.2% each while 'semi-general hospital' in 25.0% and 35.3% each as showing th! e attentive difference (p=0.000) according to school level. The examination method of internal medicine was shown 'whole students examination' to be 54.4% and 'partial students examination' to be 39.4%. The examination hours were showed 'less than 4 hours' to be 38.3%, 'less than 6 hours' to be 31.3%, and 'more than 6 hours' to be 30.6% in order. School dentist's oral examination was carried out 'the whole student examination' in 76.2% and was shown 'submission the examination report to school after individual examination and other method' to be 20.7%. Oral examination time was spent 'less than 4 hours' as the highest rate 41.6%, 'more than 6 hours' as 32.6%, and 'less than 4-6 hours' as 25.8% in order. After performing constitutional examination, students of abnormal health were taken care by means of 'asking parents cooperation for teacher's letter' as the highest rate 96.8%. hyperlipidemia examination (92.2%) and urine examination (93.2%) were the most performed in pathology examination. The infectious diseases control area was shown 'infectious disease occurred inside of school'(84.4%), 'current infectious disease'(77.1%), 'seasonal infectious disease' (67.7%), and 'infectious 야sease designated by law occurred inside of school'(58.9%) in order. The vaccinations concerned in school nurse were shown 'influenza'(82.4%) and 'Japanese encephalitis'(76.5%) to be the highest rate. The connection with the local public health center was shown 'yes' to be 91.9% in the whole schools and the details of the connection were in order of 'prevention of epidemics and water examination'(70.5%), 'vaccination'(49.4%), 'tubercle and parasite control' (34.7% ), 'health education'(30.7%), and 'physical examination' (23.3%). The others connection with the local community organizations was shown 'yes' to be 68.9% in the whole schools and the connected organizations were 'hospital-physician's office'(77.4%), 'health concerned organization'(26.3%), 'village office'(ll.3%), and 'pharmaceutical company'(2.3%). The details of the connection were in order of 'physical examination' (64.0%), 'emergency treatment' (61 .O% ), 'contagious diseases control' (16.9%), and 'health education' (10.3%). When the school health activity was shown its planning and valuation status as 5 points measure, 'school health activity planning' was 3.55 points and 'school health activity valuation' was 3.09 points. The school health activity planning was shown in order of elementary, middle, high school to be 3.67 points, 3.25 points, 3.55 points as showing the attentive difference(p=0.015) according to school level. When the health record computerization was shown its business burden as 5 points measure in order of elementary, middle, high schools, they were 2.76 points, 2.83 points, and 2.79 points each. The practical use of the health record computerization data was shown as 2.08 points, 2.00 points, and 2.06 points each. In the aspect of school environmental hygiene management, drinkable water management status was shown 'drinking water examination request' to be 83.4%, 'water purifier hygiene management' to be 83.4%, and 'water tank cleaning request' to be 65.8%. And the toilet sterilization business was replied 'never charged' as 33.7%, 'regular sterilization' and 'cleaning and ventilation but irregular sterilization' as 31.1% and 30.6% each, and the sterilization business inside of school was replied 'regular sterilization' as 60.6%, 'irregular sterilization' as 25.9%, and 'never charged' as 13.5%. And the above two questions were all together shown the attentive difference (p=0.000, p=0.001) according to school level. The circuit business around school was shown 'never practice' to be 40.4% and '1-2 times quarterly' to be 26.9% while 'everyday circuit' only to be 2.1%. In the aspect of feeding and lunch supply business status, assigned school feeding ways were shown 'direct school feeding' to be 70.5% and 'commission school feeding' to be 28.0%. Elementary schools were shown 'direct school feeding' to be 88.6% while middle and high schools were only shown '47.2% and 29.4% each as showing the attentive difference (p=0.000) statistically. The feeding and lunch supply business were shown 'never charged' and 'whole business charged except receiving feeding cost' to be 52.3% and 27.5% each as the most rate. Researching school level, elementary schools were shown 'never charged' to be 69.1% and middle and high schools were shown 'whole business charged except receiving feeding cost' to be 50.5% and 58.8% each as it was shown the attentive difference (p=0.000) statistically. Feeding business was shown 'difficulty was given' about giving difficulty to other job by feeding business' to be 66.3% as the most rate. Charged staffs of milk ! feeding were shown 'nutritionist' to be 47.7% and 'school nurses' to be 14.0% while 'milk feeding is not served' to be 35.2% and it was shown the attentive difference (p=0.000) according to school level. The circuit serving school nurses were 40.4% of the whole and they were shown elementary, middle, high schools to be 52.0%, 30.6%, 8.8% each as showing the attentive difference (p=0.000) according to school level. The average circuit serving schools were 1.12 and serving times were 5.07 yearly. And the circuit serving school nurses were in charge of 'cooperation of health education and health education', 'school health room facilities and medicine management', and 'health record and other health concerned records management' as the most rate of 96.1%, 73.0%, and 65.4% each while the problems seriousness according to the circuit service were average 3.62 points as 5 points measure. Other affairs of school nurse were investigated as toilet paper control, reception affairs, safety mutual aid association affairs, Christmas seal sales, students blood donation campaign, environment cleanup area control, health class operation, and health examination business for the teaching staffs and the dependent while the Christmas seal sales and safety mutual aid association affairs were shown the highest rate as 79.2% and 61.7% each. The above results showed the various problems to be improved in accordance with the school nurse's school health business. To resolve those problems, the political support should be prepared and also the legal and systematic contrivance should be arranged in relation to the school nurse's position. School nurses are also required themselves to be shown the positive wills and efforts to improve and overcome the problems about their school health affairs.;학교보건은 학생과 교직원이 건강하고 안전하게 생활할 수 있도록 질병을 예방하고 건강을 보호, 증진하는 것을 목적으로 한다. 오늘날 질병의 양상은 급성질환에서 만성퇴행성 질환으로 변화하고 있고 이와 관련하여 학교보건에서 학생들의 건강한 생활습관 형성을 위한 보건교육 및 건강증진이 강조되고 있다. 이에 본 연구는 보건교사가 학교현장에서 수행하는 업무를 알아봄으로써 현 시점에서 보건교사의 업무에서의 문제점을 파악하고 21세기 학교보건에 적합한 보건교사의 업무를 구체화하는 데 기초자료를 제공할 목적으로 진행되었다. 본 연구의 표집은 경기도내 보건교사가 배치된 학교 1236개교에서 26%를 초·중·고 별로 층화하여 무선할당방법으로 뽑는 비율층화표집방법을 사용하였으며, 이를 통해 표본으로 선출된 총 308개교의 보건교사를 대상으로 설문지를 우편 발송하여 2002년 10월 4일부터 10월 28일까지 회송되어 돌아온 총 193부(회송율 :62.6%)를 통계분석에 활용하였다. 본 연구의 측정도구인 설문지는 지역사회 간호학 관련도서와 학교보건법 시행령 제 3조에 규정된 보건교사의 직무, 2002학년도 학교보건관리지침 및 선행연구논문(정정화 ; 1997, 박정자 ; 1994, 김기주 ; 1999, 박남희 ; 1992, 최향숙 ; 2001), 2001년 9월 전국보건위원회가 실시한 전국보건교사 실태조사를 기초로 삼아, 본 연구자가 수정·보완하여 제작한 것으로서 총 52개의 문항으로 이루어져 있다. 자료 수집된 자료는 SPSS 통계프로그램을 사용하여 빈도와 백분율을 산출하고 x^(2)-검증, ANOVA 검증법을 통하여 학교 급별 차이를 분석하였다. 이와 같이 행해진 본 연구의 연구결과를 요약하면 다음과 같다. 우선, 학교 보건 물리적 환경에서 보건실은 1개교를 제외한 모든 학교에서 확보하고 있었으나 규모에서는 대부분의 학교가 학교보건법 상의 최소기준치인 66㎡(교실 한칸)에 크게 못 미쳐 이에 대한 개선이 요구되었다. 그리고 보건실의 시설 및 기구 확보율은 '온수'(34.7%), '정수기'(42.0%), '발 세면기'(4.1%),' 가습기'(28.4%),' TV'(36.8%), '비디오'(23.3%)에서 50% 이하를 나타내어 이에 대한 재정적 지원이 시급한 것으로 나타났다. 학교보건지원체계에서 년 간 응급약품 구입비는 60%에 가까운 학교가 '50만원 이상'이었다. 그리고 전체 학교보건예산 중 보건교육 예산의 비율은 '5% 미만'인 경우가 74.1%를 차지하여 학교보건교육에 대한 재정적 지원이 여전히 미흡한 것으로 나타났다. 다음으로 학교보건전문인력의 확보에서 체질검사를 실시하는 학교의의 전공과목과 소속은 일정한 기준 없이 다양성을 나타내어 학생체질검사 실시자의 전문성 확보 면에서 제고가 필요하였다. 또한 학교와 보건소와의 연계는 예방접종, 방역 및 수질검사 등에서 활발한 것으로 나타났고, 보건소 이외의 지역사회기관과의 연계는 병·의원을 통한 신체검사 실시, 응급처치가 주를 이루었다. 보건실 운영현황에서 일일 평균 응급 처치자 수는 '10∼29명'이 45.1%로 가장 많은 비율을 차지했고, 보건실 방문 환아의 주 질환은 '외상'(41.1%), '복통'(33.6%)으로 나타났다. 그리고 한달 평균 상담 아동 수는 보건교사의 45%가 6명 이하로 전반적으로 보건교사의 상담활동이 미흡한 것으로 나타났고, 응급환자 후송체계는 전체의 반 이상의 학교에서 확립되어 있지 않아서 이에 대한 대책마련이 시급하였다. 보건교육 현황에서 정규적으로 보건교육을 실시하는 경우는 26.4%, 주당 보건수업 시간 수는 2시간 미만이 49.4%를 차지하여 '보건교사 1인당 주당 6시간의 정규적인 보건교육을 실시한다'라는 교육청 권장사항에 크게 못 미쳤다. 특히 이러한 현실은 상급학교로 갈수록 더 심각한 것으로 나타나(보건수업 형태: p=0.000, 주당 보건수업 시간 수: 0.001), 학교보건교육에 대한 정규보건교과 개설, 정규시간 확보 등 제도적 지원이 시급한 것으로 나타났다. 그리고 보건수업 주제 중 가장 많은 비율을 차지하는 것은 성교육(49.2%), 약물 오·남용(27.6%)이었고, 보건교사가 정기, 비정기적인 수업이외에 활용하는 보건교육 방법은 '보건교육 게시물'이 74.2%로 가장 많았고, 다음으로 '보건소식지 발간', '방송교육'과 '특강' 등의 방법이 주로 이용되었다. 그리고 교직원 대상 보건교육은 전반적으로 미흡하여 보건교사의 교직원에 대한 보건교육활동이 더욱 활발해져야 할 것으로 나타났다. 예방적 건강관리 중에서는 비만아 관리와 시력관리가 가장 잘 이루어지고 있는 것으로 나타났는데, 비만아 관리의 경우 '성인병 검사를 실시한다'가 93.2%, 시력관리의 경우 '가정통신문을 발송하여 학부모의 협조를 구한다'가 72.4%로 가장 큰 비율을 나타내었다. 그리고 학교 급별 구강위생 관리는 초등학교의 경우 불소양치사업과 잇솔질 교육을 실시하는 경우가 다른 학교 급별에 비하여 높게 나타났고, 요통관리는 다른 예방적 건강관리에 비하여 미흡한 것으로 나타났다. 학생건강평가에서 체질검사 시 전체학생을 검진하지 않는 등의 편법을 이용하는 경우는 45% 이상으로 자칫 체질검사의 부실을 가져올 위험성이 있는 것으로 나타났다. 그리고 체질검사 후 건강 이상자 관리 방법에는 가정통신문을 발송하여 학부모의 협조를 구하는 것이 가장 많이 이용되고 있었고, 보건교사의 각종 병리검사 실시율에서는 '고지혈증 검사'와 '소변검사'가 전반적으로 높게 나타났다. 본 연구결과 형식적이고 불충실한 체질검사를 막기 위해서는 현재의 체질검사에 대한 문제점을 직시하고 법적·제도적 장치를 강구하는 노력이 요구되었다. 전염병 관리의 범위는 '학교 내 발생 전염병'(84.4%), '최근 유행하는 전염병'(77.1%)이 가장 높은 비율을 차지했으며, 보건교사가 학교에서 실시하거나 관여하는 예방접종의 종류로는 '인플루엔자'(82.4%), '일본뇌염'(76.5%)이 가장 높은 비율을 나타내었다. 학교보건사업의 계획 및 평가의 수행 점수(5점 척도)는 '학교보건사업의 계획'이 3.55점, '학교보건사업의 평가'가 3.09점으로, 보건교사는 학교보건사업의 계획보다 학교보건사업의 평가에 다소 소홀한 것으로 나타났다. 그리고 건강기록부 전산관리 업무의 부담정도는 건강기록부 관리의 생활기록부 관리와의 전산통합으로 전반적으로 낮아진 것으로 나타났고, 건강기록부 전산자료의 활용도는 전반적으로 미흡하여 보건교사가 건강기록부 자료를 학생들의 건강평가, 건강상담, 보건교육 등에 활용하는 노력이 요구되었다. 학교환경위생관리에서 보건교사의 91.7%는 음용수 수질검사 의뢰, 정수기 위생관리, 물탱크 청소 의뢰 등의 학교 먹는 물 관리업무를 담당하고 있는 것으로 나타났다. 그리고 보건교사가 화장실 소독업무를 담당하는 경우는 61.7%, 학교 내 소독업무를 담당하는 경우는 86.5%였으며, 화장실 관리와 학교 내 소독업무는 초, 중학교가 고등학교보다 과중한 것으로 나타났다(화장실관리:p=0.000, 학교 내 소독업무:p=0.001). 그리고 보건교사가 학교 주변환경에 대한 순회를 전혀 실시하지 않는 경우는 40% 이상으로 보건교사의 학교순회활동의 중요성에 대한 자각이 요구되었다. 급식 및 중식지원 업무현황에서 소속학교의 급식형태 중 위탁급식의 비율은 28.0%였고, 보건교사가 급식 및 중식지원 업무를 담당하는 경우는 47.7%였다. 이는 모두 중·고등학교가 초등학교보다 높았으며, 학교 급별로 유의한 차이를 보였다(p=0.000). 이러한 결과는 현재 영양사의 배치율 부족으로 인해 급식관련 업무가 보건교사에게 부여되고 있기 때문인데, 행정당국의 급식관련사업의 추진에서의 개선대책이 시급한 것으로 여겨진다. 순회근무현황에서 전체 보건교사의 40.4%가 순회근무를 실시하고 있었고, 평균 순회근무 학교 수는 1.12개교, 년 간 실시횟수는 5.07회였다. 그리고 순회근무 시 보건교사가 담당하는 업무는 보건교육에 관한 협조 및 보건교육, 보건실 시설 및 약품관리 등이 주를 이루었고, 이로 인해 소속학교의 건강위협, 보건교사의 업무과중 등의 문제가 심각한 것으로 나타났다. 보건교사의 기타 업무로는 화장지 관리, 접대업무, 안전공제회 업무, 크리스마스 씰 판매 그리고 학생헌혈운동, 환경정화구역관리, 보건반 운영, 교직원 및 피부양자 건강검진 업무 등이 조사되었는데, 이중 크리스마스 씰 판매와 안전공제회 업무가 각각 79.2%, 61.7%로 가장 높은 비율을 나타내었다. 본 연구결과를 바탕으로 다음과 같이 제언하고자 한다. 첫째, 본 연구에서는 학교 급별에 따른 보건교사의 업무를 비교하였는데, 보건교사의 학교보건업무와 관련성이 깊은 것으로 생각되는 보건교사 소속학교의 규모, 학교설립 주체에 따른 학교보건업무를 비교하는 연구가 요구된다. 둘째, 최근 들어 학교보건에서 보건교육 및 학교건강증진에 대한 중요성이 증가하고 있는 것과 관련하여, 보건교사의 학교건강증진프로그램 개발과 관련한 연구가 요구된다. 셋째, 현재 보건교사에게 중식 및 급식관련 업무, 순회근무, 각종 잡무 등이 강요되고 있는 것과 관련하여 많은 문제점이 야기되고 있는데, 이에 대한 구체적인 연구가 요구된다.