Shimizu et al., Int J Nurs Clin Pract 2022, 9: 358
https://doi.org/10.15344/2394-4978/2022/358

International Journal of
Nursing & Clinical Practices

Open AccessOriginal Article

Evaluation of Social Environment Adaptation to a Cambodian Type ofJapanese School Health Room System

Hiroko Shimizu1*, Hoshina Uehara1, Michiko Inage2, Shiori Ota2, Mai Yamaguchi2, Yuka Masuko2 and Tomiko Kusugawa3
Department of Chronic Adult Nursing, Academic Group of Life Sciences, Kagawa University, Japan
Former Assistant, Chronic Adult Nursing, Academic Group of Life Sciences, Kagawa University, Japan
3
Former Collaborative Researcher, Chronic Adult Nursing, Academic Group of Life Sciences, Kagawa University, Japan
1
2

Abstract

Publication History:

Objective: This study aimed to evaluate the social environment adaptation of the Cambodian school Received: May 05, 2022
health room system model, a technology transfer of the Japanese school health room system, and evaluate Accepted: May 31, 2022
Published: June 02, 2022
the quality of the Cambodian school health room in the future.
Method: The target was a Japanese-style school health room model by Team Cambodia of University A. Keywords:
The set consisted of Cambodian school health room standards, visitor records, a health room material
management book, symptom observation items, collaborative organizations, and health examination School health room, Social
environment adaptation,
records.
Cambodia
Results: The Cambodian School Health Room Standard was applied locally. If there were no vacantrooms, the room was set up in a clean library area. Visitor records were aggregated to clarify the problem.
In the school health room management sheet, funding for materials replenishment is an issue. Models
were put into practical use for symptom observation items and health teacher behavior flow charts. The
health check record sheet was upgraded to the Cambodian government version.
Conclusion: Team Cambodia obtained the data at model public elementary schools in Kandal Stueng
District, Kandal Province, by observing maintenance status, usage status, usage history, and actual data.

BackgroundBy 1979, when the civil war ended, the education and economy ofCambodia experienced a slump, the country lost its governance, andmany people lost their normal lives. In particular, children’s healthproblems continue today because of poverty and a lack of learning
opportunities. It has been reported that nutritional disorders inchildren still affect them 40 years after independence [1,2].
Previous studies have pointed out that children’s health problems
include the physical disparity between children in the capital andsuburbs and the coexistence of obesity and thinness. This is an issue
not only for Cambodia but also for some countries in Southeast Asia
[3-6]. Most of the reports of these previous studies were carried out aspart of the support activities in Cambodia using cross-sectional survey
methods. In addition, there is currently no system in place for the
Cambodian government to observe children’s health longitudinally.
Given this situation, data such as school health examinations thatprovide indicators of improvement are needed to improve children’s
health. However, as of 2016, no school health checkups have been
conducted for children.
The Cambodian government formulated the school health policy
in 2016 and proposed that the policy focus on preventing infectious
diseases and providing hygiene education. However, although themodel school in the capital progressed, promoting school health,especially in suburban areas, was postponed because of the delay inthe development of public transportation and the economic disparity
between the capital and suburban areas. Therefore, in 2017, Team
Cambodia in Japan began promoting a local school health room
system [7] and a model project for school health examinations [8].
In addition, Team Cambodia’s proposed school health system wasincorporated in the revised version [9] of the school health policy in2019. Subsequently, on September 21, 2021, when the school reopened
after the pandemic, the Cambodian government announced the
Int J Nurs Clin Pract
ISSN: 2394-4978

establishment of a school health room based on the model proposedby Team Cambodia. As a result, it will be installed in all schools, frompublic and private elementary schools to universities nationwide.
Therefore, to evaluate the quality of the school health room in
Cambodia in the future, it is necessary to evaluate the adaptationof the social environment of the school health room system in
Cambodia, which consists of a transfer of Japanese-style technology.

Research Objective
The purpose of this study was to evaluate the adaptation of thesocial environment of the Cambodian school health room systemmodel, which consists of a technology transfer of the Japanese school
health room system, and to contribute to the evaluation of the qualityof the Cambodian school health room in the future.

Methods
Research design
This study used a hypothesis-verification design. We hypothesizedthat the Japanese school health room system was socially andenvironmentally adaptable in Cambodia.
Corresponding Author: Prof. Hiroko Shimizu, School of Nursing, Faculty of
Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 7610793, Japan; E-mail: shimizu.hiroko@kagawa-u.ac.jp*

Citation: Shimizu H, Uehara H, Inage M, Ota S, Yamaguchi M, et al. (2022)
Evaluation of Social Environment Adaptation to a Cambodian Type of Japanese
School Health Room System. Int J Nurs Clin Pract 9: 358. doi: https://doi.
org/10.15344/2394-4978/2022/358
Copyright: © 2022 Shimizu et al. This is an open-access article distributed
under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided theoriginal author and source are credited.

IJNCP, an open access journal
Volume 9. 2022. 358

Citation: Shimizu H, Uehara H, Inage M, Ota S, Yamaguchi M, et al. (2022) Evaluation of Social Environment Adaptation to a Cambodian Type of Japanese
School Health Room System. Int J Nurs Clin Pract 9: 358. doi: https://doi.org/10.15344/2394-4978/2022/358
Page 2 of 7

Definition of terms
The Japanese-style school health room system manages the healthof teachers and children by arranging school health teachers who do
not teach or evaluate in Japanese schools in the school health room.
The role of the school health teacher is not a school nurse but rather
a provider of first aid, such as treatment for injuries, health activities
such as observation of sick children, provision of health information,and management of the hygienic environment of the school. This rolealso supports children’s mental counseling.
The exportable Japanese school health room system model includes
school health facilities, school health teachers, health information
management methods such as health checkups, and manuals andrecords regarding children’s conditions and responses. This study
included school health room standards, visitor records, healthroom equipment management books, symptom observation tables
and records, health diagnosis records, and a list of collaborative
institutions.
Target
The target was a set of Japanese-style school health room models
implemented by Team Cambodia of University A. The set consistedof Cambodian school health room standards, visitor records, a healthroom material management sheet, symptom observation items, aflow sheet of the school health teacher’s response, and health checkup
records.

5.

The school health room should be kept quiet and provide
clean beds and first aid kits. Children should be isolated fromthe surrounding noise and/or pollution.

6.

Assigned staff members should collect children’s healthinformation regularly, at least once a year. The collected
information should be suitably shared with their parents tomonitor the children’s growth.

7.

Health information on growing children should be recorded
continuously and linked to the governmental organizations to
be used as national health indicators.

Visitor records
In Japan, it is necessary to grasp the utility value and the actual
situation of the school health room; thus, the records of the children
who visit the school health room are taken. A record sheet was createdwith the date, name, purpose of visit, and corresponding items,
referring to the visitor record in Japan.
Health room material management sheet
The items necessary for the health room were determined byconsidering the current situation of the Cambodian school healthgovernment staff who trained in Japan, as mentioned in (1), and thesuburban school where the school health room was opened locally. A
form was created to conduct regular health room inspections.

Team Cambodia collected data at public model elementary schoolsin Kandal Stueng District, Kandal Province, by observing maintenancestatus, usage status, usage history, and actual data.

Symptom observation sheet
In the school health room in Japan, observation records of sickchildren visiting the school health room are created. These records arenecessarily used for inquiries made by parents and external medical
infirmaries.

School Health Room Standards in Cambodia

Collaborative organization

We verified the validity of the school health room standard
in Cambodia using the following procedure. First, Cambodian
government officials, state and county officials, principals of public
elementary schools in the suburbs, and health room teachers visited
Japan to receive training and to observe the facilities and functions[10]. Subsequently, these individuals after returning to Cambodia
from the schiil health training in Japan and built a health room area
and a health room in the library [11,12]. Next, Team Cambodia
members compared the Cambodian school health rooms with thoseof Japan, examined indispensable materials that should be installedin the Cambodian school health room, and verbalized the standards
for quality assurance of the school health room. Team Cambodia is
composed of a group of school health technical supports for Cambodia
at A University in Japan. The criteria were as follows.

The school health room may ask sick children to attend a medical
infirmary or use an ambulance in an emergency. It is also necessary
to post information such as school doctors related to school healthcheckups. These must be included in the school health room system.

Data collection

1.

Staff members in charge of the health issues of school children
and teachers should be assigned. The principal should be a
responsible representative.

2.

Schools should give suitable first aid treatments to school
children in case of injuries or abnormal physical symptoms.

3.

Schools should establish school health rooms to suitably manage
children’s health information and provide suitable care tochildren complaining of health problems.

4.

Children with health problems can have a temporary rest withpeace of mind and/or receive first aid treatments in the school
health room.

Int J Nurs Clin Pract
ISSN: 2394-4978

Health diagnosis record
The Cambodian government created a provisional sheet, but it
was not used. This was compared with Japan’s school health checkup
record and reorganized to create the school health checkup record
sheet in Cambodia.
Analysis method
Multiple researchers will observe the local situation and empiricallyexamine whether the initial purpose has been achieved, whether there
are any points to be improved and the remaining issues.
Ethical considerations
Because this study did not include human research subjects, it was
not subject to ethical review.
Research period
We conducted this study from November 2017 to February 2020.

IJNCP, an open access journal
Volume 9. 2022. 358

Citation: Shimizu H, Uehara H, Inage M, Ota S, Yamaguchi M, et al. (2022) Evaluation of Social Environment Adaptation to a Cambodian Type of Japanese
School Health Room System. Int J Nurs Clin Pract 9: 358. doi: https://doi.org/10.15344/2394-4978/2022/358
Page 3 of 7

Results
We applied the Cambodian school health room standards, visitor
records, health room material management sheets, symptom
observation items, collaborative organizations table, and healthcheckup records locally.

which allowed information to be shared. In addition, when the visitor
records were tabulated after half a year, we confirmed that the numberof children in poor physical condition in the health room increased
during the hot season before the Khmer New Year, as shown in Figure
6.

School health room standards
The school health room established by transferring the technologyof the Japanese school health room to Cambodia is shown below.
Figures 1–4 show the school health room opened in an empty
classroom. The bed has white sheets, a desk for the health teachers’
records, a blindfold screen, and storage. The project of Team
Cambodia provides white sheets and screens.
In addition, a health teacher who could provide first aid and medical
materials for first aid (Figure 5) was installed in the school healthroom. University A planned a local seminar for health teachers andconducted practical exercises such as resuscitation, injury treatment,
and symptom observation.
Figure 3: School health room C in Cambodia.

Figure 1: School health room A in Cambodia.

Figure 4: School health room D in Cambodia.

Figure 2: School health room B in Cambodia.

Visitor record
The visitor record was recorded by the school health room teacher.
Team Cambodia developed a model of the recording form used in
the school health room of the local school. The items on the form
included date and time, name, gender, age, chief complaint, response,
consequences, remarks, and so forth. The Khmer language was used,
Int J Nurs Clin Pract
ISSN: 2394-4978

Figure 5: First aid supplies.
IJNCP, an open access journal
Volume 9. 2022. 358

Citation: Shimizu H, Uehara H, Inage M, Ota S, Yamaguchi M, et al. (2022) Evaluation of Social Environment Adaptation to a Cambodian Type of Japanese
School Health Room System. Int J Nurs Clin Pract 9: 358. doi: https://doi.org/10.15344/2394-4978/2022/358
Page 4 of 7

Figure 6: Records of school health rooms.

Figure 6: Records of school health rooms.

School health room equipment management sheet

Symptom observation items

A well-ventilated school health room area, a set of beds, pillows,
blankets, screens, desks, chairs, recording form, and first aid kits were
deployed as the first step in the school health room model. Because
theft and destruction of school health room equipment have often
occurred, we decided to regularly check the status of these items(Figure 7).

We created standard observation items for observing children who
presented to the school infirmary. Having an objective observation
item and the child’s chief complaint allowed for grasping the child’s
overall condition (Figure 8).

Int J Nurs Clin Pract
ISSN: 2394-4978

IJNCP, an open access journal
Volume 9. 2022. 358

Citation: Shimizu H, Uehara H, Inage M, Ota S, Yamaguchi M, et al. (2022) Evaluation of Social Environment Adaptation to a Cambodian Type of Japanese
School Health Room System. Int J Nurs Clin Pract 9: 358. doi: https://doi.org/10.15344/2394-4978/2022/358
Page 5 of 7

Emergency treatment flow chart

Assessment of the Student

Call Parents
Serious condition

Non-serious condition

Ambulance
Make First Aid

Hospital with a teacher asscorting the student

Clinic/Health center

Under Observing

Home

Figure 9: Behavior flow chart of school health room teachersclassrooms in the schools. In addition, because classrooms havedirt floors and the windows are not sealed, dust can be seen in theclassroom. Therefore, local principals created a clean area in the cornerof the clean library room and used it as a school health room. Theserooms included a bed covered with white sheets, as the screening was
effective when the child was at rest.
Figure 8: Symptom observation items.

Behavior flow chart of school health room teachers
When a child arrives, the teacher in charge of the school healthroom observes along with the flow chart, provides instructions for
rest, contacts parents, provides first aid, and finally inquires with a
medical institution (Figure 9).
Health checkup record
After comparing the items of the child’s notebook draft preparedin Cambodia and the draft by Team Cambodia, the children’s
school health checkup record sheets were finally confirmed by thegovernment school health officer.
Because the child’s handbook prepared in Cambodia did not havethe date of birth, family structure and relationship, birthday record,
dental/internal health checkup, height/weight curve, obesity curve,or education consultation record, the government approved Team
Cambodia’s additions. In addition, the items deleted in the children’s
notebook from the school health checkup were reflexes, genitals, andvenereal diseases (Figure 10).

Discussion
On September 21, 2021, the Cambodian government notified
schools nationwide to set up school health rooms for the reopeningof schools after the pandemic. The standards for school health rooms
were similar to those of Team Cambodia. The total number of children
in Cambodia is on the rise, and thus, there are not many vacant
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In addition, the principals who received school health training
in Japan instructed children to clean up. As a result, the school
health room must be kept at a certain level of cleanliness. However,children wear sandals, and there is a shortage of hand-washing areas;
thus, a foot-washing area was also necessary. The visitor record
was enthusiastically recorded. From the record, we observed many
children who became sick due to the heatwave in March before the
Khmer New Year. For this reason, parents must be reminded to pay
attention to their children’s health in March. Although such alerts
must be given to parents, there is a need to develop news for parents
in the future because of the lack of parental cooperation.
The equipment in the school health room in the model district was
first maintained with a donation from Team Cambodia. A shortageof school funds occurred in 2021; thus, government measures are
expected. Therefore, washing and replenishing linens to maintaintheir cleanliness will be an issue that must be addressed in the future.
The symptom observation record describes the child’s complaint
items, such as general headache and abdominal pain. Because therecord is written in Khmer so that children who attend the school
health room can read it, it can also be used to provide explanations
to the children.
The teacher in charge of the school health room observes when thechild comes to the room and decides what to do. The standard flow
was shown in the chart so that inexperienced health teachers could
decide their own actions based on this flow chart. This chart makes it
clear to the teachers what they can and cannot do in the school healthroom.
IJNCP, an open access journal
Volume 9. 2022. 358

Citation: Shimizu H, Uehara H, Inage M, Ota S, Yamaguchi M, et al. (2022) Evaluation of Social Environment Adaptation to a Cambodian Type of Japanese
School Health Room System. Int J Nurs Clin Pract 9: 358. doi: https://doi.org/10.15344/2394-4978/2022/358
Page 6 of 7

Figure 10: Health checkup record.

We examined the school health checkup records as follows.
Cambodia’s ready-made school health record sheet was preparedin accordance with the 2016 School Health Policy. Among theobservation items of the children in the record, some items, includingreflexes, genitals, and venereal diseases, are difficult to record at school;
therefore, these items were considered to require care at a medical
institution by the parents. On the other hand, family information andbirthdays are important information. However, in Cambodia, thesedata were not collected because, until recently, the child’s birthday
was not recorded accurately. Currently, the birthday is clarified bysubmitting a yellow card at admission.

Phnom Penh and the suburbs. The implementation of school healthcheckups in the training of health teachers is an issue for the future.

Conclusion
The contents of the school health room system proposed by Team
Cambodia have been adapted to the social environment of Cambodia
and put into local practical use. From there, the issues became clear,and it is necessary to proceed with solutions in the future.

Acknowledgments

Team Cambodia added these necessary items in the modelversion. The other item for which the model version differs from theready-made recording form was the time-dependent record of thedental and internal medicine school health checkups. School healthcheckups have not been conducted in Cambodia, and school healthroom teachers have not yet been assigned nationwide; however, if
school health teachers are assigned due to the future development of
the school health room, it will be necessary to proceed with school
health checkups.

We would like to express our gratitude for this research, supportedby the Japan International Cooperation Agency Grassroots TechnicalCooperation Project. We would also like to express our thanks forthe implementation in collaboration with the Ministry of Education,
Youth and Sports of Cambodia.

Therefore, from November to December 2019, Team Cambodia
conducted a model project for school dental and internal checkups in

The author declare that there is no competing interests regarding
the publication of this article.

Int J Nurs Clin Pract
ISSN: 2394-4978

Competing Interests

IJNCP, an open access journal
Volume 9. 2022. 358

Citation: Shimizu H, Uehara H, Inage M, Ota S, Yamaguchi M, et al. (2022) Evaluation of Social Environment Adaptation to a Cambodian Type of Japanese
School Health Room System. Int J Nurs Clin Pract 9: 358. doi: https://doi.org/10.15344/2394-4978/2022/358
Page 7 of 7

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Volume 9. 2022. 358