INTRODUCTION

After nearly 18 months of school closures to lower the prevalence of COVID-19 transmission, WHO and UNICEF advise schools in Indonesia to resume face-to-face learning as soon as possible ⁽¹⁾. The reopening of schools must be done as soon as possible, given that COVID-19 cases in Indonesia are beginning to drop and the extended duration of distance learning creates several physical and emotional challenges ^(2),(3). Distance learning can also raise the risk of long-term interpersonal stress and social isolation throughout adolescence ⁽⁴⁾. Based on these factors, the Republic of Indonesia's government has decreed that restricted face-to-face learning would begin in January 2022, with numerous restrictions that must be followed by all educational institutions ⁽⁵⁾.

The opening of schools increases the likelihood of an increase in COVID-19 cases, and to prepare for this, schools must begin to create various checklists, as indicated in the Joint Decree of Four Ministers on Guidelines for Implementing Learning During the COVID-19 Pandemic. Safe school openings are possible provided sufficient planning and mitigation are implemented, such as through the use of accepTable school opening guidelines ⁽⁶⁾. Back-to-school initiatives must review and ensure the education system's preparation for school reopening, including infrastructure, teaching staff, pedagogy, students and their families; learning continuity; and system resilience to foresee and cope with future crises ⁽⁷⁾. One of the things that the school must prepare is the Health Protocol. The health protocols that must be implemented are as follows: a) use a mask under the provisions, namely covering the nose, mouth, and chin; b) maintain a distance of at least 1 (one) meter between people and/or between chairs/Tables; c) avoid physical contact; d) do not borrow each other's equipment or learning supplies; e) do not share food and drink, and do not eat and drink together face to face and close together; f) apply coughing and sneezing etiquette; and g) regular hand sanitizing ⁽⁸⁾.

Teachers have not adequately executed health procedures during restricted face-to-face learning in primary schools, which focused on wearing masks appropriately and correctly, washing hands, and keeping distance ⁽⁹⁾, despite the fact that schools are an excellent location to teach students the discipline of wearing masks ⁽¹⁰⁾. There is still a lack of awareness of the key tasks of the COVID-19 task force in schools; there has been no official covid-19 task force coaching; coaching is only available through social media and self-taught; Human resources are still scarce when it comes to adopting health regulations in face-to-face learning in schools ⁽¹¹⁾. This is most likely the reason of the threefold spike in COVID-19 cases, or roughly 6000 cases, in August 2022 ⁽¹²⁾.

Face-to-face learning should begin with five critical considerations: reopening schools in phases, keeping physical and social distance, managing infections using testing and tracking accessible in schools, protecting children and instructors, and doing research and assessment ⁽¹³⁾. Starting with the pre-condition stage, timing, priorities, central-regional cooperation, and monitoring and evaluation, the process of opening schools in Indonesia is carried out in stages ⁽¹²⁾. Based on a survey conducted by Fitriah et al.(2020) that The majority of principals, teachers, parents, and education offices are ready to implement face-to-face learning in all aspects, including implementing health protocols during face-to-face learning, but the condition of supporting facilities and infrastructure is still inadequate, including poor health data collection. Although, clinically, children (1-18 years old) exhibit moderate symptoms or no symptoms due to COVID-19, the number of hospitalized children is likewise minimal and no more infectious than adults ⁽¹⁵⁾-⁽¹⁸⁾, Because students, teachers, and other school residents contact in schools, the transmission of this disease must be monitored. This condition produces concern in both students' parents and instructors. Furthermore, parents of students are concerned that their children may spread the disease to their family at home ⁽¹⁹⁾. The reopening of schools during the pandemic has also created concern among parents and teachers because to the possibility of COVID-19 transmission in schools, where students often contact with a large number of individuals ⁽²⁰⁾.

During an era of ongoing communicable disease outbreaks, nurses serve as a valuable resource in preventing and responding to threats to the health of school populations by teaching prevention and basic but important precautions, with a focus on respiratory and hand hygiene, as well as other important precautions, due to the vital roles they play in communication between students, school personnel, and public health officials ⁽²¹⁾. Therefore, nurses have an obligation to participate in overcoming the spread of COVID-19 in school clusters ⁽²²⁾.

Based on this description, it is required to evaluate the application of health protocols during face-to-face learning, which has been underway for roughly 2 months, to serve as a foundation for anticipating the expansion of COVID-19 in school clusters.

OBJECTIVE

To ascertain the adoption of school health protocols during COVID-19 in West Java, Indonesia, as well as the variations in implementation of school health protocols during COVID-1 across participants.

METHODS

RESULTS

Demographic data

This research looked at descriptive information regarding the features of the schools studied. As shown in Table 1, the highest percentage is associated with schools that implemented face-to-face learning during the pandemic (99.7%), while the lowest percentage is related to schools that implemented blended learning and online learning (0%). Learning occurs practically every day (97.8%), and almost all learning time (85%) is spent in line with the school curriculum (Table 1)

Table 1. Characteristics of school. 

Descriptive analysis

The mean score on sub-variable availability of sanitation infrastructure, cleanliness, and health facilities was high (27.49/5.391), with the evaluation of teacher participants yielding the highest mean score (30.52/4.808). Canteen availability has a mean score of 18.84 (4.094), with teacher participants receiving the highest score (19.45/4.298). The last sub-variable, behaviour of adhering to health guidelines, had a mean score of 20.89 (4.641), with the principal's participants having the highest mean score (22.93/4,363) Table 2.

Table 2. Descriptive analysis per sub variabel. 

Overall, from highest to lowest, the evaluation of the implementation of health protocols in face-to-face learning is an assessment of principal participants 74.29 (13.923), an assessment of teacher participants 71.03 (10.551), and an assessment of student participants 65.91. (12.316).

Comparison analysis

Hypothesis 1: There is a considerable difference in participants' availability of sanitary infrastructure, hygiene, and health facilities. The Kruskal-Wallis test was performed to test the above hypothesis, and the results are shown in the Table below: As shown in Table 3, the value of Sig = <.001, which is less than 0.05, is less than 0.05.

Table 3. Comparison analysis based on partisipants. 

Hypothesis 2: There is no statistically significant variation in Canteen availability among participants. The Kruskal-Wallis test was performed to test the above hypothesis, and the results are shown in the Table below: As shown in Table 3, taking into account the value of Sig =.255, which is more than 0.05.

Hypothesis 3: There is a considerable difference in the behavior of participants in sustaining health protocols in schools. The Kruskal-Wallis test was performed to test the above hypothesis, and the results are shown in the Table below: As can be seen in Table 3, the value of Sig =.255 is more than 0.05.

DISCUSSION

In general, learning in elementary schools has been almost entirely conducted face-to-face in the classroom, under the Joint Decree of the Four Ministers, which states that beginning with the 2022-2023 school year, odd semesters of learning have been allowed face-to-face by paying attention to the state of the school area at levels 1 and 2 of the PPKM (Implementation of Community Activity Restrictions) and paying attention to strict health protocols⁽²³⁾. Learning is carried out every day (6 days per week) with a learning duration that is under the curriculum. Only a tiny fraction of schools plan to learn in an alternate method (3 days per week) with a maximum learning time of 6 hours per day or not in compliance with the curriculum. This is because face-to-face learning is tailored to the capability of classrooms and teachers, hence some schools cannot conduct 100% face-to-face learning ⁽²⁴⁾.

The application of health protocols in face-to-face learning is separated into three sub-variables: sanitation infrastructure availability, cleanliness and health facilities, cafeteria availability, and behaviour of maintaining health protocols in schools. The average value per sub-variable is relatively high in general. This is because the school has begun to prepare health protocol infrastructure long before the implementation of face-to-face learning is fully implemented to ensure that the school remains a safe place for everyone to learn and that thorough planning and preparation are undertaken by the principal, teachers, students, parents, and other school personnel ⁽²⁵⁾. Schools must also carefully plan for the reopening of schools and alter existing buildings and infrastructure to meet the defined requirements that are required for schools to reopen⁽²⁶⁾.

The assessment of the teacher in charge of health protocols in the school or the teacher of a health-promoting school delivers the highest average score of the first sub-variable, while the assessment of students generates the lowest average score. The lowest score on this sub-variable is on question item number 10, which concerns the availability of the Peduli Lindungi QRCode at the school's entrance and departure. Almost many schools lack the Peduli Lindungi QRCode as a way of tracing people who enter a public location, including schools, although obtaining the QRCode is simple; every school registers to receive the QRCode online ⁽²⁷⁾. QRCode Peduli Lindungi is also a government initiative to restrict the spread of COVID-19, thus public facility managers should be aware of this ⁽²⁸⁾.

In the second sub-variable on the administration of school cafeterias during the COVID-19 pandemic, teachers in charge of health procedures in schools have the highest average assessment and school students have the lowest. The question item with the fewest scores is number 12, which is about the capacity of the canteen that has been opened 100%, implying that practically all school canteens have been opened properly and the school cafeteria is rarely cleaned regularly. The school cafeteria has been closed for a long time, and the school finally feels ready to reopen the canteen; however, some schools are not ready to open the canteen, so the practicality of the canteen is questionable ⁽²⁹⁾.

The last sub-variable in this study, school health protocol conduct, received the highest average score from the principal's assessment. Question item number 25 has the lowest score of all the question items in this sub-component. This item inquires about the practice of eating together and facing each other without keeping their distance, implying that many students still do not retain their distance and face each other when eating and drinking. This is possible since the school cafeteria has begun to open completely, resulting in crowds when purchasing and enjoying meals from the canteen, as the canteen is also a source of crowds that must be considered when the school opens ⁽²⁵⁾.

In this study, researchers also investigated the differences in each sub-variable based on participants to reach the results: there were differences in sub-variables of availability of sanitation infrastructure, cleanliness, and health facilities based on participants, which suggests that the evaluation between participants in this variable differs from one another. There is no variation in the Canteen availability sub-factors per participant, implying that participants' assessments of these sub-variables are the same. Furthermore, there are variances in the evaluation of sub-variables of the behaviour of maintaining health protocols in schools based on participation, implying that the assessment of these sub-variables varies between one set of participants and another. The equation of the assessment of canteen capacity by each set of participants demonstrates that the research instruments utilized are fairly reliable.

Limitation of the study

The limitation of this study is that data gathering is not directly observed by the researcher, thus the correctness of the data collected from the outcomes of participants filling out the questionnaire cannot be cross-tested.

Contributions to nursing and health

The findings of this study help to broaden nurses' understanding of health promotion as part of nursing intervention, particularly in health-promoting schools.

CONCLUSION

In this study, administrators, instructors, and students evaluated the adoption of health protocols during face-to-face learning in primary schools. The study's findings revealed that the introduction of health protocols in primary schools during face-to-face learning was effective, with a high average total score. Participants' judgments of the availability of sanitation infrastructure, cleanliness, and health facilities varied, as do their assessments of the third sub-variable, the behaviour of upholding health protocols in schools. Meanwhile, there is no variation in evaluation for the second sub-variable, canteen availability.