HEALTH EDUCATION FOR NURSES
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HEALTH EDUCATION
FOR NURSES
Miss. R. K. Manelkar
J® VORA MEDICAL PUBLICATIONS
B O M B a Y - 400 003.
HEALTH EDUCATION FOR
NURSES
Miss. R. K. Manelkar
M, A., M.I.P.H.A., M.R.S.H. (London)
Ex-Lecturer in Health Education & Family
Planning, Post Partum Programme
General Hospital, Sangli & T. N. Medical
College, Bombay.
’ • Publishers :
Vora Medical Publications
6, Princess Building,
Near J. J. Hospital Signal,
E. R. Road, Bombay-400 003.
y-
1 .
(
5
© Publisher
First Edition
Reprinted
-1900
- 2004
Price: Rs 30.00
ISBN 81-86361-37-5
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For Publication, Distribution, Marketing & Export.
Printed & Published by:
Ratilal K.Vora
Vora Medical Publications
6, Princess Building, E.R. Road
Near J.J. Hospital Traffic Signal,
Mumbai: 400 003. (India).
PIONEER OF MODERN NURSING
Born on> 12th May 1820.
Died on.-!3th August 1910
Health Education
CHAPTER - I
HEALTH EDUCATION
In the modem era of health system health education has become
the most important tool in community health. Health education plays
a very important role in delivering health services so much so that
every aspect of community health is health education and every health
worker is a health educator. Health education is concerned with
promoting health as well as reducing behaviour induced disease. Thus
health education attempts to bring about changes in health behaviour
of every individual and to maintain good health. Therefore, educating
people to change their behaviour in order to prevent disease and to
maintain health is probably the primary health care worker’s most
important type of activity.
Meaning & Objectives of Health Education
It is difficult to explain the correct meaning of health education,
as different people have different views and opinions. To some, it
means changing the behaviour of an individual or of people in health
aspects while to others it simply imparts the knowledge on diseases
and how to prevent them, still others feel that indulging in propaganda
or publicising activities of the health departments is health education.
According to WHO Committee “Health is the state of complete
physical, mental and social well-being”, therefore, it is essential to
educate the people by imparting knowledge about health. The
definition adopted by the National Conference on Preventive and
Social Medicine in U.S.A, in 1977 states that “Health education is
a process that informs, motivates and helps people to adopt and
maintain healthy practices and lifestyles, advocates environmental
changes as needed to facilitate this goal and conducts professional
training and research to the same end." Yet another definition is
Health Education For Nurses
2
"health education as a state of health consciousness in a person, a
family or in society which expresses itself in accepted norms for
health behaviour for the environment."
After going through these definitions it is clear that the objective
of health education is to bring changes in the behaviour of people
and remove those unwanted behaviours, which are responsible for
causing or spreading the disease. There are three main objectives
of health education viz. (1) Informing people (2) Motivating people
(3) Guiding them into action.
(1)
Informing People:-
For ages, people have been engulfed in ignorance about how the
illness or disease occurs. They have always accepted it as punishment
from almighty for bad deeds or some evil eyes. But with advancement
in medical sciences, all these notions have been proved useless.
Unless people are given information regarding causes of disease or
illness, there won’t be changes in human behavior Exposure to
knowledge about health will remove the ignorance, prejudice and
misconceptions, that people may have about health. Health Education
would provide them with information on health and causes of disease,
making people aware of health needs and responsibilities on the part
of people. In this way health education provides information to
people.
Motivating people:This is more important as merely imparting information on health
is not enough. People must be motivated to change their habits and
ways of living. This is a difficult task, one time information is not
enough. Motivating an individual or the whole population means
changing their attitudes. Attitude changing is not so easy, as every
individual has a concrete attitude towards everything, which has been
formed through one’s socialization period, by influence of peer groups.
or opinion leaders. Therefore, by using proper channels, educatiori
must provide information, which would influence habits, attitudes,
and knowledge relating to the individual’s family and community.
In short, health education should be like cafeteria service leaving
the choice of decision making about health matters (i.e., what kind
of health practices to be adopted when and how) to the individual
himself.
(b)
(c)
Guiding into action:-
Our people are tradition and culture oriented while our
governments have implemented infrastructures of health services to
fight the National Health Problems such as Leprosy, Tuberculosis,
Blindness Malaria, Mother child health, Population Control and new
problems on AIDS. People need to be encouraged to use these health
services which are available to them. However, the health services
Health Education
3
are not utilized by our people as it should be. Theoretically, health
education forms an essential part of the modem health system.
Structurally, however, it has occupied an isolated position at the
lowest rung of the status of hierarchy in the health bureaucracy. The
health administrators are now recognizing the important role of health
education which would act as cement in making the health
infrastructure a strong one. Many governments have recognized the
importance of health education, which would not only improve the
state of health of the people but also their standard of living and
economical status. Therefore the need for upgrading and reorienting
its role in health system has been perceived due to the following
reasons:
(1)
The important nature of the health education system;
(2)
The decision to provide basic health for All by 2000 AD;
The curative orientation of the Medical Personnel, which
has reduced the effectiveness of the health care
system;
(3)
(4)
As an essential prerequisite for community participation.
Principles of Health Education:Health education acts as a link between Medical subjects on the
one hand and behavioural sciences such as sociology, social
psychology and social Anthropology on the other hand. Therefore,
it is the art and science of medicine. From social psychology it takes
the learning process, while from social Anthropology, it takes the
traditional and cultural aspects of a given population, from sociology
it takes the interaction between traditional and modem behaviour
of a given population. Health education involves teaching, learning,
inculcation of habits concerned with the objectives of healthful living.
To the health education, the community is a classroom where he
could utilize all his experiences, knowledge and efforts to bring about
the desired changes. Health Education is based on the following
principles derived from medical sciences, and behavioural sciences.
(1)
Known to Unknown:-
In health education activities we start from known to unknown
i.e., from what they know and proceed towards what they do not
know. For example, importance of breast feeding. The knowledge
that people have about breast feeding is that it is natural and
traditional but they do not know the other advantages likes its easy
transportation, sterile germ-free and naturally heated upto body
temperature availability. They are also unaware that it develops
immunity against diseases for the baby and results in natural
contraception etc. This, if explained in proper way, will bring new,
enlarged understanding and knowledge. However, it is difficult to
Health Education For Nurses
4
expect immediate results. It is a long process, full of obstacles and
resistance, still it is adventurous and rewarding, if done with devotion.
(2)
Comprehension:-
In health education, it is necessary to know the type and kind
of community, their educational level, their economical status and
type of occupational, their culture, religion, caste, habits and general
behaviour. All this information about the community gives the health
educator the clues for communication. He can either use their own
language and interpret his ideas to suit their standard of living,
thinking and behaving. This will make it easy for those people to
understand him. Communication plays an important role in health
education.
(3)
Reinforcement or Persuasive Communication:-
In order to bring about the desired change one time contact is
not enough, one has to build up a rapport by visiting or contacting
again and again. There should be repetition at intervals. This assists
in comprehension and understanding. An election campaign can give
the classic example of reinforcement.
(4)
Motivation:-
Or desire is of two types, (1) Primary: It includes hunger, sex,
thirst sleep, survival etc., (2) Secondary: It includes motives or desires
which are created by outside forces or incentives. The need for love,
praise, rivalry, recognition, rewards or punishment is felt by everyone.
Motivation plays an important role in health education. Without
motivation it is difficult to change the attitude of a person, in a desired
way. Ideas have to be used to change the attitude of people. This
can be done directly or indirectly. For example, if the individual
is educated or with modem outlook well informed and social
(extrovert), it is easy to change his attitudes, on the other hand, if
he is introvert ethnocentric with values attached to his own culture
and community, it is difficult to change him. Instead the opinion
leader’s help has to be sought for changing his attitude.
Public Relation:This plays a major role in the performance of the health educator
because service with smile, kind advice and guidance is all that
matters to win the confidence of the petson who could be a V.I.P.,
a target for changing the behaviour. The health educator must be
kind, co-operative and ready to help. He must be like one of the
community, a real friend in need.
(5)
(6)
Learning by doing:-
A Chinese proverb says “If I hear, I forget it; If I see, I remember
it; but If I do, I know it." Therefore, health education should be
Health Education
5
transmitted in such a way that until and unless people do not put
it into practice, the education should continue. The fruits of efforts
put in by health educator do not become visible in a short period,
but in the long run their effectiveness can be evaluated.
(7)
Participationt
it is the key word. It is based on active role, and is better than
passive learning. Counselling, group discussions, workshops, seminars
and symposia are all a part of active learning.
(8)
Participants:The people or community to be educated should be categorized
according to age, sex and education. It becomes easy to pass on
the information by using simple language and health education
machineries. The younger the group, the easier it is to tackle the
problems. The health education on personnal hygiene should be
ideally started from primary classes. It is easier to change the attitudes
at a young age i.e., during socialization period when values and norms
are easily accepted as a way of life than at later age when the values
of community have been rigidly imbibed in the minds.
Health Education and Public Health:- '
In modern political system, health education and public health
go hand in hand. In order to make the health programmes acceptable,
it is necessary to change the attitudes of the population. Therefore,
health education becomes a useful tool in the practice of public
health. There are three well known approaches to public health; they
are (1) Regulatory Approach (2) Service Approach (3) Educational
Approach.
(1)
Regulatory Approach:It is also known as legal approach by means of enforcement or
laws approved by the governments to protect the health of people
e.g., laws concerning adulteration of food. Act to protect people
during epidemical disease is practiced during outbreaks of epidemical
diseases. This approach requires not only large machinery equipped
with manpower, but should be really put into practice. If it remains
only on paper, then it is of no use.
(2)
Service Approach:-
Or the administrative approach it has been a failure in India, as
it has not been used effectively nor has it been accepted by the people.
It is used mostly in community development programmes such as
providing latrines free of cost, borewells etc.
(3)
Educational Approach:-
It has been most useful, effective and major mode of achieving
the desired change in the behaviour of people. Though it is a slow
Health Education For Nurses
6
process yet it is a very effective and lasting method. It can be divided
into (1) Individual and family level (2) group level (3) mass level.
The education approach can be utilized depending on the circum
stances and problems. The health problems like individual counselling
or family counselling or group discussion on subjects like nutrition,
immunization, contraception etc., can be tackled.
Utility of Health Education:-
Health Education covers a wide field as it is concerned with
Community Health. It is widely used in outpatient, indoor patient
or in the field; wherever the health service goes health education'
also goes hand in hand. At one stage, when public health was
practiced by the general practitioner, the doctor not only became the
family doctor in dispatching health service but also gave health
education and counselling whenever his patient had any other
problems. But with the changing view of modem practitioners as
a curative agent, the role of health education has been underutilized.
Therefore, the need for health education has come to stay in modem
health service staffing pattern. However, it can be practiced at all
levels to make it more effective and fruitful. It can be utilized in
different fields as follows:Human Biologyt
it is studied right from the school level. If along with physiology
and anatomy, hygiene is also taught effectively, the values attached
to the health can be modified right from socialization period. The
children can be taught about personal care such as bathing, cleaning
their body, hair care, dental care, need for exercise, fresh air, rest
and sleep. The effect of alcohol, smoking and drugs can also be
explained in early stages of life.
(1)
(2) Nutrition:The education in the area of nutrition is to educate people to make
use of available food resources to provide the knowledge of food
value and its usefulness in repairing the wear and tear of the body,
and for the growth of the body. People should be explained that
how good nutrition can prevent diseases and build immunity against
infection etc., as most of the diseases are caused by malnutrition
which is the major problem in developing countries. The Eight WHO
expert committee on Nutrition recommended the education on
nutrition to fight malnutrition. It also includes teaching about storing
and preserving of food.
(3)
Hygienet
it has two aspects (1) Personal (2) Environmental. The Personal
Hygiene should start from a very young age. Personal Hygiene
explains the cleanliness of body such as care of feet, hands, nails,
Health Education
7
hai., teeth, bathing, clothing, spitting and coughing. Personal hygiene
plays a major role in bringing about behaviour changes. Health
Education at school level will be more effective in doing this. Again,
Environmental Hygiene covers two aspects of health education (1)
domestic (2) community level. Hygiene at domestic level includes
fresh air, light, ventilation, doors, flooring, kitchen place, bathroom,
lavatories, road and- gutters; maintaining gardens for fresh air and
playground for children, recreational centres for old, aged etc.,
providing a good sanitary system and keeping it free from pollution.
Environmental Hygiene is regarded as a major task by WHO Experts,
to keep" away the disease and pollution at the global level.
(4)
Family Welfare Programme:-
This is an important area in India for (1) controlling population
growth (2) maintaining the health of mother and children. More stress
is laid on this aspect as government health service in this area has
been a failure. Therefore, the services have been modified to make
it more aeffective. Under Mother-child-health it includes immuni
zation, tost-natal care and family planning services.
(5)
Prevention of Accidents:-
Accidents are a regular feature of modem hectic life. Accidents
in homes, accidents on roads, accidents at work are common
problems, both in rural and urban areas. At home, preventive steps
can be taken at the kitchen level against spreading fire and causing
bums, suffocation due to smoke, care should be taken that children
do not ]?ut their heads in plastic bags, inflammable things should
not be kept near the fire place, injuries may result due to fall from
high level, drug, or medicines having been kept in the wrong place
or without labels and thus administered by mistake. Educating the
people about these minor mistakes can prevent major accidents.
Safety at work, factories, railways, mines and machinery works will
be another preventive measure. This, together with precautionary
education will help to minimise or control the accidents. The road
safety is controlled by Police Department and Public Works
Department. Health Education on road safety is also taught at school
level through National Cadet Corps. However the main cause for
accidents is carelessness.
(6; Control of Communicable &
Non-Communicable disease:
Communicable and non-communicable diseases such as Malaria,
STD, AIDS, trachoma, leprosy, tuberculosis, dental disease, drug
addiction, alcoholism, blood-pressure, diabetes, cardio-vascular
diseases etc. require health education either to control the spread of
diseases or to eradicate them.
Health Education For Nurses
8
Mentel Health: ■
The emphasis on the study of mental health is the outcome of
modem life. An increase in mental problems is noticed when an
agrarian society changes into an industrial or urban one. This
brings about changes in behaviour and affects the mental health. The
trauma, a shock, or isolation or a particular incident could affect
the mental state. Here the patient needs sympathetic care and
rehabilitation for which education of relatives will be useful for the
health educator.
(7)
Acceptance of Health Services:A person working in Government health agency has to see that
the health services rendered by the government reach the target
population and in turn accepted by them. Therefore, he has to provide
health education and make propaganda of it. For example, National
Health programmes etc.,
(8)
Methods of Health Education:Health Education is carried on at three different levels individual, group and general public, by using mass media of
communication.
Individual & Family Health Education:This is also known as counselling. This is done in privacy. When
an individual is reluctant to accept the health services, he along with
his relatives and opinion leaders are called and given the health talks
and explanation by using models, audio-visual aids, leaflets,
pamphlets to read, according to the prevailing requirements. Topics
for health education can be selected according to the situation. The
counselling is done in the hospital by doctors, nurses, health
educators, extension educators or co-ordinators. But in case the
patient or individual is reluctant to see the doctor concerned, the
public health nurse and field working staff have to make a home
visit and give the health education. In this method, the health
educator has to create a friendly atmosphere before coming to the
subject. He has to create confidence in the client. The advantage
of individual discussion is that we can argue, persuade and change
his attitude. Still it has its limitations, it is time consuming, hence
it is difficult to cover the whole given population in short a time.
1.
2.
Group Health Education:-
Every society is made up of a number of groups. A group is
a collection of people with a common goal such as a class, a family,
mothers' group, teachers, group, patients, industrial or factory
workers. Group teaching is an effective way of educating the
community. The health topic will depend upon on tne type of group.
For example,at anti-natal clinic health talks on nutrition; follow-up
9
health Education
schedule health check-up, preparation for labour,contraceptive
methods eic.t can be selected for group teaching. This, together with
audio-vistat methods such as leaflets, booklets, models, exhibiting
charts or posters on walls, should be utilized for further effect.
(3)
Group Discussiont
it can be a small or big group. The smaller the group, the easier
it is to manage. There is “two way communication”. In this method
one gives the information and tries remove the doubts of the people
by discussing their problems. Views and experiences are also
exchanged. In this group the members should be extrovert, then
only discussion will be made more interesting. The members should
know each other, so that a feeling of awkwardness will not be felt.
Every point must be recorded. The group discussion is always
effective. In turn the members of one group can educate others acting
as opinion leaders to lay people..
Panel Discussion:In this method there are 4 to 8 members on a panel. Among
them one person acts as moderator or chairperson. They are qualified
persons to talk on a given topic and discuss a given problem before
the audience. The chairperson opens the speech and introduces
members. He introduces the topic and invites the panel members to
give their opinions and discuss the topic. It is the chairperson who
carries on the discussion smoothly effectively and for sufficient time.
After the panel members have presented their views, people from
the audience are invited to give their opinion. If the members of
the audience are not prepared, they are given time and discussion
is then carried on. This system is very effective if planned well.
(4)
Symposium:Symposium is a series of speeches on a given subject. There is
no discussion among the members. The chairperson makes a brief
summary at the end. The members from the audience may ask
questions about their problems.
(5)
Lectures:Are given to a large audience, as in the college or before a large
audience, who have gathered for hearing the newer knowledge. This
is a one way communication, hence it is not so effective. The lecturer
must have high a pitched voice and be a talented orator.
(6)
Demonstrations: This is useful in nutrition education. The demonstrator has to show
how a tasty, cheap nutritious dish is made; a nurse can show a mother
how to bathe the baby. A demonstration leaves a visual image on
the minds of people and is effective among illiterate people.
(7)
ffealtK Education For Nurses
10
Role Playing:Role playing or social drama is played by a group assigned with
roles to represent the story based on some health problems. The
audience listens, watches and digests the message through Lie drama
played. Sometimes puppets are also used to enact a story. Fo. this
stories from local incidences are selected; folkstones, folkways,
folkdances are also adopted to make it more appealing to the
audience, because people always prefer their ow.i tradition and
culture. Role playing is a useful technique to use in providing
discussion of problems of human relationships. Ro’.e playing followed
by a discussion of the problem is an effective method of teaching.
It is better suited for young school children and village folk; as they
can grasp the subject through it rather than through talks, which they
find boring.
(9) Institutes:The institutional ways of imparting health education has its
origin in the U.S.A. It has become popular in big cities in our country
under the popular names of “Forum of so—and—so.” They hold
various panel discussion, seminars, symposia etc. The main objectives
of such institutes is to provide information and knowledge about a
prevailing topic of interest to the population.
(10) Programmed Instructiont
it consists of a schedule for of testing one’s knowledge on a
subject It consists of sets which are used one at a time for testing.
It consists of questions like filling up blanks, or pairing the phrases
as well as solving problems, answering questions or any other
instructions. This is useful in collection of data for finding out the
knowledge and attitude of given population.
Educating the General Public:This is done on a large scale. It is the most difficult task. There
is only one way communication and the effect is measured on a
statistical scale. This is done by using mass media of communication.
The traditional mass medium in rural places was that by beating the
drum in public places, the informer would gather the public and give
the message. Sometimes they propagated the message by the bullock
cart using a huge megaphone so that the informer’s voice could be
magnified to- reach the public. With advances made in the scieiltific
field new media have been put to use. They are. (1) News Papers:These contain information from Government, private and social
fields, economical market, public entertainment programme and
forum of free enterprises where public opinions are printed. There
is a separate column for editorial views, sports, games, adverjisercents
on various topics like birth, death, marriage, -engagement,
matrimonial, job vacancy and so on. The news papers also issue
special supplements on weekends and on special occasions. In
(&)
11
Health Education
Western developed countries the press is free to purhch its opinion,
white in .India it is controlled by the govemmer.l. The news paper
is the most widely used communication system among the educated
lot.
Magazines:- There are various magazines available on
different subjects meant for youngsters, teenagers, women and men.
They provide us with information on different topics from health
to wealth. The health magazines are also published in many Indian
languages. (3) Posters or wall papers:- These are yet another
medium, through which the messages can reach millions. People
curiously watch the posters and would like to get information. It
should be presented attractively with a catchy slogan. Social
psychologists can develop the best of communication system. Posters
have a short life, because, as they get old, people lose interest. Posters
are useful for mdustrial products or fashionable clothing etc. In health
education it can be used only during any epidemic or campaign. (4)
Health Exhibitions:-Consists of set a of charts telling a story or
stages of diseases, prevention, care, curative methods, etc. If properly
organized by pre-planning and pre-propaganda, it can attract a large
number of people. Small mobile exhibitions are useful at fairs, and
festivals. (5) Health Museums:- are better than the health exhibitions.
They are permanent ones. A good exhibition can be very effective.
It can be put in the garden place as in Baroda and Hyderabad. (6)
Flow charts, flipcharts flannel graphs, flash cards:- are handy a
set of aids which can be used in small group talks. They are more
effective than only talks, as they help to attract and make the people,
who are participating in talks concentrate on the topic. (7) Radio,
Television and Cinema:- arc a good medium for spreading any
message. They are useful for illiterate people. However, our people
are more interested in seeing entertainment programmes like film,
drama, music than the ones which give them useful information and
knowledge. Radio has an advantage over television and cinema,
because while listening to the radio one, can do some other work,
but in case of television or film show, one has to concentrate on
the screen.
India is dominated by a traditional society. The health education
has adopted the media to suit the culture and tradition of Indian
Society. Therefore, The Traditional Folk media channels include a)
Drama b) Kathputhli or Puppet show c) Kirtan Bhajan (Hinduism)/
Qawali (Islam) d) Yatra or Mela e) Nautanki f) Tamasha. This
medium in the Indian context, enjoys some unique features and
advantages over other media, these are:(I) The medium has a historical continuity in the cultural
tfcvelopment of the country.
(2) In "vti culture the spoken word is considered sacred.
(3) It Is Tally integrated with the values and philosophy of life
of our people.
Health Education For Nurses
[2
(4) The performers are part of the audience from v/hich they are
locally drawn. Thus there is a common sharing of the symbols, words
and actions oi the communicators and their audience.
(5) The understandability and credibility of the medium is very
high as it embodies the value system of the people, their attitudes
beliefs, customs, philosophy of life, behaviour patterns and thought
professes.
(6) The presence of folk media even in remote areas of die
country, can serve the need and fill the modem media gap in the
non-urban centres. As they are very often locally improvised, their
cost is much less compared to other modem media.
(7) According to communication experts, the more precarious the
people’s economic living conditions are, the larger is the role which
folk media occupy in their lives. In this sense, these are the poor
people’s chief communication channels and it is this poor group
which has remained outside the reach of modem media in our
country.
Planning & Evaluation:A health education programme requires three kinds of careful
planning:- (1) Diagnosis or assessing the health needs, problems,
attitudes and behaviour of individuals, families and communities.
their risk of illness and then deciding which of their ways of behaving
can be changed by education, and how they can be changed. (2)
Designing and testing a health education programme with the
participation and support of the people who will be involved in it.
(3) Co-ordinating the programme with other development workers
and organizations that can assist in development and education. When
a thorough diagnosis of a community is completed and has taken
into consideration all the issues, successful implementation of a health
education programme will be more acceptable to the participating
or target group, and more likely to lead to internal motivation that
will change behaviour.
Before, designing and implementing a health education programme
the health educator must understand as much as possible about the
general socioeconomic situation and related epidemiological patten s
of illness in families and communities. To promote an effective health
education programme the health care workers must look beyond the
known illness patterns to the personal attitudes, behaviour and
community activities which cause or encourage the spread of those
diseases. The health care worker must determine also whicn ol the
health-related attitudes and behaviours contributing to die spread of
illness can be changed by health educauon. Then the healtn workei
is ready to work with community representatives in designing an
appropriate educational programme.
13
(1)
Health Education
Assess Community health Prohlems:-
Using information available from health officials or other sources,
the health worker analyses carefully the health problems of the
community. Illness can be prevented if people know what the most
important diseases are, how they spread, how they are affected by
people’s behaviour, and how they can change that behaviour.
(2)
Determine health behaviour:-
It is important to find out why the risk-groups are vulnerable
to health problems and which kinds of personal behaviour e.g.
hygiene, nutrition, fertility, sanitation, are likely to promote or
ihcrease the chances of health problems. Individual and group
altitudes feelings, ideas, beliefs, and customs lead to such behaviour
and all aspects of those health-related attitudes and behaviour should
be made investigated, in order to determine which attitudes can be
changed by education.
Because of the limited availability of health workers and other
educational resources health care workers must decide which groups
and individuals are:- 1) Most in need of education because of critical
health risk. 2) Most likely to be receptive to the introduction of ideas
affecting health behaviour. 3) Most likely to be able to change their
behaviour once they have accepted new ideas. These characteristics
will help to indicate, which groups should be the primary target group
of the education programme. Initial educational 'success' with a more
receptive group early in the educational programme will increase the
chance of success with a more difficult group at a later time.
Opinion leaders
and Communicators:-
The health worker also should look at the channels of
communication within 'at-risk' groups in order to determine which
members of the family and community would be most effective in
educating others. The health worker should find answers to the
following questions: What is the role of father or mother in making
decisions for the family about size, -diet, sanitation practices
expenditure etc.? Which political, religions, tribal qr other community
le&ders influence decisions affecting health, nutrition or fertility?
Which health-related subjects should be communicated by whom?
Those who may be important in a health education programme
arc traditional healers, midwives, tribal chiefs, religious teachers,
school teachers, administrators, political leaders, trade union leaders,
and leaders of voluntary. organizations. The involvement of key
community individuals and groups in developing the educational
programme is essential if it is to be accepted and effective.
Health Education For Nurses
14-
The messages of the health education programme must be
understandable, acceptable and possible for the people to act on. For
example, mothers can be taeght to take simple important steps to
keep their children healthy. They should o Bring children for immunization.
o Breast feed for about two years.
© Recognize danger signals for diarrhoea and coughing.
• Give child salt and sugar water when he has diarrhoea.
o Wash and keep child clean to prevent any infection.
Plan for appropriate time & place:The educational programme should be held at a time and place
most accessible and comfortable for the participating community.
This may include:
1. Community meeting places or centres.
2. Home visits or small discussions.
3. Clinics or health centres.
4. Schools, Clubs, folk-singing
temples etc..
gathering, Mahila-Mandals,
Group meetings should be carefully planned by (1) Meeting in
a known traditional place. (2) Adequate publicity well in advance
of the occasion. (3) Comfortable place, size, temperature, quiet place,
etc.
Use Appropriate teaching Aids/Methods:The health care workers should learn to develop and use
educational methods when available and to develop visual aids such
as posters, blackboards, flipcharts, etc.
Opportunities for Health Education in Hospital and Community:There are ample number of opportunities for giving health
education in the hospital at the individual and group level both in
outdoor patients’ departments as well as indoors in the wards too.
Every O.P.D., should be equipped with flow charts, wall charts.
leaflets, booklets and flip charts as per the subject that the O.P.D
is dealing with. These activities can be carried out with assistance
from student nurses. While the patients are waiting to be examined
the health talk with the help of flip charts can be carried out. If
the patients are educated, then leaflets and booklets can be provideo
for reading and they can be even told about the wail charts too.
For example in Anti-Natal Care O.P.D., the Public Health Nurse or
Staff can select the topic on nutrition and personal care, hygiene
and exercises of the patient. The follow-up schedule, its importance.
15
Health Educatior.
preparation for delivery, contraception etc., can also be included in
the health talks. In medicine O.P.D., topics such as care of the body
hygiene, diet, exercises, rest, etc., should be included. In the centre
open space, if there is any, a film show or health exhibition can
be organized. Service with a smile, a pleasant smile with ‘how do
you do’ is all that will win the patient’s confidence and then one
can slowly tackle the health infonjnation. Posters on walls should
be kept changing as per availability and supply from the hospital
store. The same charts or posters will make the walls dull and
uninteresting. People always look for new things.
In the wards or indoors, posters should be put on walls to attract
the lying in patients as well as visitors. In the afternoon or when
the doctors’ rounds are over, the health exhibition activities can be
started. One day health talk can be given, either by using microphones
or tape recorder. Some other day flipcharts can be used or anatomical
parts can be explained with the help of models. In this way the
patients can understand where the conceived baby remains in the
uterus and where tubectomy is done. Sometimes film shows can be
organized both for patients, relatives and visitors. While administering
medicine or taking temperature, try to share patients doubts and fears
about the disease and its treatment, give confidence and explain the
facts.
Those health workers who work in the community have more
chances of imparting health education than those in hospitals. During
survey and home visits the health worker must keep her senses alert.
She should be able to see if any member is suffering from illness
or is affected with disease. Here she can hold individual and family
counseling or group-talks which may be verbal and with flipcharts.
Flipcharts are more handy as compared to other aids. If need be
she should give assurance and referral note. In the community she
should organize group-discussions, meetings, health exhibition and
film shows for people and the opinion leaders, gram panchayat staff
and very prominent members of the community. By using these VIPs
of the community, one can change the attitude of the target people
and it becomes easy to motivate them. So orientation training should
be organised camps for opinion leaders rather than the lay people,
who will not respond so easily. As explained earlier the modus
operandi of the health education programme, if followed properly,
can bear fruit to some extent for health education is not one time
effective but it is a long run process which should start from school
age till old-age, to get the desired result.
Role of a Nurse as a Teachers:-
Education in any form is the production of changes in human
behaviour changes in what people know, in what they think, in
what they can do and in what they actually do. Viewed broadly.
Health Education For Nurses
16
education is the most potent force yet discovered for moulding a
free society into the desired form. It is the most basic means available
in a society for promoting things 'good' or things 'bad'. Guiding it
properly and making it effective, therefore, is ’ a high-level
responsibility and a vastly complex undertaking. All modem societies
place education at the top in their value system as a means of
promoting progress by the people. The person who imparts the
education is the teacher. The nurse, while giving health education
to her patient, is playing the role of a teacher. Therefore, as a teacher,
which is a noble occupation, she should perform the role perfectly.
Just as the school teacher while imparting the education to his pupils,
sees that it is given without expecting a reward or immediate result,
in the same the way, nurse as a health teacher to the patient should
impart the health education without expectation of reward or
immediate result Education is a continuous process, it should be
carried on effectively and perceiving communication, then only the
effort will bear fruit in the long run.
Health Education in India:In India, the importance of health education was recognised long
run before independence. In fact social reformers and like minded
rulers had built a permanent health museum, as the one at Baroda
and the other at Hyderabad. The following events will explain the
changes taken place for upgrading health education activities:1929 -
Recognizing the importance of health education the
Directorate of Health Services of the then State of Mysore
established the publicity unit
1940 -
By now most princely states had established the publicity
unit
1946 -
Bhore committee had recommended the health education
bureau at central and state level. The integration of health
education in preventive and curative health pin-pointing al
sections of population including school children as target
for health education.
1954 -
Central council of health recommended the establishment
of state health education bureau (SHEB).
1956 -
Central Health education bureau was established (CHEB)
at New Delhi.
1957 -
Ministry of Education set up the health education, nutrition
education committees to prepare syllabi on health education
for school and training courses.
1963 -
Extension Education, Mass education and publicity was
included in Family Welfare programme.
Health Education
17
1964 -
State Family Welfare Bureau included the post of Mass
Media Officer and specialist in Health Education Officer.
1969 -
Lecturer in Health Education and Family Planning in
type A Post Partium programme was created in teaching
hospitals functioning through the Department of Preventive
and Social Medicine.
1979-80 -Extension Education
work.
Work to boost up Family Welfare
1984-85 -During this period 50,000 orientation training camps were
held in villages and urban slums.
1989-90 -World Health Organisation observed “Let’s Talk Health”,
which gave the priority to Health Education Activities.
Communication Skills
CHAPTER - H
COMMUNICATION SKILLS
The world has never seen a time when the role of the
communication has been as important as it is today. This is so because
the world has never seen a time when there was so much to know,
so much that people need to know, and so many who want to know
so much, and so quickly. Certainly, while working among slums or
in a rural development project, nothing is more important than the
transfer of useful ideas from one person to another. In this process
of communication lies the potential for millions of village people
to overcome ignorance, poverty, and disease, and to attain a status
of economic and social well-being.
Interaction & Communication
Human interaction is based on communication. The behavior of
one person, the messages that he sends by speaking are received by
an other person and he responds to that message by another message
which the first person receives and so on. The simplest everyday
instance of such communication and interaction is the way in which
two illiterate rustic persons interact with one another when they are
angry. Yet another illustration of such interaction is the mother-child
behaviour. The child, who is ten to twelve months old, will get
stimulated and will stimulate the mother in innumerable ways. We
not only communicate our emotions to the other person, but we also
communicate information that is most vital for the survival and
promotion of culture. Sharing of information will make that
information the common property of the whole group, I'J. thus
enchance the cu.'t'iral life of the group It increases tbc store of
information in each member of the group. Since lone’s attitude
towards anything depends on one’s store of information about it,
Health Education For Nurses
19
sharing of information also enables the sharing of attitudes, though,
of course, this is not always inevitable.
Fig. 1 Interaction Situation
(From New Comb T. M. “Social Psychology”.)
CHA«Acre«/ST;
CHARACTERISTIC
OF
INtDIVtOUAE
GROUP
msrriBERs
INTERACTION PROC
In the above figure 1 the process of interaction is explained. The
individual at A has his own motives and attitudes when he enters
into the interaction process as in arrow 1. Each group has its own
shared rules or norms which affect the interaction process as in arrow
3. As a result of the interaction the motives and attitudes of the
individual may be affected and some change may be brought about
as in arrow 2. The changes in the individuals who are interacting
may bring about changes in the characteristics of the group as in
arrow 4. This is a simple way of depicting the complicated social
situation where the group influences its members through interaction
and how these individuals can influence the group characteristics.
Nature of Communication
Communication is the process by which two or more people
exchange ideas, facts, feelings or impressions in ways that each gains
a common understanding of the meaning intent and use of messages.
The term communication stems from the latin word communismeaning common. Communication, then is a conscious attempt to
share information, ideas, attitudes, and the like with others. In essence
it is the act of getting a sender and a receive tuned together for
a particuler message, or a series of messages. Communication means
the movement of knowledge to people in such a way that they act
on that knowledge to achieve some useful result. This result may
20
Communication Shills
range all the way from a small improvement in doing some productive
task, to the generation of a sense of national unity and strength in
the country. Communication in this sense includes the entire learning
process. It encompasses the teacher, the message or material to be
taught-thc means or media used to carry the message; the treatment
given by those media-th'e learning achieved by the audience or student
and the actions by which the learning is put into practice. Good
communication, therefore is the essence of good extension teaching.
One has not taught, if he has not communicated.
Communication is essential to all human association. One’s ability
to influence others is closely linked with one’s ability to communicate
one’s ideas. The essence of learning is the gaining of the meaning
of new ideas in relation to recognised problems. For two or more
people to engage in the common, cooperative effort, they must be
able to communicate with each other. To strive toward common goals,
they must have a body of common knowledge and ideas.
Much misunderstanding results from faulty communication. Too
many people saying the wrong things at the wrong time, in the wrong
way, to the wrong people, slows down progress. What is needed is
more people saying the right thing at right time, in the right way,
to the right people. This is the formula for good communication.
Critical Factors in Communication:
Communication is a process. Process is an act of proceeding a
series of actions definitely conducive to a desired end. There are
three phases of communication (1) Expression (2) Interpretation and
(3) Response. If the expression is not clear, the interpretation is not
accurate and the response is not proper, one’s effort to communicate
will not succeed. Following arc th<± key facts for bettet
communication.
ilU t'U IO 'O fc
The central task of health educators is to promote common bodies
of knowledge, attitudes and skills among the community members
that will help them to improve their own health and the health of
their kith and kin. To teach and lead the villagers to understand,
accept and put new knowledge to work for them is a gigantic task
and one that requires great communicative ability. Diffusing
knowledge is a relatively easy task. Getting people to understand,
accept and apply it is the difficult one. It is a challenge to the health
education worker. Good communication does not consist merely of
giving, orders, but of creating understanding. It does not consist
merely of imparting knowledge, but of helping people gain a clear
view of the meaning of knowledge. Most of the progress in the future
will stem from better technology and greater skill in communicating
to others.
Health Education I'or Nurses
21
1. Communication is limited by one’s concept of the
communication process. There are many different concepts
communication, a. The linguists—about vocabulary, grammar and
writing, b. The reading experts as well listening experts, c. The
rhetorians. d. the journalists, e. The visual experts-about photography,
colours, symbols etc., f. The broadcasters on the air or on television.
g. public relations and advertising experts, h. Behavioral scientists.
Each unit has its own values. By combining these values the
communication has to be developed.
2. Communication is a two way process always involving
interaction between those who are aspiring to communicate and those
who are the receivers. The health educator as a communicator must
make the audience understand clearly what is to be learned and what
they should do about it. Questions and comments by the receiver
and observation of his behavior are good ways to tell if one has
really communicated one's message. Direct questioning by the com
municator establishing a friendly environment and a permissive
climate arc others among the many methods for making
communication a two-way road to loaming. The two-way process
is necessary to assure that the information presented is interpreted
as intended. Without this the response cannot be as desired, because
the respondent cannot know exactly the kind of action that is
expected of him.
3. One must have correct ideas before one can communicate with
others. One must communicate about things that exist, that are real,
and as the audience secs them. Implied here is the fact that people
must be willing to listen, negotiate, arbitrate and discuss, so that
communication takes place. In considering ideas to communicate, one
should not cling always to what one knows is so, but must also
pay some attention to what the audience thinks is so.
4. The system of symbols used to represent ideas, objects or
concepts must be accurate and used skillfully. Practically all
communications arc done by the use of symbols. A symbol is a
substitute for a real object.
It is the abstraction of an idea. It is the symbol which when
understood conveys meaning by reason of relationship, association
or conventional use. The use of symbols is necessary because of two
primary reasons: (a) the inconvenience, impracticability or impos
sibility of having objects always available when one wishes to convey
ideas and (b) many abstract ideas can hardly be made clear except
by the use of symbols. For these reasons, early man invented language
as e mcens, vornl or other, of expressing or communicating his
feelings or thoughts. More recently, people concerned with
communication have created a wide range of devices referred to as
22
Communication Skills
visual and audio-visual aids. Al! of these arc symbols in one form
or other and arc employed to express ideas or feelings through sound,
shape, colour or motion. Symbols are useful for a person only when
he understands what they stand for. For example, the symbois used
in statistics or other forms of matnematics mean nothing to him until
he understands the object, concept or action they represent. Likewise,
word symbols to which an audience is unable to attach meaning do
not communicate. Visual aids, either in the form of words, colours,
shapes or motions, must be chosen so as to (1) represent the ideas
they are expected to convey and (2) be readily understood by the
audience. The basic means of communication is words. Words are
more effective when supported by other forms of symbols that also
communicate, such as the many forms of visual aids. Words link
together all human association, and form connecting links in every
human relation. How many words are there. The number of course,
differs according to the language understood. Word symbols have
no meaning to a listener unless he perceives in his experience the
object or idea the word symbolises. Not only must such symbols,
be selected and used that convey meanings to a learner, but it can
also be expected that the symbols used may convey different
meanings to different persons. Not only complex words, but even
common ones thought to have only one meaning are often misleading.
For example the word “run” has more than 800 meanings and the
word “table” has more than 14 meanings when used as a noan.
Hence, all symbols used to communicate ideas must be so chosen
and used so as to convey mental images to which the audience can
attach realistic meaning in terms of useful behavioral change
Symbols are known as non-verbal method of communication while
words are known as verbal method of communication. Effective
communication in health education is assumed to be a matter of
promoting learning. This being accepted, it must be further assumed
that communication offers something useful to be learned. Learning
cannot go on in a vaccum. It requires content or subject-matter.
Something must be learned when learning takes place. Communi
cation must have a message to be conveyed to an audience. A
message is an information which a communicator wishes his audience
to receive, understand, accept and act-upon. This is the mode of
changing the attitudes. Changing of altitudes is the most difficult
task to be performed by the Health educator. Il is lhe most important
factor studied by social psychologists, and behavioral scientists.
According to Allport “an attitude is a mental and neural state
of readiness, organized though experience, exerting a directive or
dynamic influence upon the individual’s response to all objects and
situation with which it is related”. Our attitudes are derived primarily
from social influences. From birth, the human-being is enmeshed in
social institutions which constitute his environment in lhe same sense
Heqlth Education For Nurses
23
as the physical world. The home being the primary social unit, has
a great influence on the formation of one’s attitudes. This is why
later experiences cannot easily alter these altitudes.
How attitudes are formed ' Attitudes are formed by the following
factors experienced by an individual in his life.
(1) Acquired from family members, relatives and peer groups from
births or through socialization.
(2) Personal experiences.
(3) Traumatic experiences.
(4) Cognitive approach which can be positive or negative, (here
cognitive approach are those formed during cognitive process by
which concepts, interpretations and understanding are achieved.)
There are different theories based on different assumptions for
studies in the formation of attitudes. They are (1) Conditioning and
Reinforcement theory in which the basic assumption is that attitudes
are learnt like other habits since childhood. Just as people acquire
informations and facts, they also acquire feelings and values
associated with these facts. According to their view the principles
and theories derived from studying the learning process can be applied
to attitude also. (2) Incentives and Conflicts Theory - According to
this theory a person adopts that attitude which maximizes his gains.
It views the attitude situation in terms of an approach, avoidance
or conflict. (3) Cognitive Consistency Theory—though people differ
considerably among themselves, this theory generally assumes that
there is a tendency for all the people to seek consistency among
their cognitions and that this a major determinant of all attitude
formation. According to these theories, whenever there is
inconsistency between a particular set of beliefs and values and
ar.oJrer set of beliefs and values in an individual he strives to alter
them so that they become more consistent with each other.
Factors affecting attitude change:Whcn a health educator wants to change the opinion of the people,
he has to change the attitude of the people. This can be changed
by (1) Through mass media, propoganda. (2) Attitude may change
though direct .experience. (3) When there is a change in a cognitive
component, there could be a change in attitude. (4) Through
legislation e.g. removal of untouchability etc.,
Communication Process in attitude change Communication—>
24
Communication Skills
COMMUNICATOR-----► COMMUNICATION
SURROUNDING
SITUATION
TARGET
PERSON WITH
PREVIOUS COMMITMENTS
Fig-2
As shown in fig. 2. There must be a “Communicator” who holds
a particular opinion on some issue and is trying to convince others
to hold the same opinion. In order to do this, he produces a
“Communication” designed to persuade people to change their views.
This Communication is presented in a given situation. These three
things constitute the essential features the source, the communication
and the situation and surroundings. But the communication may not
reach the target intact. Probably the communication may not reach
the target at all because the lines of communication do not exist.
There is considerable evidence with regard to what is now
identified as the “two-step flow of information”. Most people do not
read the newspaper and do not hear the radio. Only a small fraction
of society reads newspapers carefully and hears the significant
programmes on the radio. These people tend to be the most influential
members of their community or group. "They are called the Opinion
leaders" because they have a considerable impact on the attitudes
of their associates. They pass on the information to their friends.
By means of this "two-step flow of communication" some of the
pursuasive material does reach the people. Thus one of the critical
points in propaganda and attitude change is to reach these opinion
leaders.
Public Opinion:
Though the term “Public Opinion” is familiar still it is difficult
to define. According to Allport, a social psychologist “The term
Public Opinion is given its meaning with reference to a multi
individual situation in which individuals are expressing themselves,
as favouring or supporting or else disfavouring some definite
conditions, person, proposal of widespread importance in such a
proportion of number, intensity and consistency as to give rise to
the probability of affecting action, directly or indirectly toward the
object concerned.” It is clear that public opinion arises with respect
Health Education For Nurses
25
io some issue. It is also clear that there are differences of opinion
regarding the issue. If the whole group has one opinion about the
problem there is no question of public opinion. Public Opinion
implies that there is a difference of opinion about the problem that
there is a controversy, some people are holding one view and some
others holding another view. It also implies that these two or more
groups try to mobilize the whole group or, at any rate, the majority
of members of the group, so that some definite action may be taken
with respect to the problem.
Formation of Opinion:
An issue begins to take root only when many individuals have
the same or similar opinions and when another group has a different
opinion. The next step for each group is to increase its own strength,
so that it’s view can prevail. Each group will write articles in the
newspapers, hold public-meetings, enlist signatures and so on so as
to convert as large a proportion of the group as possible to its point
of view. This is where the groups employ the techniques of
propaganda which will be described in another section. The opinion
may be a well-informed opinion or it may be an uninformed one.
Propaganda:
Is an act of advocacy. It is a deliberate attempt to use one sided
statements to a mass-audience. The aim of propaganda is to convert
people to the views of the person who undertakes it. He may use
many kinds of symbols, words, gestures, flags, posters etc. He may
use various media of communication.
Techniques:
(1) Repetition: An impression becomes more permanent and
influential with repetition. People are ready to accept a statement
that is commonly asserted by others, eg. repeated advertisement of
brand names etc.,
(2) Exaggeration: is another technique used in commercial
advertisements and during election campaigns. For example osc of
words and phrases like The Best, Unrivaled etc.
(3) Identification: We arc easily impressed by a fimiliar person
rather than by a stranger. There are several ways of identification,
a. familiar expression b. Using familiar environment c. identification
of interest of the people and using it as target.
4. Appeal to authority: Identification with a familiar or popular
personality by using him as representative etc.,
5. Appeal to discontentment: Comparison with unfamiliar object/
subject
6.
Use of Slogans: or catcny phrases,
26
Communication Skills
Therefore, ii is clear that for good results the health education
should have persuasive communication. Persuasion is important in
the daily life of every human being, because each individual is highly
dependent on others for securing the basic needs of life as well as
for education enlightenment, entertainment etc., As human interaction
increase, the necessity for persuasion also increases. One of the
distinguishing features of persuasion is that it always involves
communication. At the simplest level a communication situation
exists where one person (source) transmits a message that is received
by another individual (receiver) and is acted upon by that individual.
Thus communication situation is a typical interaction situation.
In order that a communication situation becomes persuasive, it
must involve a conscious attempt by one individual to change the
behavior of another individual or a group through the transmission
of some message. Thus in persuasive communication the main aim
of the source is to deliberately produce a message designed to elicit
some specific behavior in the receiver, whether it is an individual
or a group. Consequently, persuasive communication can be judged
in terms of its success or failure in producing the desired behavior
in the receiver. The effect of persuasion is indeed difficult to judge.
Haveland and Jains suggests that persuasive effects can be looked
upon as bringing about attitude changes which may lead to opinion
changes affect changes and perception changes. According to them
attitude change is the underlying variable.
There are four basic factors in persuasion, which appear to be
central to persuasive communication from the point of the receiver,
namely variations in the source, in the message, in the channels used
and in the situation itself. As regards the source, the important factors
are his creditability, social power, social role, relationship with
receiver and various demographic factors such as age, sex,
occupation, caste, religion etc. Regarding message, the important
factors are not only the organization of the message, but also the
appeal used, the language, and the style with respect to the channel
(style depends upon whether it is a face-to-face situation or through
the newspaper, the films, the radio, the television, or advertisement
and several other channel) Finally, there is the problem of the
situation, whether the persuasive communication is in the presence
or the absence of others, whether it is communicated in familiar or
unfamiliar surroundings, whether it is given at a pleasant moment
or not etc.,
The term propaganda has a bad reputation. Since it is associated
with the deliberate manipulation of public opinion to serve the
interests of a small group, it is associated with the use of special
techniques to increase the power of a small group over the majority.
Health Education For Nurses
27
The techniques of propaganda may be used for anti-social
purposes or to enable the people to know the dangers of the
population explosion and change their attitudes in order to learn the
techniques to control the birth rate and to accept the small family
norm.
Propaganda & Education:
The aim of health education should be to educate the people,
so that they arc able to discriminate between propaganda used to
improve anti-social objectives and that used to improve the conditions
of living and to enchance the value of the individual in the society.
The chief aims of education are (a) to give knowledge and
information and (b) to enable the individual to be critical in his
outlook. On the other hand, the aim of propaganda is to convert
people to accept certain propositions and views; in other words,
indoctrination. The aim of educative process is to convince while
the aim of propaganda is to convert. The teachers will present both
aspects; those in favour and those against, and leave it to the
individual to make his own choice or remain neutral, but the aim
of the propagandist is to present only one aspect of the problem and
decry the other aspect, so that the individual will accept the view
promoted by him and reject the other viewpoints. The objective of
the superior kind of newspapers is to educate public opinion. While
in the editorial columns, the editor of the newspaper expresses his
own opinions in the other columns he will publish the opinions for
and against. This will enable the critical readers to form their own
judegments.
Mass-Media
Right through, it has been noticed that the attempts to change
attitudes and public opinion and the attempts to deliberately influence
the thinking of the people using propaganda techniques are made
through the mass-media. We may now consider the problems
connected with mass-media.
Mass-Media includes newspapers, cinema, television, radio, ad
vertisements etc.,
Mass communication is the mass production and mass distribution
of public messages which can reach people within and outside the
country. This is a characteristic feature of the industrial society. There
is a mass production of messages for education and for entertainment
by special institutions set-up for this purpose by the newspaper
companies and news agencies, the cinema, the radio, and the
television studios etc., Highly trained specialists work in these
institutions to keep a regular flow of messages. Both the mass
production and mass distribution of these messages is possible
28
Communication Skills
because of the developments in technology and because of the
formation of huge institutions for this purpose and because the
modem nations have come into existence.
Mass communication is directed toward a relatively large
heterogeneous and anonymous audience. This is why mass media are
used by propagandists in order to influence or change public opinion.
Mass communication systems are quite powerful since they can reach
a large audience in a brief span of time. They can have tremendous
impact.
As regards the nature of communication experiences mass
communications are public rapid and transient. They are public
because they are not directed to any given individual or group. They
are rapid because the scene can be witnessed on the television or
movie screen as it is happening, the news can be heard on the radio
within a few minutes of occurrence of the event and can be read
in the newspapers within a few hours. The mass communication
messages are transient because they are intended to be consumed
immediately. Put some of them may be safely deposited for further
use in film libraries and radio transcriptions.
Studies have been made to investigate the effect of mass-media
on attitude and opinions. Two types of responses have been noted
(1) strengthening of attitudes that have been already held by the
receiver. (2) Changing the attitude that has been held by the receiver,
that is from positive to negative or negative to positive. If the receiver
is well informed then the effect will be negative and vice versa.
As has been seen already, the agents of the attitude formation aresocialization, peer-groups, new experiences, group morale, ethnocen
trism education etc..
Art of Listening & Observing:
During health education activities it is essential to keep a watch
over the audience. (1) Whether each and every individual or member
of the audience is listening, watching or paying full attention to the
ongoing programme before them. (2) It is a common habit of women
to carry their young ones with them, who in turn not only distract
the mother, but also other members from concentrating on the health
talks or show. Therefore, it is necessary to prevent the child from
accompanying the mother. (3) Sometimes people are not interested
in attending health education programmes, but attend them for the
sake of getting some gift, tea, snacks etc as in case of orientation
paining camps. In such as case, they do not listen or watch
attentively. Therefore, it is necessary to keep watch over the audience
to see whether they are listening. One should also observe the
expression, and remarks made by the audience. One should also note
whether the on going programme is against their cultural values,
Health Education For Nurses
29
ethics, religion etc, et., All these have to be noted down, which helps
to prepare the next programme witn better effect and result.
Principles of Reporting and Recording:
In order to keep an account of the work done in health education,
it is necessary to write down the notes oa each programme organized.
These should include place of activities, type of people, community,
socio-economical data, literacy level, number of male, female,
children, day, date, time, total hours, age-group of audience and
whether target group is present i. e., eligible couples should be
exposed to health talks on family planning methods, mothers groups
should be told about immunization. After entering all this information
in a diary, make a special note on “listening and observation” whether
they had previous knowledge, or were without information, whether
they were attentive, cooperative or not.
The year 1989-90 was observed by WHO as “Let’s talk health”,
which gave importance to the health educatioi activities. In order
to create the awareness of health, the health education indicators have
been formed. Each health centre is given a target on health education
activities. Therefore, the reporting is an essential task for which the
efficient recording as mentioned earlier is very essential. Recording
should be done immediately and perfectly after the performances.
When the information is fresh in the mind one can write down
information to the pin-points, clues etc, in the registers provided for
health education indicators.
Audio Visual Aids
CHAPTER - HI
AUDIO VISUAL AIDS
Audio Visual Aids are that part of teaching, which imparts
knowledge and inforrration to the lay people for changing their
attitude from negative to positive or positive to negative, as it holds
the audio (hearing) visual (seeing) senses together to give accurate
information. The visual aids help to hold the attention of the audience.
They make it easier to understand the message being propagated.
They axe entertaining and stimulating, and most important of all they
increase the possibility that the ideas and concepts will be
remembered.
But they will not do the justification tc the job by themselves.
Visuals aids are only helpers. What one has to say and the way it
is said is most important. Therefore, it is necessary to prepare the
message/talk before hand and carefully. Give it considerable thought.
The more imagination and enthusiasm one uses, the more effective
one will be. However, one caution is necessary in any and all visual
aids. They are only helpers and what their name implies — just aids.
They will assist the user, but the aids cannot do the actual job of
communicating. That is upto the educator — and the amount of time
one spends in preparing one’s potentials.
Values of Visual Aids:
An old Chinese proverb says :If I hear, I forget. If I see, I
remember, If I do, I know. This proverb suggestn hea_-.ng alone is
not enough in the learning process. One must see and try ><. co,
along with hearing in order >_o gain understanding. Telling alone, fx
example, is usually not enough to promote learning that results in
action. Visual and audio-visual aids offer teachers a fast, accurate
Health Education For Nurses
31
and direct approach to understanding on the part of learners. Good
visual and audio-visual aids are good communicators. “The best way
to a man’s heart is through his stomach but the best way to his
brain is through his eyes and ears.” Some evidences indicate that
85% of what is learned is through the eyes. Therefore, the use of
visual aids in teaching cannot be overlooked. It must be pointed out
that the contents of the visual-aids must be explained, if they are
to be effective. Visual aids are a universal language and over come
the following difficulties:-
(1) Overcome language barriers:- Where the learners and teachers
do not speak the same language, there are language barriers, which
can be overcome by the use of visual-aids.
(2) Reach more people:- Visual aids permit the health educator
to bring learning to more people in less time. He can use his
knowledge and skill to produce visual aids that may reach thousands
of people while he can personally • e.ch only a few.
(3) Make learning faster:- When people understand things, they
learn faster and remember longer. Visuals make understand); g clear
and explain ideas in a univeisal language.
(4) Make learning real:- Words alone may not convince people.
People believe what they see. When visuals are used to show people
new practices they are more convinced than when words alone are
used.
(5) Reach many people at low cost:- When the cost of visuals
is figured on a per-person-reached basis, it is low, as the same visuals
can be used many times.
(6) Adapt teaching to local conditions:- Visuals can be locally
produced to fit local conditions. Visuals suited to the people ar.d
to the available materials can be made locally.
(7) Visual aids help to hold the attention of one’s audience. While
the verbal message is given, the non-verbal message or visual aids
hold the public attention.
Uses of selected Aids:
The: are several basic principles which apply to all types of
visual aids. So, let’s go over these principles together.
Know your Audience: Take some time to think about the desires,
needs and customs of your audience. A talk you give to the mothers
handicraft club will be different from a presentation to the farmers’
association. This is because the needs and interests of the two groups
are different. Talking to a community about using fertilizers when
what they need most is improved public sanitation could lead to
32
Audio Visual Aids
failure and disappointment. Try to find out what the community feels
is its greatest need.
Choose your objective:- May be you want to introduce a new
idea, or technique....encourage people to adopt something. Don’t try
to do too much at one time.
Select your method:- The informative talk is probably the most
often used. It may describe a process or method, explain principles
or facts, or introduce a new idea. You may want to stimulate
participation by presenting a problem to the group and then ask them
to try to solve it. The narrative or story is another type of approach.
You will probably find yourself using a combination of this and other
methods.
Prepare a script or outline:- First write out all the things you
want to cover in your talk. Next, check to see if you have tried
to cover too much. If so, select the most important points and
eliminate the less necessary ones. Finally, pick out the main points
and use visual aids to emphasize them.
Prepare your presentation:- You should prepare your talk well
in advance of giving it. This is important so that you can practice
it. Try it on your friends. Get them to tell you what was not clear
in your presentation. Then make any needed changes.
Choose your visual aids:- Will you use posters or flipcharts.;
a chalkboard or flannel board? In making your decision, you should
consider the cost and availability of materials.
Making visual aids:- Directions are given in the following pages.
Be Enthusiastic:- Deliver your presentation with enthusiasm. Face
your audience and talk loudly, clearly and with confidence. Stand
so that all may see your visual aids. Arouse audience interest by
using your aids dramatically.
Encourage participation:- One way to do this is to ask the
audience questions and encourage discussion, know all you can about
your topic, so that you can lead the discussion.
Summarise the main points:- After the discussion summarize
and emphasize the main points which have been brought out.
Allow time for questions:- Always leave time for a question and
answer period. This gives an opportunity to clear up points which
the people may not have understood, and offers the audience an
opportunity to contribute their ideas. You can also make a quick
evaluation of your effectiveness by observing the reaction of the
audience at this time.
SELECTING THE
VISUAL AID
GENERAL DESCRIPTION
RECOMMENDED
AUDIENCE SIZE
Chalkboard
A rigid surface painted green
or black; on which on can write
or draw with chalk.
10 to 30 people If used with
more, a large board is needed
and careful audience place
ment is necessary.
Flannel Board
A piece of flannel, flannelette.
terry cloth or felt cloth at
tached to a rigid surface on
which cut-out figures will ad
here if backed with flannel or
felt cloth, sand paper or glued
sand.
15 to 20 people. Audience
size depends on the size of
the flannel board and the size
of the figures that are being
used.
Posters
A message on a large sheet of
paper, and with an illustration
and a simple written mes
sage.
No limit, because it is not
necessary for everyone to
look at a poster at the same
time
Flip charts
Illustrations made on paper
that is usually larger than 21
cm by 27cm, bound together
with rings or string They flip
over in sequence
15 to 30 people. Audience
size depends on the size of
the flip chart illustrations
Flash cards
Illustrations made on heavy
paper that is usually smaller
than 21 cm by 27 cm. The
illustrations are not bound, but
are arranged in sequence
5 to 15 people. Because the
illustrations are small, nc
more than 15 people should
be in the audience
Bulletin Boards
A surface, at least 3/4 m by 1
m, into which stick pins can be
placed. Drawings, photos and
lettering can be displayed on
the board.
No limit, because it is not
necessary for everyone to
look at the bulletin board at the
same time.
Demonstration
Using actual ingredients,
tools, or land, the educator
shows how something is
done. Either at that time, or
soon thereafter, each audi
ence member displays "h
ability to do the new thing.
1 to 30 people Because it is
difficult for an educator to fol
low up on more than 30 per
sons. this is the recom
mended limit.
Slides
35 mm film in plastic or card
board mounts 5 cm by 5cm. In
color or black and white, they
are projected on a screen or a
wall.
About 30 people. Though
slides can be used with more
people, the educator can
stimulate better discussion
among a smaller group.
Filmstrips
Strip of 35 mm film, color or
black and white. Photographs
in sequence. Filmstrip pro
jected on screen or wall. Uses
projector with filmstrip
adapter. Filmstrips horizontal
or vertical format.
About 30 people. Though
filmstrips can be used with
more people, the educator
can stimulate better discus
sion with a group of this size
Film
Color or black & white, 16 mm
or 8 mm cinema film, with
sound, projected on a screen
or wall.
30 to 100 people. Group can
be larger than 100 but it is
difficult to have any discus
sion with larger groups.
TOOL YOU
NEED
ADVANTAGES
DISADVANTAGES
Inexpensive, can be homemade, easily
maintained, minimum of preparation
Enables audience participation. Used
day or night.
Transport can be difficult in remote ar
eas. Limited to the user’s artistic ability
Inexpensive, easily made from local
materials. Easily maintained and trans
ported in remote areas. Figures can be
used in different presentations. Ideal for
showing “sequence of events" and re
viewing lesson, as figures can be
brought back on the board
Requires considerable advance prepa
ration. Difficult to use out of doors if there
is any kind Some artistic ability is re
quired if making homemade figures.
Inexpensive, easy to make. Requires a
minimum amount of time to prepare and
use. Easy to transport
Deteriorate rapidly. Can confuse the
audience with too much or too little infor
mation. Need some artistic ability if
making own posters
Inexpensive, can be homemade, and
can be easily transported Good way to
give information in sequence; because
they are bound, illustrations stay in
sequence
Deteriorate with constant use. Some
artistic ability required if making home
made flipcharts.
Inexpensive, can be homemade from
local materials Good way to present a
"changing" message in areas where
people gather.
If out of doors, weather damage can
occur Constant supply of good educa
tional material to put on the board is
needed
Excellent way to use actual materials in
a real situation. Uses local materials
Easy to understand by people not used
to looking at illustrations. Good way to
get audience participation.
Takes a lot of pre-planning and prepara
tion
Dramatic, less expensive than cinema
film, excellent way to bring distant things
to audience and to show time sequence
Battery-operated projectors available.
Local photos easily made.
Easy to damage, easy to get out of
sequence and project upside down or
sideways. Requires projection equip
ment, mains electricity or batteries, and
darkened projection area
Dramatic, less expensive than cinema
film and slides. Once inserted correctly
in the projector, impossible to get out of
sequence. Can show photos of the real
thing and shows sequence in time. Bat
tery-operated
projectors available.
Relatively easy to transport.
Requires projection equipment, can be
damaged, requires either mains or bat
tery-supplied electricity (Sometimes
batteries are expensive.) Requires
darkened projection area. Limited ap
propriate filmstrips available.
Dramatic and gets the audience's atten
tion. Shows motion and therefore helps
explain step-by-step and time sequence
very well.
Very expensive, requires expensive
equipment, electricity and dark projec
tion area. Difficult to transport and oper
ate.
Health Education For Nurses
33
Evaluating the presentation:- After your presentation evaluate
its effectiveness. Ask yourself: -
(1)
(2)
(3)
Was the people’s interest aroused?
Did they understand the ideas expressed?
Were they stimulated to change or to act?
Simple Teaching Aids Preparing.
Posters:- Simple ideas can be graphically presented by making
posters which combine picture and short headline.
Good posters tell their story at a glance. Thus, they must present
brief,clear ideas and be eye-catching. A concise, striking slogan draws
attention and is easily remembered. Colourful drawings, designs and
pictures also hold the attention of the viewer.
Three Kinds of Posters
There are three general types of posters in which we are
interested. (1) A poster attempts to inform, remind or encourage
people to do something. Posters reading 'Build your own fish pond'
'Join thee green revolution' - 'Use I.R.8. Rice' are some examples.
(2) The announcement Poster tells of a coming meeting,
conference, show or celebration. It is an effective way of informing
many people in a short time.
(3) The educational poster teaches people one principle. They are
often used in a series of two or three. They should stimulate the
reader to learn more about the subject.
(4) Posters differ from the other visual aids we have discussed
because they must be able to do the job alone. No one is usually
around to tell the reader anything more than what the poster conveys.
Planning the Posters:In making posters first write out on a sheet of paper the words
that express the message. Also, draw a rough sketch of the picture
needed. Next, cut down the number of words and try to think of
a slogan or phrase which expresses the idea, such as “A HAND UP
- NOT A HANDOUT”.
Once you have decided on what the poster will contain make
a small scale working poster. This will give you an idea of what
the finished product will look like. Also, it lets you make any changes
easily.
Materials To Use:You are now ready to make the poster. Thick construction paper,
cardboard or newsprint can be used. Possible writing material-
34
Audio Visual Aids
include coloured chalk, heavy wax crayons, black ink, water colours,
poster paint, heavy coloured pencils and felt-tiv marking pens.
Posters vary in size, but ones 55 cm. wide by 70 cm. long (22"
x 28") or 70 cm. wide by 112 cm long (28" x 45") are most effective.
Avoid crowding the letters by first lightly penciling in letters and
lines. Then fill in the letters. Most of the lettering should be 5 cm
(2') high. If too many of the letters are smaller, you are trying
to say too much.
Use colour to attract attention and for contrast. Don’t overlock
the possibility of cutting the poster to a shape which helps convey
the message. For example, posters cut in the shape of fertilizer bags
helps to suggest the use of fertilizer.
Flannel Boards:-
Easy-to-make flannel board and cut outs add drama to village
level programmes and help people remember the message.
The flannel board allows you to illustrate a story or an idea as
you add cutouts one by one. In this way you hold the interest of
your audience by action and suspense.
The Board:- The flannel board is easy to make. Use 3/4 or 1/
2 inch plywood, hardboard or thick cardboard. Saw a piece 80 cm
(32”) wide by 120 cm (48") long, a board this size will serve an
audience of up to 160 people. If the board is made to fold in the
middle it becomes easily portable.
The Cloth:- The board is covered with flannel, flanette, felt
or even mosquito netting. A dark coloured the cloth doesn’t show
dirt as fast, and is easier on the eyes. In securing cloth to the board,
stretch it taut and secure it with pins, tacks, staples or glue. The
cloth may also be secured to the board with elastic or string. Sew
a hem in the flannel then run the elastic or string through the hem.
The flannel may now be stretched over the board, or tied to it.
This way the cloth may be rolled up for travelling. Also, the
flannel may be removed and the board used for another purpose.
Some workers take only the rolled flannel with them when they travel
and then secure it to any available stiff backing where they make
their talk
The Cutout:- The heart of the flannel board is the cutout. Cutouts
may be drawings, pictures from magazines or newspapers,
photographs, printed words, silhouettes, or any kind of illustration.
Three dimensionalc objects made of sponges, balsawood, styrofoam
may also be used. The cutouts should be atleast 15 to 20 cm (6"to
8") high but may also be larger. In making letters, remember that
a letter 3 centimeters (about 1") high can be seen at 10 meters
(32 feet).
Health Education For Nurses
35
If you cut illustrations from magazines, mount them on cardboard
or heavy poster board; or, it may be easier to draw the picture
on a sheet of heavy poster board; or draw the picture on a sheet
of paper and mount it as a cut illustration.
On the back of the cutouts you must put some material to make
the cutouts stick to 'he flannel. You can use strips of sandpaper
pieces of llanne1, felt, flanette or woolly blotting paper. Secure the
backing materials to the cutouts with glue or gum. If these materials
are not available, coarse sand may be sprinkled on the back of the
cutouts after spreading glue or the surface.
Using the Flannel Boards:First organize your talk, then decide what illustrations to use ard
then make them. To help you organize the order of presenting the
cutouts, numbe them 1, 2, 3, 4, etc., in the order that you will use
them.
Be Dramatic:In making your presentation be sure to build up your story
dramatically — using the cutouts one by one to hold the attention
of the audience. In some cases, it helps to collect the cutouts in
a folder or large envelopes. If the folders are numbered and labeled,
it will help you to quickly locate the desired cutout the next time
you make your talk.
Chalk Boards:The versatile chalkboard helps the audience understand as you
draw diagrams or list the main points of the talk. The many uses
of the cnalkboard (or blackboard) make it one of the most widely
used visual aids. It can be used to draw pictures and diagrams write
down key words for emphasis or to summarize the main points of
a talk. Organizing materials and programmes for a conference is
easier with a chalkboard. It can also be used for writing directions
for using or making something, or to describe some process step
by step. These are just a few uses—how many can you add?
Making a Chalkboard:A fixed chalkboard may be made by plastering a smooth surface
on a wall. A good size is Im x 1.3m (90" x 50"). The mortar is
made of four parts sand and one part cement. When the plaster is
almost set, the surface is smoothed with a steel trowel.
Before you try to paint the mortar.be sure it is well cured. This
is done by keeping it wet for about two days, and then allowing
to dry completely.
A portable chalkbnaid can be made from plywood or pressboaid
after sand papering the surface till it is s ncoth.
36
Audio Visual Aids
Tips on painting the Board:- To paint your chalkboard there
are special paints available if you can find them. However, if you
can’t, you can make your own. Be sure to use a non-glossy or “flat”
paint. (Chalk won’t stick to glossy surfaces) Black or dark green
paint is the best.
The key to making your own paint is to add a slight abrasive
that will cause the chalk to mark. First, take an old kiln-fired brick
and grind it to a fine powder. One good way is by rubbing two
bricks together and using the powder obtained.
Next sift the powder through a cloth. Add one part sifted powder
to 10 parts of paint for the final coat. Be sure the powder is thoroughly
stirred into the paint But remember, use this special paint only
for the last coat
Chalkboard Hints:- If coloured chalk is available, use it to
emphasize points and to make diagrams easier to understand, while
yellow chalk on black paint is more likely to be available.
To prevent permanent impressions from getting oh your new
chalkboard, condition it Do this by patting the entire surface with
an eraser or folded cloth filled with chalkdust.
Keep the chalkboard clean. Never use oily rags to clean your
board as this will ruin the surface.
The methods of preparing material so far discussed are meant
for big sizes. Making handy board and preparation of glue, chalks,
etc., are explained further to give more imagination and ideas.
How to make a Flannelgraph:The flannelgraph is essentially a piece of cloth fastened to a
stiff backing. The cloth may be felt, flannel, suede or cotton cutting,
burlap flour or potato sacks, a rough weave blanket, turkish towel,
or any other roughly napped material. The backing may be
wallboard, masonite, plywood or heavy cardboard. The following are
instructions for making a portable flannelboard.
Materia ls:2 pieces of masonite, plywood or cardboard each 75 x 50 cm
1 piece of flannel
75x 100 cm.
canvas hinges or heavy masking tape
Process:-
1.
Join 2 pieces of board together by using canvas (or metal) hinges
or by using heavy masking tape.
2.
Flannel (or similar material) may be stretched over the boards
on one side and glued in place, or it may be tacked to the
Hen1th Education Eor Nurses
37
board only when used and folded under the arm for traveling
purposes. Other ideas for mounting flannel are provide in the
“Suggestions” section.
Suggestions:- The measurements given here are only suggestions.
Adapt them as you see fit, keeping in mind the size of the audience
and the space needed for your usual visual presentations.
When not being used as a flannelgraph, the board may also be
used as a bulletin board. By drilling or punching several small holes
along one side of the 2 boards, you can loop pieces of string through
the holes and hang it on a wall.
If you prefer to combine the flannelgraph with a blackboard,
prepare one or both sides for a blackboard, following instructions
under “Portab'c Blackboards.” You can then use one side as a
flannelgraph and the other side as a blackboard for making notes
and illustrations suggested by the group during discussion.
38
Audio Visual Aids
The important thing to remember in using a flannelgraph is that
it works best when placed at a slant (10° to 15° angle). If it is
used in an upright position, the pictures will fall off—no matter how
.irmly secured with backing material. It will therefore be necessary
to use some sort of easel (see “Bamboo Tripod Easel”) or to prop
it against a table, for example, at an angle.
To ensure a tight fit of the flannel over the board, use a slightly
larger piece of flannel than the board and hem a length of elastic
band along the edges. The fiannel backing can then be easily slipped
over the board and will have a smooth, flat fit. When not in use,
remove the flannel and fold it for storage.
NOTE: Fasten pieces of sand paper to back of pictures to be
used on flannelboard.
HOW TO MAKE TWO DIFFERENT FLIP CHARTS
The following instructions are for making a durable flip chart
that can stand without any support (that is, it does not need to be
held or does not need any other presentation stand). Included under
“suggestions” are ways in which it also can be used as a “mini”
chalkboard or flannelboard.
Materia ls:2 pieces of plywood or thin (5 mm) hardwood measuring
45 cm x 50 cm
2 strips of wood measuring 38 mm x 40 cm x 8 mm
2 hinge joints
2 bolts and 2 wing nuts
piece of cord 3 mm thick x 28 cm long ruler, pencil, paper
Process:1. Drill two holes in each long wooden strip at approximately
13 cm from each end.
Health Education For Nurses
2.
39
Hinge each strip to a piece of plywood.
3. Place a sheet of paper, the size that you will be inserting
in the flip chart, on one of the joined wooden strips and plywood
boards. Position the paper in the middle of the top edge of the wooden
strip. With a pencil, gently punch a hole through the paper that
corresponds to the holes in the wooden strip.
4. Remove the paper and measure the distance from the side and
top of each hole. These are the measurements you will use in
punching holes in the papers you will be inserting in your flip chart.
Punch holes in all the papers you ate going to use. Be sure to
add some additional clean sheets for further notes or drawings that
may come up in the discussion.
5. In the middle of the bottom edge of one plywood board, drill
a 3 mm hole. (This now becomes cover A.)
6. In the middle of the bottom edge of the other plywood board,
cut a vertical slot 2 mm wide and 1.5 cm long. (This now becomes
cover B.)
7. Stack your papers together evenly. If the holes have been
punched accurately, you should be able to see through the holes.
Audio Visual Aids
40
8. Insert a bolt through the back of each hole in the wooden
strip of cover A. Place cover A flat with the bolts sticking up (the
hinged joints should be flat against the table). Insert punched (face
up) papers over bolts.
9. With the hinged surface of cover B facing you, place it over
the punched papers, inserting the bolts through the holes in the
wooden strip of cover B. Fasten securely with wing nuts.
10.
Pass the cord through the hole at the bottom of cover A.
Health Education For Nurses
41
Make a knot at both ends of the cord large enough so that it will
not slip through the hole. To keep the flip chart open while you
use it, pull the cord through the vertical slot, until the second knot
catches in it. The flip chart will now stand up A).
Suggestions:- For further adaptability of your flip chart, you may
want to consider painting the inside of one cover with a flat black
paint which will give you a small chalkboard. (See instructions for
preparation in recipe book, under "Chalkboards") The other inside
cover can be covered with a piece of flannel to give you a small
flannelgraph.
a Use plain, pliable paper in the flip chart (not cardboard:) sc that
you can easily flip through the pages.
0 Newspaper can be cut and used as pages in the flip chart.
Remember to select newspaper pages that are free of large print
and photographs as these can be very distracting.
o This flip chart can be easily refilled so feel free to tear off any
sheets and give to members of the group for their reference.
o The addition of blank sheets placed e:ther at the end or interpersed
throughout the presentation will allow you to make notes and
respond to the group discussion.
o If more than one subject is included in your presentation, or
if the topic you are discussing has several different components,
use blank sheets to separate the components.
o Experiment with writing on the paper you use in the flip chart
before binding it:
make your drawing big and bold, use thick lines. Stand at a
distance to check that the drawing or writing can be easily seen.
-
you can use crayons, chalk, felt pens or charcoal to write on
the paper; chalk and charcoal have a tendency to smear easily
and, if used, should be protected by a blank cover sheet.
-
Some inks will soak through one sheet of paper and onto the
next; you may have to do your ink drawings or writing before
placing them in the flip chart.
® The measurements of the boards are only suggestions; use
whatever dimensions you desire. The size of the flip chart is
determined by the number of people with whom you plan to use
it. Keep in mind that the covers of the flip chart should be
larger than the pages and that the length of the wooden strips
should be the same width as the boards for the cover.
42
Audio Visual Aids
• If you have someone cut the boards and strips, ask that the holes
be drilled at the same time. If you use the measurements
suggested, you might simply show the diagram to the person
cutting the materials with the following instructions.
NOTE: If flip-chart will have heavy use, glue strips of tape
or paper where holes will be punched and around edges of
paper.
I need:
2 boards cut with these measurements
2 strips of the same material cut with these measurements.
Please drill two holes in each wooden strip, each
end.
13 cm from the
In the middle of the bottom edge of one board, drill a 3 mm hole.
In the middle of the bottom edge of the other board, cut a vertical
slot 2 mm wide and 15 mm long.
If this is done before you begin putting your flip chart together, you
need only do the following steps in the process: 2, 3, 4, 7 - 11.
You can use metal, cloth, or canvas hinges. If hinges are not
available, drill additional holes at the same point in each wooden
strip and board and use a loop of heavy co.d for the hinge.
Health Education For Nurses
43
Flip Chart #2: The following instructions are basically the same
as those given for the first flip chart. However, this flip chart
will not be freestanding and offers less protection for the enclosed
pages than does the first flip chart. It also involves fewer materials
and is cheaper and easier to make.
Materials:1 piece of plywood (or similar material), 40cm x 50 cm
1 long strip of plywood, 40 cm x 40 mm
2 bolts and 2 wing nuts
Process: 1. Drill two holes at the top of the plywood board approximately
13 cm from each end. Drill two matching holes (13 cm from each
end) in the wooden strip.
2. Position a sheet of paper slightly below the top of the plywood
board and center it. Gently punch a hole through the paper that
corresponds to the holes in the board. Taking the measurements of
these holes, punch holes in all sheets to be used.
3. Place bolts through back of board and slip the punched sheets
over the bolts. Place the wooden strip over sheets, inserting bolts
through the holes in the strip. Secure firmly with wing nuts.
Read suggestions and adapt Ideas given for Flip Chart #1.
44
Audio Visual Aids
CHALKBOARDS:Making a cloth Chalkboard:- This small portable chalkboard
which is both light and easy to carry can be used with groups
ot up to 15 people.
Materia ls:a 55 x 75 cm piece of oilcloth
a round wooden pole or stick
a can of opaque black paint
sandpaper.
Process: 1. Roughen the shiny side of the oilcloth with sandpaper. Apply
two coats of black paint, allowing the first coat to dry thoroughly
before applying the second coat.
2. When the paint is dry, fix a round, smooth wooden rod or
pole to the long end of the painted cloth.
3. Connect both ends of the rod with a piece of "ord so that
you can hang it on a nail.
4. In rolling up the chalkboard, '•oil the painted side in so that
the unfinished surface is on the outside.
Suggestion:- If oilcloth is not available, use a. smooth, thick piece
of cotton cloth. Give the cloth a very thin coat of (carpenter’s) glue
on one side. When glue is dry, apply two coats of paint as above,
remembering to let each coat dry completely.
Before using chalkboard, go over it with an eraser containing
chalk powder to make it erase what you write.
PORTABLE CHALKBOARDS
Materials:55cm x 75 cm piece of linoleum, plywood, masonite or similar
material. If you are planning to carry this chalkboard, remember that
the material you select should be lightweight.
Sandpaper
Black paint or chalkboard pa:nt
Process:-
1. Whatever material you select, whether it is smooth as linoleum
or rough as plywood might be, it should be sanded carefully to an
even roughness.
2. A.pply two separate coats of black paint to the roughened
surface. Be sure that the first coat of paint is dry before applying
the second coat.
Health Education For Nurses
45
3. A good wooden frame is suggested to help prevent warping
and to give the chalkboard more permanency.
CHALKBOARD
Suggestions:- Before using the chalkboard, rub a chalk-dusty
eraser or cloth over it—it will be easier to write on !
CHALKBOARD PAINT
1 part lamp black
1 part varnish
1 1/2 parts of kerosene Mix varnish and kerosene thoroughly
before blending thoroughly with lamp black.
MAKING CHALK
Ingredients:-
1 part soil to 4 parts water
Process:-
1. Shovel up some chalky looking soil. Put in bucket, leaving
room for about
.imes as much water as soil.
Audio Visual Aidi
46
2. Add water and stir vigorously. Crumble large pieces and
dissolve soil as much as possible. Ignore hard rocks or pebbles.
3. Allow soil to settle overnight.
4. Pour water off the top and skim off top layer of silt. (This
is usually several inches thick.) The top layer you have just skimmed
off is “chalk” in a liquid state.
5. Put “chalk” in bag made of muslin or similar coarse, porous
cloth and let drip overnight. To speed up the process, water may
be squeezed out.
6. Roll chalk, which now looks like clay or bread dough, into
long, snake-like pieces, cut to desired lengths, and let dry. Or, split
bamboo stalk and use for chalk mould. Thicker chalk will not break
as easily.
7. Now test it. If your soil is the right kind, you have chalk.
Suggestions:- You may be puzzled about how to find “likelylooking soil.” One way is to observe what people in the village use
for marking. For example, in Nepal, red clay is frequently used by
villagers for marking.
• If you want colored chalk, add any dye available in the village.
FORMULAS AND SUBSTITUTES
INKS,
DYES
AND
PAINTS
FORMULA
22 cc alcohol
14 cc water
2 grams dry or powdered blue dye
Other dyes which may be used instead
of indigo blue are:
orange
green
Add ingredients and stir well.
Experiment with using dyes common
to your area.
DYES AND PAINTS
A wide variety of roots, barks, seeds,
and leaves can be used.Check with
local dyer for ideas or buy commercial
dye. Mix with a thin glue solution until
desired consistency is achieved (same
consistency as paints commercially
prepared). This glue, can be made/
obtained from the residue of boiled
bones.
Health Education For Nurses
47
How To Make Paste
FLOUR PASTE
Commercial wheat or cassava flour
Water (as needed)
Remove all lumps from the flour by
sifting it through wire screening. Add
water as needed to the flour to form
a smooth paste. Insecticide may be
added in areas where insects are a
problem. WARNING: If insecticide is
used, store out of reach of children who
sometimes eat paste !
Another recipe:-
Suggestion:- In Nepal, field workers have found that cooking a
minute of flour and water, stirring it constantly until all flour is
dissolved, is a good means of preparing.paste. Allow to cool before
using.
RICE PASTE:
and another recipe:
Handful of rice
Water
Cook rice in water as usual until
rice is moist and sticky. Do not
allow rice to become dry. Allow
to cool, drain off any excess water.
Dab a small amount of cooled,
sticky rice on area of paper on
which picture is to be -mounted.
With finger, smooth rice onto
paper pressing out any lumps.
Picture can then be mounted.
RUBBER CEMENT
Ingredients:-
5 grams of raw rubber (translucent, light brown sheet kind-crepe soles
from shoes, or some baby bottle nipples may be used)
250 cc of uncoloured gasoline (If not available, see below.)
Process:-
1.
Put rubber and gasoline in a jar with a screw top.
2. Let stand about 3 days until rubber is dissolved in gasoline.
3. If any globs of rubber remain, stir until dissolved. Rubber
cement should be smooth and milky-colored in appearance
4. Store in airtight brown bottle in ventilated cupboaro. One
idea you may want to try is to insert a one-inch paint brush through
48
Xudio Visual Aids
the metal cover of the jar. This will then give you a brush with
which you can apply the rubber cement.
Suggestions:- If uncoloured gasoline is not available, use the
following process to filter colored gasoline:
1. Take a clean tin can and puncture a hole in the bottom. Place
a small piece of cloth at the bottom to keep particles of charcoal
out of filtered gasoline.
2. Fill the rest of the can with small particles of charcoal.
3. By holding the can over a bowl, pail or other container, pour
the gasoline over the charcoal.
4. This process may have to l>e repeated several times to remove
all color from the gasoline. Charcoal also may have to be changed
after 3 to 4 pourings.
CAUTION:- Gasoline-is flammable. Use care when mixing and
applying the rubber cement. Work with gasoline
outdoors only. Do not use • ear fire. KEEP OUT OF
THE REACH OF CHILDREN.
Modeling Clay
1 part flour to 1 part salt. Add enough water so
that when flour and salt are mixed, balls of dough
are formed.
2. Shred newspapers or paper towels. Mix with any
starch paste and knead thoroughly.
1.
Another Recipe:3.
Dissolve 250 ml of starch paste in water to thin
it slightly. Add 375 ml of plaster; 500 ml of
sawdust; knead to consistency of tough dough.
Another Recipe:-
4.
Soak small pieces of newspaper in a bucket of
water overnight. Remove from water and rub wet
paper between palms of hands until it is ground
to a pulp. Mix 1 ml of glue in 250 ml of water;
add 500 ml of plaster; 1 litre of wet paper pulp.
Knead to a doughy consistency.
and another:5.
Mix 250 ml of dry clay powdered and sifted
through a screen with 5 ml of glue in 250 ml
of water; add wet paper pulp and knead to
doughy consistency, adding more water as
necessary.
Health Education For Nurses
49
6.
Powder mud from ant hill and mix with water.
7.
Check to see if clay is available in yuur locality—
you may only need to dig a bit.
MAKING A BAMBOO TRIPOD EASEL
A bamboo tripod easel can be easily constructed to hold a
flannelboard or flip chart or other lar6e, stiff-backed visual
materials. It is sturdy, made of low-cost materials, and convenient
to carry and to use.
Materia ls:-
Three 1.5 m poles
Two 8 cm wooden pegs or sticlr
4 m of heavy cord
Process:1. Drill a hole through the bamboo near one end of each pole.
With 20 cm of heavy cord, tie the three ends together securely, but
not so tightly that tripod legs cannot be opened.
2. Drill another hole near the center of each pole. Beginning with
the first pole, slip the heavy cord through the hole and tie a knot
at one end of the cord leaving at lean 8 cm hanging free.
3. Pull the rest of the rope through the hole until the knot you
have made rests firmly against the pole.
4. Measure off a distance of 60 cm and insert the rope through
the hole in the next bamboo pole and make another knot.
5. Follow this same process with the third pole, always allowing
a 60 cm length of rope for the distance between poles. For the last
length of rope, tie the two ends together (remember you have 8 cm
hanging free), measuring first to be sure the length of cord between
the two poles will be approximately 60 cm in length when the knot
is completed.
6. Set your tripod up now as it will be when you use it. Decide
at what height you want to place the bottom edge of your visual
materials and mark this spot on the front two poles. (It would be
a good idea to measure this distance to make sure both marks are
the same length from the bottom.)
7. If your ropes holes are big enough, you may be able to slip
the wooden pegs through these. If not, drill two holes and insert
wooden pegs or sticks to support flannelboard or other display.
Suggestion:- The length given for the wooden pegs will vary
according to the size of the bamboo. You will want at least 7 cm
of the peg sticking out in the front, so cut your pegs with this
in mind.
50
Audio Visual Aids
Bamboo Sticks
BAMBOO STICKS
Health Education For Nurses
51
HOW TO MAKE A BAMBOO COMPASS
Materia ls:2 bamboo rods about 1.5 cm in diameter and 40 cm long a knife
wooden peg 2 cm in length and a diameter that fits into the hole
in bamboo (piece of pencil may be used) with one end sharpened
1 piece of chalk
2 strong elastic bands, a bolt and a wing nut
Direc tions:1. Make a slit 1/2 cm wide and 3 cm deep in one end of both
rods. (Note: If chalk and/or wooden peg fit securely into bamboo
holes, this step is not necessary.)
2. Fit a piece of chalk in the end of one of the rods and clamp
it firmly with an elastic band. (A)
3. Fit a sharpened wooden peg in the end of the other rod and
clamp it firmly with a rubber band. (B)
4. At the other ends of the both rods slice off 3/4 of circumference
to a depth of 3 cm, leaving thin end pieces.
5. Puncture or drill holes in the protruding end pieces and fasten
them together with the bolt and wing nut. (C)
6. In using this compass, loosen wing nut and set compass at
desired distance; then tighten wing nut.
Audio Visual Aids
52
HOW TO MAKE THREE LETTERING MARKERS
BAMBOO MARKER (To be used instead of felt-nib pens)
Materials:10 cm stick of bamboo (the inside diameter should be the same
size as the line you want to draw)
wad of cotton or any very absorbent material, a small piece of
loose-weave muslin
^BAMBOO stick
MUSLIN OVER
COTTON
Procedure:1. Compress cotton tightly and cover with muslin. Stuff into end
of bamboo.
2. Using ink or dye (see Recipe Section under Inks & Dyes),
dip cotton into dye and allow a reasonable amount to be absorbed.
Wipe off excess.
3. Begin lettering;
FLAT STICK PEN
For making large letters you can wrap a small piece of felt over
the end of a flat stick such as a tongue depressor and secure tightly
with an elastic band. Dip into ink and begin lettering !
BAMBOO LETTERING
PEN
Materia ls:12 cm stick of bamboo cane knife; or razor blade
Carve an excellent lettering pen as shown in the drawing. Be
sure that the end is flat and even in thickness as this will affect
the lettering you produce!
Health Education For Nurses
53
SHARP KINFE
BAMBOO STICK
PROTECTIVE
COATINGS
Apply a preservative or protective finish to the surface of your
visual materials to protect them from the wear and tear of frequent
handling and possible damage from the weather. What you are
looking for is a substance which when dry is transparent and yet
gives a hard finish. Here are two suggestions:-
By coming 2 parts white glue with 1 part water, you will have
a mixture which, when applied to the surface of your visual, will
give a glossy, pearl-like protective coating against scratches. It will
not protect your visuals from damage due to wet weather.
A thin coating of shellac or lacquer will also give a protective
finish to your visual materials and it will also resist water.
These are just two ideas. In some places, you may find that a
clear floor wax will serve equally well and may be cheaper to buy.
Experiment with different products in the market, keeping in mind
the characteristics of the finish you want.
CAUTION:- In applying these coatings, make certain the colors
of the picture are waterproof (permanent ink). Otherwise, the colors
will run. If you are not sure about the materials you arc using,
experiment on scrap paper.
Other Coatings:
Suggestion:- A clear plastic sheet also may
be used to protect your visual materials.
ADHESIVE PAPERS
Dry mounting tissue and other adhesive materials are simply thin
sheets of tissue paper coated on both sides with a finish of some
sort. Dry mount tissue is coated with shellac or lacquer; other tissues
are coated with a thin coat of wax.
If you are unable to purchase this material, you may try making
it by dipping a thin sheet of paper or cloth into shellac or melted
wax. If you use wax as a protective coating, you may not need to
apply any heat; pressure with your thumb or with a stack of books
54
Audio Visual Aids
will make the adhesive material stick. Wax coated materials will not
give you a permanent mount but can nevertheless be most useful.
If you want to temporarily tack a picture to cardboard or some other
backing material, use only small squares or strips of the adhesive
paper to stick on the comers and edges.
Do not be afraid to experiment--you may come up with something
better!
Other Ideas:
Unlike other basic education, health education starts from infancy
and last till death. The mother being the first teacher of the child,
every prospective mother should be made the target for health
education activities. From' weaning of breast-milk to brushing teeth,
bathing, eating, drinking, speaking, sitting, standing and walking, all
include certain etiquettes and manners, which itself is health
education. If properly imbibed from infancy, then there will be no
difficulties in bringing about effective and desired health behaviour.
Health Education has been given priority and an important role in
health programme attached to "Health for AU by 2000 A.D.)".
If we have to make the International Theme a success, through
effective use of Health Education, we have to fight the problems
in the area of personal hygiene, environmental hygiene, sanitation,
maternal and child health, communicable disease and national health
problems including population growth. Once these problems have
been brought under control then everything will be esay.
Difrerent topics should be used as per the audience, their age,
educational level, occupation and income, religion etc. A list should
be made (1) Pre-school children (2) School Children (3) Adult - (a)
Illiterate (b) Literate (c) Women (d) Men.
Pre - School :
a.
brushing teeth, washing mouth and face
b.
taking a bath,
c. combing hair, taking care of hair including washing, preventing
lice, nits, skin infections.
d.
Proper clothing, shoes, chappals
e.
nutrition
z
f. walking postures talking, sitting position, covering mouth with
palm while coughing, sneezing, yawning etc.
Health Education For Nurses
55
Schools
More or less same topics should be carried out but in detail.
Adults : (1) Each disease with causative factors, preventive care
including personal and environmental hygiene.
(2)
National Health Programme
Women
(1) Women being the most vulnerable and under-previldged
group in the society, they should be given additional talks on:(a)
Ante-natal care
(b)
Post-natal care
(c)
Spacing the pregnancy
(d)
Care of self and baby
(e)
Nutrition
(f)
Immunization
(g)
Excersis to keep body fit, slim, active
(h)
Above all, the importance and uses of contraception.
Teenagers
(1) Drug Addiction
(2) Sex-Education
(3)
Diseases related to drugs,-sex, etc.
167
Records and Reports
CHAPTER TEN
Records and Reports
Health records refer to forms on which information about an in
dividual and family is noted. They may include information about
socio-economic, psychological and environmental factors. Records are
a practical and indispensable aid to the doctor, nurse and paramedical
personnel in giving the best possible service to individual, family and
to the community.
Recorded facts have a value and scientific accuracy far more than
mere impression of memory, and these are guidelines for better ad
ministration of family health service. The contributions that the nurse
and other members of the team make are reflected in case records.
Records are a means of communication between the health workers
and the family. For example, any health or socio-economic problem
observed by the health workers during home visits is recorded, which
may require the attention of the doctor or other members of the health
team. Similarly when the doctor or other worker visualises situation
requiring help from the health worker a note is made on the records for
their attention.
An effective health record shows the health problem and other
factors in the home that affect individual and his ability to carry out or
ders; it tells what the family believes. What has been done and what is
being done about health conditions, and also what the family wants or
plans to do and of medical and nursing service being given. It indicates
plans for the next steps to be taken to help the family meet their health
needs so that the health worker’s efforts are well directed and coor
dinated towards common goals.
Each record should show essential aspects of service in such logi
cal order that a new worker may be able to maintain continuity if serv
ice to individuals, families and communities. Records have been shown
not only to help ensure effective service, but at the same time to save
effort and money. The doctor who knows, what has been done before,
can plan his therapy wisely and effectively.
A Community Health Nursing Manual
168
1.
(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)
(i)
(j)
Rigid imposition of rules regulating record writing ruins in
itiative. Nurses should develop their own method of expres
sion and form.
Records must be written clearly and legibly. Illegible
records are a waste of time, money and energy.
Records are legal documents and should contain true facts
based on observation, conversation and action.
Select relevant facts and factors in the situation and record
them briefly and clearly. Printing is advisable.
Records are used as a basis for research and evaluation.
Hence accuracy and completeness is essential. Fill in each
blank space on each form.
Record systems are essential for efficiency and uniformity
of service. Study the system used bj the agency and help
develop new or revise old forms to meet the needs. Develop
efficient filing system.
Record forms should include the following family folder
and case records for individual and family. Combined
checking and narrative record forms are useful and save
time.
Records should provide for periodic summary or inventory
to determine progress and to make plans.Records should be written immediately after an interview
and should be neat and concise.
Records are confidential documents, not to be shown or dis
cussed with other than those providing health services.
Records are valuable documents — they should be carefully
handled, carefully filed and always accounted for. A
misplaced record means that health service to a family suf
fers.
2.
A.
A GUIDE TO RECORD WRITING
VALUE AND USE OF RECORDS
For a Nurse
(a)
The record provides basic facts for services. Records show
the health condition as it is and as the patient and family ac
cepts it;
Records and Reports
169
Provides a basis for analyzing needs in terms of what has
been done, what is being done, what is to be done and the
goals towards which means are to be directed;
(c) Provides a basis for short and long term planning;
(d) It prevents duplication of services and helps follow-up serv
ices effectively.
(c) Helps the nurse to evaluate the care and teaching which she
has given;
(f) It helps the nurse organize her work in an orderly way and
to make an effective use of time:
(g) It serves as a guide to professional growth;
(h) It enables the nurse to'judge the quality and quantity of work
done.
(b)
B.
For the Family and Individual
The records help them to become aware of and to recognize their
health needs. A record can be used as a teaching tool too.
C.
For the Doctor
(a)
The record serves as a guide for diagnosis, treatment and
evaluation of services;
(b) It indicates progress;
(c) It may be used in research.
D.
For the Sanitarian
The record helps identify families needing service and those
prepared to accept help;
(b) It enables him to draw the nurse’s attention towards any per
tinent observation he has made.
(a)
E.
For the Organisation and Community
The record helps the supervisor evaluate the services ren
dered, teaching done and a person’s actions and reactions;
(b) It helps in the guidance of staff and students — when
planned records arc utilized as an evaluation tool during
conferences;
(a)
A Community Health Nursing Manual
170
(c)
(d)
(e)
(f)
It helps the administrator assess the health assets and needs
of the village or area;
It helps in making studies for research, for legislative action
and for planning budget;
It is legal evidence of the services rendered by each worker;
It provides a justification for expenditure of funds.
3.
TYPES OF RECORDS
There is considerable uniformity in records being used and yet
there are differences in forms used by municipalities, States and
private agencies. The nurse must know the purpose for which records
are used by the agency and follows regulations accordingly. She
should, at the same time, study the record forms and systems and make
recommendations for changes that will help meet the needs of the or
ganization and community in the most effective manner.
Cumulative or Continuing Records
Cumulative or Continuing Records have been found to be
economical and time saving, for example, having one basic record for
each mother is much better than having a new record for each preg
nancy. The child’s record should provide space for new bom, infant
and pre-school data rather than having a separate record for each
growth period. Each school child should have a cumulative health
record that may go with him from grade to grade and from school to
school.
By using and continuing keeping of cumulative records it is pos
sible to review the total history of an individual and evaluate the
progress over a long period. Continuing records saves time and much
filing space by avoiding repetition.
The system of utilizing one record for home and clinic services in
which home visits are recorded in red and clinic visit in blue ink helps
coordinate the services and saves the time of all the personnel con
cerned.
Family Records
The basic unit of service is the family, and so the central record
unit should also be a family unit. In practice, because of difficulty in
Records and Reports
171
defining "family", the unit is the "household", meaning the group of
people who live together and share one cooking facility.
Separate record forms may be needed for different types of serv
ice, such as tuberculosis, maternity, infant and pre-school, school and
industrial. One family may be making use of any or.c or "all of these
types of services. Such forms provide space to make notes at the time
of each visit, in order to describe symptoms, report observations,
record the service rendered, make suggestions on further follow-up
visits and refer the patient for help or consultation to another worker.
The usual health centre provides combination of such types of
service. All the records which relate to members of one family should
be placed in a single family folder. Only in this way the doctor and
health workers can see the total situation, and give effective, economi
cal service to the family as a whole. This is another basic principle of
record keeping in a health centre.
The family folder which contains all the individual records of one
family, has all the identifying data plus observations about the general,
social and environmental factors that affect health in the family, on it.
There may also be a summary of the health status of the family, with
space for periodic evaluation. Here can be included the immunization
status of all the individuals in the family. (See suggested family folder
form in the appendix).
Record forms are generally printed. The nurse should sec that
they are complete and accurately filled in.
4.
SECURING RECORD INFORMATION
Records are started in the centre or in the home at a time
when the individual is seeking some service or when the
health worker recognizes the need for service. The nurse
and the individual should be comfortably seated in a private
quiet area so that confidential information can be given and
kept at a professional level.
(b) Economic and social information may be difficult to obtain
as people are often reluctant to talk about personal matters.
Do not press the person for such information until he gives it
freely.
(c) The individual and family cooperation in making out the
record is important Explain the reason for making the
record, how the record will be used and the confidential na-
(a)
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A Community Health Nursing Manual
(d)
(e)
(f)
ture of the record.
Ask questions in a friendly but definite and direct manner.
When securing data about food habit, ask questions such as
what did you feed the baby yesterday? How long do you
boil the water? Look at the child’s vaccination scar and ask:
When was the child vaccinated? Avoid unnecessary ques
tions. Observe the environment and record what you see.
Discuss the condition and record attitude or statement in
quotation if possible, for example "I have never given other
children anything except the breast. Why should I give this
child extra foods ?" "The baby takes breast when she is
hungry". "Ram was vaccinated 2 years ago; scar good."
Write brief notes of every visit showing.
(i) the reason for the visit;
(ii) particulars of observations made;
(iii) What was done;
(iv) attitude of the individual and the family towards help;
(v) evidence of change or benefit to family
(vi) plans for next visit;
(vii) referrals to other workers, such as the doctor or the
sanitarian, for their attention, comment, or appropriate
action, as indicated.
(g)
The record should show chronologically, to what extent
progress is being made towards the goal of better health for
the individual and the family. This is particularly important
in regard to better nutrition and sanitation.
5.
REGISTERS
Use of the usual registers is not a practical way of achieving con
tinuity of the service, or of coordinating service about the family unit.
The register usually provides only an indication of the total volume of
service and of the types of cases seen. It gives no idea of the quality of
service or the results achieved. However until individual record and
filing systems are developed, registers must be continued. It is neces
sary to keep each register up-to-date and accurate. A good record sys
tem provides all the information available from the usual clinic
register, adds more useful information. Once established, a good record
173
Records and Reports
system consumes little time in its maintenance.
The nurse should make every effort to secure the services of a
clerk to assist in maintaining the files, registers, or other clerical duties
in the centre.
6.
RECORD FILING
Correct filing of records is essential. Hours of time and effort are
saved when records are set.up and maintained in a systematic, planned
and organised manner.
Some agencies file records alphabetically and others use a
numerical system. In villages geographical system is found to. be
preferable.
When a numerical filing system is used, 3" x 5" card alphabetical
cross-file is needed, in case a person misplaces his number. Experience
has shown that patients learn to preserve and bring with them a card
which shows their clinic number. This saves much clinic time.
Every nurse should know how to file records.
7.
REPORTS
A report summarizes the services of the nurse and/or the agency.
Reports may be in the form of an analysis of some aspect of a service.
Reports are usually written daily, weekly, monthly and yearly.
Purposes
Reports are written;
to show the kind and amount of service rendered over a
specified period;
(b) to illustrate progress in reaching goals;
(c) as an aid in studying health conditions;
(d) as an aid in planning;
(e) to interpret the services to the public and to the other inter
ested agencies.
(a)
Each agency has specified regulations about reporting services on
a daily, monthly and annual basis. In addition to the statistical reports
that the nurse maintains, she should also write a narrative report once
each month as a measure of illustrating some of the human interest
174
A Community Health Nursing Manual
situations that she meets and how she deals with them. A monthly nar
rative report provides an opportunity to present problems for ad
ministrative considerations.
Description for Filling out and Using the Family Folder
The "single" family folder is designed to give basic information
about the positive and negative personal and environmental factors that
effect each person in a family unit. The folder provides space for more
than one observation. When the record is properly filled out and used,
the worker should be able to identify the health situation in the home
without loss of time or effort.
It may not be possible to get all the information needed for the
record during one visit. Necessary information includes:
(a)
(b)
(c)
Name of head of the household: print last name (usually of
the senior male):
Address: print direction for reaching the house and village:
Family names and health survey.
Write names of each member of the household. Write the
names of each child, bom alive, in chronological order. For
example write the name of the oldest child first, then follow
with second, third etc. Indicate condition of health of each
member, immunization status and history of treatment as
directed on the form. To fill in the observation and com
plaint section, it is necessary to see the person and make a
physical inspection (particularly of the children). Talk with
adults to ascertain history of illness and treatment. The last
column, indicating where treatment was obtained, should be
filled only after verification of the facts. Each individual
"block" is divided into two sections, which provides space to
indicate the date on which that condition was found and the
date on which that condition was corrected. Write the date
of correction in red in the same block as the date on which
condition was observed. Use the second line of blocks to
record findings during subsequent visits;
(d)
Sanitation: To fill in this section of the form it is necessary
to see each condition as listed. Write the date of initial and
subsequent observations using blue ink and the date on
Records and Reports
(e)
(f)
175
which that condition changed, in red;
Diet and eating habits: Use a check *x’ to indicate when the
food is obtained and how the food is cooked;
Major health problems: space on this sample form is
limited. When the record is printed on a larger double
folder, more space should be provided. Review the total
record and lists the major health problems in order of
priority, and then write a brief plan of action. Write the out
come of each part of this plan in red.
8.
FILING SYSTEM
A simple method of building up a filing system is staled
below which will be useful guide for those who wish to set
up a proper filing system and visiting-index system.
(ii) In order to start a proper filing system, survey the area. Note
down the name of the head of family and simultaneously put
house number which will be used as Family Folder Number,
i.e., (F.F. No.).
(iii) In a village with consecutively numbered houses, the num
ber is used as the F.F. No. and checked by the Panchayat list
(the community health nurse can successfully number an
unnumbered village for the same purpose).
(i)
In an urban area with mixed house numbering the F.F. No. is
unrelated. Consecutive numbering is maintained as far as possible.
In area of several villages or easily separated parts, different let
ters may be used to precede the number and each section filed
separately. This makes the filing less unwieldy. In an area without
clearly fixed demarcations or where people tend not to know where
they live, one consecutive numbering system is to be preferred.
(a)
All cards are kept in the Family Folder which are filed
numerically. Different divider between every 100 and 10
folders.
(b) Each family must be given a F.F. No. identification card
which the member must be expected to bring on all primary
health centre visits. This card can have a dual purpose, i.e.,
weight or appointment card but the F.F. No. must be clearly
marked on the front and this is its most important function.
(c) There must be a cross index in order to discover the F.F. No.
A Community Health Nursing Manual
176
easily, should the identification card be lost or forgotten.
The cross index filing is based on head of family or
husband’s name.
(ii) English or regional language cross index is to be made
and is filed alphabetically within each letter.
(i)
If cross index filing is not available due to lack of cards then a
cross index register can be maintained having Heads of family or
husband’s name written alphabetically with the F.F. Nos. written side
by side.
Drill when someone comes to the community health centre
(1)
(2)
Present identification F.F card and F.F. is immediately
found.
If F.F. No. identification card is not available, ask husband’s
name, look up in cross index and F.F. number is discovered.
Make out a new F.F. identification card.
Drill when new family comes whether that attends clinic or not
(1)
(2)
(3)
(4)
Make individual cards and family folder and put F.F. No. on
each.
Give family F.F. No. identification card.
Make out cross index cards and file alphabetically.
Make out visiting index card and file in a correct way for the
next visit.
Visiting Index System
A second index system is used to record visits due and work
done.
Each worker’s area is divided into four separate functional units.
They should be roughly the same size in work load (The four parts may
be called I, II, III, IV and each part will normally be visited during the
corresponding week of the month).
An index card must be prepared for each Family Folder. This has
the family name and F.F. No. in the front and record of visits done is
kept on the back (Post cards are printed to last for 5 years, but we can
work the system with */2 post card hand-ruled to last the same period
Records and Reports
177
for economy reason or if primed cards are not available).
A card file or a box with divider must be provided for each
worker separately. Divider should be of different colour, and set up as
under:
(1) 12 dividers labelled with the months;
(2) 6 sets of dividers labelled for the 4 weeks;
(3) 1 special visits divider.
The visiting index cards must now be divided into four areas and
a mark placed at the bottom of each card to denote the area to which it
belongs, i.e., I, II, III, IV, which will correspond to the week in which
visiting is to be carried out. It is essential to ensure that the card is
returned to its right place after special visits and to enable quick check
ing on die correct use of the index.
To begin with, the index card must be placed with reference to
the Family Folder only. Taking area I, the decision has to be made for
each card. Is the family to be visited in die current month or one, two
or three months into the future ? The card is then placed in front or
after the 1st week divider in the appropriate month (according to filing
preference). The same procedure is followed for the other three.sec
tions II, III, and IV. Having made this original distribution of work
ready for the first week of month the method is simple. The cards in
the current first week section represent the families to be visited that
week. These F.F.’s must be got out and prepared. When the visit has
been paid the date is entered on the back of the index card and the time
for die next visit is then judged, and the index card is then placed in the
first week section of the month in which the next visit will be due, or
else under special visits if visit is to be carried out earlier than a month.
N.B.: No. index card must ever be placed out of its right week. If
visit is required more often titan once a montii for some reason,
the index card must be removed to the special visits section and
remain there until monthly visiting cards begin again — care must
then be taken by reference to the section number at the bottom of
the index card, to return it to its right week in the month.
Some families attend the community health centre and these at
tendances are in response to that desirable pattern of home visiting.
When preparing for home visit, the clinic attendances made by the
family since tfjc last home visit should be entered in red on the back of
178
A Community Health Nursing Manual
the index card and if appropriate the indei put immediately to a later
date. This entry of visits and clinic attendances gives a better picture of
family supervision and is much quicker to check reference to the
family folder.
This system makes it possible for a second worker to take over
the visiting intelligently from the beginning since priorities are indi
cated. It also reduces planning time by indicating immediately what
visit is due. It makes it easier for the worker to plan her visit in rela
tion to reality, since if at the end of every week she has half her
families unvisited, it is obvious that she must either visit twice as fast
or half as often.
Unvisited families at the end of the week must be carefully
reviewed.
Usually these families should be visited when their turn falls in
the regular course. The number of families receiving special visits
when out of their correct week must be carefully watched, or the whole
system will break down.
There is one situation that is different to record immediately in
this system. This is the follow up of a clinic visit by special visits. In
this case the record of visits done will have to await the previously pre
dicted date of visit and consequent appearance of the visiting index
card.
N£.: For the same reason that it is possible to find any one
without visiting index card, no attempt should be made to try to
record clinic visits after they have been made. Only during pre
visiting preparation when the index card and the Family Folder
are brought, should this attempt be made.
When the visiting area is made up of several villages, each village
may be taken as a separate week’s visiting; or each village may be
divided into four parts and one day each week devoted to each. In the
latter case, sub-divisions for each village may be necessary to keep
proper visiting schedule. Also village visits may be made as under.
Village with less than 500 population----- visit once a month.
Village between 500-1000 population—- visit twice a month.
Village with more than 1000 population—Four times a month.
In this manner full justice can be given to villages of all sizes by a
methodically divided home-visits schedule.
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