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Euthanasia

Euthanasia refers to the practice of intentionally ending a person’s life to relieve pain and suffering.

Euthanasia comes from the Greek words “Eu” (good) and “Thanatosis” (death), meaning “Good Death” or “Gentle and Easy Death.” It is often referred to as “mercy killing.”
Euthanasia involves ending a person’s life, either through lethal injection or suspension of medical treatment.
The term “euthanasia” was first used in a medical context by Francis Bacon in the 17th century to describe a painless, happy death where it was a physician’s duty to alleviate physical suffering

Types of Euthanasia

Active Euthanasia
- Definition: Death is brought about by a direct action, such as administering a high dose of drugs.
- Example: Taking a high dose of drugs to end a person’s life, with or without the aid of a physician.
Passive Euthanasia
- Definition: Death results from an omission, like withholding or withdrawing treatment.
- Examples:
  - Withdrawing treatment: Turning off life-sustaining machines.
  - Withholding treatment: Refraining from performing surgery that might extend the patient’s life for a short period.
Voluntary Euthanasia
- Definition: The patient willingly cooperates without external pressure.
- Example: A patient makes an autonomous decision to end their life with assistance.
Non-Voluntary Euthanasia
- Definition: A decision is made for an unconscious or incapable patient.
- Example: An appropriate person makes the choice for an unconscious patient, which can sometimes be considered a favor for the patient.
Indirect Euthanasia
- Definition: Providing treatments (mainly to reduce pain) with the side effect of shortening the patient’s life.
- Example: Administering pain-relieving treatments that inadvertently shorten the patient’s life.

Religious Perspectives on Euthanasia

1. Islam:

Beliefs: Muslims generally oppose euthanasia, considering life sacred and under Allah’s control.
Permissible Exceptions: The Islamic Medical Association of America (IMANA) allows for the discontinuation of mechanical life support for patients in a persistent vegetative state.

2. Christianity:

Stance: Most Christian denominations oppose euthanasia, emphasizing the sanctity of life.
Ethical Considerations: Many churches stress not interfering with the natural process of death and respecting human life as a gift from God.

3. Judaism:

Diverse Views: Jewish medical ethics show division on euthanasia and end-of-life treatment.
Acceptance: Some support voluntary passive euthanasia in specific circumstances.

4. Shinto:

Beliefs: In Japan, where Shintoism is dominant, a majority of religious organizations agree with voluntary passive euthanasia.
Opposition: Shintoism discourages artificial life prolongation.

5. Buddhism:

Compassion Principle: Compassion is a core value in Buddhism and can be used to justify euthanasia in relieving unbearable suffering.
Moral Boundaries: Despite compassion, Buddhism maintains restrictions on taking actions aimed at destroying human life.

Nurses Roles in Euthanasia

Phase I: Pre-Euthanasia

Assessment:
- Listen attentively to the patient’s request for euthanasia.
- Assess the underlying reasons for the request and contributing factors.
- Evaluate the patient’s knowledge regarding their medical diagnosis, prognosis, and available alternatives, including palliative care.
- Assess the patient’s general condition, physical examination, and the severity of their illness.
- Evaluate the patient’s family’s reaction to the request for euthanasia, encourage communication, and identify their needs.
Consultation:
- Nurses become advocates representing the patient’s condition and their relatives’ wishes in a panel of experts, including clinical psychologists, social workers, nurses, and doctors.
Written Consent:
- Ensure the consent process takes place in a quiet and non-disturbing environment.
- Explain the consent with a non-threatening tone and allow time for questions.
- Ensure that the patient and their family fully understand the euthanasia process, potential discomfort, and the patient’s right to revoke their request within a specified period.

Phase II: Intra-Euthanasia

Preparation:
- Establish intravenous access for medication administration.
- Reiterate the procedure to the patient and family members, providing reassurance and support.
- Assist in preparing medication, including sedatives, analgesics, and euthanatics, and ensure proper labeling.
- Administer premedication, such as midazolam, if the patient wishes to be unaware of the moment of coma induction.
Assistance:
- Prepare an emergency set as per the protocol.
- Offer emotional support to family members if present during the procedure.
Record:
- Maintain a detailed record of all medications used, events, and persons involved.
- Complete forms, including signed consent forms, pain assessment records, records of euthanasia, and the last office chart.

Phase III: Post-Euthanasia

Certifying Death:
- After doctors have certified the patient’s death, nurses can explain the cessation of euthanasia.
Support for the Family:
- Provide emotional support to the patient’s family, as they may experience grief and guilt.
- Offer reassurance and actively listen to their feelings.
- Utilize communication and counseling skills to address their emotional needs.
- Consider timely referral to a counselor for uncontrolled emotions.
Safe Disposal:
- Ensure that all unused euthanatic agents are returned to the pharmacy for proper disposal.
- Prevent the improper use of euthanatic agents through appropriate disposal methods.
Incident Evaluation:
- Complete an incident evaluation form in case of unexpected problems, such as underdosing.

Ethical Dilemmas Surrounding Euthanasia

An ethical dilemma in euthanasia refers to a situation where there is a conflict between different ethical principles, values, or beliefs when considering end-of-life decisions and the practice of intentionally hastening the death of a person who is suffering from a terminal illness or unbearable pain.

Ethical dilemmas often arise due to conflicting principles such as autonomy (the right to self-determination and control over one’s own life), beneficence (the duty to do good and alleviate suffering), non-maleficence (the duty to do no harm), and the sanctity of life (the belief that life is inherently valuable and should be protected).

These ethical dilemmas can manifest in various ways, such as:

Balancing Autonomy and Sanctity of Life: One ethical dilemma revolves around the tension between respecting an individual’s autonomy and the belief in the sanctity of life. Advocates for euthanasia argue that individuals should have the right to decide when and how to end their lives to escape suffering, while others believe that life is inherently valuable and should be protected, even if the individual desires to die.

A patient with a terminal illness expresses a strong desire to end their life to avoid further suffering. However, healthcare professionals and family members who believe in the sanctity of life may struggle with the decision to honor the patient’s autonomy and assist in euthanasia.

Role of Healthcare Professionals and their morals:: Healthcare professionals often face ethical dilemmas when their personal beliefs conflict with their professional duty to provide care and alleviate suffering. Some healthcare providers may have moral or religious objections to participating in euthanasia, which can create a conflict between their professional responsibilities and personal values.

A nurse who opposes euthanasia on moral grounds may face a dilemma when asked to administer medication to hasten the death of a patient. They must navigate their personal beliefs while also respecting the patient’s autonomy and ensuring the provision of appropriate care.

Palliative Care and Access: The availability and quality of palliative care can present ethical dilemmas related to euthanasia. If individuals do not have access to adequate pain management and end-of-life care, they may feel compelled to choose euthanasia as a means to alleviate their suffering.

A patient with a terminal illness who is experiencing severe pain and has limited access to palliative care options may consider euthanasia as a way to find relief. This raises ethical questions about the responsibility of healthcare systems to provide comprehensive end-of-life care and support.

Psychological Impact and Role: Euthanasia can have a profound psychological impact on healthcare professionals involved in the process, as well as on family members and loved ones. Witnessing or participating in euthanasia may lead to moral distress, guilt, or emotional trauma, raising ethical concerns about the potential harm inflicted on those involved.

A physician who performs euthanasia on a patient may experience emotional distress and moral conflict, questioning the decision and its implications. This highlights the ethical dilemma of balancing the relief of suffering with the potential psychological harm to healthcare professionals.

Assessing the Quality of Life and Need: Evaluating the subjective experience of suffering and the quality of life is another ethical dilemma. Determining whether a person’s suffering is unbearable and if their quality of life has significantly deteriorated can be challenging, as it involves subjective judgments and personal values.

A patient (ALS) may experience a gradual loss of motor function, leading to difficulties in breathing, swallowing, and speaking, may also suffer from pain, discomfort, and a loss of independence and autonomy.Assessing the quality of life becomes an ethical dilemma. Healthcare professionals, caregivers, and family members may have differing perspectives on what constitutes an acceptable quality of life. Some may argue that the patient’s suffering is unbearable, and their quality of life has significantly deteriorated, others may argue that even in the face of severe physical limitations, individuals can find meaning and joy in their lives. They may emphasize the importance of palliative care, psychological support, and interventions to alleviate suffering, rather than resorting to euthanasia.

Safeguards and Slippery Slope: Establishing clear criteria and safeguards to prevent abuse or misuse of euthanasia can be an ethical challenge. The concern of a “slippery slope” arises when there is a fear that legalizing euthanasia for specific cases may lead to broader acceptance and potentially open the door to abuse or involuntary euthanasia.

In a country where euthanasia is legal for terminally ill patients with unbearable suffering, there is a debate about whether to expand the criteria to include individuals with chronic illnesses or psychiatric conditions. Proponents argue that these individuals may also experience significant suffering and should have the right to choose euthanasia. However, opponents express concerns about the potential slippery slope. They fear that individuals with chronic illnesses or psychiatric conditions may be coerced or influenced into choosing euthanasia, even if they may still have potential for improvement or quality of life.

Euthanasia Read More »

TEACHING METHODS

Teaching methods refer to the regular ways or orderly procedures, employed by the teacher in guiding the learners in order to accomplish the aims of the learning situation.

Teaching strategies: refers to methods used to help students learn the desired course content and be able to develop achievable goals in future.

Teaching Learning activities: Learning activities are things students do, or are supposed to do, during the lesson, e.g. reading, taking a test, listening, taking down notes, etc. Any learning activity a teacher incorporates into a lesson is part of the teacher’s strategy.

Factors to consider when selecting a teaching method to use.

Efficient teaching methods are essential tools that can help students achieve success in the classroom. There are several factors that a teacher must consider when choosing a teaching method for their students. Some determining factors for selecting a teaching method to be applied include;

Instructional objectives: Attaining instructional objectives depends on the teaching method used. For example, if the instructional objective requires students to administer an injection, the teaching method should be Demonstration.
The cognitive nature of the learners: The teaching method used depends on how quickly learners understand the content—slow learners versus fast learners. If there are more slow learners in the class, the teacher may choose a method that is easier for those students to grasp the lesson or subject matter.
The age of the learners: Every method selected should relate to the learners’ age. Adults may be more comfortable with problem-based learning than lecturing, teenagers might be more interested in experimentation and demonstration, while infants may be influenced by concept cartoons rather than experimentation.
Availability of teaching aids: Teaching aids are materials used to help learners better grasp a given concept. If a teacher lacks proper teaching aids, they may need to adapt their method to align with the available resources.
The size of the class: The number of students in the class guides the choice of the teaching method. Lecture methods are suited to large groups, while other methods like group discussions and demonstrations work well with smaller groups.
Teacher’s ability and preference: The teacher’s ability to handle a method and their experience play a role in method selection.
Student learning style: Students have different learning styles—some learn best by hearing, others by seeing, and some by touching. Therefore, different teaching methods are required to accommodate these styles.
School policies: School policies can influence the choice of teaching method. Some schools emphasize learner-oriented methods like problem-based learning, while others prefer more traditional teaching approaches.
Examination setup: Examination formats can also impact teaching methods. Teachers often align their teaching to help students prepare for the specific exams they will face.
Time constraints: Methods of teaching are bounded by time. Teachers must consider the available time for covering a topic when selecting a teaching method.
Available resources: The availability of resources can determine the final choice of teaching method. For instance, if a teacher wishes to use the demonstration method but lacks the required facilities, they may opt for video demonstrations if electrical gadgets are available.

CLASSIFICATIONS OF TEACHING METHODS

There are two major divisions of teaching methods:

Teacher-centered methods – the learner is not directly involved in teaching (passive).
Student-centered methods – the learner is directly involved in teaching (active learner).

TYPES OF TEACHING METHODS

LECTURE METHOD

A lecture is defined as the method of instruction in which the instructor has full responsibility for presenting the subject content orally.

Lecture is an oral presentation by a teacher to students about a particular subject.

Usually, the lecturer will stand in front of the room and recite to the students. It involves no student participation, and the students are usually passive, and teaching aids may be used such as a projector, charts, chalk, and chalkboard, etc.

When is it applicable:

When introducing a new topic.
To stimulate the interests of the learners.
To clarify some misunderstood points.
When there are no appropriate or adequate textbooks for the learners.
When students are mature enough, like in tertiary institutions.

Advantages of lecture method of teaching:

Allows the instructor to precisely determine the aims, content, organization, pace, and direction of a presentation.
It facilitates large class communication, as a single teacher can communicate with the whole class.
It can be used to arouse interest in a subject, like the introduction of subject content.
It also encourages great control of the class by the teacher as he or she is recognized to be an authoritative figure.
Time-saving, as large amounts of new information are delivered at once.
Gives the instructor the chance to expose students to unpublished or not readily available material.
Useful method for auditory learners (those who learn by hearing).
It is cost-effective as it enables a high student/teacher ratio to be achieved.

Disadvantages of lecture method of teaching:

It places students in a passive rather than an active role, which hinders learning.
It enhances one-way communication, therefore the lecturer must make a conscious effort to become aware of student problems like where to simplify hard content.
It does not provide immediate feedback to the lecturer since there is no verbal communication with students.
It pays little regard to individual differences of students.
It usually provides little time for questions and does not encourage teamwork.
It cannot teach skills to be acquired by students.
Since it doesn’t involve student participation, their rate of learning and attention declines as the lecture proceeds.
It does not enhance the retention of content as it leaves gaps in understanding since there is no demonstration or experimentation.
Requires the instructor to have effective speaking skills and be audible.

INTERACTIVE LECTURE

It is also called modified lecture.

This is a method of teaching where the instructor uses oral presentation but breaks the lecture at one point to have students actively participate in an activity of teaching and learning.

Interactive lecture is different from the traditional lecture method in that it involves participants in discussion as much as possible.

When is it applicable:

Interactive lecture is applied in similar situations as the traditional lecture method but it enhances:

Active engagement of learners and avoids one-way communications.
Critical thinking.
Assessment of how well students are learning.

Advantages of modified lecture method:

It allows active engagement of learners.
It brings flexibility in learning like a teacher can switch to previous content in an explanation.
It improves the student attention span.
The lecturers can inspire the audience with enthusiasm.

DEMONSTRATION METHOD

Demonstration is a means of presenting material visually and audibly to a group of learners, emphasizing the important steps of a process or task.

Students witness a real or simulated activity in which one uses materials from the real world. Return demonstration is a process by which a learner accurately portrays a procedure, technique, or operation which the teacher demonstrated. The teacher may demonstrate the different processes relevant for students in order to perform a given task effectively, i.e., skills acquisition. Thereafter, the students are also given the opportunity to practice.

When is it applicable:

When teaching a process leading to skills acquisition.
When materials and equipment are insufficient.
When experimenting with dangerous chemicals or solutions.

Advantages of the demonstration method:

It trains the students to be good listeners and observers.
It stimulates thinking and the formation of concepts and generalization.
It permits active participation of students in the teaching-learning process as, in turn, they will be required to perform return demonstrations.
It has a high interest value since it often involves the use of gadgets and equipment that may be new to the students.
It is very effective in skills acquisition.
It permits reinforcement, as it allows the actual performance of the task through return demonstration.
Reduces the gap between theory and practice.

Disadvantages of the demonstration method:

Active participation is likely to be reduced during the demonstration because students are acting as mere observers.
When the class is big, there is likely to be a problem of audibility and visibility.
It is likely to foster class management and control problems.
May foster negative motivation (students thinking, “I can’t do that!”).
It is economical in terms of time and money.
It’s time-consuming in application.
It requires pre-preparation, i.e., requires the instructor to have mastery of the skill or task being demonstrated.
Often difficult to isolate tasks, skills, and behaviors in a step-by-step manner.

SIMULATION

A method of instruction whereby an artificial or hypothetical experience is used to engage learners in an activity reflecting real-life conditions but without the risk-taking consequences of an actual situation is created.

It is defined as activities that mimic the reality of the clinical environment. In healthcare, simulation may refer to a device representing a simulated patient or part of the patient.

Types of simulation:

Standardized patient or patient simulator – an individual who is trained to act as a real patient in order to simulate a set of symptoms or problems.
Part-task trainer – designed to replicate only a part of the body or a portion of the environment (e.g., teaching injection technique using a banana, pelvic model, plastic IV arm).
Integrated or human patient simulators – combine whole-body mannequins and computerized technology that allows mannequins to respond in real time to specific care interventions and treatment (e.g., chest compressions). These mannequins are capable of realistic physiological responses like respirations, heart rate, breath sounds, etc.
Simulation game – represents real-life situations in which learners follow a set of rules to accomplish a task. It involves computer screen-based clinical case simulators.

Application of Simulation to teaching situations:

Simulation is preferred in the following situations:

Having few patients. This makes it unable for every patient to perform a skill.
Limited faculty teaching time to allow every learner practice.
Preceptor/mentor shortages to supervise every learner.
Lack of clinical sites to place the students for clinical placement.

Advantages of simulation:

Allows students to practice reality in a safe setting.
Enjoyable and motivating activity.
Allows students to practice in real situations with the freedom to make mistakes and learn from them.
Allows independent critical thinking, decision-making, and delegation.
Provides immediate feedback.
Boosts self-confidence and reduces anxiety.
Reduces training variability and increases standardization.
Guarantees experiential learning for every student.
Can be customized for individualized learning.
Bridges the gap between theory and practice.
Is student-centered learning; hence the learner is actively involved.

Disadvantages of simulation:

Models or mannequins are expensive.
They are time-consuming to design and execute.
Not real, and students may not take it seriously.
Limited realistic human interaction.
No/incomplete physiological symptoms.
Assessment is more complex than some traditional teaching methods.
Does not enhance attitude learning.
Lack of transferability of skill.
Requires trained personnel to operate some task trainers.

DISCUSSION METHOD

Discussion is a method of teaching where there is effective participation of students in the teaching-learning process.

Both the educator and the learner combine ideas and arrive at the same conclusion or a dialogue. Unlike the lecture method where the teacher is the dominant person, in the discussion method, the teacher poses a problem, initiates interaction, and allows students to pursue the discussion towards the attainment of an objective.

Types of discussion:

Spontaneous discussion – this generally starts from students’ questions about some current event that may be related to the topic under study. This helps students understand current events, analyze, and relate facts to real-life situations.
Planned discussion – this may be initiated by the teacher presenting a problem and asking students to discuss it in detail. It can involve the whole class, a small group, or a panel.

When is it applicable:

When learners are familiar with the content to be delivered.
To actively involve all learners.
When there are appropriate or adequate textbooks for the learners to use.
To stimulate critical thinking and presentation skills.

Characteristics of a good discussion:

Every group discussion should have educational purposes or be goal-oriented.
There is a need for the teacher to create open communication and a supportive atmosphere.
All members of the group think for themselves, and all have a chance to express their opinions.
The topic for discussion should be related to the common needs and interests of the participants.
Students should have sufficient information and knowledge about the discussion topic to effectively participate in the group discussion.

Advantages of the discussion method:

There is active participation by everyone in the class.
Students learn more readily from each other (peer learning).
It is an effective means of developing academic/study skills, e.g., utilizing facts and information, formulating and applying principles, etc.
Arouses students’ interest in effective learning since it emphasizes students’ experiences to be utilized.
Promotes the development of life skills, e.g., sharing, research, negotiation, conflict resolution, communication skills, critical and creative thinking skills, etc.
There is rapport created between the teacher and students (teamwork).

Limitations of the discussion method:

It may give opportunities for brighter students to dominate the class.
It is difficult to achieve maximum interaction when the group is large, and class control is always difficult.
When a discussion leader is weak, a discussion can result in a disorganized and unproductive activity.
It can create chances of deviation from the topic during the session.
It cannot be applied in all subjects or topics because it needs students to have some idea of the topic.
It takes time to prepare, implement, as well as evaluate the discussion method.

ROLE PLAYING

In role-playing, learners adopt and act out the role of characters or parts that may have personalities, motivations, and backgrounds different from their own.

Role-playing is like being in an improvisational drama, in which the participants are the actors who are playing parts.

When is role play applicable:

The following are the chief purposes of this instructional method:

Develop concepts since it stimulates their imagination.
To adopt a simulation approach.
Illustrate aspects of interpersonal problems.
Promote understanding of the viewpoints and feelings of others.
Develop insight into personal attitudes, values, and behavior.
Heighten the students’ awareness of psychological and social problems.
Develop specific interpersonal or communication skills.

Advantages of role-play:

Raises students’ interest in the topic/subject matter.
Integrates experiential learning into activity.
Degree of retention is high as true learning takes place.
Involves all students at the same time.
Reduces or removes boredom in a classroom.
Students become aware of the feeling of others and try to view situations from others’ points of view.
Verbalizing the actions makes the students get insight into behavior patterns.
It gives an opportunity for students to express their feelings.
Dramatically introduces problem situations.
Allows for exploration of solutions.
Provides an opportunity to practice skills.

Disadvantages of role-play:

Students who are not alert and fluent will not be suitable to do the role-play.
It is a time-consuming method. Competent leadership is required to prepare, perform, and conduct follow-up discussions.
If students misrepresent the assumed character, the objectives will not be achieved.
If not well managed, students will not take the role play seriously, but as entertainment.

CLINICAL TEACHING

This is teaching and learning focused on and usually directly involving patients and their problems.

It is applicable in medical education.

Different clinical teaching methods:

Bedside teaching – teaching and reinforcing skills at the patient’s bedside.
Case study – a scenario is presented to learners followed by discussion.
Nurses rounds – planned patient visits in which two or more nurses frequently check patients for comfort, assess their clinical needs, and perform routine nursing care.
Clinical conference – a scheduled event at which practicing physicians present interesting clinical cases to their colleagues, share experience, and learn the latest practices.

Advantages of clinical teaching:

Increases students’ knowledge and skills.
Refines practice efficiency and effectiveness.
Promotes increasing clinical independence and the development of clinical reasoning.
Prepares students for optimal health outcomes with patients.
Allows observation of communication skills.
Clinical skills and ethical issues in the process of patient care can be assessed.
Helps students become competent, compassionate, independent, and collaborative clinicians.

Advantages of clinical teaching:

Discomfort to patients when discussing their problems.
Lack of privacy.
Lack of patient consent.
May disrupt hospital routines.

Limitations of clinical teaching (to learners):

Negative attitude towards bedside teaching.
Fear by the learners.
Many students compared to patients.

Limitations of clinical teaching (to teachers):

Lack of confidence in teaching at the bedside.
Large numbers of students making it hard to supervise.
Needs a lot of time to select and prepare patients.
Patients are hard to locate or may be uncooperative.

Environment:

Disruption by the patient’s condition or activities like ward rounds or other patients.

SEMINAR

A seminar may be defined as a gathering of people for the purpose of discussing a stated topic.

Such gatherings are usually interactive sessions where the participants engage in discussions about the selected topic. The sessions are usually headed or led by one or two presenters who guide the discussion.

When is it applicable:

To gain a better insight into the subject.
To impart knowledge and skills to learners.
To enhance the sharing of knowledge among learners.

Advantages of a seminar:

Learning is achieved efficiently.
A great way for those who don’t like to read or attend classes to improve their knowledge of a specific subject.
A sense of mutual trust and friendship, where individuals can meet others with the same interest in their chosen field.
Usually, learner-centered.
Encourages students to search for information on their own.

Disadvantages of a seminar:

It is expensive and not reliable to be setting it up for every topic.
The speaker may give incorrect knowledge.
There is a chance that the attendees will expect too much from the seminars and thus may be disappointed.
Time-consuming.
It requires forming many subjects relevant to the theme.

SELF-DIRECTED LEARNING

This is a method in which individuals take initiative, with or without the help of others, to diagnose learning needs, identify learning resources, implement learning strategies, and evaluate learning outcomes.

Here the individual assumes full responsibility for a learning experience.

When is it applicable:

In institutions that cannot meet all the training needs of their employees.
When there are limited teachers available.
When there’s limited availability of learning materials.

Advantages:

Less costly.
It promotes learners’ self-confidence.
It stimulates critical thinking and research skills.
Learners get up-to-date information.

Limitations:

If no syllabus is available, learners may not know what to learn.
Lack of time for research.
Lack of enough educational resources.

Difference between teachers-directed learning and student directed learning

Teacher-Directed Learning	Student-Directed Learning
Learner depends on the teacher.	Learner is self-directed.
Teacher has responsibility for what and how learners should be taught.	Teacher works as a consultant.
Subject-centered.	Task or problem-centered.
External motivators like good grades and punishment.	Internal motivators like satisfaction, need to know something, curiosity.
It relies on the teacher’s experience, so the learner’s experiences are less valuable.	Learner’s experience becomes an increasingly rich source of learning.

TEACHING METHODS Read More »

STEPS IN RESEARCH PROCESS

The Research Process

Steps in research process consists of a series of systematic procedures that a researcher must go through in order to generate knowledge that will be considered valuable by the project and focus on the relevant topic.

To conduct research effectively, you have to understand the research process steps and follow them. Here are a the steps in the research process;

Table of Contents (Click to Expand) ▼

STEP I: Identifying the Research Problem
STEP II: Reviewing Related Literature
STEP III: Develop Problem Statement, Objectives, Questions & Hypothesis
STEP IV: Select Design, Sample & Data Collection Methods
STEP V: Develop Instruments and Pilot Test
STEP VI: Data Collection
STEP VII: Analyze & Interpret Data
STEP VIII: Generate the Research Report
STEP IX: Present Findings to Stakeholders
STEP X: Dissemination of Findings
STEP XI: Monitoring & Evaluation (M&E)
Five Research Phases

1st Step

Identifying the
Research Problem

↓

↑ Literature not well reviewed

2nd Step

Reviewing
related
literature

↓

↓ Literature well reviewed

3rd Step

Develop Research Objectives,
Questions & Hypotheses

↓

4th Step

Select the appropriate research
design/ sample design & data
collection methods.

↓

5th Step

Develop data collection
instruments and plot test them
for validity & reliability

↓

6th Step

Collect data

↑ Data not sufficient

↓

7th Step

Analyze &
Interpret data

↓

↓ Sufficient & well analyzed

8th Step

Generate the research Report

↓

9th Step

Present findings to stakeholders.

↓

10th Step

Dissemination of findings

STEP I: IDENTIFYING THE RESEARCH PROBLEM

This is the first step in any research project, before a researcher proceeds with conducting research, s/he must endeavor that the research problem is clearly identified and has a vivid understanding of the research problem at hand.

A research problem in this context may refer to:

An issue at hand.
Any form of imbalances
Technological challenges
Missing links
Any unsatisfactory state of affairs
Unanswered questions.
An existing gap
A problem that needs a solution
A crisis
An urgent situation / Extremity / Emergency

Those among others are the common ways you can basically classify a research problem.

Most researchers find challenges in identifying a researchable problem and as a result most of the researchers, identify problems which are not researchable. Some researchers are frequently heard asking questions as "where can I find a research problem?" Some researchers have been disappointed by their supervisor(s) and others by proposal defence panels where in most cases a researcher's proposal. Some proposal defense panels have failed to identify a researchable problem in the statement of the problem and forced the researcher to go back and identify a researchable problem.

Common sources of a research problem include:

Existing related literature mostly the unanswered questions.
Observation and logical reasoning. This could be
- Deductive reasoning - General to Specific reasoning
- Inductive reasoning - Specific to General reasoning
Practical issues.
Experience. This could be direct experience or indirect experience.
Existing theories such as the Goldratts Theory of Constraints and the Maslow's hierarchy of needs theory.
Authority such as a directive from a superior to undertake a given research.
Current Political, Economic and Social issues such as; High rates of youth unemployment, Inflation rates, Exchange rates, Increase youth migration, Religious issues and Poverty rates to mention but a few

Features of a good research problem

These are the characteristics or attributes of any research problem. They include:

It must be researchable, implying that a good research problem is one that can be adequately investigated.
It should be relevant, a good research problem should be significant and connected with the current issues. It should not only be relevant for today but for the future generations as well.
Theoretical or practical significance.
Feasibility, implying that a research problem should be one whose effect can be eradicated as a result of research. Therefore it should be accomplishable.
It should be original in its state, a research problem should be of a new kind or different from other research problems. Therefore it should be novel in nature.

STEP II: REVIEWING RELATED LITERATURE

This is the most important step in any research process, reviewing of literature is a continuous process and it helps the researcher to become more grounded about his/her research area. Through reviewing related literature the researcher is able to develop a scholarly language, appreciate the works of other scholars and further conceptualize the research problem at hand. Reviewing of related literature will enable the researcher to identify study variables, theory(ies) to underpin the study and helps the researcher to refine the research problem and topic of the study. However, in a study where the research proposal may contain a section of literature review, then this step becomes very vital since it helps a researcher to compile the literature review section of the research proposal.

STEP III: DEVELOP THE PROBLEM STATEMENT, RESEARCH OBJECTIVES, QUESTIONS & HYPOTHESIS

At this level the researcher is assumed to have a deeper understanding of the entire research.

Therefore this stage involves "state of the problem" where the researcher clearly states the current problematic situation, this section must show the gravity of the problem and reflect why the research should actually be conducted today and not tomorrow. The statement of the problem must show that the problem is researchable, backed with statistical evidence and its as well a practical problem. The statement of the problem must be concise, brief and specific, therefore it should not exceed ¾ (3 quarters or 0.75) of a page or maximumly 1 page.

This stage further involves the development of the research objectives where the general objective is formulated directly from the research topic and the specific objectives are developed directly from the general objective by relating the independent variable(s) and the dependent variable. However, it's important to note that a researcher will only identify good and researchable variables only and only if s/he has sufficiently reviewed the related literature.

Research Questions are further developed from the specific objectives implying that the number of specific objectives will always determine the number of research questions in a case where we have 3 objectives, there will be 3 questions if the specific objectives are 5 in number then the questions will equally be 5 in number". In this case research question(s) refer to the question(s) that the researcher intends to answer through specifically undertaking a study.

Research Hypothesis; these are the tentative answers to the research questions above. At this point the researcher develops research hypotheses, it's important to note that unlike the research questions, research hypothesis may not necessarily be of the same number as the research questions, the hypotheses may even be less or more than the research questions.

STEP IV: SELECT THE RESEARCH DESIGN, SAMPLE DESIGN AND DATA COLLECTION METHODS.

At this stage, the researcher is expected to select the overall plan of the research or roadmap. Therefore at this point the researcher will select the most appropriate research design and the selection of the research design will be based research strategy or approach, that is to say whether it's a purely quantitative study, qualitative study or a triangulation (mixed method).

The quantitative research designs include; Experimental Design, Survey Design & Correlation Research Design among others.
The qualitative research designs include; Ex-Post Facto design, Ethnography design and Historical design among others.
Research design for mixed methods includes; The Longitudinal design, Cross-sectional design and Cross-cultural research design among others.

This stage as well involves the selection of the most appropriate sample design to use in the study. Selection of the sample design depends greatly on the research strategy either qualitative research strategy, quantitative research strategy or mixed research strategy. Therefore the three forms of sample designs include;

Quantitative / Probability / Random-sampling design
Qualitative/ Probability / Non-Random sampling design
Mixed Sample Design.

Sampling Designs:

Quantitative / Probability Sampling Design: This is adopted when the research strategy is quantitative in nature and under this strategy the researcher will adopt sampling techniques such as; Simple Random Sampling (SRS), Stratified Sampling, Cluster Sampling, Systematic Sampling & Probability Proportionate to Size Sampling and Multi-stage Sampling.
Qualitative / Non-Probability Sampling Design: This is adopted when the research strategy is qualitative in nature and under this strategy the researcher will adopt sampling techniques such as; Judgmental sampling, Convenience sampling, Quota sampling, Snowball/ Chain Referral Sampling and Accidental Sampling among others.
Mixed Sampling Design: this is where the researcher adopts both the quantitative and qualitative sample designs and this is usually adopted where the research strategy is mixed research strategy (a combination of both qualitative and quantitative strategies).

This step as well involves the selection of the most appropriate data collection methods, these methods will depend on the research strategy or approach, the research design and sample design that was adopted. There are three (3) main classifications of data collection methods these include;

Quantitative data collection methods.
Qualitative data collection methods
Mixed data collection methods.

Data Collection Methods:

Quantitative data collection methods: these are methods that are used to collect data which is numeric, figures or counts in nature. These data collection methods include; Questionnaire survey & experiment among others.
Qualitative data collection methods: these are methods that are used to collect data which is in form of words, statements, themes and descriptive in nature. These data collection methods include; Focus Group Discussions, Documentary Review, Observation and as well as Key Informant Interviews.
Mixed data collection methods: these include a triangulation of both qualitative and quantitative data collection methods in a given study.

STEP V: DEVELOP DATA COLLECTION INSTRUMENTS AND PILOT TEST THEM

This step is guided by the previous step, at this level the researcher starts by developing the data collection instruments, these instruments are classified into 3 broad categories which include;

Quantitative data collection instruments.
Qualitative data collection instruments.
Mixed data collection instruments.

The choice of the data collection instrument greatly depends on the data collection method(s) that was adopted.

Types of Instruments:

Quantitative data collection instruments: include; Questionnaire/ Survey Guide and Experiment Checklist among others.
Qualitative data collection instruments: include Focus Discussion Topics / Focus Group Discussion Guide, Documentary Review Checklist, Observation Checklist and as well as Key Informant Interview Guides.
Mixed data collection instruments: this includes the adoption of both qualitative and qualitative data collection instruments. This is adopted in a study whose research design adopts both qualitative and quantitative research designs.

This step as well involves the pre-testing of the selected instruments for both validity and reliability.

Validity in this context refers to the correctness of a research instrument or it can be understood as how well a research instrument measures what it is supposed to actually measure. The common method of measuring of validity is usually the Content Validity Index given by number of items declared valid divided by total number of items. Amin, (2005) recommends that CVI should be above 0.7 for the instrument to be considered. However, I recommend that for the sake of more valid result this value should be at least 0.8 for social research if the instrument is to be rendered valid.
Reliability or consistence of an instrument; this measures how consistent a given research instrument is, usually by examining the level of consistence of results produced by the instrument over time. It is usually measured using the cronbanch's alpha coefficient, this value is produced by statistical software. Amin (2005) recommends that the coefficient value should be more than 0.7 for an instrument used in social research. However, for the sake of more reliable results, I recommend that this value should be at least 0.8.

STEP VI: DATA COLLECTION

After pre-testing for validity and reliability of the research instruments (quality control). The researcher then embarks on data collection, at this point the researcher collects;

(i) Primary data - this is data that is directly collected by the researcher from a respondent. The researcher uses research instruments that have been tested for both validity and reliability.
(ii) Secondary data - this is data collected by a researcher from secondary sources of data such as text books, journals, recordings, newspapers & magazines among others.

Note that:

In a single study a researcher can collect both primary and secondary data depending on the objectives of the study and interests of the researcher.
The researcher may decide to employ research assistants to help him/her in the process of data collection. Research assistants must be well trained before any research project in order to ensure that the research is ethical and its findings can actually be generalized.

STEP VII: ANALYZE & INTERPRET DATA

After collecting data, the researcher then thinks of presenting, analyzing and interpreting the data. It's important to note that quantitative data will be treated differently from qualitative data.

Quantitative data analysis techniques include: Uses of Correlations, Regression Analysis, Analysis of variance (ANOVA) and as well as Chi-square tests among others.
Qualitative data analysis methods include: Content Analysis & Thematic Analysis among other methods.

Before data analysis a researcher must do data management which includes; cleaning of data, coding of data & capturing of data usually into statistical software.

STEP VIII: GENERATE THE RESEARCH REPORT

After presentation, Analysis and Interpretation of data, the researcher then compiles the research report. The format of a research report varies from Institution to Institution or Organization to Organization, therefore it's imperative that a researcher vividly understands the format of the research report of his or her organization. However, it's important to note that generally a research report will include; the summary of the findings, dissension of findings, conclusion of the study and as well as the recommendations of the study. Therefore ensure that you are conversant with the required format of a research report.

STEP IX: PRESENT FINDINGS TO STAKEHOLDERS.

After compiling the report, you should then present your findings to the concerned stakeholders. The researcher should organize a PowerPoint slide preferably with about 8-12 slides depending on the length of the report, purpose of the report and the target audience. Then present the findings to the concerned stakeholders.

The slides may include:

A slide with the topic of the research, author of the report (Researcher) month/year (Date)
A slide with a summary of the abstract.
A slide with the study objectives.
A slide with the conceptual framework.
A slide with the significance and justification of the study.
A slide with the summary of literature review.
A slide with the methodology.
A slide with the findings of the study.
A slide with the recommendations.
A slide to thank the audience.

These should range from 8-12 slides and depending the length of the report, purpose, audience and complexity of the subject matter, the report should be presented between 10 and 30 minutes. However, these are not standards all these guidelines may as well vary from Institution to Institution.

STEP X: DISSEMINATE FINDINGS TO STAKEHOLDERS

If it's an academic research then once it's approved, endeavor to disseminate the research findings to all the concerned stakeholders. These stakeholders may include;

The academic institution (Usually 2 copies),
Your research supervisor(s) (Usually 1 copy per supervisor),
The case you studied for example "A case of Uganda Revenue Authority" (Usually 1 copy) and
All other concerned stakeholders that you could have highlighted in the document as some of the potential beneficiaries of your research, including you the researcher. Don't give out everything and remain with totally nothing.

Note that:

You can disseminate your findings in soft copy or hard copy. You can disseminate in form of a standard /report or an article in a peer reviewed Journal or in form of a conference presentation among other forms. Use a form that the target beneficiaries can easily access.

MONITORING & EVALUATION (M&E)

After dissemination of findings, any focused researcher should monitor whether his/her findings made a contribution towards solving the existing problem, whether his or her findings influence policy making, decision making and whether they are appreciated by the target beneficiaries.

The researcher should as well evaluate whether his/her findings were Relevant, whether they were Efficient, Effective, Impactful and whether his/her recommendations provided Sustainable solutions to the existing problems.

Conducting of M&E is not part of the mainstream research process but it helps in making a researcher better and much better through identification of mistakes and learning hence improvement in any subsequent research project(s).

Five Research Phases

Phase	Activities
Phase 1: Conceptual Work	Identifying research problem/questions Reviewing relevant literature Developing theoretical framework & conceptual Generating logical hypotheses
Phase 2: Study Design & Planning	Research design & methods Identifying population & accessible sample Selecting measures Establishing study protocol
Phase 3: Research Implementation	Data collection Intervention if applicable
Phase 4: Analysis	Data screening & cleaning Data analysis Interpretation and writing up of findings
Phase 5: Dissemination	Communication of findings

STEPS IN RESEARCH PROCESS Read More »

TEACHING-LEARNING (EDUCATIONAL) OBJECTIVES

Teaching-learning(Educational) objectives are statements describing desired changes in behavior as a result of specific teaching-learning activity.

Behavior is what the student should know or be able to do after teaching-learning activity, i.e. Therefore in education: the objective describes students’ performance, not teacher performance.

Educational objectives refer to what the student should be able to do at the end of a learning activity.

Difference between goal and objectives

Goals and objectives are often used interchangeably but they are different in the following ways

Goals	Objectives
Long-term aims that you want to accomplish	Short-term statements
They are broad statements (e.g., students should know the human body)	Narrow statements (e.g., students should name all bones of the human body)
They are abstract and Intagible	They are concrete and tangible

PURPOSE OF WRITING EDUCATIONAL OBJECTIVES

Objectives inform students what is required of them so that they can better prepare their work.
Objectives help the planning team to select and design instructional content, material, or methods. It also allows teachers to organize and put into sequence the subject matter.
Objectives provide means of measuring whether students have succeeded in acquiring knowledge and skills.
Objectives provide a basis for self-evaluating both the student’s learning.
Objectives provide the best means for communicating to colleagues, parents, and others what is to be taught and learnt.

QUALITIES/CHARACTERISTICS OF A GOOD OBJECTIVE

An objective should be SMART:

Specific: No argument, dispute about the meaning. It should clearly communicate an expected behavior modification. It should be unequivocal (not to bear more than one meaning); hence avoid words like to know, understand since they are not specific.
Measurable: There should be provision to evaluate the end result, i.e., quantified in an objective way. The measure should be observable so that one can view the progress.
Achievable: Can be attained/performed within the allocated time and with available resources.
Realistic: Makes sense in the situation, i.e., should have a direct relationship with the aims of learning and based on the needs of the learners (relevant).
Time-bound: It should have a time frame within which the outcome is evaluated.

MAIN ELEMENTS OF AN OBJECTIVE

The main elements of an objective are:

Condition of performance: An objective always describes the important conditions (if any) under which the performance is to occur. For example, ‘By the end of this session’ or after attending this demonstration.
Audience: The learner – who will be doing the behavior, like diploma students.
Behavior: An objective always says what the teacher expects the learner to be able to do. It is the description of the task to be done expressed by an active verb. The performance indicator is the act whose satisfactory performance implies that the student is able to accomplish the task required. For example, ‘student will be able to perform intramuscular injection’ is the student behavior.
Criterion or standard: It specifies the level of performance that the teacher will accept as successful attainment of the objective or describes how well the learner must perform in comparison with a predetermined standard or criteria. For example, ‘correctly’, 100%, ‘accurately’ indicate the criteria.

Determinants of educational objectives

Needs of the learner– based on development stage, interests of learner.
Subject matter– appropriate to the contents of the subject.
Needs of society– one has to considers the contemporary life outside school.

Classification (Types) of Educational Objectives

Educational objectives are classified differently:

According to the Level of Objectives:

Institutional or general
Departmental or intermediate
Specific / Instructional Objectives

According to the domains of learning:

Cognitive domain
Affective domain
Psychomotor domain

According to the Level of Objectives:

1. Institutional (General) Objectives: These objectives are usually formulated in consensus with general curriculum objectives of the educational program by the curriculum committee of the institute. They are broad in focus and align with what the institution aims to achieve. For instance, at the end of training at a medical college, the medical graduate should be able to diagnose and perform first-level management of acute emergencies promptly and efficiently.

2. Departmental or Intermediate Objectives: Derived from institutional objectives, these objectives are related to a specific learning experience or subject matter. For example, at the end of the training in the Department of Medicine, students should be able to perform methods of first-level management of acute emergencies in medicine.

3. Instructional/Behavioral Objectives: These objectives are specific, precise, attainable, measurable, and correspond to each specific teaching-learning activity. They are formulated by the teacher at the instructional level. For instance, at the end of the training sessions, the students should be able to perform CPR measures outside the hospital also without any access to modern resuscitative equipment.

According to the domains of learning:

BLOOM’S TAXONOMY OF EDUCATIONAL OBJECTIVES

Taxonomy means ‘a set of classification principles’, or ‘structure’, and Domain simply means ‘category’.

The most well-known description of learning domains was developed by Benjamin Bloom, hence it is known as “Bloom’s Taxonomy.” Bloom’s taxonomy (classification) of educational objectives divides the learning objectives into three major domains, namely:

The Cognitive Domain (knowledge or intellectual abilities)
The Affective Domain (attitudes, values, or interests)
The Psychomotor Domain (motor skills)

These categories are further categorized according to the level of behavior, progressing from the simplest to the highly complex.

COGNITIVE DOMAIN

The Cognitive domain is further subdivided into a hierarchy of six intellectual functions from the simplest to the most complex, as follows:

Knowledge: The ability to memorize, recall, or otherwise repeat previously learnt materials. Action verbs used include; define, state, name, list, describe, write (e.g., define hypertension).
Comprehension: Ability to grasp/understand the meaning of material. Ability to translate data from one form to another in the form of translation, interpretation, and extrapolation. Action verbs used include; classify, explain, justify, convert, formulate (e.g., given a set of B.P values, classify hypertension).
Application: Ability to use material learnt such as rules, concepts, and principles in new and real situations. This demonstrates a higher level of understanding than comprehension. Verbs used include; demonstrate, construct, perform, prepare (e.g., formulate a diet plan for a patient with diabetes).
Analysis: Ability to break down information into its component parts so that its organizational structure may be understood. It separates important aspects from less important. Action verbs include; analyse, justify, differentiate, discriminate, distinguish (e.g., differentiate between hypertensive urgency and emergency).
Synthesis: Ability to build up information together to create something new. The learner is expected to combine various parts to form a new whole. Action verbs include: discuss, summarize, compose, plan, derive (e.g., compose a care plan for a patient with heart failure).
Evaluation: The ability to make judgments, qualitatively and quantitatively based on a definite criteria. Typical verbs include, judge, assess, predict, evaluate, determine, appraise, compare, and contrast.

AFFECTIVE DOMAIN

This domain is divided into five hierarchical levels from the lowest to the highest, as follows:

Receiving: Refers to the student’s willingness to respond or give attention to particular phenomena or activity (classroom activities, textbook, music, etc.). For example, the learner would be able to show awareness of anxiety of the patient waiting for an invasive procedure.
Responding: Refers to active participation on the part of the student to particular phenomena, reflecting interest but not commitment. For instance, the learner would be able to reassure an anxious patient waiting for an invasive procedure.
Valuing: Refers to perception of worth or value in phenomena. For example, the learner would be able to realize that it’s worth spending time reassuring patients whenever they are anxious.
Organization: Refers to bringing together different values, resolving conflicts between them and beginning the building of an internally consistent value system. For instance, the learner would be able to form judgments as to the responsibility of the health care team for commitment towards the emotional well-being of patients.
Characterization: At this level, a student has a value system to the extent of representing a philosophy of life. The learner would be able to display commitment toward emotional well-being of patients undergoing invasive procedures.

PSYCHOMOTOR DOMAIN

These are objectives which emphasize manipulative and motor skills such as handwriting, swimming, typing, operating machinery, and driving, etc. This domain is divided into six ascending levels of manipulative skills as follows:

Readiness: Refers to the willingness to perform an activity. For instance, the learner develops interest in learning how to establish an IV infusion.
Observation: Refers to attending the performance by a more experienced person. For instance, the learner observes the mentor establishing an IV infusion.
Perception/Imitation: Refers to sensation and being able to perform the skill. The basic rudiments/steps of the skills acquired. For example, the learner mentions steps needed in the establishment of an IV infusion as observed.
Practice/Response: Refers to practicing a skill or repetition of the sequence of phenomena as conscious effort decreases. For example, the learner performs the establishment of an IV infusion on the patient as demonstrated by the teacher.
Adapting: Refers perfection of the skill, although further improvement is possible. For example, the learner demonstrates mastery of establishing an IV infusion.
Origination: It involves the origination of new movement patterns to suit a particular circumstance. For example, design a split to restrain the forearm of the child on IV infusion.

ADVANTAGES OF WRITING BEHAVIORAL OBJECTIVES

a) Provides an opportunity for the teacher to examine the content to teach.
b) Motivates the teacher to present the content in a student-friendly manner.
c) Helps the teacher determine whether he/she has actually taught what was intended to be delivered.
d) Allows the teacher to evaluate a student’s performance.
e) Justifies the selection of content, learning experiences, and teaching-learning methods.

LIMITATIONS OF BEHAVIORAL OBJECTIVES

a) Most objectives relate to the lowest cognitive level (recall of information), which is the least important. This means that the really important outcomes of education receive little attention.
b) The procedure employed for specifying objectives applies best to cognitive and psychomotor behaviors. Only rarely can objectives in the affective domain (attitudes) be stated in observable and measurable terms.
c) They lead to predictability of outcomes rather than open-endedness, discovery, and creativity opportunities for learners.
d) A teacher cannot specify in advance all potential outcomes of an instructional program. This narrow path of an objective may hinder useful un-anticipated needs and outcomes.

TEACHING-LEARNING (EDUCATIONAL) OBJECTIVES Read More »

ANDRAGOGY

ANDRAGOGY.

Andragogy, often referred to as adult education, encompasses both the art and science of facilitating adult learning.

Andragogy is the art and science of helping adults learn.
It also refers to a method and practice of teaching adult learners.

Reasons Behind Adult Learning

Adults engage in learning for a variety of reasons, driven by their unique life circumstances and goals.

Staying Competitive: The dynamic nature of today’s world demands that adults continuously update their knowledge and skills to remain competitive in their professional fields. Learning becomes a means to adapt to changing landscapes and evolving technologies.
Job Training and Advancement: Many adults engage in learning as a part of their job requirements or career advancement. Keeping up with new industry standards, technologies, and practices is essential for job performance and growth.
Financial Growth: Learning can lead to better job opportunities and increased earning potential. Acquiring new skills and qualifications often opens doors to higher-paying positions or entrepreneurship.
Self-Improvement: Adult learners also seek personal growth and self-improvement through learning. Whether it’s acquiring a new hobby, exploring a new field of interest, or enhancing personal skills, learning contributes to their overall well-being.
Acquiring New Skills: Adults recognize the value of acquiring new skills that may not only be relevant to their careers but also enrich their personal lives. Learning a new language, mastering a musical instrument, or becoming proficient in a creative endeavor are examples of skill-based learning.

Characteristics of Adult Learners

Control over Learning: Adults tend to be self-directed in their lives, although responsibilities with jobs and families can remove a degree of their freedom to act. Adulthood brings an increasing sense of the need to take responsibility for our lives, and adults strongly resent it when others take away their rights to choose. This fact is clearly seen in educational efforts among adults. When not given some control over their learning, most adults will resist learning, and some will even attempt to sabotage education efforts. They require autonomy.
High Motivation to Learn: Adults are particularly motivated to learn information that seems immediately applicable to their situation and needs. They tend to be frustrated with “theory” that needs to be stored away for future use or learning for the sake of learning.
Pragmatic (Practical) Learning: Adults in the workplace prefer practical knowledge and experiences that will make work easier or provide important skills. In other words, adults need personal relevance in learning activities. Many adults prefer to learn by doing rather than listening to lectures.
Learning as a Secondary Role: Adults fulfill multiple roles, and these roles inevitably create conflicting and competing demands on the adult learner. Multiple responsibilities and commitments to family, friends, community, and work cause most adults to have far less time and energy to read, study, or learn.
Resistance to Change: Learning often involves changes in attitudes or actions. Adults tend to be somewhat resistant to such changes because life itself teaches us that change is not always for the better and that many outcomes of change are unpredictable. Youth tend to be more idealistic and are often open to change just for the sake of change.
Diversity among Adult Learners: Adults vary from each other as learners in terms of age and experiences much more than traditional age learners. Such differences can be used as a powerful resource for adult learning. Through collaboration in small groups, adults can benefit from their variety of experiences. Dialogue with other adults enables adult learners to perceive more nuances of application and possible problems with new concepts than could ever be gained from private reflection.
Drawing on Past Experiences in Learning: The adult’s experience is a key resource in any learning effort. Adults have a greater reservoir of life experiences simply because they have lived longer and seen or done more. Consciously or unconsciously, adults tend to link any new learning to their prior learning. Learning through mutual sharing is important.
Goal-Oriented Learning: Learning is aimed at an immediate goal. Many adults have specific goals they are trying to achieve. They prefer to partake in learning activities that help them reach their goals.
Results-Oriented Approach: Adults are results-oriented. They have specific expectations for what they will get out of learning activities and will often drop out of voluntary learning if their expectations aren’t met.

Adult Learning Theory

Andragogy, also known as adult learning theory, was proposed by Malcolm Shepard Knowles in 1968. Previously, much research and attention had been given to the concept of pedagogy – teaching children. Knowles recognized that there are many differences in the ways that adults learn as opposed to children.

Knowles’ Five Assumptions of Adult Learners

Knowles’ theory of andragogy identified five assumptions that teachers should make about adult learners:

Self-Concept: Because adults are at a mature developmental stage, they have a more secure self-concept than children. This allows them to take part in directing their own learning.
Past Learning Experience: Adults have a vast array of experiences to draw on as they learn, as opposed to children who are in the process of gaining new experiences.
Readiness to Learn: Adults are ready to learn things that relate to their life and responsibilities. Many adults have reached a point at which they see the value of education and are ready to be serious about and focused on learning.
Practical Reasons to Learn: Adults are looking for practical, problem-centered approaches to learning. Many adults return to continuing education for specific practical reasons, such as entering a new field.
Driven by Internal Motivation: While many children are driven by external motivators – such as punishment if they get bad grades or rewards if they get good grades – adults are more internally motivated.

Principles of Andragogy

Educating adults involves understanding adult learning principles. Based on Knowles’ assumptions about adult learners, he discussed five principles that educators should consider when teaching adults:

Self-Directed Learning: Since adults are self-directed and increasingly independent, they should have a say in the content and process of their learning.
Building on Experience: Adults bring life and job experience with them. This experience is a resource for learning. Therefore, their learning should focus on adding to what they have already learned in the past.
Readiness to Learn: Since adults are looking for practical learning, content should focus on issues related to their work or personal life. Adults want to learn what they can apply in their real-life situations.
Problem-Oriented Approach: Additionally, learning should be centered on solving problems instead of memorizing content. Learning is organized around life/work situations rather than subject matter units.
Motivation to Learn: Motivators for adults can be both external and internal. External motivators include better jobs and higher salaries. Internal motivators include increased job satisfaction, self-esteem, recognition, better quality of life, self-confidence, and self-actualization.
Respect for Adult Learners: Adult learners like to be respected.

Application of Andragogy to Teaching

Applying andragogy to teaching involves tailoring the educational approach to meet the specific needs, backgrounds, and expectations of adult learners. Here are some ways in which andragogy can be applied to teachers:

Understanding Learners: Teachers should start by understanding the needs, experiences, and expectations of their adult learners. This knowledge serves as the foundation for creating effective learning experiences.
Learner-Centered Environment: Establishing a learner-centered educational environment is crucial. This means designing the learning process around the interests and goals of adult learners, allowing them to take an active role in shaping their education.
Active Engagement: Teachers should design courses and activities that actively engage adult learners. This could involve hands-on activities, group discussions, problem-solving tasks, and real-world applications.
Motivation: Recognize that adult learners are motivated when they see the immediate relevance and applicability of what they are learning. Teachers should emphasize the practical benefits and outcomes of the material being taught.
Sharing Experiences: Create opportunities for adult learners to share their own experiences and insights. This promotes a collaborative learning environment where learners can learn from each other.

Lessons from Adult Learning Theory:

Lesson 1: Make Sure Your Adult Students Understand Why: Clearly communicate the importance and relevance of the material being taught. Adult learners are more engaged when they understand the significance of what they’re learning.
Lesson 2: Respect Different Learning Styles: Recognize that adult learners have diverse learning styles – visual, auditory, and kinesthetic. Accommodate these styles to enhance comprehension and retention.
Lesson 3: Allow Experiential Learning: Encourage experiential learning where learners actively engage with the subject matter. Any activity that involves learners in the learning process enhances their understanding.
Lesson 4: Seize Teaching Moments: Pay attention to opportune teaching moments. If a topic naturally arises in conversation or during activities, take advantage of the opportunity to teach it immediately.
Lesson 5: Encourage and Recognize Contributions: Foster a positive and encouraging atmosphere in the classroom. Give learners time to respond, recognize their contributions, and offer words of encouragement. Clear expectations motivate learners to meet them.

Differences between Pedagogy and Andragogy.

Pedagogy	Andragogy
Learner is dependent upon the instructor for all learning.	Learner is self-directed and responsible for own learning.
The teacher assumes full responsibility for what is taught.	Self-evaluation is characteristic of this approach.
Teacher/instructor evaluates learning.	The learner brings a greater volume and quality of experience.
The learner comes with little experience as a resource.	Adults are a rich resource for one another.
Experience of the instructor is most influential.	Different experiences assure diversity in groups of adults.
Students are told what they have to learn.	The need to know in order to perform more effectively in some aspect of life is important.
Learning is acquiring prescribed subject matter.	Learning must have relevance to real-life tasks.
Content units are sequenced by subject matter logic.	Learning is organized around life/work situations.
Primarily motivated by external pressures.	Internal motivators: self-esteem, recognition, better quality of life, self-confidence, self-actualization.

1. What is the main difference between pedagogy and andragogy in terms of learner responsibility?
A) Pedagogy involves self-directed learning.
B) Andragogy involves instructor-directed learning.
C) Both pedagogy and andragogy rely on instructor guidance.
D) Both pedagogy and andragogy involve equal learner responsibility.

Answer: B) Andragogy involves instructor-directed learning.

2. Which of the following best describes the role of the instructor in andragogy?
A) Complete responsibility for learner outcomes.
B) Providing step-by-step guidance in all activities.
C) Facilitating learning and encouraging self-evaluation.
D) Evaluating learners’ achievements without input from learners.

Answer: C) Facilitating learning and encouraging self-evaluation.

3. What is a key characteristic of adult learners’ motivation to learn?
A) Focus on theory for future application.
B) Reliance on external rewards for learning.
C) Emphasis on learning for the sake of learning.
D) Interest in immediate practical applicability.

Answer: D) Interest in immediate practical applicability.

4. In the context of andragogy, what does the term “self-directed” mean?
A) Learning without any guidance from the instructor.
B) Relying solely on textbooks for learning.
C) Taking initiative and responsibility for one’s learning.
D) Following a strict curriculum without flexibility.

Answer: C) Taking initiative and responsibility for one’s learning.

5. What distinguishes adult learners from children in terms of their experiences?
A) Adults have fewer experiences to draw upon.
B) Children have more varied life experiences.
C) Adults bring a greater volume and quality of experience.
D) Children’s experiences are more relevant to education.

Answer: C) Adults bring a greater volume and quality of experience.

6. Which motivation factor is more relevant to adult learners than to children?
A) Grades and competition.
B) External rewards and punishments.
C) Desire for recognition and self-esteem.
D) Idealistic aspirations and curiosity.

Answer: C) Desire for recognition and self-esteem.

7. What does andragogy suggest about the relevance of learning content?
A) Content should be abstract and theoretical.
B) Content should be unrelated to real-life situations.
C) Learning content should be irrelevant to learners’ needs.
D) Learning content should have relevance to real-life tasks.

Answer: D) Learning content should have relevance to real-life tasks.

8. How should learning be organized according to andragogy?
A) Around subject matter units.
B) Sequentially based on pedagogical logic.
C) Around life/work situations.
D) Focused on theoretical concepts.

Answer: C) Around life/work situations.

9. What is a primary role of instructors in andragogy-based teaching?
A) Delivering lectures without interaction.
B) Following a strict curriculum.
C) Tailoring content to learners’ needs.
D) Assessing learners without their input.

Answer: C) Tailoring content to learners’ needs.

10. In andragogy, why is recognizing the contributions of adult learners important?
A) To maintain teacher authority.
B) To keep learners dependent on the instructor.
C) To encourage learners to drop out of the course.
D) To motivate and empower adult learners.

Answer: D) To motivate and empower adult learners.

11. Which learning style does andragogy emphasize in teaching adult learners?
A) Visual learning.
B) Auditory learning.
C) Kinesthetic learning.
D) All learning styles are equally emphasized.

Answer: D) All learning styles are equally emphasized.

12. What type of motivation is more intrinsic to adult learners?
A) External rewards and punishments.
B) Grades and competition.
C) Internal motivators like self-esteem and self-actualization.
D) Recognition and rewards from instructors.

Answer: C) Internal motivators like self-esteem and self-actualization.

13. What is the focus of learning in andragogy?
A) Memorizing content.
B) Gaining theoretical knowledge.
C) Problem-solving and practical application.
D) Achieving high grades.

Answer: C) Problem-solving and practical application.

14. Which teaching approach allows adult learners to actively engage, gain and share experiences, and collaborate?
A) Instructor-centered approach.
B) Traditional lecture-based approach.
C) Learner-centered andragogical approach.
D) Rote memorization approach.

Answer: C) Learner-centered andragogical approach.

ANDRAGOGY Read More »

INTEGRATED DISEASE SURVEILLANCE

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INTEGRATED DISEASE SURVEILLANCE AND RESPONSE-IDSR

IDSR – Is a strategy for a multi-disease surveillance of selected priority diseases or conditions which links the community, health facility, district and national levels allowing the rational use of resources for disease control and prevention.

Integrated Disease Surveillance is a comprehensive approach used by public health systems to monitor, detect, and respond to various diseases and health events in a coordinated manner.

Surveillance – Is the ongoing systematic collection, analysis and interpretation of health data. It includes the timely dissemination and use of information for public health actions.

Surveillance is also used for planning, implementation and evaluation of public health practices at any level

Disease surveillance refers to monitoring of diseases and factors affecting their distribution/trends in order that action may be taken of the health system.

Disease Outbreak: A sudden increase in the number of cases of a particular disease in a defined geographic area and time period that is greater than what is normally expected.

Communicable Diseases: Also known as infectious diseases, these are illnesses caused by microorganisms such as bacteria, viruses, fungi, or parasites that can be transmitted from one person to another, directly or indirectly.

Case Definition: A set of standardized criteria that define what constitutes a confirmed case of a particular disease. It helps health workers accurately identify and classify cases during disease surveillance.

Priority Diseases: Diseases that are given special attention due to their significant impact on public health and the potential for rapid spread and serious consequences. Priority diseases vary by region and context.

Supervision, Monitoring, and Evaluation: These are components of disease surveillance that involve overseeing and assessing the implementation of surveillance systems, tracking data quality and completeness, and evaluating the effectiveness of response strategies.

IDRS works in collaboration with bodies under Center for Disease Control (CDC) in order to achieve the goal of disease surveillance and response.

The outstanding bodies are:

Division of emergency infectious and surveillance services (DEISS). It provides expertise to design, develop, implement, monitor and evaluate strategies for IDSR. They organize tools for the program like laboratory equipment.
Division of epidemiology and surveillance capacity building: provides experts for strengthening target countries by giving information on disease outbreaks.
Global Immunization Division (GID) that provides experts in surveillance for vaccines for preventable disease and integrated data management for an expanded program for immunization related surveillance, routine immunization.

In 1996, there was a big problem with a disease called Ebola. Because of that, Uganda decided to join the IDSR program. They made a CDC to look out for disease outbreaks. Other African countries, like Ethiopia, Ghana, and Burkina Faso, also use IDSR to handle outbreaks.

Objectives of Integrated Disease Surveillance and Response

To strengthen national capacity for early detection, complete recording, timely reporting, use of electronic tools, regular analysis and prompt feedback of IDSR priority diseases, events and conditions at all levels.
To strengthen national and subnational laboratory capacity to confirm IDSR priority diseases, events and conditions.
To strengthen capacity for public health emergency preparedness and response at all levels.
To strengthen the supervision, monitoring and evaluation system for IDSR.
To integrate multiple surveillance systems so that tools, personnel and resources are used more efficiently.
Emphasize community participation in detection, reporting and response to public health events including case-based and event-based surveillance and response and risk communication in line with International Health Regulations (IHR).

According to WHO AFRO 1998, the objectives for IDSR include:

To strengthen district level surveillance.
To integrate the laboratory with laboratory reports.
To reduce duplication of reporting on the outbreak.
To share resources among disease control programs.
To translate surveillance and laboratory data into specific and timely public health actions.

Basic Ingredient for IDSR

The IDSR also identified basic ingredients for it to achieve the goals as follows: To make IDSR work well, we need a few important things:

Clear case definition and reporting mechanism.
Efficient communication systems.
Basic but sound epidemiological framework.
Good laboratory report.
Good feedback and rapid response.
Nurses/Midwives attached to health centres to document the surveillance reports.

Core functions of IDSR

Step 1 – Identify and record cases, conditions and events: Use of standard case definitions for health service delivery points (human, animal and environment), simplified case definitions for community level, to identify priority diseases, conditions, and alerts that can signal emerging public health

Step 2 – Report suspected cases or conditions or events to the next level for action: If this is an epidemic prone disease or a potential Public Health Emergency of International Concern (PHEIC), or a disease targeted for elimination or eradication, report immediately to the next level

Step 3 – Analyze (person, place and time) data and interpret findings: Surveillance data should be compiled, analyzed for trends, compared with data from previous periods and interpreted for public health actions at all levels

Step 4 – Investigate and confirm suspected cases, outbreaks or events: Take action to ensure that the cases, outbreaks or events are investigated and confirmed by laboratory

Step 5 – Prepare: ensure the availability of public health emergency preparedness and response plans, as well as a mechanism for coordination of response measures. Take steps in advance of occurrence of outbreaks or public health events, to prepare teams that may respond quickly and set aside essential supplies and equipment which will be available for immediate action

Step 6 – Respond: On confirmation of the outbreak, coordinate and mobilize resources (human, financial etc.) to implement the appropriate public health response

Step 7 – Risk communication: Risk communication is the real-time exchange of information, advice and opinions between experts, community leaders, or officials and the people who are at risk. It encourages communicating with all levels and across sectors including communities that provide data, report outbreaks, cases and events

Step 8 – Monitor, evaluate, supervise and provide feedback to improve the surveillance system: Assess the effectiveness of the surveillance and response systems, in terms of timeliness, quality of information, preparedness, and overall performance. Provide feedback to reinforce health workers’ efforts to participate in the surveillance system. Take action to correct problems and make improvements

Detecting and Planning for Disease Outbreak

From the previous section where we introduced Integrated Disease Surveillance and Response (IDSR), you learned that the main group responsible for controlling diseases is the people who work in the Center for Disease Control (CDC), which is usually located in a hospital setting.

You also learned about the important members of the team needed to make the work effective, including midwives like yourself who are stationed at the outskirts of the district. With the help of clear case definitions, you can accurately detect diseases and provide detailed reports to the CDC.

In the earlier part of our community health discussions, you learned how to carry out health assessments to identify health issues within the community and diagnose priority diseases. You also understood that in order to reach a diagnosis for a community health problem, you have to perform surveillance. This involves screening through laboratory tests and actively searching for cases.

Similarly, when you’re dealing with infectious diseases, you will follow similar guidelines. You’ll select and conduct surveillance activities to gather information, analyze it, interpret the findings, and create a report for the CDC to take action.

To carry out these activities effectively, you need to organize your team, which will consist of:

District Health Officer: This is an important leader who oversees health activities in the district.
Community Health Workers: These are the frontline workers who engage directly with the community and gather information.
Laboratory Technician: This person handles lab tests and analysis, which is crucial for confirming diseases.
Subordinate Nurses: You’ll work with at least one nurse who assists you in carrying out various tasks.

Together, this team will collaborate and follow the outlined guidelines until the final step of report writing. This coordinated effort ensures timely and accurate response to disease outbreaks and contributes to safeguarding public health.

Approaches to public health surveillance

A. Passive surveillance: a system by which a health institution receives routine reports submitted from health facilities and the community. This is the most common, and it includes the surveillance of diseases and other public health events through the Health Management Information System (HMIS)

B. Active surveillance: It involves actively looking for the cases in the community or health facilities through;

Records review by health workers at health facility level
Screening for specific health conditions e.g., at points of entry, health facilities etc.
Regular communication and keeping in touch with key reporting sources. This may take various forms such as telephone calls to health care workers at a facility or laboratory or physically moving to the site.
Finding additional cases and contacts during outbreaks.
Finding diseases targeted for elimination and eradication e.g., Polio (through Acute Flaccid Paralysis (AFP) surveillance), Guinea Worm etc.

C. Integrated Disease Surveillance: This approach aims at collecting health data for multiple diseases using standardized tools, and supports Early Warning Alert and Response (EWAR) systems. To ensure robust early warning and prompt response, the IDSR data collection and analysis system relies on two main channels of information or signal generation, namely:

Indicator Based Surveillance (IBS)
Event-Based Surveillance (EBS).

Indicator-based surveillance (IBS)

Indicator-based surveillance is the regular, systematic, identification, collection, monitoring, analysis and interpretation of structured data, such as indicators produced by a number of well identified, mostly health-based formal sources. Methods of indicator-based surveillance include; facility-based surveillance, case-based surveillance, sentinel surveillance, syndromic surveillance, laboratory-based surveillance, disease-specific surveillance and community based surveillance

Event- based surveillance (EBS)

Event-based surveillance is rapid capture of information about events that are of potential risk to public health. Information is initially captured as a rumor or signal with the potential of becoming an alert after verification. All alerts may not necessarily become real events, as such they all need to be triaged and verified before a response is initiated.

Detecting and Planning for Disease Outbreak

To carry out these activities effectively, you need to organize your team, which will consist of:

District Health Officer: This is an important leader who oversees health activities in the district.
Community Health Workers: These are the frontline workers who engage directly with the community and gather information.
Laboratory Technician: This person handles lab tests and analysis, which is crucial for confirming diseases.
Subordinate Nurses: You’ll work with at least one nurse who assists you in carrying out various tasks.

Priority diseases, conditions or events

Epidemic prone disease, conditions or events

Diseases targeted for eradication or elimination

Other major disease, events or conditions of public health importance

─ Acute hemorrhagic fever syndrome*

─ Anthrax

─ Chikungunya

─ Cholera

─ Dengue

─ Diarrhea with blood (Shigella)

─ Listeriosis

─ Malaria

─ Meningococcal

meningitis

─ Monkeypox

─ Plague

─ SARI**

─ Typhoid fever

─ Yellow fever

─ Zika

─ Also;

─ A cluster of deaths in the community (animal or human deaths)

─ A cluster of unwell people or animals with similar signs or symptoms

─ *Ebola, Marburg, Rift Valley, Lassa, Crimean Congo, West Nile Fever, Dengue.

─ Trachoma

─ Yaws and endemic syphilis or bejel

─ Poliomyelitis

Diseases or events of international concern

─ Human influenza due to a new subtype1

─ SARS1

─ Smallpox1

─ Zika

─ Yellow fever

─ Any public health event of international or national concern (infectious, zoonotic, food borne, chemical, radio nuclear, or due to unknown conditions.

─ Acute viral hepatitis

─ Adverse events following Immunization (AEFI)

─ Diabetes mellitus (new cases)

─ Diarrhea with dehydration less than 5 years of age

─ HIV (new cases)

─ Hypertension (new cases)

─ Injuries (Road traffic Accidents)

─ Malaria

─ Malnutrition in children under 5 years of age

─ Maternal deaths

─ Perinatal deaths

─ Epilepsy

─ Human Rabies

─ Severe pneumonia less than 5 years of age

─ STIs

─ Schistosomiasis

─ Soil transmitted helminths ─ Trachoma

DETECTING AND REPORTING OF PRIORITY DISEASES, CONDITIONS/EVENTS

An essential component of a public health surveillance system is its ability to detect priority diseases which fall within the mandate of public health officials at all levels. Early detection, reporting and response of public health events help to reduce the burden of mortality and morbidity.

Detection of suspected cases of outbreak prone diseases always be vigilant in your health facility and community for the following;

Targeted outbreak prone diseases, conditions and events.
Conditions that are reported more frequently than expected in the community.
Cluster (group) of diseases or sudden deaths following public gatherings.
Any unusual events that may cause health risks.

Health staff (human, animals and environmental) conduct surveillance activities at all levels of the health system (public and private) so that they can detect public health problems of concerns in their community.

In Community.

Community Case definition for all priority diseases plays important roles in surveillance by facilitating early detection and action to priority diseases, conditions and events.
Community members should be oriented in surveillance so that they actively participate in detecting, reporting, responding to and monitoring health events related to humans or animals in their catchment areas.
Encourage vigilance in ensuring that these events are identified and reported on time to facilitate early and quick response.

Ways of detecting priority diseases, conditions and events.

A person falls ill and seeks treatment from a facility.
High rate of hospital admission for the same disease or symptoms.
Community members report unusual events or occurrences at local level such as clusters of deaths or unusual disease patterns to the health facility or perhaps school.
Health workers who conducted routine record reviews to find cases for a specific disease observe that cases of another priority disease have not been reported e.g. AFP, cholera, measles.
During conducting routine record reviews of lab register and observe recorded continued cases of priority diseases e.g. yellow fever, cholera.
Radio/T.V, newspapers or social media report a rumor of rare or unexplained events in the area with potential exposure for humans.
Vital events records show an increase in maternal deaths.
Unusual reports of illness among health care workers.
An unusual death or number of deaths among animals, such as livestock, birds or rodent species, or an unusually high number of sick animals presenting with the same signs.
Environmental officers observed during assessment of water bodies contamination which might be due to chemicals like lead or due to other related chemicals due to mining activities.

A STANDARD CASE DEFINITION

Case definition is an agreed-upon set of criteria used to decide if a person has a particular suspected disease or condition. The definition specifies clinical criteria, laboratory diagnosis and specifications on time, place and person.

A case definition of a disease is a standardized set of criteria that outlines the specific characteristics and symptoms that an individual must meet in order to be classified as having that particular disease.

It serves as a clear guideline for healthcare professionals and public health authorities to accurately identify and classify cases of the disease.

In simpler terms, a case definition is like a checklist that helps healthcare workers determine whether a person’s symptoms and characteristics match those of a specific disease. If they meet the criteria in the checklist, they can be considered a “case” of that disease. This is important for accurate disease tracking, monitoring, and response.

Disease	Clinical Presentation
Measles	– High fever that gets serious quickly- Rash appears 3 to 5 days after fever, followed by Koplik’s rash around the mouth and forehead 2 to 4 days after infection.
Tetanus	– Symptoms show up around 5 to 10 days after infection,- Common symptoms include jaw stiffness, restlessness, difficulty swallowing, headache, fever,- Other symptoms: sore throat, neck stiffness, abdominal rigidity, raised eyebrow.
Poliomyelitis	– Symptoms start 3 to 5 days after infection,- Early symptoms: slight headache, sore throat, vomiting in younger children,- Older children: symptoms appear 7 to 14 days,- Major symptoms: fever, severe headache, stiff neck and back, deep muscle pain, brain damage leading to paralysis of certain muscles.
Tuberculosis	– Patient may appear well or have a cough,- Cough might produce green or yellow sputum in the morning,- Night sweats and shortness of breath,- Pneumothorax (air in pleural space) in young adults,- Weight loss.
Cholera	– Symptoms begin 1 to 3 days after infection,- Range from mild, uncomplicated diarrhea to severe,- Common symptoms: sudden, painless watery diarrhea and vomiting,- Severe cases: loss of more than 1/4 of fluid an hour, eye sickness, intense thirst, muscle cramps, weakness, minimal urine.
Hepatitis	– Acute viral form: sudden onset with poor appetite, feeling ill, nausea, vomiting, and often fever,- Person develops joint pains with itchy red hives on the skin,- Dark urine, jaundice (yellowing of skin and eyes) with general itching, liver enlargement.

Why do we need case definitions?

To help decide if a person has a presumed disease or condition or event, or to exclude other potential disease diagnoses.
To ensure that every case is diagnosed in the same way, regardless of where or when it occurred, or who identified it.
To initiate action for reporting and investigation quickly if the clinical diagnosis takes longer to confirm.
To compare the number of cases of the diseases, conditions or events that occurred in one time or place with the number occurring in another time or place

Standard Case Definitions, for health facility level.

Three-tiered classification system is normally used – Suspect, Probable, Confirmed:

A Suspected case: indicative clinical picture i.e., patient will have fewer or atypical clinical features without being a confirmed or a probable case

Probable case: Clear clinical picture (meets the clinical case definition) i.e., patient will have typical clinical features of the illness or linked epidemiologically to a confirmed case but a laboratory sample cannot be taken because the case is lost or dead or a sample has been taken but not available for laboratory testing or was not viable for sufficient laboratory testing

Confirmed case: A suspected or confirmed case verified by laboratory analysis.

Priority Diseases in Uganda and their Case Definition

Activity:

1. Write down the most common priority diseases that you have ever participated in managing.

Measles
Tuberculosis
Poliomyelitis
Tetanus
Cholera
Hepatitis B

2. Outline the case definition of the diseases.

Measles: A fever accompanied by a rash, cough, and red, watery eyes.
Tuberculosis: Persistent cough for more than two weeks, chest pain, and weight loss.
Poliomyelitis: Muscle weakness or paralysis, often affecting the legs.
Tetanus: Muscle stiffness and spasms, usually starting with the jaw muscles.
Cholera: Profuse watery diarrhea and vomiting, leading to dehydration.
Hepatitis B: Jaundice, fatigue, abdominal pain, and dark urine.

As a quick reminder, priority diseases are communicable diseases caused by biological agents or their products.

They spread from one person to another and are called priority diseases because of their serious impact on humans. Many of these diseases can lead to disasters, increase illness and death, and even cause economic problems for a country.

In Uganda, there have been several outbreaks of diseases that have resulted in loss of lives. Some of these diseases include:

Measles: Common among children aged 1 to 3 years. Symptoms include rash, cough, and red, watery eyes.
Tuberculosis: Affects people of all age groups and is characterized by a persistent cough, chest pain, and weight loss.
Poliomyelitis: Recent research shows an increasing trend in this disease, which causes muscle weakness or paralysis, often in the legs.
Tetanus: Affects people of all ages, usually starting with stiffness and spasms in the jaw muscles.
Cholera: Common during rainy seasons and can become a disaster. Symptoms include severe watery diarrhea and vomiting, leading to dehydration.
Hepatitis B: Rampant throughout the country, presenting symptoms like jaundice, fatigue, abdominal pain, and dark urine.

REPORTING SUSPECTED CASES OF PRIORITY DISEASE/EVENTS.

Rationale for Reporting Include;

To identify emerging problems or conditions and plan appropriate responses including informing relevant staff or levels.
Take action in a timely way.
Monitor disease trends in the area.
Evaluate the effectiveness of the response

In IDSR, data collection and data reporting follow different timelines for different purposes.

i. Immediate reportable diseases, conditions and events

Report case based information to next level
Notifying a potential public health emergency of international concern under IHR 2005
Reporting events from the community sources

ii. Summarize immediate and Weekly reportable diseases.

Weekly reporting of immediate notifiable diseases
Zero reporting

iii. Monthly /quarterly reporting.

Report monthly and quarterly routine summary information for other diseases of public health importance

iv. Improve routine reporting practices

Review the flow of information at the reporting site
Keeping records and procedures for managing reporting forms
Perform periodic checks on data quality
Enhance linkages to strengthen community based surveillance
Strengthen linkages between laboratory and surveillance information
Promote a Multisectoral one health approach with effective involvement from human, animal and environmental health sectors as well as other relevant sectors to strengthen reporting.

v. Data protection and security to protect patient’s confidentiality and privacy by using unique numbers instead of names and this will prevent identities

1) Record details of the sick person including;

The name of the sick person.
Sex, age and job of the sick person.
Address and location of the household.
The signs of the disease.
The date of the onset.
How many people are affected in the household?
The action taken.
Any previous contacts as necessary.

2) Report immediately to the local area leaders, nearest health facility in the community and the health sub district, DHO or surveillance team and MOH using phone calls, SMS, Android and web.

3) Create a line list for the cases seen in the facility.

ANALYZING/INTERPRETATION OF DATA IN PRIORITY DISEASES

Data is a set of values of subjects with respect to qualitative or quantitative variables. OR;
Data is information that has been translated into a form that is efficient for movement or processing.
Analysis refers to breaking a whole into its separate component for individual examination of raw data and converting it into information useful for decision-making by users.
Data analysis is the process of inspecting, cleansing, transforming and modeling data with the goal of discovering useful information, informing conclusions and supporting decision making.

Analyzing data provides the information that is used to take relevant, timely and appropriate public health action.

Analyzing a surveillance data allows for;

Observing trends over time and alerting health staff about emergent events or unusual patterns.
Identifying geographic areas of higher risk.
Characterizing personal variables such as age, gender or occupation that a person is at higher risk for the disease or event.
Monitoring and evaluation of public health interventions

1. RECEIVE, HANDLE AND STORE DATA FROM REPORTING SITES

a) Receive data

Make a careful record of all data received from the reporting site.
The surveillance team at each level or reporting site where data are received should;
Acknowledge the recipient of the data/report
Log into an appropriate logbook any data set or surveillance report received for any reporting site.
Record with log the data, they were received, what is the report about and who is the sender.
Verify whether the data send arrived timely or was late
Check the completeness of the data set or reports
Review the data quantity:
Verify whether the information (hard copy or electronic file) is filled out accurately
Ensure that the form is filled out completely
Check to be sure that there are no discrepancies on the form
Merge the data then store in database
For electronic surveillance refer to eIDSR guide

b) Enter and clear the data

Extract the priority IDSR diseases from the register and enter correctly into aggregated IDSR reporting forms while listing data from all the reporting sites through liaison with health information assistants (HIAs).
Ensure that health facility personnel know the algorithm for reporting including reporting levels.

Use the following practices regardless of the method

2. Analyze data by time, place and person

	Objective	Method	Data display tools
Time	To detect abrupt or long-term changes in disease or unusual event occurrence, how many occurred, the seasonality and the period of time from exposure to onset of symptoms	Compare the number of case reports received for the current period with the number of cases received in a previous period (days, weeks, months, quarters, seasons or years	Record summary total in a; ∙ Table ∙ Line graph ∙ Histogram ∙ Sequential maps
Place	To identify where cases are occurring	Plot cases on a map and look for clusters or relationships between the location of the cases and the health events being investigated, e.g cases near a river, near a market or near a slum	Plot cases on a spot map of the district or area affected during an outbreak Dot density analysis can also be used to depict the number of cases by geographical location
Person	To describe reasons for changes in disease occurrence, how it occurred, who is at greatest risk for disease and potential risk factors	Depending on the disease, characterize cases according to the data reported for case based surveillance such as age, sex, place of work, immunization status, school attendance and other known risk factors for the diseases	Extract specific data about the population affected and summarize in a ∙ Table or ∙ Bar chart

Analyze data by time
Analyze data by place
Analyze data by person
Make a table for person analysis
Calculate the percentage of cases occurring with a given age group
Calculate the attack rates
Calculate a case fatality rate

3. Compare analysis results with thresholds for public health action

An alert threshold– Is the critical number of cases (or indicator, proportion, rate etc) that is used to sound an investigation at the start of an epidemic and prepare to respond to the epidemic.
Action( Epidemic) threshold– Is the critical number or density of susceptible hosts required for an epidemic to occur.

4. Draw conclusions from the findings to generate information through;

Routinely gather or present the graphs, maps and tables and meet with district health teams or relevant stakeholders to review analysis results and discuss the findings.
Systematically review the findings following the district’s analysis plan if one has been prepared.
Make sure you also correlate the analysis you have done with other data sources like from animals, or the environment to assist in correct interpretation of the findings.
Consider quality of the data when interpreting results.
At minimum, review the findings to;

∙ Assess

∙ Compare

∙ Consider possible explanation for increase in cases

∙ Changes in reporting of cases

∙ Changes in reporting procedures

∙ Changes in case definition that is being used to report

Summarize and use the analysis to improve public health action.
Prepare and share with all the stakeholders including the affected communities

INVESTIGATION AND CONFIRMATION OF SUSPECTED CASES, OUTBREAKS/EVENTS:

Purposes

Verify the outbreak or confirm the public health event and risk.
Identify and treat additional cases that have not been reported or recognised
Collect information and laboratory specimens for confirming the diagnosis ∙ Identify the source of infection or cause of the outbreak.
Helps to describe the epidemiological situation in time, place and person.
Describes how the disease is transmitted and the population at higher risk ∙ Select appropriate response activities to control the outbreak or the public health event.
Strengthen prevention activities to avoid future reoccurrence of the outbreak

Steps of outbreak investigation

1. Prepare to conduct an investigation. Mobilize Public health emergency rapid response team (PHERRT)

Specify tasks of the people in the PHERRT what they are expected to perform
Define supervision and communication lines
Decide where the investigation will take place
Obtain the required authorizations
Finalize forms and methods for collecting information and specimens
Arrange transportation and other logistics
Gather supplies for collecting laboratory specimens

2. Verify and confirm the outbreak/event

Review the clinical history and epidemiology
Collect laboratory specimens and
Obtain laboratory results to confirm the diagnosis

3. Define and search for additional cases;

Develop a case definition to be used
Isolate and treat cases as necessary
Search for additional cases through; Search for suspected cases and deaths in the health facility records and Search for contact persons and suspected deaths in the community (contact tracing)

4. Develop a line list and record information about the additional cases

5. Analyze data about the outbreak; Interpret analysis results;

Interpret the time analysis results
Interpret the person analysis results
Interpret the place analysis results
Analyze data and generate hypothesis
Test and refine hypothesis with analytic study

6. Report writing and dissemination of findings.

7. Implement prevention and control measures.

8. Conduct an assessment to determine if the event is a potential public health emergency of international concern (PHEIC).

9. Maintain and intensify surveillance.

10. Conducting regular risk assessment after the outbreak has been confirmed.

RESPONDING TO OUTBREAKS AND OTHER PUBLIC HEALTH EVENTS

Preparation: Preparations for public health events involves the following;

1. Establish a permanent PHEOC (command and control Centre) for overseeing public health emergency preparedness and response activities. The PHEOC will need to develop the following essential elements so as to be fully functional to support the preparation and response to emergencies.

Plans and procedures for operations
Telecommunication technology and infrastructure to enable timely communication
Information system to support informed decision making (Hms/DHI3).
Trained human resources

2. Establish a district or regional public health emergency management committee (PHEMC)

Identify members of the PHEMC
Identify functions of the PHEMC
Regular PHEMC meetings.

3. Establish public health emergency management committee at all level These includes;

Coordination/management subcommittees.

Roles: Coordinate all aspects of the operations response, planning and management including:

Selecting participating organizations and assigning responsibilities
Designing, implementing and evaluating control interventions
Coordination of technical EPR subcommittees and overall liaison with partners
Daily communication through situation report about the evolution of the outbreak
Managing information for public and news media
Operational support including mobilization of resources
Responsible for staff wellbeing, security

Finance and administration

Tracks expenditure, makes payments, and provides administrative services
Ensures appropriate cash flow management, tracking material and human resources, looking at cost, budget preparation, monitoring, and maintenance of administrative records.

Logistics committee

Provide budgetary support/ funding for epidemic preparedness & response.
Procurement of equipment and supplies.
Maintain adequate stocks of supplies and equipment.
Arrange for transport and communication systems.
Liaison with other agencies for logistic support.
Provide accountability for all the resources used during epidemic preparedness & response.

Planning committee

Evaluate the situation (information gathering and analysis), assessment of the options for dealing with it, and keeping track of resources.

Case management and infection prevention and control committee

Ensure or make available guidelines and SOPs for case management and infection prevention and control in all health facilities.
Strengthen isolation facilities and reinforce infection prevention and control measures.
Conduct risk assessment of health care workers.
Ensure appropriate medical care is being provided to patients.
Provide ambulance services – collection of suspected cases from the community using the defined referral system.
Collect data from all treatment facilities (if available) and submit to the surveillance sub committee.
Ensure appropriate disinfection of homes and environments with suspected/ probable/ confirmed cases/ deaths of an infectious disease.
Conduct safe burial of dead bodies from isolation facilities and community deaths.
Training and refreshers training of health workers in the isolation facility and other health facilities in the affected district

Surveillance and laboratory

Ensure or make available all surveillance guidelines and tools in the health facilities.
Ensure the use of the outbreak case definition.
Conduct active case finding, case investigation, contact tracing and follow-up.
Verification of suspected cases/ alerts/ rumors in the community.
Ensure proper filing of case investigation, contact tracing and follow-up forms.
Ensure proper collection, packaging, transport, and testing of specimens from suspect/ probable cases/ deaths.
Communicate test results to clinical services.
Conduct data management and provide regular epidemiological analysis and reports.
Training of health personnel in disease surveillance.
Close linkage with burial, infection control and social mobilization groups

Risk communication and social mobilization

Ensure or make available risk communications materials and plans
Conduct rapid assessment to establish community knowledge, attitudes, practices & behavior on prevailing public health risks/events
Organize sensitization and mobilization of the communities
Serve as focal point for information to be released to the press and public
Liaise with the different subcommittees, local leadership and NGOs involved in activities on mobilizing communities

Psychosocial support committee

Provide psychological and social support to suspected/probable/confirmed cases; affected families and communities
Provide wellness care and psychological support to the response team
Prepare bereaved families/ communities for burials
Prepare communities for reintegration of convalescent cases/ patients who have recovered

Water sanitation and hygiene- WASH committee

Conduct environmental health risk assessment for the outbreak
Ensure provision of clean water
Improved water management at household and community level.
Plan for sanitation improvement campaign
Plan for improved hygiene practices including hand-washing, food hygiene and sanitation.

Vaccination campaign committee/EPI team

Identify high risk groups during the outbreak that should be targeted for vaccination
Compute the targeted population for the vaccination campaign
Conduct micro-planning for all vaccination logistics including cold chain facilities, vaccine delivery and distribution, human resource needs, waste handling, social mob.
Conduct the vaccination campaign and post vaccination campaign validation exercise

Establish public health emergency rapid response team (PHERRT)
Roles of PHERRT includes;

Investigate rumors and reported outbreaks, verify diagnosis and other public health emergencies including laboratory testing
Collect additional samples from new patients and old ones if necessary (human, animals, food, and water
Make a follow up by visiting and interviewing exposed individuals, establish a case definition and work with community to find additional cases
Assist in laying out mechanisms for implementation of Infection Preventive Control Measures
Assist in generating a line list of the cases, and perform descriptive analysis of data (Person, Place and Time) to generate hypothesis including planning for a further analytical study
Propose appropriate strategies and control measures including risk communications activities
Establish appropriate and coordinated risk communication system through a trained spokesperson
Coordinate rapid response actions with national and local authorities, partners and other agencies.
Initiate the implementation of the proposed control measures including capacity building
Conduct ongoing monitoring and evaluation of effectiveness of control measures through continuous epidemiological analysis of the event
Conduct Risk Assessments to determine if the outbreak is a potential PHEIC
Prepare detailed investigation reports to share with PHEMC committee
Contribute to ongoing preparedness assessments and the final evaluation of any outbreak response.
Meet daily during outbreaks, and quarterly when there is no outbreak
Participate in simulation exercises

4. Risk mapping for outbreaks and other public health events.

Risk assessment and mapping is used as an aid to preparedness to identify at-risk areas or populations, rank preparedness activities, and also to engage key policy and operational partners.

5. Resource mapping to identify the available resources in every geographical area to ensure prompt mobilization and distribution of such resources including materials, human and funds in an outbreak situation

6. Prepare an emergency preparedness and response plan to strengthen the ability of the national to subnational levels to respond promptly when an outbreak/event is detected. This plan should; Response to outbreaks/events

Declaring an outbreak and activating the response structures- once an epidemic threshold is reached at district level the head of DHMT should notify the region and MOH will assess whether the event is potential public health event of international concerns.
Mobile PHERRT for immediate action which includes;- convene the district public health management once an outbreak/event is confirmed, DHMT will work with the district authority to convene PHEMC to assess and implement the response.
Select and implement appropriate public health response activities. These includes;
Strengthen case management and infection prevent and control measures (IPC)
Build the capacity for response staff
Enhance surveillance during the response
Enhance surveillance with neighboring boarder districts
Engage community during response
Inform and educate the community
Conduct a mass vaccination campaign if indicated
Improve access to clean and safe water
Ensure safe disposal of infectious waste
Improve food handling practices
Reduce exposure to infectious or environmental hazards
Ensure safe and dignified burial and handling of dead bodies
Ensure appropriate and adequate logistics and supplies

7. Provide regular situation reports on the outbreak and events

8. Document the response including minutes of meeting, activity, process, epidemic report, evaluation reports and other relevant document

9. Treatment of cases during an outbreak with appropriate medicine and procedures. These may include;

Antibiotics
Rehydration with fluids orally or intravenously
Assessment of pain and management
Ensure appropriate infection control
Observation- vitals and specific observation
Other routine nursing care

The Different Levels Where Surveillance Activities Are Performed

Community: Represented by basic community-level services such as VHTs, village leaders (religious, political, traditional), school teachers, extension workers, veterinarians, chemical and drug sellers, and traditional healers.
Health facility: For surveillance purposes, all institutions (public and private health services providers) with outpatient and/or in-patient facilities are defined as a “health facility.”
Health Sub-district (HSD): The HSD is the basic level for delivery of the Uganda National Minimum Health Care Package. It is mandated with planning, organization, budgeting, supervision, and management of health services at this and lower-level health centres. It carries an oversight function of health care services within the HSD with a referral facility at the level of a general hospital or HC IV. For surveillance purposes, the HSD receives and reviews reports from lower-level health facilities in its catchment area and submits aggregated reports to the district.
District: The District Health Services have the responsibility of planning and directing implementation, supervision, and monitoring of integrated service delivery in the context of the One Health approach.
Regional Level: It consists of regional referral hospitals (RRH), which provide referral services, support supervision, and response to public health threats to the districts within their respective regions.
National level: The national health system consists of the Ministry of Health and other national-level institutions, including national referral hospitals, national reference laboratories, and national medical stores. It is where policies, guidelines, and standard operating procedures are developed and resources allocated. In relation to surveillance, this level reports on priority diseases and uses the IHR decision instrument.

Roles and Responsibilities of Various Actors in IDSR

Community-Based Surveillance Focal Person (Community Health Worker)

Using lay simplified case definitions to identify priority diseases, events, conditions, or other hazards in the community.
Conducting household visits on a regular basis.
Meeting with key informants on a regular basis.
Attending local ceremonies and events and following up on anything unusual, e.g., someone you were expecting to be there doesn’t show up.
Recording priority diseases, conditions, or unusual health events in the reporting forms and tools (tally sheets) and reporting immediately within 24 hours.
Participating in verbal autopsies by performing interview questions prepared by the supervisor at the health facility.
Sending rapid notification to the nearest health facility and other relevant sectors of the occurrence of unexpected or unusual cases of disease or death in humans and animals for immediate verification and investigation according to the International Health Regulations (IHR) and in line with the IDSR strategy (within 24 hours).
Involving local leaders in describing disease events and trends in the community.
Sensitizing the community to report and seek care for priority diseases, conditions, and unusual events.
Supporting health workers during case or outbreak investigation and contact tracing.
Mobilizing local authorities and community members to support response activities.
Participating in risk mapping of potential hazards and in training, including simulation exercises.
Participating in containment and response activities in coordination with the district level.
Participating in response activities, which could include home-based care, social or behaviour change of traditional practices, and logistics for distribution of drugs, vaccines, or other supplies. Providing trusted health education in a crisis is a useful contribution.
Giving feedback to community members about reported cases, events, and prevention activities.
Verifying if public health interventions took place as planned with the involvement of the community.
Participating in meetings organized by sub-district, district, and higher-level authorities.

Health Facility Staff and Point of Entry

Identifying cases of priority diseases using the standard case definitions.
Recording case-based information and reporting for immediately notifiable diseases, conditions, and events to the next level.
Liaising with the district on how to conduct immediate laboratory investigation of suspected cases.
Case treatment/ referral.
Preparing for and participating in outbreak investigation and response and case treatment.
Reporting summary data and case-based (weekly report) to the next level timely.
Conducting simple data analysis (graphs, tables, charts) at the point of collection.
Communicating diagnosis for outbreak-prone diseases to the district/ community.
Convening the district rapid response team.
Identifying resources (human, financial, commodities, phone cards) and timeline for deployment.

District Surveillance Officer at District Level:

Investigate and verify possible outbreaks, collect diagnostic samples, and advise on treatment/prevention protocols.
Prepare and analyze weekly surveillance reports and submit them to higher authorities in a timely manner.
Ensure that surveillance sites maintain surveillance reports and ledgers/logbooks appropriately.
Maintain a list of all reporting sites.
Establish and maintain a database of all trained and registered healthcare workers who can serve as surveillance focal persons at the reporting sites as well as other CBS FPs.
Ensure there is an adequate supply of data collection and reporting tools available at the surveillance reporting sites.
Ensure that the IDSR standard case definitions for all the priority diseases are understood and used by healthcare workers at the site, and provide on-the-spot training if needed.
Monitor the performance indicators (such as timeliness and completeness) of the IDSR as stipulated in the IDSR guideline.
Periodically update graphs, tables, charts, etc. and compare current data with previous months, quarters, weeks, or years (important for seasonal events) and make recommendations for response.
Provide in-person feedback to surveillance reporting sites on a weekly or monthly basis regarding the implementation of the IDSR.
Closely follow up (through calling) with the reporting sites to ensure they report data on time.
Conduct regular supportive supervision visits to surveillance sites, including health facilities, border entries, and communities, and build their capacity to analyze and interpret their data to guide decisions. Sign and date the inpatient and outpatient record books, registries, or phone entries to document the visit and write recommendations for improvement.
Support healthcare facilities to verify alerts from the community.
Arrange and lead the investigation of verified cases or outbreaks.
Maintain an updated line list of suspected cases.
Assist healthcare facilities in the safe collection, packaging, storage, and transport of laboratory specimens for confirmatory testing.
Receive laboratory results from the Province/Region and provide them to the healthcare facility.
Conduct/coordinate on-the-job trainings for the surveillance sites with new staff.
Review the quality of surveillance data from time to time by conducting data quality audits and develop appropriate measures to improve data quality in the district.
Maintain a rumor logbook to record events for the surveillance site.
Ensure cross-border (district-district) coordination and collaboration on surveillance issues and provide notification of any outbreaks in the neighboring district. International or cross-border notification should also be done if needed.
Document the value added of IDSR and advocate to the health management team to support IDSR activities.
Participate in outbreak investigations and ensure there is an updated register/line list.

The District Health Management Team:

Through the District Medical Officer, liaise with the District Executive Director/District Commissioner/Regional Medical Officer on overall surveillance activities and plans.
Support the Surveillance Officer at the district level to implement planned activities.
Ensure surveillance activities are included in the District Health Planning of overall activities.
Liaise with the District officials to mobilize funds (at the district level) for surveillance activities.
Ensure timely release of funds for surveillance activities.
Monitor IDSR performance and outputs of data analysis and monitoring tools.
Participate in risk mapping of the district and in the development of a plan of action based on the findings.
During outbreaks, assist the Emergency Preparedness and Response (EPR) committee in organizing the rapid response teams and ensure functionality (see section 5 for details).
Report findings of the initial investigation to the Province/Region.
Participate in risk mapping and community assessment.
Participate in the establishment and ensure the functionality of the emergency preparedness and response committees.
Design, train, and set up the implementation of community health education programs.
Participate in and support response training for healthcare facilities and the community.
Together with the Province/Region, select and implement appropriate public health responses.
Plan timely community information and education activities.
Document response activities.
In case of outbreaks, send daily district situation reports.

Other Political Leaders at the District Level:

Political leaders like Village//Ward//District Officers are very important people and they assist in fostering behavioral change on disease surveillance. They can play the following roles:

Support any declarations of a public health emergency.
Develop an inventory and identify local human/financial/logistics support that can be provided locally. A quick response will often prevent spread.
Ensure principles of hygiene and sanitation are followed (environmental cleanliness, availability of latrines and their utilization, advocate for people to drink clean and safe water, advocate personal hygiene and sanitation measures including handwashing).
Report clusters of illness/death to a nearby health facility.
Implement the bylaws to enhance principles of hygiene and sanitation.
Take an active role in sensitizing community members on how to promote, maintain, and sustain good health.
Facilitate community-based planning, implementation, and evaluation of health programs within the Ward (IDSR is among the programs).
Make follow-up on any outbreak in collaboration with healthcare providers and other extension workers at the Ward level.
Provide administrative backup to healthcare providers at the Ward and Village levels.
Support the enforcement of relevant legislations to prevent/control the outbreak of infectious diseases.
Supervise subordinates in ensuring principles of hygiene and sanitation are followed.
Ensure the convening of regular Public Health Care Committee (or institute a Public Health Committee) when an outbreak occurs.
Discuss disease patterns and their implications for action, as part of regular meetings with the District Medical Officer.
Ensure that various committees are established and facilitated to perform activities.
Solicit resources from various sources to respond to disasters, including epidemics.
Conduct advocacy on health matters in different campaigns carried out in the district.

Regional or Provincial Health Management Team:

Liaise with the Regional/Provisional Commissioner and national-level Chief Medical Officer/Director General of Health on surveillance activities and plans.
Support the Regional Surveillance Officer and district surveillance officers to implement planned activities.
Ensure surveillance activities are included in regional/provincial and district health plans.
Mobilize funds and ensure timely release for surveillance and response activities.
Monitor district IDSR performance and data analysis.
Assist districts in risk mapping, developing action plans, and community assessments.
Support districts in emergency preparedness, response training, and public health response.

Ministry of Health/National Level:

Set up a Public Health Emergency Operation Center and incident management system.
Identify a spokesperson and develop risk communication plans.
Set standards, policies, and guidelines for IDSR and update emergency preparedness and response plans.
Assess and rectify national-level capacity, including surge capacity.
Mobilize and coordinate domestic and external support for IDSR implementation.
Conduct overall supervision, monitoring, and evaluation of IDSR activities.
Produce and disseminate epidemiological bulletins.
Support investigation of suspected epidemics.
Provide national-level data management and analytical support.

WHO and Other Partners:(UN Agencies, CDC, USAID, PATH MSF, REDCROSS, UNICEF)

Contribute to setting standards and developing guidelines.
Provide technical assistance, expertise, and material support to strengthen surveillance, laboratory, and health information systems.
Support resource mobilization for surveillance and response activities.
Assist in supervision, monitoring, and evaluation of IDSR.
Provide management support, such as writing funding proposals.
Support capacity building through training and equipment provision.
During public health emergencies, provide technical experts, surge staff, portable laboratories, and other equipment and vaccines.

Roles of a Nurse in IDSR

Before we proceed with outlining the roles, let’s engage in the activity:

Activity:

Why is it important to involve a nurse in IDSR programs?

Answer: Nurses are vital in IDSR programs as they assume significant roles in healthcare delivery. Their involvement is crucial due to their extensive patient interactions and responsibilities in various healthcare settings. Nurses often serve as the frontline healthcare providers, offering care, education, and support to patients. Their presence in IDSR ensures early detection, prompt response, and effective management of disease outbreaks, leading to improved community health outcomes.

Roles

Assessment and Reporting: Evaluate and report priority disease cases from lower levels to higher levels of authority.
Coordination of Activities: Facilitate the smooth coordination of IDSR activities among stakeholders, including community members and technical personnel at the CDC.
Planning and Preparation: Strategize and prepare for effectively managing disease outbreaks within the community.
Assistance in Monitoring and Evaluation: Actively participate in monitoring and evaluating disease outbreak programs.
Assessment, Analysis, and Reporting: Analyze, interpret, and compile straightforward reports for priority disease outbreaks using your knowledge in epidemiology.
Engagement in Immunization Programs: Participate in immunization initiatives aimed at protecting the community against vaccine-preventable diseases. The Center for Disease Control and Prevention (CDC) advocates for early childhood vaccination against preventable diseases, a role that nurses fulfill.

Advantages of IDSR:

It is cost-effective as it utilizes the same health personnel and reporting formats for routine health data.
It enables the computerization of available data at the central level.
It provides training and capacity building opportunities for health personnel to develop new skills.
It encourages community participation in detecting and responding to disease outbreaks.
It facilitates effective resource utilization and allocation.
It enables quick response to public health events.

Challenges in IDSR implementation:

Non-sustainable financial resources for IDSR activities.
Lack of coordination among different stakeholders.
Inadequate training and high turnover of peripheral/frontline health staff.
Unreliable feedback mechanisms from higher to lower levels.
Inadequate supervision and support from higher levels.
Weak laboratory capacities and lack of job aids (case definitions, reporting formats).
Poor availability of communication and transport systems, particularly at the peripheral level.
Inadequate data management and analysis capabilities at various levels.
Resistance to change from routine disease surveillance practices to the integrated approach.
Lack of community engagement and ownership of the IDSR system.
Weak linkages between animal and human health surveillance systems.
Insufficient political commitment and leadership to sustain IDSR implementation.
Fragmented health information systems that hinder data integration and analysis.
Inadequate use of digital technologies and innovations to enhance IDSR.
Challenges in adapting IDSR to changing epidemiological patterns and emerging threats.
Limited capacity for timely outbreak detection, investigation, and response.

Let’s summarize what you’ve learned.

What Have We Learned?

Throughout this section, we delved into Integrated Disease Surveillance and Response (IDSR) in comprehensive detail. We covered its aims, objectives, and foundational requirements for effective implementation.

Major priority diseases were identified, with detailed case definitions provided for each. We explored the crucial aspects of supervisory monitoring and evaluation within IDSR and highlighted key individuals involved in these activities. Lastly, we delved into the roles a nurse plays in IDSR, emphasizing the importance of their involvement.

Now, it’s time to evaluate your understanding through a self-test. Attempt to answer the questions and consider discussing the information with your colleagues as you review your notes.

Self-Test:

Which organization is directly involved in the implementation of IDSR in Uganda?
Outline the measures you would take when planning for an epidemic disease outbreak.
Utilizing a table, explain the case definition for the following diseases:
- Tetanus
- Tuberculosis
- Cholera
- Hepatitis “B”
State one activity you would perform when monitoring and evaluating disease outbreaks in your workplace.
Enumerate two major roles you would play in the IDSR program as a nurse.

INTEGRATED DISEASE SURVEILLANCE Read More »

SCHOOL HEALTH PROGRAM

School Health Program is a strategic endeavor designed to elevate the quality of life for students while fostering a culture of proactive health awareness. Its fundamental purpose is to instill a sense of responsibility towards one’s well-being among students, their families, and school staff.

The School Health Program is like a special plan that helps students, their families, and school staff learn about staying healthy. It’s not just about books and classes; it’s also about taking care of our bodies and minds. This program makes sure that students have the tools they need to learn and grow in a healthy way.

The programmes are to improve the quality of life and promote healthy seeking behavior to health positive school children; their families with staff.

Core Objectives of the School Health Program

Promoting Health and Self-Care: The program aims to empower students with the knowledge and skills to value and maintain their own health. It encourages them to adopt healthy lifestyles and instills a lifelong commitment to well-being.
Early Detection and Care: Timely identification of health deviations is crucial. The School Health Program strives to recognize signs of disease and abnormalities in their early stages, facilitating prompt intervention, treatment, and follow-up.
Disease Prevention: Combating both communicable and non-communicable diseases is a priority. By imparting knowledge and promoting healthy practices, the program acts as a shield against illnesses that can hinder learning.
Creating a Nurturing Environment: The program recognizes that a supportive environment is vital for the holistic development of students. It strives to provide a safe, nurturing space that promotes their physical, mental, social, emotional, and moral well-being.
Optimizing Education: A healthy body and mind optimize the learning process. The School Health Program aims to help students capitalize on educational opportunities by ensuring they are in the best possible health.
Fostering Health Consciousness: Beyond students, the program extends its impact to parents and teachers. It encourages them to embrace a health-conscious mindset, fostering the right attitudes towards health and illness.
Empowering with Knowledge: Knowledge is a potent tool for prevention. The School Health Program empowers students and stakeholders with the essential information and skills needed for preventive health measures at various levels.

In Summary,

Promote health and develop concern for their own health.
Detect disease and deviation from normal heath at an early stage and arrange for promotion, treatment and follow up.
Prevent communicable disease and non – communicable disease.
Provide a healthy and safe environment in all rounds for development of child physical, mental, social, emotional and moral well-being.
Help children to make the best use of educational facilities.
Help children, their parents and teachers to be health conscious and develop the right attitude towards health and illness.
Increase the basic knowledge and skills of children and those concerned in their welfare in all levels of prevention.

Importance of School Health

Empowering Health Education: The school health program plays a crucial role in spreading knowledge and changing behaviors among different groups, including students, teachers, parents, and school management. It raises awareness and guides positive health choices.
Ensuring Clean Water: The program ensures that the school’s water sources are used properly and kept clean. This is essential for maintaining a healthy environment.
Maintaining Sanitation: A clean and safe environment is crucial for learning. The program focuses on providing proper sanitation facilities such as clean latrines, well-kept rooms, hygienic dormitories, and spaces for handwashing and sanitary disposal.
Medical and Dental Care: The program ensures that students and staff have access to medical and dental care. Regular check-ups and health awareness campaigns are part of this effort.
Fighting Communicable Diseases: Schools can be breeding grounds for diseases like malaria, diarrhea, HIV/STIs, skin issues, and tuberculosis. The program works to prevent and manage such health threats.
Addressing Non-Communicable Health Issues: Apart from infectious diseases, students and staff may also face non-communicable health concerns like dental problems, mental health issues, psychological challenges, and injuries.
Promoting Nutritional Health: Proper nutrition is vital for learning. The program ensures that both day and boarding schools offer nutritious meals, fruits, and drinks to students.
Creating a Healthy Environment: The school health program fosters a positive psychological atmosphere. It reinforces rules against harmful practices such as smoking, alcoholism, drug abuse, unsafe sexual behaviors, and violence.
Providing Support Services: Counseling and adolescent health services are an integral part of the program, helping students cope with various challenges they may face.
Community Engagement: The program encourages active involvement between the school and the community. This collaboration extends to community-based primary health care activities like cleaning, protecting natural resources, improving infrastructure, and supporting immunization efforts.

School health components (key elements)

Health Service	Environmental Protection and Control	Health Education
-Early detection	– Construction of toilets and waste disposal	– Teaching about first aids
– Health screening	– Use of toilet	– Teaching about personal hygiene
– School child nutrition and feeding practices	– Water supply	– Teaching about environmental sanitation
– Sanitation	– Proper waste disposal	– Sex education
– Life skill education	– Cleanliness of the compound	– Nutrition education
– Medical and dental services for schools		– Extra-ordinary activities (e.g., club)
– School psychosocial environment
– Sexual and reproductive health
– Treatment of minor ailments
– Surveillance of immunization status
– Case finding for early detection of health problems
– Case management
– Counseling
– Care of pupils/students with special health needs
– Health promotion
– Minimum routine examination (e.g., of common eye problems and intestinal parasitosis and their Rx)
– Simple first Aid facilities
– Accident control (fall injury, burn injury, cut injury, traffic accident, drowning, snake bite)

Describe the school health components?

School Health Components

School health programs encompass a range of key elements aimed at promoting the well-being and overall health of students, staff, and the school community. These components are strategically designed to create a conducive environment for learning, growth, and development while addressing various health challenges. Let’s delve into the core components that constitute a comprehensive school health program:

1. Health Services:

Health screening to detect and address potential health issues early.
Medical and dental services to provide necessary care for students and staff.
Treatment of minor ailments and injuries.
Surveillance of immunization status to ensure vaccination coverage.
Case finding for early detection of health problems.

2. Environmental Protection and Control:

Ensuring a clean and safe school environment by constructing proper toilets and waste disposal facilities.
Providing clean drinking water and facilities for handwashing.
Maintaining cleanliness of the school compound.
Monitoring the presence of stagnant water and addressing it.

3. Health Education:

Educating students about first aid, personal hygiene, and environmental sanitation.
Providing sex education and nutrition education.
Promoting health awareness and responsible behaviors among students, staff, and parents.

4. Extraordinary Activities and Clubs:

Engaging students in clubs or activities focused on health promotion and awareness.
Encouraging students to actively participate in community-based primary health care activities.

Recommended School Screening Examination

The recommended school screening examination encompasses a variety of assessments to ensure the well-being of students. The components of this examination include:

Growth and Vital Signs:

Height and Weight: These measurements are taken and recorded on a growth chart to identify cases of underweight and obesity.
Blood Pressure: Hypertension criteria in children vary with age.

Head (Scalp) Screening:

Lice
Fungal Infections: Conditions like Tinea capitis (Tinea of the head) can lead to patchy hair loss, broken hairs, and scaling. Treatment with oral griseofulvin for 4-8 weeks is the recommended choice.

Vision Screening:

Visual Acuity: Assessed using an eye chart (Snellen chart) to identify any visual impairments.
Inflammation and Signs of Infection

Ear Examination:

Hearing Impairment: Using the finger rub test for hearing acuity, assessment for any symptoms or signs of hearing problems.
Presence of Earwax
Otitis Media (Acute or Chronic Ear Infections)

Mouth Examination:

Tonsils
Teeth for Caries

Neck Examination:

Lymph Nodes
Enlargement of the Thyroid Gland
Nodules (Masses) of the Thyroid Gland

Chest Examination:

Auscultation of Lungs
Presence of Exercise-Induced Asthma (Assessed by history)
Auscultation of the Heart (Detection of Murmurs)
Palpation of the Apical Area (Enlargement of the Heart)

Abdominal Examination:

Palpation to Detect Occult Abdominal Problems: Enlargement of the Liver or Spleen, Tumors of the Kidney

Genitalia Examination (Males):

Check for Undescended Testicles
Assessment for Hernias

Screening of Spine and Extremities:

Scoliosis: Bending the child at the waist to examine for back asymmetry
Identification of Possible Deformities in Extremities

Skin Screening:

Bacterial Skin Infections: Impetigo, Cellulitis, Folliculitis, Abscesses, Acne
Fungal Infections: Tinea corporis, Tinea cruris, Tinea pedis
Viral Conditions: Warts, Herpes Viruses
Dermatitis (Eczema)

Assessment of Family Violence and Depressive Symptoms

Through assessment.

School Health Inspection

Purpose and Approach: School health inspection is a critical process carried out by a team of health workers to ensure that the school environment is conducive to maintaining good health. The aim is to create a healthful and safe setting for students. Several key aspects are considered during this inspection.

Location of the School:

The school should be situated away from unpleasant odors and excessive noise.
It’s essential that the school is not in close proximity to markets, factories, cinema halls, bars, or restaurants.

Building Conditions:

School buildings should be constructed with durable materials, such as bricks or stress-resistant materials, and have weatherproof roofs.
The halls and floors must be smooth to enhance safety.

Healthy School Environment:

It’s vital to assess whether the school environment promotes good health. Key points of consideration include:

Availability of clean drinking water
Presence of sufficient and well-maintained sanitary toilets
Facilities for handwashing
Adequate arrangements for refuse collection and disposal
Absence of stagnant water
Well-ventilated and well-lit classrooms
Comfortable seating arrangements that promote good posture
Identification and mitigation of accident hazards, such as defective wiring or fire hazards
Precautions against accidents, like provision of sand buckets and first aid kits
Availability of space for breaks and play
Suitable area for midday meals
Preventing children from buying and consuming exposed food from hawkers near the school
Collaborating with the school’s principal and teachers to address health hazards and improve cleanliness
Providing shelter or shade to protect students from heat

Classroom Conditions:

The number of classrooms should be suitable for the number of students, ideally accommodating 35-40 students per room.
Proper lighting is crucial, with windows constituting at least 20% of the floor surface area.
Adequate ventilation is essential for classrooms.

Furniture:

Furniture should be simple, sturdy, and comfortable, catering to different age groups of students.

Playground:

The school yard should be smooth and free of hazards to prevent accidents.
Ample space is necessary for children to play and engage in school gardening activities.

Sanitation:

The school should have proper water supply, latrines, urinals, and waste disposal systems.
Separate latrines for male and female students, as well as teachers, should be provided, accommodating 30-50 students per facility.

Emotional Climate:

Fostering a warm and supportive environment at school is essential for the emotional development of students.
Reducing unnecessary tension and frustration contributes to a positive emotional climate.

Implementation Strategies of School Health

Multi-Sectoral Approach:

Involves engaging all stakeholders in school health, regardless of their level of involvement.
Collaboration among various entities ensures a comprehensive approach.

Integration:

School health activities are seamlessly incorporated into the existing service delivery arrangements of organizations like the Ministry of Education and Sports (MOES), Ministry of Health (MOH), local governments, and other social services.
Integration streamlines processes and optimizes resources.

Coordination and Networking:

MOH and MOES collaborate to ensure cohesive school health services.
Effective coordination and networking enhance the impact of school health programs.

Capacity Building:

Training, operational research, infrastructure development, research mobilization, and networking efforts contribute to capacity building at all levels.
Capacity building equips stakeholders with the skills and knowledge needed to implement effective school health initiatives.

Advocacy and Behavioral Change Communication Strategies:

Advocacy efforts raise awareness and support for school health programs.
Effective communication strategies drive behavioral change among students and the broader community.

School-Community Link:

Promotes active engagement of schools in community-based primary health care activities.
Strengthening the link between schools and communities enhances overall health outcomes.

Support Supervision, Monitoring, and Evaluation:

Regular supervision, monitoring, and evaluation ensure the effectiveness and sustainability of school health programs.
These processes allow for adjustments and improvements as needed.

Potential Benefits from Health Services:

Health Benefits:

Improved health status of school children, who are future parents and leaders.
Positive spillover effects that impact health status indicators.

Education Benefits:

Health education becomes an integral part of school curriculum.
Increased investment in health education contributes to overall well-being.

Social-Cultural Benefits:

Adoption of hygienic practices, such as using sanitary facilities and safe water sources, becomes a cultural norm.
Positive health practices cultivated through school health programs extend to both students and the community.

Role of Community Nurse in School Health Program:

As a vital member of the school health team, the nurse participates in planning and coordinating health programs.
The nurse serves as a school health consultant, offering expertise in health-related matters.
Overseeing the establishment and maintenance of a safe and healthful environment within the school setting.
Demonstrating proper techniques for teacher health inspections and related procedures.
Assisting in screening physical, mental, and special examinations of school children.
Contributing to communicable disease control efforts.
Playing a pivotal role in setting up facilities and demonstrating first aid procedures.
Conducting health programs within the school.
Assisting in school medical examinations and follow-up procedures.

SCHOOL HEALTH PROGRAM Read More »

CONSTRUCTIVISM

Constructivism is a type of learning theory that explains human learning as an active attempt to construct meaning in the world around us

Constructivism divides learning into two types:

Accommodation.
Assimilation.

The focus is on the individual’s desire and ability to learn, and the teacher is merely there to help guide self directed learning.

Constructivism is a teaching philosophy based on the concept that learning (cognition) is the result of mental construction. Students construct their own understanding by reflecting on their personal experience, and by relating the new knowledge with what they already know.

Jnassen(1995) defines construction, from the education perspective, as learners producing and constructing their own personal knowledge. He distinguishes this from instructivism whereby the learner is the passive receiver of knowledge, as in the traditional educational model. One of its main principles is that learning is searching for meaning, therefore, to be effective; a teacher must help the student in discovering his or her own meaning.

Characteristics of constructivist learning and teaching

Teachers serve in the role of guides, monitors, coaches, tutors and facilitators.
Activities, opportunities, tools and environments are provided to encourage metacognition, self-analysis and self- regulation, self-reflection & reflection self-awareness
The student plays a central role in mediating and controlling learning.
Goals and objectives are derived by the student or in negotiation with the teacher or system
Learning situations environments skills, content and tasks are relevant, realistic and authentic and represent the natural complexities of the real world
This construction takes place in individual contexts and through social negotiation, collaboration and experience.
The learne’s previous knowledge constructions, beliefs and attitudes are considered in the knowledge construction process
Problem Solving, higher order thinking skills and deep understanding are emphasised
Errors provide the opportunity for insight into student’s previous knowledge construction
Exploration is a favoured approach in order to encourage students to seek knowledge independently and to manage the pursuit of their goals.
Learners are provided with the opportunity for apprenticeship learning in which there is an increasing complexity of tasks, skills and knowledge acquisition.
Scaffolding is facilitated to help students perform just beyond the limits of their ability

Constructivism theorists

Jean Piaget is a Swiss psychologist who began to study human development in the 1920s. His proposed development theory has been widely discussed in both psychology and education fields.

Piaget work has identified four major stages of cognitive growth that emerge from birth to about the age of 14-16. To learn, Piaget stressed the holistic approach. A child constructs understanding through many channels: reading, listening, exploring and experiencing his or her environment.

A child will develop through each of these stages until he or she can reason.

Approximate Age	Stage	Major Development
Birth to 2 years	sensorimotor	Infants use sensory and motor capabilities to explore and gain understanding of their environment
2 to 7 years	preoperational	Children begin to use symbols. They respond to objects and events according to how they appear to be
7 to11 years	Concrete operational	Children begin to think logically
11 years and beyond	Formal operational	Children begin to think about thinking. Thoughts are systematic and abstract.

The learner is advanced through three mechanisms.

Assimilation -fitting a new experience into an mental structure (schema)
Accommodation – revising an existing schema because of new experience.
Equilibrium – seeking cognitive stability through assimilation and accommodation.

2. Lev Vygotsky, a Russian psychologist and philosopher in the 1930s, is most often associated with the social constructivist theory. He emphasizes the influences of cultural and social contexts in learning and supports a discovery model of learning

3. Jerome Bruner (1915) is an American psychologist and cultural – interested education. He developed the discovery learning theory, which states some major ideas about learning: Learning is an active social process in which students constructs new ideas or concepts based on current knowledge

His view is: Good methods for structuring knowledge should result in simplifying, generating new propositions, and increasing the manipulation of information. He believes that instruction must be structured so that it can be easily grasped by the student and the instructions should be designed to facilitate extrapolation and or fill in the gaps

Advantages of constructivism

Students have the opportunity to get directly involved with phenomena and materials. Effective for the learner who does better with hands-on activity. Getting directively involved in the activities helps students relate the information to their own lives.
Constructivism calls for the eliminations of a standard curriculum, allowing the curricula customised to the student’s prior knowledge
Allows teachers to focus on what information is truly important. Relieves time constraints to allow teachers spend more time on topics that students show interest in
Working in groups, learners support each other’s understanding as they articulate their observations, ideas, questions and hypotheses. Working in groups helps students learn social interaction skills they will need later in life. Students will learn to value each other’s input and opinions.

Disadvantages

Curricula customized to the student’s prior knowledge. All students are going to have different prior knowledge, teachers cannot customize curriculum to every single student
Constructivism calls for the elimination of grades and standardized testing. Makes it impossible to compare student progressive institution to institution or state to state no reward or goal for student to work towards
Training that affects student centred teaching cannot come in one day workshops, systematic, long term development that allows practice and reflection on that practice is required

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Behaviorism

Behaviorism , also known as behavioral psychology, is a theory of learning based upon the idea that all behavior’s are acquired through conditioning.

Conditioning occurs through interaction with the environment. According to behaviourism, behaviour can be studied in a systematic and observable manner with no consideration of internal mental states.

There are two major types of conditioning:

Classical conditioning: is a technique used in behavioural training in which a naturally occurring stimulus is paired with a response.
Operant conditioning: operant conditioning (sometimes referred to as instrumental conditioning) is a method of learning that occurs through rewards and punishments for behavior. Through operant conditioning, an association is made between a behaviour and a consequence for that behaviour.

Major theorists in Behaviorism

Ivan Pavlov
B.F.Skinner
Edward Thorndike
John B.Watson

Criticisms of Behaviorism

Many critics argue that behaviorism is a one-dimensional approach and that behavioral theory does not account for free will and internal influences such as moods, thoughts and feelings.
Behaviorism does not account for other types of learning, learning that occurs without the use of reinforcements.
People and animals are able to adapt their behavior when new information is introduced, even if a precious behavior pattern has been established through reinforcement.

Strengths of Behaviorism

Behaviorism is based upon observable behaviors, so it is easier to quantify and collect data and information when conducting research.
Effective therapeutic techniques such as intensive behavioral intervention, token economies, and discrete trial training are all rooted in behaviorism. These approaches are often very useful in changing maladaptive or harmful behaviors in both children and adults.

Some of the behaviorists

a) Ivan Pavlov (1849-1936) a Russian physiologist who discovered the theory of classical conditioning.

Classical conditioning is a learning process that occurs through associations between an environmental stimulus and a naturally occurring stimulus.

Pavlov wanted to see if external stimuli could affect the salivation process. He rang the bell at the same time he gave the experimental dogs food. After a while, the dogs-which salivated when they saw and ate their food –would begin to salivate when the bell rang, even if no food were presented.

Pavlov called this learning process “Conditioning”. He thought that conditioned reflexes could explain the behavior of people.

In order to understand how classical conditioning works, it is important to familiarize yourself with the basic principles of the process.

The Unconditioned Stimulus

The unconditioned Stimulus is one that unconditionally, naturally, and automatically triggers a response. For example, when you smell one of your favourite foods, you may immediately feel very hungry .In this example, the smell of the food is the unconditioned stimulus.

The Unconditioned Response

The unconditioned response is the unlearned response that occurs naturally in response to the unconditioned stimulus. In our example, the feelings of hunger in response to the smell of food are the unconditioned response.

The conditioned stimulus

The conditioned stimulus is previously neutral stimulus that, after becoming associated with the unconditioned stimulus, eventually comes to trigger a conditioned response

E.g. when you smelled your favourite food, you also heard the sound of the whistle. While the wrestle is unrelated to the smell of the food, if the sound of the whistle was paired multiple times with the smell, the sound will eventually trigger the conditioned response. So in this case the sound of the whistle is the conditioned stimulus.

The conditioned Response

Is the learned response to the previously neutral stimulus. In our example, the conditioned response would be feeling hungry when you heard the sound of the whistle.

b) B.F,Skinner’s Operant conditioning

What is Operant Conditioning?

Is referred to as instrumental conditioning, is a method of learning that occurs through rewards and punishments for behavior.

Though operant conditioning, an association is made between a behavior and a consequence for that behavior.

Operant conditioning coined by behaviorist B. F Skinner, sometimes it’s referred to as Skinnerian conditioning .As a behaviorist, Skinner believed that internal thoughts and motivations could not be used to explain behavior. Instead, he suggested we should look only at the external, observable cause of human behavior.

Examples of operant conditioning

We can find examples of operant condition work all around us. Consider the case of children completing homework to earn a reward from a parent or a teacher, or employees finishing projects receive praise or promotions

In these examples, the promise or possibility of the rewards causes an increase in behavior, but operant conditioning can also be used to decrease a behavior. The removal of an undesirable outcome or the use of punishment can be used to decrease or prevent undesirable behaviors.

Components of Operant conditioning

Some key concepts in operant conditioning:

Reinforcement is any event that strengthens or increases the behavior it follows. There are two kinds of reinforcements:

Positive reinforcers are favourable events or outcomes that are presented after the behaviour. In situations that reflect positive reinforcement, a response or behaviour is strengthened by the addition of something, such as praise or a direct reward.
Negative reinforcers involve the removal of unfavourable events or outcomes after the display of behaviour. In this situation, a response is strengthened by the removal of something considered unpleasant. In both of these cases of reinforcement, the behaviour increases

Punishment, on the other hand, is the presentation of an adverse event or outcome that causes a decrease in the behaviour it follows. There are two kinds of punishment

Positive punishment, sometimes referred to as punishment by application, involves the presentation of an unfavourable event or outcome in order to weaken the response it follows.
Negative punishment also known as punishment by removal, occurs when an favourable event or outcome is removed after a behaviour occurs

Advantages of behaviorism

Shapes behaviour quickly
The learn adopts to the environment
Behaviour can be measured

Disadvantages

Internalised reasoning may not be an outcome e.g, a student may act respectful but not feel respect towards a teacher
The learner may adapt to the poor environment
The behaviour measured may not be the true picture of understanding

Behaviorism Read More »

METHODOLOGY

CHAPTER THREE: METHODOLOGY

Methodology is the longest and most examinable, take note.

3.1 Introduction
3.2 Study Design and rationale
3.3 Study setting and rationale
3.4 Study Population
3.4.1 Sample Size Determination
3.4.2 Sampling Procedure
3.4.3 Inclusion Criteria
3.5 Definition of Variables
3.6 Research Instruments
3.7 Data collection Procedure
3.7.1 Data management
3.7.2 Data analysis
3.8 Ethical Consideration
3.9 Limitations of the study
3.10 Dissemination of Results

Methodology therefore consists or covers the methods the researcher is to follow while carrying out research. Therefore it includes the following.

Introduction.
Study Design.
Study Setting.
Study Population.
Sample Size. Determination.
- Diploma level studies should have a minimum of 30 participants.
- Student should give justification for selected sample size.
Sampling Procedure.

Inclusion Criteria.
Definitions of Variables.
Research Instruments.
Data Collection Procedures.
Data Management.
Data Analysis.
Protection of Human Subjects.
Dissemination of Results.
Limitations of the Study.

3.2 Study Design

Study or Research design defines the approaches, methods and the rationale of picking that appropriate research design

Eg descriptive cross sectional design
Approaches can be Quantitative/qualitative or both
Note that it is advisable to use one of these at our level.

The design is the structure of the study. This is the framework for the methodology to be applied while collecting data, sampling, analyzing data, etc.

The function of a study or research design is to ensure that the evidence obtained enables us to answer the initial question as unambiguously as possible. In other words, when designing research we need to ask: 1. Given this research question/problem, what type of evidence is needed to answer the question in convincing way?
You should always state the reason/rationale for using that particular design (why that particular design).

Example: “The study will use a retrospective comparative study design and this is due to the fact that it involves comparing virological outcomes in 4 different groups of patients on different arms of first-line ART regimens. The study will also employ a quantitative method of data collection in order to quantify the most efficacious
1st– line ART regimen in terms of virological suppression”

3.3 Study Setting

Also called the study area.
It helps the reader to locate where your study is to be done from.
Direct the reader in terms of location (Where are you’re
going to do the study from?)
Why that setting? (State the rationale for using that
setting).

Example: “Study will be carried out at ART clinic of Kayunga Hospital in Kayunga district which is located in central part of Uganda. ART clinic operates on daily basis from Monday to Friday from 8am to 4pm. It has a total of 10 nurses, 2 laboratory technicians, 2 clinical officers and I medical officer. This clinic receives on average a number of 150 patients on every clinic day. The study setting was chosen because ART clinic serves a big population of about 4500 HIV/AIDS infected people”.

3.4 Study Population

Explain the population from which your sample will be collected from.
This is the population that the results will be generalised to.
Give the rationale for the selected population.

Population: This is the total of items or events in a set; with relevant characteristics that a researcher need (It is the total number of potential subjects /respondents for a study).

The population should be clearly defined before a decision is taken on how to sample it.
• Sampling is not necessary if the population is small.

Example: “This study will be carried out among HIV-infected clients attending Kayunga ART clinic and who are on first-line ART regimens for at least three years. Kayunga ART clinic has a total of 4791 of which 2728 are on 1st line ART regimen. The clinic usually receives about 50 clients who are on 1st-line ART regimen per day and therefore a total of 250 clients on 1st-line ART will be available for Data collection within 5 days of data collection”.

3.4.1 Sample Size Determination

Sampling is the process of selecting a subset(sample) from a large group of people(population)
Steps in sampling
- Define the population
- Identify the sampling frame ie list of participants from which a sample can be selected
- Select a sampling procedure this could be probability or nonprobability sampling
- Determine the sample
- Draw the sample
- Give justification
State the standardized method you will use to estimate
the sample size.

For example: “Using Krejcie and Morgan (1970)’s table, when a population is-250, a total of sample size of 150 respondent is supposed to be sampled”

3.4.2 Sampling Procedure

This refers to the way you select your participants to include in your study.
It can be Probability or non probability sampling.
Probability sampling involves;
- Simple random sampling.
- Systemic sampling.
- Stratified sampling.
- Cluster sampling.
Non probability sampling involves;
- Convenience sampling.
- purposive/ judgemental sampling.
- Snowball sampling.
- Quota sampling.

Explain how the subjects will be selected during sampling.

For example, a proportionate quota sampling method will be used to sample representative clients on the different first -line ART regimens.

State the reason (rationale) why you have decided to use that particular procedure.

3.4.3 Inclusion Criteria

This gives a narration of which people among the selected population will qualify to participate in your study.
Those who do not qualify are the excluded from your study.

Inclusion criteria: are characteristics that the prospective subjects must have if they are to be included in the study.- Inclusion criteria may include factors such as age, sex, race, ethnicity, stage of disease, the subject’s past treatment history, E.T.C.

Example: “For participants to be included in this study, they have to be clients on 1st line-ART regimen for at least 3 years and are attending ART clinic at Kayunga Hospital during the time of data collection. They must also be of 18 years of age and above. Since 18 year of age is the consent age according to the Ugandan constitution”.

3.5 Definitions of Variables

A measurable characteristic that assumes different values among the subjects
It’s a value of interest to the researcher
Basically variables can be;
- Dependant
- Independent
- Intervening
Let the reader know what, (define), your dependent variable and independent variables of the study are.

For example; “the dependent variable of this study is the virological outcome (level of viral load). In this study the level of viral load means the amount (measure) of Plasma HIV-1 RNA. Viral load is measured in ml/copies. Viral load of >5000 copies/ml at 12 months of antiretroviral treatment will be taken as indication for virological failure (similar to WHO recommendation in resource- limited countries)”.

3.6 Research Instruments

This refers to the tools you are going to use to answer your objectives
They include;
- Questionnaires
- Interviews
- Checklists
- Standardized tests

Explain the instruments that will be used to collect data.
For, example: “The researcher will use a questionnaire which consists of both open and close ended questions written in simple language and will be filled by the researcher himself and his assistant by use of patient’s files and interview of clients. The questionnaire written by the researcher will be pretested to adjust for any ambiguity or errors and corrections will be made”.

Questionnaires: This mainly involves the use of pre-determined answers to gather information from participants

It mainly has two forms
- Self administered
- Researcher administered
Questions can be closed ended or open ended

Advantages and Disadvantages

	Self-Administered Questionnaires	Researcher-Administered Questionnaires
Advantages
Convenience	Participants can complete at their own pace.	Researchers can clarify questions for better understanding.
Privacy	Respondents have privacy for sensitive questions.	Higher motivation can lead to improved response rates.
Time Flexibility	Participants can choose when to complete the survey.	Allows probing to ensure thorough and accurate responses.
Cost-Effective	No researcher presence reduces data collection costs.	Researchers can control the survey environment.
Large Sample Size	Suitable for reaching a larger, geographically spread sample.	Offers control over data quality and completeness.
Reduced Researcher Bias	Participants may provide candid responses.	Offers the ability to probe and clarify ambiguous answers.
Disadvantages
Non-Response Bias	Response rates might be lower, potentially biased.	Time-consuming due to researcher presence.
Misinterpretation	Participants might misunderstand questions.	Presence of a researcher can influence participant responses.
Incomplete Responses	Respondents may skip or provide incomplete answers.	Can be costly due to resources needed for administration.
Low Control	Researchers have limited control over survey environment.	Limited anonymity might affect the honesty of responses.
Limited Probing	Researchers cannot probe further for clarification.	Geographical constraints limit participant availability.

Interviews: These are mainly used to get responses for qualitative data

They could be used as;
- Interview guides.
- Focus Group discussion interviews- of 5 to 10 members.

Checklists: Also called observation forms.

Researcher ticks responses on observation of what has been done or not.
In many studies rating is done there after.

Standardized tests:

These are tools used to score all populations across the board.
For example when scoring IQ levels of children, cognitive tests.

3.7 Data Collection Procedures

This involves the use of the selected tool/tools to gather information from the participants.
It explains how the selected data tool will collect the information.
These are selected depending on the design and approach selected.
Here, you explain the whole procedure of data collection.

For Example: “A letter obtained from research committee will be taken to the management of Kayunga Hospital and to the ART clinic to allow researcher carry out data collection among HIV- infected clients on 1st
line ART regimens. One clinician will be identified from ART clinic and will be trained as a research assistant to help in filling in the questionnaires. A verbal and written consent will be obtained from respondents before data collection and an appreciation in form of thanks will be told to clients.”

3.7.1 Data Management

This involves the cleaning of data to correct any missing errors.
It involves pre cleaning before actual data entry to eliminate wrong data entry.
Explain how data will be managed.

For, example: “After data collection, every questionnaire will be checked for completeness and any gaps will be filled immediately before the client leaves the clinic. The questionnaire will be kept under key and lock only accessible to the researcher and his assistant on request then it will directly be entered into SSPS soft ware package for social science version.”

3.7.2 Data Analysis

After data has been cleaned, it then analyzed and interpreted to make meaningful statements.
This is then followed by making interpretation of findings before the actual generalization of the research findings.
Explain how data will be analyzed.

For example, “Data will be entered directly into SPSS 17 for data analysis and will be analyzed starting with the demographic data and then the other objectives. The Analyzed data will then be presented in form of percentages and frequencies in tables, pie charts, and graphs”.

3.8 Ethical considerations

This looks at the ethics of your research(Protection of Human Subjects)
- Informed consent
- Confidentiality
- Ethics committees
- Privacy
Explain how you will meet the ethical guidelines of research.

For example: “Research proposal will be submitted to Research and Ethical Committee at Makerere University for approval. A letter from the Committee will be taken to Mulago Hospital management and ART clinic to seek permission to pre-test the Questionnaire. The same letter will be taken to Kayunga District hospital management and ART clinic where data collection will be done to seek permission to carry on data collection among HIV-infected clients on 1st —line ART regimens”.

3.9 Limitations of the Study

These are anticipated challenges imposed by methods, period and location of research.
The researcher may not have control over them and therefore the need to identify them so that possible solutions before beginning the study.
They also help in predicting the necessary help need and the feasibility of the research.
Explain the constraints you are like to meet and how you overcome them.

For example: “The researcher expects to encounter time constraints in the course of study, balancing the research study and other demanding work. The researcher will overcome this limitation by drawing up a time table that will be strictly followed”

3.10 Dissemination of Results

Research findings must be shared to the relevant concerned bodies who might be interested in your findings.
It can also be published as reports, journals, CMEs, posters in conferences etc.
Dissemination helps other scholars know what has been done.
List how and where you will communicate your results.

For example: “Information from the study wilt be compiled into a research report and four copies of research report will be made. A copy will be submitted to; Makerere University, Kayunga Hospital ART clinic, Research Supervisor and the Researcher.

References/Bibliography

This includes all sources of cited, used and have been reffered too in he write up.
It is a list of all authors whose work has been used in your proposal.
This is written following the referencing guidelines of any institution.
APA style is the preferred for our case.

Reference list:
This is an important part of the proposal. In the literature Review and in Background, you must have cited various authors. The page on References must show all the details about all the citations made in text.

Example;
References

Byakwaga. Ff., murray,1., Petnumenos.K. (2E104). Prognosis of CPA in persons receiving ART. Aids Res Hum Retroviruses: 75(6):756-76
CoIlia., Diedrichl. 6 JoAnna. (711U8). Unexpected low-level viremia among HIV-infected Ugandans adult with untreated active LB, i.acquir immune Defic synd.119:458
Daar, E.. Mnudgil, T. 6 Meyer, R. (1991): Transient high levels of viremia in patients with primary human immunodeficiency virus type l infection. N Eng! J Med: 324(14):961-4

Appendices

These extra things necessary for you to finalise your proposal
They include;
- Budget
- Work plan
- Consent for patients
- Data collection tools
- Any other necessary document

Budget

Budget	Example:
1. Stationery
– 10 reams of duplicating paper @shs 10,000	100,000
– 3 boxes of pens @ 8,000	24,000
Sub-total	124,000
2. Travel
– 5 return trips @ 10,000	50,000
Sub-total	50,000
Total	174,000

(Note: This example is for illustration purposes. Actual research budgets can vary significantly.)

Consent form:

Informed consent is the authorization granted with an awareness of the possible consequences, provided by the respondent to the researcher for their involvement in the study. (With a complete understanding of potential risks and benefits)

A consent form is the documentation that demonstrates the occurrence of the informed consent process.

Essential Components of the consent form:

A clear and concise elucidation of the research’s purpose, incorporating the study’s title.
An account of the procedures participants will undergo during the study, along with an indication of the time commitment for each element.
Explanation of potential risks, side effects, or discomfort associated with the procedures.
Detailing of potential benefits.
Declaration that the participant’s engagement is voluntary, and they retain the right to withdraw without facing any repercussions.
Assertion that the participant is permitted to raise inquiries regarding the study.
Outline of the measures in place to safeguard participant confidentiality.
Explanation of the data’s use after the study concludes.
Confirmation that the participant shall receive a copy of the signed and dated consent form.
Identification of the investigator(s) and contact information.
A “statement of consent” along with the participant’s name and signature.
Identification and signature of the person obtaining consent.

Example of a consent form

Consent Form

Introduction

Dear participant,

I am Tusing, a student pursuing a Diploma in Nuring at Nurses Revision school of Health Sciences. I am conducting a research study on the most effective first-line ART regimen among HIV-infected patients at Kayunga Hospital.

By participating in this study, you will contribute to preventing drug resistance and lowering mortality rates among HIV-infected patients at Kayunga Hospital. We do not foresee any risks to you during the course of this study.

Confidentiality: If you agree to participate in this study, the information obtained during the study will be kept confidential and will only be accessible to the researcher and the supervisors. Your name is also not needed on the questionnaire in order to participate in the study.

Voluntary Consent: You are free not to participate in the study and you have the right to refuse answering any question that you feel uncomfortable with. You are also free to withdraw from study at any time without fear of any consequences.

By signing below, you indicate your comprehension of the information provided about this study, and you willingly provide your consent to participate.

Name of respondent………………………….Signature of the respondent…………….Date…………….

Name of researcher…………………………Signature of the
researcher………………Date…………

Workplan

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