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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

CONSTRUCTIVISM Read More »

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

Chapter three (3) shall be structured as follows:

3.0 Introduction: It should introduce the summary of this Chapter in one paragraph.
3.1 Study design: which must include the rationale;
3.2 Study setting: which must include the rationale;
3.3 Study population;
3.4 Sample size determination and its justification (Use simple scientific methods);
3.5 Sampling method/procedure which must include the rationale;
3.6 Inclusion and exclusion criteria;
3.7 Study variables;
3.8 Research instruments/tools;
3.9 Data collection method /procedure;
3.10 Data management and analysis;
3.11 Quality Assurance: Validity and Reliability;
3.12 Ethical considerations;
3.13 Limitations to the Study;
3.14 Dissemination of study findings;

3.1 Study Design

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

Example: descriptive cross-sectional design.
Approaches can be Quantitative/qualitative or both.
Note: 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:
- Given this research question/problem, what type of evidence is needed to answer the question in a convincing way?
You should always state the reason/rationale for using that particular design (why that particular design).

Example: “The study will use a cross-sectional descriptive study design enables the researcher to collect data from many participants at a single point in time, saving both time and resources.”

3.2 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 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 the central part of Uganda. ART clinic operates daily from Monday to Friday from 8 am to 4 pm. It has a total of 10 nurses, 2 laboratory technicians, 2 clinical officers, and 1 medical officer. This clinic receives on average a number of 150 patients on every clinic day. The study setting was chosen because the ART clinic serves a big population of about 4500 HIV/AIDS infected people.”

3.3 Study Population

Explain the population from which your sample will be collected.

This is the population that the results will be generalized 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 needs (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 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 (i.e., list of participants from which a sample can be selected).
Select a sampling procedure; this could be probability or non-probability sampling.
Determine the sample.
Draw the sample.
Give justification.
State the standardized method you will use to estimate the sample size.

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

3.5 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/judgmental sampling.
- Snowball sampling.
- Quota sampling.
Explain how the subjects will be selected during sampling.

Example: “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.

3.6 Inclusion and Exclusion 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 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, etc.

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 18 years of age and above, since 18 years of age is the consent age according to the Ugandan constitution.”

3.7 Study Variables

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:
- Dependent
- Independent
- Intervening
Let the reader know what (define) your dependent variable and independent variables of the study are.

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. A viral load of >5000 copies/ml at 12 months of antiretroviral treatment will be taken as an indication for virological failure (similar to WHO recommendation in resource-limited countries).”

3.8 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.

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.”

I. Questionnaires

This mainly involves the use of pre-determined answers to gather information from participants. It mainly has two forms: Self-administered and Researcher administered. Questions can be closed-ended or open-ended.

Comparison of Questionnaire Types

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

Self-Administered Questionnaires

Researcher-Administered Questionnaires

Advantages:

Convenience: Participants can complete at their own pace.
Privacy: Respondents have privacy for sensitive questions.
Time Flexibility: Participants can choose when to complete.
Cost-Effective: No researcher presence reduces data collection costs.
Large Sample Size: Suitable for reaching a larger, spread sample.
Reduced Researcher Bias: Participants may provide candid responses.

Advantages:

Clarity: Researchers can clarify questions for better understanding.
Motivation: Higher motivation can lead to improved response rates.
Probing: Allows probing to ensure thorough and accurate responses.
Control: Researchers can control the survey environment.
Data Quality: Offers control over data quality and completeness.
Clarification: Offers the ability to probe and clarify ambiguous answers.

Disadvantages:

Non-Response Bias: Response rates might be lower, potentially biased.
Misinterpretation: Participants might misunderstand questions.
Incomplete Responses: Respondents may skip or provide incomplete answers.
Low Control: Researchers have limited control over survey environment.
Limited Probing: Researchers cannot probe further for clarification.

Disadvantages:

Time-Consuming: Due to researcher presence.
Researcher Influence: Presence of a researcher can influence responses.
Costly: Due to resources needed for administration.
Limited Anonymity: Might affect the honesty of responses.
Geographical Constraints: Limit participant availability.

II. 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.

III. Checklists

Also called observation forms. Researcher ticks responses on observation of what has been done or not. In many studies, rating is done thereafter.

IV. Standardized tests

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

3.9 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.

Example: “A letter obtained from the research committee will be taken to the management of Kayunga Hospital and to the ART clinic to allow the researcher to carry out data collection among HIV-infected clients on 1st line ART regimens. One clinician will be identified from the 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.”

3.10 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.

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 SPSS software package for social science version.”

3.11 Data Analysis

After data has been cleaned, it is then analyzed and interpreted to make meaningful statements.

This is then followed by making interpretations of findings before the actual generalization of the research findings.
Explain how data will be analyzed.

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.”

3.12 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.

Example: “Research proposal will be submitted to the 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.”

3.13 Limitations to 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 can be planned before beginning the study.
They also help in predicting the necessary help needed and the feasibility of the research.
Explain the constraints you are likely to meet and how you will overcome them.

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 timetable that will be strictly followed.”

3.14 Dissemination of Study Findings

Research findings must be shared with 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.

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

METHODOLOGY Read More »

LITERATURE REVIEW

CHAPTER TWO: LITERATURE REVIEW

Literature review refers to the collection of scholarly information about any research problem/topic.

It is a systematic gathering of information, analysing and reviewing documents from written or done by other scholars that have a relation to your problem being investigated.
It is a requirement for any researcher to do a preliminary background search of information about a problem so that one discovers what has been done and what the gap in the field of study is.

This is one of the most important sections of the research proposal. It provides a discussion of literature that is related and relevant to the study. This section provides the researchers comprehensive perspective of all studies associated to the study at hand.

While writing your literature review section, always do a brief review of the existing literature, not a whole or comprehensive or full report. This section must be brief and on point.

While writing this section, you should always refer to the original source of literature, therefore if you find something of interest in a quotation, endeavor to find the original publication, by doing this you will minimize any forms of interpretation and reporting errors.

This chapter contains only one item, i.e. literature review.

Purpose of literature review

To identify what is already known in your area of study.
To justify why you need to study the problem you are interested in since it identifies the gaps.
To orient the reader on how the research will be used to make discussion of the findings.
To know what has been reported so that you report on what needs to be reported on.
Forms part of the research process.

Classification of the Sources of Literature

The sources discussed above are classified into 3 main categories. These include;

Primary Sources; these are publications by the researcher that conducted the research. This is where we get the data from the first hand information especially the people who existed, observed and witnessed the occurrence of a certain event. For example Dissertation and Thesis, Conference papers among others.
Secondary Sources; these are publications by authors who are reporting the works of other researchers. These publishers did not directly participate in the research. This is where we get the literature from second hand information like published data, articles books, etc written by people/Authors who were not present when these events were happening.

Main Sources of Literature include

Conference papers, these are scholarly research papers presented in conferences.
Text books, researchers may use a computer based catalogue or a card catalogue to find a book of their choice. The catalogue is usually alphabetically indexed by Author, Subject and Title.
Dissertations and Thesis, this is original research work produced by a Doctor of Philosophy (PhD) or Master's degree candidate in partial fulfillment of the requirements for an award. These publications are of great value to a researcher.
Periodicals, this includes; magazines, newspapers and journals among other periodically published information.
Government Documents, these include government research reports, ministerial policy frameworks and policy papers among other documents of government.
The Internet or computer search, this entails the use of computers and other such facilities to browse the web and get the latest literature of interest.
Abstracts, these provide a list of journal articles with a summary of the document or text.
Reference Section of the library, this is a source of Literature where all books classified as reference material are catalogued in the same way within a library. This is done for easy access by researchers and scholars.

Importance of Reviewing Literature

The researcher develops a more comprehensive understanding of the study area, specifically the research problem and other variables.
It shows the relevance of earlier research to the present study.
It helps the researcher to avoid duplication.
It helps to reveal the contributions, weaknesses and gaps to be filled.
It helps in the identification and recognition of those who have already worked on the problem at hand.
Reviewing literature justifies the researcher's project.
Helps in discovering new variables relevant to the study.
Adequate literature review is a symptom of scholar or researcher academic maturity.
Reviewing literature as well helps the researcher to vividly know all the research projects related to his/her current project. The researcher will know all completed projects and those in the pipeline but this will only be limited to reported projects alone.
Reviewing literature equips the researcher with better explanations, theories, methods and ideas of research that are credible in studying and formulating the problem.
Reviewing literature provides alternative approaches to the research project.
Reviewing of literature helps to synthesizing facts about a given research area.

Main focus while reviewing literature

Researchers should always focus on the following 10 areas;

Self-Study Review, the researcher should ensure that the research work exhibits his/her high levels of familiarity with the research area. If well done, this will increase the confidence of both the researcher and the reviewer.
Actual Reviews, while reviewing literature the researcher should highlight specific arguments and doctrines in his/her current study through illustrating what has been done in the field, gaps (areas that need further study) and as well as weaknesses. The researcher should endeavor to organize this information "objective by objective".
Theoretical Reviews, while reviewing literature, the researcher should as well illustrate how different theories address an issue over time.
Historical Reviews, in the process of reviewing literature, the researcher should concentrate on tracing the developments of the research issue overtime.
Methodological Reviews, the research should ensure that his/her literature review sections illustrate how the methodology he/she has used varies with regards to the study.
Conceptual Reviews, the literature review section should as well illustrate the previous researcher's opinions and operationalization of your study variables.
Ongoing Reviews, your literature review section should be a discussion of current issues on the study area or what is known at that point in time. Avoid outdated literature.
Synopsis Review, your literature review must only provide a brief summary of the previous studies and must as well be concluded with a summary of literature you have reviewed.
Organizational Review, the researcher must review how other scholars have organized their literature and "pick a leaf" most especially if the institution your writing for does not have vivid guidelines.
Empirical Review, the researcher should ensure that he/she demonstrates thoroughness in the field of study by critically reviewing factual studies that have been done in similar or related studies.

The Literature Review Process

The process of reviewing literature and ultimately generating a literature review section is not linear in nature as many researchers think. This is usually one of the most cumbersome stages in the research process. However, if well understood, it may as well be one of the most interesting stages of the researcher process.

I have developed a simple model referred to as the FEM Literature Review Model to enable researchers appreciate the process of reviewing literature. In this model some of the connectors between phases are curved-upwards, downwards, side-ways and while as others are linear (Horizontal and Vertical). This is meant to show the researcher that the process of effectively reviewing literature is not as direct as most scholars presume. Therefore researchers that will persistently follow this model will actually find this process fascinating than cumbrous.

The FEM Literature Review Model

STEP 1: State your topic and list the key words or concepts or variables or constructs.

At this point the researcher is expected to have a research topic. Therefore, you state the title of your research, from the title you then identify the key words that will support in the process of searching for current valid literature. The variables of the study must as well be considered while stating the key words.

STEP 2: Search for current material related to your topic and constructs

After clearly stating your topic and key words in step 1 above, then conduct an exhaustive search for current, relevant and related literature. Use all possible sources of literature to get the necessary material. Scholars may use books, articles, abstracts, dissertations and reports among other documents in your areas of study.

Ensure that you plan for how long you expect to review literature or for the time you expect to utilize while reviewing literature.

Note, literature search should be based on topics and constructs but organized objective by objective.

STEP 3: Extract important fragment from the available material

Based on the material generated in step 2 above, then you should review the Books, Articles, Journals and abstracts among others that were collected in the previous stage. As you review these documents, any information found relevant should be captured immediately while citing the source of the information or author.

While reviewing documents focus on;

Definitions of terms by different scholars.
Findings, conclusions and recommendations of others scholars.
Areas for further studies, relevant to this cause.
Gaps in the literature (these may be directly observable or indirectly observable).
Any form of disagreements about the researcher constructs.

Note; These fragments generated in this step will be preserved either by typing them or hand writing.
Note; These fragments should be organized objective by objective.

STEP 4: Chronologically compile your literature.

After all the 3 steps above, the researcher then starts organizing his or her literature in order of time of publication for example 2016 comes before 2012. And in order of relevancy implying that literature will as well be arranged in order of important and relatedness of information will as well be considered.

Note: This should be done objective by objective.

STEP 5: Scrutinize your literature

This step encourages the researcher to review the generated literature in Step 4 above, this is to ensure that the literature is free of technical and non-technical errors including errors attributed to citation.

STEP 6: Draft the literature review section

At this level, the researcher compiles the entire literature review section and ensures that you have a draft version of this section.

STEP 7: Synopsize the literature review section.

The researcher should now generate a brief summary of his/her literature review section. This summary should reflect the gaps in the reviewed literature, controversial agreements and as well as any key lessons learnt.

STEP 8: Consolidate your Literature Review section

This is the final step and at this level the researcher is expected to harmonize the entire section and probably combining this section with other completed sections of the research proposal.

Note that: The final version of this section must be arranged objective by objective.

Types of Reviews

Theoretical Review. This entails the review of the theory (ies) that underpin the study. The researcher will elucidate the theory and illustrate how other scholars have used the theory or theories underpinning the study.
Procedural review. This entails the researcher analyzing how methodology varies by studies and this definitely guides the methodology to be adopted by the current research/ study.
Historical review. Adopting this form of review enables the researcher to trace the advancement of an issue or research problem over time. The researcher will therefore keenly review how a given phenomenon has evolved over a given period of time. A comprehensive historical review will enable the researcher to generate a good justification, problem statement and historical background of the study.
Self-boost review. This form of review is specifically done to boost the researcher's comprehension, familiarity and knowledge about his/her research study. Therefore this form of study upgrades the researcher's self-confidence specifically about the study.
Conceptual review. This is done by the researcher to find out or discover more about his or her study variables. Conducting this form of review will support the researcher to develop a good conceptual background and the content scope of the study. This must as well be directly linked to the conceptual framework of the study.
Contextual review. This form of review enables the researcher to vividly understand the case of the study or unit of analysis. You will understand "What" or "Who" is being studied and why this specific unit and the history of the problem in this chosen unit of analysis. This form of review will support the researcher in the development of the contextual review section and the geographical scope of the study.

Writing the Chapter Two Section

(Note: The title "CHAPTER TWO: LITERATURE REVIEW" should not be included in your Chapter Two text itself, but as a researcher you should know that under this section you start the actual review of literature objective by objective.)

The sub-headings under this Section should be based on the number of specific objectives of the study. Therefore each sub-heading must be given a title that represents the independent variable and dependent variable of the study.

This section should highlight specific arguments, gaps, weaknesses and contributions by earlier researchers and as well as ideas in a given combination of variables of the study. Endeavor to discuss relevant, current (not too old literature) and related literature under each of the themes.

This section is only valid if it has more than enough citations in the text. Basing on the policies of the institutions, while citing the researcher must include the author and the year of publication. However, that is incumbent upon the referencing style and policy of the institution. According to UHPAB, include a minimum of 20 references.

2.1 Specific Objective 1 (One) - "Restated as a title"

Under this section, specific objective 1 (one) should be restated as a title in the form "Independent Variable 1 and the Dependent Variable" (IV1 & DV). Therefore the title of this section should be "2.1 Hospital related challenges that affect performance of diploma student nurses and midwives in clinical practice."

Discuss literature on the subject with the motive of bringing to light the contributions made by other researchers, gaps in existing literature, weaknesses and as well as emerging ideas.

2.2 Specific Objective 2 (Two) - "Restated as a title"

Under this section, specific objective 2 (Two) should be restated as a title in the form "Independent Variable 2 and the Dependent Variable" (IV2 & DV). Therefore the title of this section should be "2.2 Individual student, relate challenges that affect performance of diploma student nurses and midwives in clinical practice."

Discuss literature on the subject with the motive of bringing to light the contributions made by other researchers, gaps in existing literature, weaknesses and as well as emerging ideas.

Note that:

This Chapter shall have 3-5 pages and it shall be arranged as follows;- 2.0 Introduction: This shall not be more than half a page 2.1 Body shall be 3-5 pages

Remember;

a) Include a minimum of 20 references (Books, Journals and Articles, websites and other acceptable sources):
b) The oldest references should be less than 10 years before the Trainee’s year study;
c) The sub-headings of the literature review shall be in line with the specific study objectives.

Whenever you are writing someone’s work, you have to acknowledge the person who did the work, and in research, we call that REFERENCING. This will be covered under References.

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PRINCIPLES OF TEACHING AND LEARNING

The principles of teaching and learning will assist the teacher to achieve purpose of teaching. It guides the teacher on the elements pertaining teaching such as whom to teach, why teach, where to teach, what to teach, how to teach and when to teach.

Principle of motivation: The best teacher is one who inspires students. This provides an atmosphere of confidence and helps student to develop positive attitude towards the subject
Principle of activity: Teaching should aim at having students active not passive. Teachers should set various tasks which learners should get involved in like discussion, assignment, case presentation e.t.c
Principle of individual difference: Teaching should respect individuality of students by considering each student as unique
Principle of selection: Teachers should select appropriate content, teaching method or aids basing on the level and needs of learners
Principle of division: Teaching should have definite division into steps and sequenced appropriately e.g lesson of cardiac failure can be broken down into definition, types, pathophysiology, clinical feature, diagnosis and management
Principle of correlation or association: The previous knowledge should correlate with present knowledge because our brains were not designed to recall information in isolation e.g teaching medical or surgical nursing requires knowledge of anatomy or foundations of nursing
Principle of creativity: Teaching should allow learners to come up with new ideas or suggestions from the content taught. So the teacher should also set activities allowing room for innovation
Principle of revision and practice: Teaching has to ensure revision or summarizing the content at the end and encourage practice of learned content periodically
Principle of objectives: Teaching has to have well-defined objectives in order to ease content delivery and evaluation
Principle of effect: Behaviour that leads to satisfying outcomes are likely to be repeated whereas those that lead to undesired outcomes are less likely to recur. Teaching activities should lead to the best results so that students can continue practicing them
Principle of connection to real life: Teaching should relate the content taught to real life so that it maintains the learner’s attention span and understanding. For example, teaching in nursing has to be connected to lived experiences and that of the patient.

LESSONS LEARNED FROM THE PRINCIPLES OF TEACHING

Subject matter must possess meaning, organization, and structure.

Meaning: Content becomes more meaningful when learners understand how the subject matter can be applied.
Organization: Content should be divided into instructional units that clearly demonstrate the usefulness of what is being taught.
Structure: Content must be sequenced in a way that allows learners to see and comprehend the interconnectedness of concepts.

Readiness is a prerequisite for learning.

Educators must familiarize themselves with their learners’ interests, aspirations, aptitudes, and prior knowledge.
Learners demonstrate their readiness for instruction.
Instruction should be tailored to the experiences and contexts that make students willing and capable of learning. This state of readiness is highly valued by many educators.

Learners must be motivated to learn.

The finest educators inspire students and foster their active involvement during teaching.
Motivation to learn encompasses factors that influence learners to engage in and successfully complete learning activities.
Motivation is influenced by personal and environmental factors.

Teaching needs to have well-defined objectives.

Teaching activities should be based on predetermined objectives to achieve favorable outcomes.
Learners are motivated by clearly established learning goals.
Objectives guide the selection of content, delivery methods, and evaluation.

Success is a motivating force.

Learners are motivated when they acquire new knowledge and skills.
Educators should create learning activities where attainable success is achievable through proper instruction and supervision. Unrealistic standards for assessments should be avoided.

Learners are motivated when they are challenged.

Tasks should present a level of challenge where success is attainable but not guaranteed.
Educators must acknowledge that what is achievable for one learner might be unrealistic or uninteresting for another.
Instructional material should cater to various difficulty levels and encompass a range of activities.

Learners must receive feedback on their learning progress.

Feedback should encompass both strengths and weaknesses in a learner’s academic performance.
Feedback mechanisms can be individual or group-based.
Behaviors that are reinforced (rewarded) are more likely to be learned.
Reinforcement should be perceived as rewarding by the learner and not solely by the educator.

Criticism should be used cautiously as research shows a negative relationship with that and academic achievement.

Negative feedback should always be accompanied by instruction on how to correct errors.
Reinforcement should follow the desired behavior as promptly as possible and be clearly linked to the student’s actions.

Directed learning is more effective than undirected learning.

Directed learning involves ensuring that both educators and learners comprehend what is transpiring and why.
Directed learning necessitates strategic instructional planning and skillful supervision.
Learning should involve inquiry rather than strict instruction in the subject matter.
Active learning is superior to passive learning.

Problem-oriented approaches enhance learning.

Problem-oriented approaches ensure that all learners can actively participate in instruction.
Revision and practice are crucial.
Teachers must summarize content and encourage students to practice.
Learning results from practiced actions.
Proper technique practice with feedback is essential for success.

Content should be connected with real life.

Retention of learning is increased when it is applied in real-life scenarios and quickly utilized after acquisition.
Practice should closely mirror the real-life context in which behavior, skills, or attitudes are utilized.

Teaching should be correlated.

Content must correlate with previous or related knowledge, offering learners a comprehensive understanding of the subject matter.
Generalizations, rules, or formulas aid knowledge retention.

Individual differences should be considered.

The teacher should recognize the uniqueness of each student and pay attention to individual differences.

QUALITIES/CHARACTERISTICS OF GOOD TEACHING

Good teaching involves the following:

Recognizes individual differences: It should consider every student as unique.
It should cause learning to take place: It allows change in behavior, i.e., they should be able to do or know something they did not know.
It involves guiding learning: It helps to develop desirable learning habits to achieve a desired aim, i.e., it should have well-defined objectives.
It provides an opportunity for activity: It should keep students as active learners but not passive.
It’s kind and sympathetic: It should make students comfortable in the presence of a teacher but not be threatened.
It should be flexible and use any teaching method to cater to learners’ different learning.
It should reduce the distance between teacher and student hence enhance teamwork.
It’s democratic: The teacher has to allow students to think and express their ideas freely but should remain in control and guide them appropriately.
It should provide desirable and selective information: The teacher should deliver information that is appropriate to the needs and level of students.
It should help the child to adjust to his/her environment: Making a child able to survive and live a productive life in society.
Consider the level of the student: Teaching should be based on the previous knowledge of the student, level of intelligence, and intellectual maturity.
It should be progressive: Teaching should enhance further development of the student to reach good positions in life.
It should be stimulating/motivating: The teacher must elicit the interest of learners with their enthusiasm for the subject, teaching method, and aid used.
It should be planned: The teacher should take prior time to plan and develop well-defined objectives. Otherwise, it implies if one fails to plan, then they plan to fail.”
It’s diagnostic and remedial: Teaching should find out educational problems of students then come up with remedial measures to address the problems.
It should be correlated: The present knowledge obtained should relate to the previous content, not distinct.

MAXIMS OF TEACHING

These are general rules of conduct to be followed by a teacher while teaching.

Proceed from known to unknown: The teacher should correlate learning with the student’s experience and previous knowledge so that the content starts from what is known and then proceeds to what is unknown.
Proceed from simple to complex: It’s also important to begin with the simplest lessons and then introduce more complex ones later. In other words, teach in increasing order of difficulty.
Proceed from overview to details: Students can easily understand if the teacher first provides an overview of the lesson and then delves into the details of the content.
Proceed from general to specific: General rules are explained first, followed by the delivery of specific information.
Proceed from specific to general: At times, it’s necessary to start with specific facts before presenting them in a general context.
Proceed from easy to more difficult: The content should be taught in increasing order of difficulty.
Proceed from concrete to abstract: Students should grasp new ideas when they are initially taught with simple illustrations (concrete aspects) before moving on to mental reasoning (abstract aspects). Therefore, start with observations and progress to intellectual reasoning.
Proceed from empirical to rational: Empirical knowledge is gained through observation and experience, while rational knowledge is based on scientific principles. Thus, it’s essential to begin with live examples and then advance to scientific reasoning.
Proceed from whole to parts: The whole holds more meaning for students compared to individual parts. Teaching the skeletal system (functions, number of bones) as a whole and later breaking down each bone’s details (e.g., femur, clavicle) allows for better correlation.
Proceed from parts to whole: In some situations, it’s beneficial to start with parts and conclude with the whole to enable students to generalize the content. For instance, teaching the advantages of rectal, oral, and sublingual routes separately before discussing the advantages of enteral routes as a whole.

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