MODULE 4
Working with groups Towards Community Development
A. Stages of Group Development
The Stage of Orientation
The members search a role for themselves in the group. If they will be liked,
respected or ignored and rejected.
They look leader for approval and acceptance.
The Stage of Conflict
This stage is characterized by the group’s concern over dominance, control
and power. Members become judgemental and the hostility towards the leader
becomes more obvious in this stage.
The Stage of Cohesiveness
During this stage, there is an increase of morale and mutual trust as member
feel group belongingness. Only when all feelings can be express and
constructively worked through in a cohesive group does the group becomes a
mature work group.
The Work Group Stage
During this stage, the uniqueness of the members and the leaders are seen
and expected. They become aware of their involvement and of the other
aspects of group process.
The Terminal Stage
The tasks of the group at this stage may include finishing agenda,
establishing key decisions, and completing the group product, tying up loose
ends and writing off unfinished business.
The Various Stages at Work
The stages of a group emerge, become dominant,and then recede,
only to have the group return again later to deal with the same issues,
concerns and problems with greater thoroughness.
B. Interventions to Facilitate Group Growth
The nursing interventions, task and techniques emphasize the importance of
working on feelings, needs and communication.
The major interventions, tasks and techniques include the following:
➢ Provide the necessary orientation, structure and directions
➢ Help meet members’ interpersonal needs
➢ Process negotiate and resolve conflicts to everyone’s satisfaction
➢ Be aware of the effects of own behavior on the group: use the self
for group growth
➢ Derive opportunities to apply learning on another situation.
PROVIDE THE NECESSARY ORIENTATION, STRUCTURE AND
DIRECTION
During this stage of orientation and dependence, the level of anxiety
can be decreased by helping provide the necessary orientation,
structure and direction to the group.
There is great positive impact on group members if they are got
introduced by the leader or facilitator.
Opportunities to clarify or elucidate on the goals and purposes of the group.
Certain structured learning exercises on group decision-making and
consensus maybe utilized to help group members performing the various task
and group building or maintenance
The facilitator or leader creates an atmosphere for producing group work when
member’s interpersonal needs are met to a satisfactory degree for each one
The leader’s task and techniques for members to open up may
include:
- Listening attentively to what each is saying
- Not judging the contributions of members or commenting on every
contribution made
- Doing away with preaching, teaching, or moralizing and
- Avoiding forcing members into participation before they are ready
The leader can encourage productive participation by:
- Observing for signs of a member’s effort to be heard and giving her
an opportunity to contribute
- Being sensitive in identifying those to eager to talk as they can take up all
group’s time.
- Encouraging and supporting all members who participate4. Summarizing
and clarifying the contributions and
- Not monopolizing the discussion or commenting too frequently.
PROCESS, NEGOTIATE AND RESOLVE CONFLICTS TO
MEMBER’S SATISFACTION
Specific interventions focus on developing the member’s competencies to
handle conflict constructively.
➢ Help members understand the nature of conflicts
➢ Help members go through the coping process of conflict resolution using
the problem solving approach
➢ Help members generate new ways of looking at the situation or problem
➢ Help members analyze the here and now experience.
Understand the nature of conflicts
Group members learn to develop a positive attitude toward conflict when they
realize that it has the following characteristics:
A. It is a natural part of any relationship and of any group
B. Conflict is desirable and extremely valuable for several reasons
➢ It encourages inquiry, promotes objectivity and sharpens analysis
Conflicts stimulates interest and curiosity, and increases motivation
and energy of group members.
➢ It can greatly reduce the natural tension and frustration of working
together.
➢ Members derive personal benefits from the experience of conflict
➢ Conflicts bring information to members about where they are.
What is important to each of them, how the group work can be made effective
➢ When the conflict is handled as it being experienced by members
arguments are kept up to date.
C. Any conflict is handled constructively by the group when members
develop specific group norms or rules to create an atmosphere
conducive to healthy management of conflicts and
D. Managed effectively by encouraging group cooperation and using
problem solving approach.
Conflict Resolution Through The Problem- Solving Approach
The basic steps of this approach are:
A. Clarify the basic rule
B. Diagnose the cause of the conflicts
C. Explore ways to settle the conflicts
D. Decide upon and implement an agreement that is satisfactory to all
members
E. Evaluate the success of the action
Generating New Ways of Looking at the Situation or Problem
To help group members analyze/ resolve conflicts, the following are some
practical techniques that can be utilized;
A. Help members isolate/separate the ideas beliefs, and concepts
from the person advocating them.
B. Role reversal to re create exactly how it is for the other person.
C. Certain structured exercise generating new way at looking at the
situations/experiences. Connect the dots help members experience the need
to detach themselves from usual ways of solving problems.
Helping Members Analyze the Here-and-Now Experience
This intervention helps members recognize, examine, and understand
the how and why of interactions or behavior soon after they are
experienced by the group members.
BE AWARE OF THE EFFECTS OF OWN BEHAVIOR ON THE
GROUP: USE THE SELF FOR GROUP GROWTH
The nurse as the facilitators or coordinator of group discussion exerts
an influence on the behavior and experience of group members.
The facilitators handles conflicts especially when the group associate
the conflicts and its sources with her.
It is vital that the facilitator becomes aware of her own behavior and its
effects on the group. Otherwise her behavior may potentiate or mitigate such
experiences and expressions of aggression, passivity and rebellion.
ACT AS THE GROUP COMPLETER/RESOURCE PERSON
The facilitator act as the group completer and ensure that the missing
aspects are made available to the group.
When the facilitator does not have the expertise needed by the group
to do the effective problem-solving on a particular solution or area of
concern she may help group members identify and mobilize resources
and act as group completer by making sure that the missing data,
expertise or resources are made available or accessible to the group.
DERIVE OPPORTUNITIES TO APPLY LEARNING ON ANOTHER
SITUATION
Group experiences provide varied learning opportunities for members.
Members gain more depth understanding group process as they realize that
the concepts and principles previously learned in handling a particular issue
can be applied in another situation dealing with a different issue
This particular intervention will also helpful when the facilitator help the group
undergo successfully the stage of termination.
The facilitator can help them realize that the advantages of investing resources,
efforts and feelings for a successful group work
C. Collaboration and Partnership
Work groups representing various geographical segments and
socio-cultural political units can be the hub of community organization
process for competence and empowerment.
Operationally done in CHN practice, work groups can take any or both
types
- Structural or Organizational sub-model such as:
Formally created committees, task/core/study, groups, clubs or other
community organizations;
- Functional sub-model where community residents demonstrate commitment
to participate in community projects/programs to create and sustain their own
health initiatives.
- Strategically designed to represent the voice of several socio-economicpolitical units in the community, the workgroup’s political will and
connectedness can be orchestrated by the nurse catalyst-partner and the
community as client-partner enhance a collective life of competence and
empowerment.
- As the work groups experience the dimensions of community
competence, they feel motivated and confident in pursuing empowerment
domains as areas of influence that allow community residents to work together
and mobilize themselves toward increase critical consciousness, level of
control and choice over health, health care /service program decisions and
options.
Laverack (2005) describes these empowerment domains as:
- Improved participation
- Developed local leadership
- Increased problem assessment capacities
- Enhanced ability to ask “why”
- Improved resource mobilization
- Strong organizational structures/support groups
- Strong links with other organizations and people
- Egalitarian/equitable relationship between the community and outside
agent and
- Increased control over program management.
ADDITIONAL NOTES:
Community Participation in Health
Levels of Community Participation
Level I – the people are just physically involved in the implementation of the
program designed by the organizing agency.
Level II – when the people are involved in making a “yes or no” decision to
the plans or programs presented by the organizing agency.
Level III – when working committees are created to make decisions for the
community.
Level IV – requires active involvement of the majority of the community
members in making decisions throughout the entire problem
solving process.
Partnership building and collaboration
The aim of partnership and collaboration is to get people to work together in
order to address problems or concerns that affect them.
A. Networking
is a relationship among organizations that consists of exchanging information
about each other’s goals and objectives, services or facilities.
This results in the organizations’ becoming aware of each other’s worth and
capabilities and how each can contribute to the accomplishment of the
network’s goals and objectives.
B. Linkage-building
C. Multi-sectoral collaboration
is the level of relationship where organizations and citizens form a partnership.
All parties give priority to the good of the community. It requires great
investment in terms of effort, time, trust and the will to make a change.
D. Interdisciplinary collaboration
E. Advocacy
it is one way the nurse can promote active community participation. She is
responsible for providing mechanisms for people to participate in activities that
aim to improve the conditions of the community
MODULE 5
Information Technology and Community Health
Definition of E-Health
E-Health is an emerging field in the intersection of medical
informatics, public health services, enhanced and delivered via internet
and related technologies
eHealth is the delivery of health care using modern electronic
information and communication technologies when health care
providers and patients are not directly in contact, and their interaction is
mediated by electronic means.
eHealth provides or delivers safer, more efficient, and better-quality
healthcare. It provides quick access to patient records and information
for efficient health care
Among other things, the services that are provided include physical and
psychological diagnosis and treatment, telepathology, vital signs
monitoring, electronic prescribing, teleconsultation, etc.
Advantages of e health
eHealth benefits patient care by providing new ways of managing
health information and the delivery of healthcare online, making it more
accessible regardless of where you live, reduces staff stress, makes an
efficient and accessible patient record.
Time saving and reducing indirect works, that leads to more direct care
delivery.
The Internet, for example, allows e-health users to communicate with
health care professionals by e-mail, to access medical records, to research
health information, and to engage in person-to-person exchange of text,
audio, video, and other data.
- Storage
Storage in Healthcare means Efficient Electronic Medical RecordKeeping. It retains data even when power is off.
Electronic health records are stored in the processes and updated by
physicians, nurses, and other healthcare providers.
Storage is a mechanism that enables a computer to retain data, either
temporarily or permanently.
Data storage refers to the use of recording media to retain data using
computers or other devices.
The most prevalent forms of data storage are file of different types and
purposes.
How long are electronic medical records and health information are
kept?
It is most likely five to ten years after a patient's last treatment, last
discharge, or death.
- Retrieval
In databases, data retrieval is the process of identifying and extracting
data from a database, based on a query provided by the user or
application.
Data retrieval means obtaining data from a database management
system.
Records retrieval is a complex set of processes to request, retrieve,
organize, and deliver medical records and other documentation
necessary to process claims.
The retrieval of medical records allows health care providers and
facilities immediate access to vital patient and demographic information
- Transmittal
Transmittal - the act of sending a message.
A transmittal document is a "packing slip" for a document or collection
of documents that are transferred from one company to another.
In the delivery of health care using modern electronic information and
communication technologies when health care providers and patients are
not directly in contact, and their interaction is mediated by electronic
means.
In the transmission of health interventions services and information,
patients may have the ability to look after themselves and improve care
provided by healthcare services
Transmission of Electronic health interventions may improve
patients' ability to look after themselves and improve care provided by
healthcare services.
B. Power of Data information
Harnessing the power of data is to improve health and social care
services
Using data well can be a powerful tool in health and social care.
It can be used to develop new services, influence strategies, inform
budget decisions and optimize processes and policy.
Websites can generate health profiles in less than a second by
comparing readily available personal information with a vast data on
other users are using sophisticated information to improve their systems
and services.
eHealth helps patients find the most convenient healthcare provider
using global positioning system location, supplies current and
personalized data and enables to compare services and treatments based
on quality and cost.
The number 39, it can be an age, house number, jersey number etc.
this is a data
The school nurse noted that it is written on the respiratory rate field of
the record of a student grade 5……..so # 39 now has a meaning to the
nurse and has become now an information.
Based on the nurse’s knowledge that the respiratory rate is above
normal and considering other findings the nurse concludes that the
grade 5 students is hyperventilating, perhaps the nurse can provide
now a brown paper bag to breath into
C. E-health Situation in the Philippines
The developing world suffers from inadequate health care and medical
services, lack of health care professionals and infrastructure contributes
to this problem, making it difficult to deliver health care to people in
rural and remote communities of the developing world.
In 2001, roughly 2.5% of the country’s population had internet access. In
the span of 10 years the rate steadily increases to 29%.
Based on the Philippines eHealth Strategic Framework and Plan 2014-
20, the DOH envisions that “. By 2020, eHealth will enable widespread
access to health care services. The application of eHealth in the
Philippines has continuously advanced and yielded considerable benefits
to an individual and public health.
Information and communication technology has been used to improve
the timeliness and accuracy of health reporting to facilitate monitoring
and surveillance of diseases and injuries, among other health problems
The DOH has created networks to increase collaboration on health
information systems and eHealth applications. These are the Philippine
Health Information Network, consist of representatives from the
different government agencies.
For remote and underserved areas and vulnerable populations, DOH
has implemented telemedicine through the National Telehealth Center,
developed and implemented mobile technology solutions in reporting
cases through the Health Emergency Management and Surveillance in
Post Extreme Emergencies and Disasters with support from WHO.
Among this is the Text TB for reporting and inventory of tuberculosis
drugs, Maternal and neonatal death reporting, and Routine health data
reporting, medical training, education, research, and others using ICT.
D. Using E-Health in the Community
The major goal of CHN is to preserve the health of the community. This
is best
achieved by focusing on health promotion and health maintenance of
individual, families, and groups within the community
The use of e-health can give people in rural and remote areas access to
quality care, empower patients and communities to engage at all levels
of the health system, and provide timely information for the prevention,
diagnosis, and management of illness.
Community health centers have the capacity to rapidly adapt EMR’s
because they utilize a standard process nationwide
EMR’s (electronic medical records) are more difficult to implement in
hospital because each hospital has its own set of protocol
EMR’s are vital in the community health centers is that each patient
record is usually used more frequently, ex patient undergoing treatment
for PTB, patients need to make regular visits to the health center for TBDOTS (Tuberculosis directly observed treatment short course), children
for immunization, deworming and micronutrient
Supplementation
E. Roles of the Community Health Nurse in the E-health
The primary role of community health nurses is to provide treatment to
patients.
Additionally, community health nurses offer education to community
members about maintaining their health so that they can decrease the
occurrence of diseases and deaths
Community health nurses’ roles are significantly diversified by eHealth.
Nurses are available to several clients at a single time, making health
care delivery more efficient.
Major roles of an eHealth nurse in the Philippine community setting:
- Data and records manager
As data and records manager , community health nurses monitor the
trends of diseases through he EMR, allowing for targeted intervention
curative services or rehabilitation
Nurses maintain the quality of data inputs in the EMRs, making sure
that information is accurate, complete, consistent, correct and current
- Change agent
Nurses act as change agent by working closely with the community and
implementing eHealth with them and not for them
Change agent also collaborate with health leaders’ policy makers
stakeholders and other community health professionals to determined
their knowledge and awareness on eHealth and appropriate ICT tools
- educator
Nurses provide health education to individuals and families through ICT
tools (teleconference, SMS, email and virtual/simulated environment)
They may also participate in making eLearning videos on specific
disease (DM, tuberculosis), which patients can watch during their
waiting time at health centers
- telepresenter
In the event that the patient needs to be referred to a remote medical
specialist through telemedicine, nurses may function as a telepresenter.
This means that the nurse may need to present the patients case to
remote medical specialist, noting salient points for case assessment,
evaluation, and treatment
- client advocate
As client advocate, community health nurses must safeguard patients’
records, ensuring that security, confidentiality and privacy of all patient
information are being upheld
Nurses must also guarantee that all eHealth intervention are performed
in a safe and ethical manner
- Researcher
Using eHealth tools patients’ records can easily be retrieved and
analyzed retrospectively by community eHealth nurses
They are responsible for identifying possible points for research and
developing a framework based on data aggregated by the system