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Facilitator’s Guide “If everyone is moving forward together, then success takes care of itself.” Henry Ford A guide to planning, starting and running a Bettercare study group

Bettercare Facilitator's Guide

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This guide was developed to help with training groups of health workers and community health workers using Bettercare study material. In this guide, you will find out: • what group work means • how to plan a group • how to start a group • how to run a group • how to keep participants motivated • how to ensure learning is applied in the work setting • how to end a course appropriately. The Facilitator's Guide also includes bonus photocopiable templates to help with planning, starting and running your group.

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Page 1: Bettercare Facilitator's Guide

Facilitator’s Guide

“If everyone is moving forward together, then success takes care of itself.” Henry Ford

A guide to planning, starting and running a Bettercare study group

Page 2: Bettercare Facilitator's Guide

Facilitator’s GuideA guide to planning, starting and running a Bettercare study group

bettercareEBWFROM

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Facilitator’s Guide: A guide to planning, starting and running a Bettercare study group

Updated 4 April 2014 Updated 25 February 2013

First published in 2012

Text © Bettercare 2014

Getup © Electric Book Works 2014

ISBN (paperback): 978-1-920218-68-3

ISBN (PDF ebook): 978-1-920218-69-0

All text in this book excluding the tests and answers is published under the Creative Commons Attribution Non-Commercial No Derivatives License. You can read up about this license at http://creativecommons.org/licenses/by-nc-nd/3.0/.

Bettercare is a division of Electric Book Works (Pty) Ltd.

Visit our websites www.electricbookworks.com and www.bettercare.co.za

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Contents

Introduction 4About the Bettercare series 4Why decentralised learning? 4Books in the Bettercare series 4Format of the courses 6Contributors 8Updating the course material 9Contact information 9

Dear Group Leader 10

1 Introduction to working in groups 11What is group learning? 11Advantages of collaborative learning 11What does the facilitator do? 11Effective small groups 12Successful collaborative learning 12Stages of group work 12

2 How to start a group 14Identifying a need 14Choosing an appropriate course 14Getting stakeholder buy-in 15Advertising 15Participant requirements 16The make-up of groups 16Group size 16Group location 16

3 Planning a group 18Group meeting times 18How to get copies of the books 18Identifying resources and material 18A training budget 19

4 How to run a group 20Establishing group rules 20How the course works 20

How the book works 20Establishing goals 21Planning for group sessions 22Identifying and inviting resource people 22Preparing for group sessions 23Using the multiple-choice tests 23

5 Hints and tips for successful group work 24Keeping participants motivated 24Keeping it interesting 24Ensuring skills are applied in the work setting 25

6 Finishing off 26Completing the course with an exam 26Arranging a certificate- handover ceremony 27Photographs 27Updating the course material 27

7 Contact details 28Bettercare 28Editor-in-Chief 28Exams 28

8 Acknowledgements 29

9 Templates 30Meeting reminder registration 31Goal setting 32Lesson plan 33Contact details 34Multiple-choice answer sheet 35

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Introduction

About the Bettercare seriesBettercare publishes an innovative series of distance-learning books for healthcare professionals, developed by the Perinatal Education Trust, Eduhealthcare, the Desmond Tutu HIV Foundation and the Desmond Tutu TB Centre, with contributions from numerous experts.

Our aim is to provide appropriate, affordable and up-to-date learning material for healthcare workers in under-resourced areas, so that they can learn, practise and deliver excellent patient care.

The Bettercare series is built on the experience of the Perinatal Education Programme (PEP), which has provided learning opportunities to over 60 000 nurses and doctors in South Africa since 1992. Many of the educational methods developed by PEP are now being adopted by the World Health Organisation (WHO).

Why decentralised learning? Continuing education for health workers traditionally consists of courses and workshops run by formal trainers at large central hospitals. These courses are expensive to attend, often far away from the health workers’ families and places of work, and the content

frequently fails to address the biggest healthcare challenges of poor, rural communities.

To help solve these many problems, a self-help decentralised learning method has been developed which addresses the needs of professional healthcare workers, especially those in poor, rural communities.

Books in the Bettercare seriesMaternal Care addresses all the common and important problems that occur during pregnancy, labour, delivery and the puerperium. It covers the antenatal and postnatal care of healthy women with normal pregnancies, monitoring and managing the progress of labour, specific medical problems during pregnancy, labour and the puerperium, family planning and regionalised perinatal care. Skills workshops teach clinical examination in pregnancy and labour, routine screening tests, the use of an antenatal card and partogram, measuring blood pressure, detecting proteinuria and performing and repairing an episiotomy.

Maternal Care is aimed at health workers in level 1 hospitals or clinics.

Primary Maternal Care addresses the needs of health workers who provide antenatal and postnatal care, but do not conduct deliveries. It is adapted from

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5introduction

theory chapters and skills workshops from Maternal Care. This book is ideal for midwives and doctors providing primary maternal care in level 1 district hospitals and clinics, and complements the national protocol of antenatal care in South Africa.

Intrapartum Care was developed for doctors and advanced midwives who care for women who deliver in district hospitals. It contains theory chapters and skills workshops adapted from the labour chapters of Maternal Care. Particular attention is given to the care of the mother, the management of labour and monitoring the wellbeing of the fetus. Intrapartum Care was written to support and complement the national protocol of intrapartum care in South Africa.

Newborn Care was written for health workers providing special care for newborn infants in regional hospitals. It covers resuscitation at birth, assessing infant size and gestational age, routine care and feeding of both normal and high-risk infants, the prevention, diagnosis and management of hypothermia, hypoglycaemia, jaundice, respiratory distress, infection, trauma, bleeding and congenital abnormalities, as well as communication with parents. Skills workshops address resuscitation, size measurement, history, examination and clinical notes, nasogastric feeds, intravenous infusions, use of incubators, measuring blood glucose concentration, insertion of an umbilical vein catheter, phototherapy, apnoea monitors and oxygen therapy.

Primary Newborn Care was written specifically for nurses and doctors who

provide primary care for newborn infants in level 1 clinics and hospitals. Primary Newborn Care addresses the care of infants at birth, care of normal infants, care of low-birth-weight infants, neonatal emergencies, and common minor problems in newborn infants.

Mother and Baby Friendly Care describes gentler, kinder, evidence-based ways of caring for women during pregnancy, labour and delivery. It also presents improved methods of providing infant care with an emphasis on kangaroo mother care and exclusive breastfeeding.

Saving Mothers and Babies was developed in response to the high maternal and perinatal mortality rates found in most developing countries. Learning material used in this book is based on the results of the annual confidential enquiries into maternal deaths and the Saving Mothers and Saving Babies reports published in South Africa. It addresses the basic principles of mortality audit, maternal mortality, perinatal mortality, managing mortality meetings and ways of reducing maternal and perinatal mortality rates. This book should be used together with the Perinatal Problem Identification Programme (PPIP).

Birth Defects was written for healthcare workers who look after individuals with birth defects, their families, and women who are at increased risk of giving birth to an infant with a birth defect. Special attention is given to modes of inheritance, medical genetic counselling, and birth defects due to chromosomal abnormalities,

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single gene defects, teratogens and multifactorial inheritance. This book is being used in the Genetics Education Programme which trains healthcare workers in genetic counselling in South Africa.

Perinatal HIV enables midwives, nurses and doctors to care for pregnant women and their infants in communities where HIV infection is common. Special emphasis has been placed on the prevention of mother-to-infant transmission of HIV. It covers the basics of HIV infection and screening, antenatal and intrapartum care of women with HIV infection, care of HIV-exposed newborn infants, and parent counselling.

Childhood HIV enables nurses and doctors to care for children with HIV infection. It addresses an introduction to HIV in children, the clinical and immunological diagnosis of HIV infection, management of children with and without antiretroviral treatment, antiretroviral drugs, opportunistic infections and end-of-life care.

Childhood TB was written to enable healthcare workers to learn about the primary care of children with tuberculosis. The book covers an introduction to TB infection, and the clinical presentation, diagnosis, management and prevention of tuberculosis in children and HIV/TB co-infection. Childhood TB was developed by Prof Dave Woods of the Perinatal Education Programme and Prof Robert Gie of the Desmond Tutu Tuberculosis Centre, in collaboration with other experts.

Child Healthcare addresses all the common and important clinical problems in children, including immunisation, history and examination, growth and nutrition, acute and chronic infections, parasites, skin conditions, and difficulties in the home and society. Child Healthcare was developed for use in primary-care settings.

Adult HIV covers an introduction to HIV infection, management of HIV-infected adults at primary-care clinics, preparing patients for antiretroviral (ARV) treatment, ARV drugs, starting and maintaining patients on ARV treatment and an approach to opportunistic infections. Adult HIV was developed by doctors and nurses with wide experience in the care of adults with HIV, in collaboration with the Desmond Tutu HIV Foundation.

Well Women was written for primary health workers who manage the everyday health needs of women. It covers reproductive health, family planning and infertility, common genital infections, vaginal bleeding, and the abuse of women.

Breast Care was written for nurses and doctors who manage the health needs of women from childhood to old age. It covers the assessment and management of benign breast conditions, breast cancer and palliative care.

Format of the courses

1. ObjectivesThe learning objectives are clearly stated at the start of each chapter. They help the

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participant to identify and understand the important lessons to be learned.

2. Pre- and post-testsThere is a multiple-choice test of 20 questions for each chapter at the end of the book. Participants are encouraged to take a pre-test before starting each chapter, to benchmark their current knowledge, and a post-test after each chapter, to assess what they have learned.

Self-assessment allows participants to monitor their own progress through the course.

3. Question-and-answer formatTheoretical knowledge is presented in a question-and-answer format, which encourages the learner to actively participate in the learning process. In this way, the participant is led step by step through the definitions, causes, diagnosis, prevention, dangers and management of a particular problem.

Participants should cover the answer for a few minutes with a piece of paper while thinking about the correct reply to each question. This method helps learning.

Simplified flow diagrams are also used, where necessary, to indicate the correct approach to diagnosing or managing a particular problem.

Each question is written in bold, like this, and is identified with the number of the chapter, followed by the number of the question, e.g. 5-23.

4. Important lessons

Important practical lessons are emphasised like this.

5. Notes

note Additional, non-essential information is provided for interest and given in notes like this. These facts are not used in the case studies or included in the multiple-choice questions.

6. Case studiesEach chapter closes with a few case studies which encourage the participant to consolidate and apply what was learned earlier in the chapter. These studies give the participant an opportunity to see the problem as it usually presents itself in the clinic or hospital. The participant should attempt to answer each question in the case study before reading the correct answer.

7. Practical trainingCertain chapters contain skills workshops, which need to be practised by the participants (preferably in groups). The skills workshops, which are often illustrated with line drawings, list essential equipment and present step-by-step instructions on how to perform each task. If participants aren’t familiar with a practical skill, they are encouraged to ask an appropriate medical or nursing colleague to demonstrate the clinical skill to them. In this way, senior personnel are encouraged to share their skills with their colleagues.

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8. Final examinationOn completion of each course, participants can take a 75-question multiple-choice examination, managed by the Perinatal Education Programme.

All the exam questions will be taken from the multiple-choice tests from the book. The content of the skills workshops will not be included in the examination.

Participants need to achieve at least 80% in the examination in order to successfully complete the course. Successful candidates will be sent a certificate which states that they have successfully completed that course. Bettercare courses are not yet accredited for nurses, but South African doctors can earn CPD points on the successful completion of an examination.

Contact the Perinatal Education Programme when you are ready to take the exam.

ContributorsThe developers of our learning materials are a multi-disciplinary team of nurses, midwives, obstetricians, neonatologists, and general paediatricians. The development and review of all course material is overseen by the Editor-in-Chief, emeritus Professor Dave Woods, a previous head of neonatal medicine at the University of Cape Town who now consults to UNICEF and the WHO.

Perinatal Education TrustBooks developed by the Perinatal Education Programme are provided

as cheaply as possible. Writing and updating the programme is both funded and managed on a non-profit basis by the Perinatal Education Trust.

EduhealthcareEduhealthcare is a non-profit organisation based in South Africa. It aims to improve health and wellbeing, especially in poor communities, through affordable education for healthcare workers. To this end it provides financial support for the development and publishing of the Bettercare series.

The Desmond Tutu HIV FoundationThe Desmond Tutu HIV Foundation at the University of Cape Town, South Africa, is a centre of excellence in HIV medicine, building capacity through training and enhancing knowledge through research.

The Desmond Tutu Tuberculosis CentreThe Desmond Tutu Tuberculosis Centre at Stellenbosch University, South Africa, strives to improve the health of vulnerable groups through the education of healthcare workers and community members, and by influencing policy based on research into the epidemiology of childhood tuberculosis, multi-drug-resistant tuberculosis, HIV/TB co-infection and preventing the spread of TB and HIV in southern Africa.

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Updating the course materialBettercare learning materials are regularly updated to keep up with developments and changes in healthcare protocols. Course participants can make important contributions to the continual improvement of Bettercare books by reporting factual or language errors, by identifying sections that are difficult to understand, and by suggesting additions or improvements to the contents. Details of alternative or better forms of management would be particularly appreciated. Please send any comments or suggestions to the Editor-in-Chief, Professor Dave Woods.

Contact information

BettercareWebsite: www.bettercare.co.za Email: [email protected] Phone: 076 657 0353 Fax: 086 219 8093

Perinatal Education ProgrammeEditor-in-Chief: Professor Dave Woods Website: www.pepcourse.co.za Email: [email protected] Phone/fax: 021 786 5369 Post: Perinatal Education Programme, 70 Dorries Drive, Simon’s Town, 7975

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Dear Group Leader

We’ve developed this guide to help you with training groups of health workers and community health workers.

Group learning is a great way for several people to update their knowledge and skills and learn from each other. But it requires one person to take responsibility for making sure that the group meets regularly, that people stay on track, and that the group makes progress. Your role in the group learning process is vital to the success of this course.

Your role is not to teach or tutor the members of the group. Each member of the group takes responsibility for their own learning. But, you need to support and encourage each person to participate in the group sessions, so that they can contribute towards the learning and understanding of the others. You also need to make sure that everything is in place so that your group’s sessions can be interesting and productive. This guide will help you do just that.

In this guide, you will find out:

• what group work means• how to start a group• how to plan a group • how to run a group• how to keep participants motivated• how to ensure learning is applied in

the work setting• how to end the course or courses

appropriately.

At the end of this guide, you will find some useful templates to use in planning and running your group.

This guide is for you, and we would like it to be as useful to you as possible. If there is anything we can do to make this guide better, please let us know.

If you have any questions or need help with any aspect of the group learning process, please contact Bettercare on [email protected].

Yours faithfully

The Bettercare Team

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Introduction to working in groups

What is group learning?

Small group learning is an ideal way for people to learn from each other, test out new knowledge and clinical skills, practise teamwork and improve their people skills. Learning in a group is about teamwork. It is about moving forward and helping others move forward with us.

We have all worked in groups before. At home, we work as a group to keep the house clean and to prepare meals. At school, we worked in groups to complete projects. At college or university, we may have worked in groups to complete assignments or prepare for exams. We know from these experiences that every member of the group has an effect on the other members of the group. We also know that in every team, someone needs to be there to lead the others, making it easier for the group to make progress and keep on track. This is the role of the facilitator.

Advantages of collaborative learning

Learning in a group is called collaborative learning. Collaborative learning helps people develop:

• interpersonal skills (people skills)• problem-solving skills• presentation skills• communication skills• listening skills• an appreciation for other people’s

views

These are all difficult to learn on your own, and they are important skills to have in the healthcare profession.

Collaborative learning also allows members of the group to question and challenge their beliefs, values and assumptions and develop a deeper understanding of the topic. If you understand a topic more deeply, it is easier to apply your learning in different situations.

What does the facilitator do?

The facilitator is not a tutor. You will not be teaching the group members.

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They should be taking responsibility for their own learning, and working through the chapters on their own. Your role is to make it easier for them to talk about and understand concepts they struggle with, share their knowledge and experience, and to make sure all the practical arrangements are taken care of. Imagine that the group is a machine. Each member of the group is a different part of that machine. You are a part of that machine: you are the steering wheel, giving the group direction, and you are also the grease that keeps the machine running smoothly.

Ideally, managing and facilitating courses should be part of your routine duties in your setting. For this, you will need to get the permission of the authorities at your clinic or hospital.

Effective small groups

Some groups are better at getting things done than others. An effective small group:

• is a group of people whose knowledge, experience and skills may differ but still complement each other

• who collaborate with one another• to achieve a common goal• for which they are accountable

together.

You can see that all members of the group need to “buy in” to the process. They need to be committed to the goals of the group and be accountable for their actions in the group.

Successful collaborative learning

There are four important elements for successful collaborative learning:

• Trust – members must feel safe in the group

• Sharing – members must feel able to share their knowledge, skills and experience with the rest of the group

• Interdependence – members must work together to achieve the goals of the group

• Accountability – each member of the group must contribute to the process, or the group will not meet its goals.

Stages of group work

Working in a group can be tough. Social researchers have spent many years studying different kinds of groups and how they work. They have found that almost every group goes through four stages:

• norming – the group establishes a leader or facilitator and group members try to find out more about each other

• storming – initially there may be difficulties between group members or between members and the facilitator

• forming – members of the group trust each other more and rules might develop to guide the group and prevent arguments in future

• performing – this is the productive period where the group is focused on its goal; members have more confidence and the facilitator only guides the process.

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As the facilitator, it is useful to understand these four stages and not to be discouraged when things are difficult at first. Most groups move successfully to a stage where they are focused and productive.

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How to start a group

Identifying a need

If you are reading this guide, you have already identified a need in your clinic or hospital. A need stems from a problem or a gap that needs to be filled. It is important to know more about that gap, and whether training will help to fill it, or if some other intervention is necessary. You also need to decide which learning areas need attention the most. Here are five steps to identifying training needs.

1. Identify the job expectations

You can get this information from the employee job description, by observing what staff have to deal with on a day-to-day basis, or by asking staff what they are required to do.

2. Compare employee performance with job expectations

Are staff able to do what is required of them? If they are not doing what is required of them, is the problem that they do not know how? Is the problem that they do not have time? Is the problem that they do not want to? Is the problem that they do not have the right equipment or resources? Often, there are many reasons for a performance gap and the solution needs to take all of these factors into account. Training on

its own can be a solution, but it can also be only part of the solution.

3. Hold a meeting to discuss training needs

Invite staff to a meeting. Ask each person to bring a list of their top 5 training needs. Talk about everyone’s lists and your own observations.

4. Put training needs into groups

Put the training needs identified in the meeting into categories. For example, HIV/Aids care and management, maternal care etc.

5. Prioritise training needs

With the group, decide which training needs are the most urgent. For example, if you have many HIV positive patients it makes sense that training on their care and management is a priority.

Choosing an appropriate course

After you have identified a need, you need to choose a course that meets that need. It is important to make sure that the course covers the essential

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knowledge and clinical skills required for your particular work setting.

You also need to decide which health workers will benefit from the course e.g. registered nurses, enrolled nurses, doctors, etc.

Look through the books or the catalogue. Compare the needs you identified to the learning material you have available or can get. Which course meets the needs you identified?

From here, you can make a training schedule to show which courses are most important and should be done first and which can wait until later.

Getting stakeholder buy-in

A stakeholder can be anyone who affects or uses a service. At a hospital or clinic, the stakeholders would be the community (who use the service), the hospital management (who set policies and manage finances), the staff (who provide the service), and the local or provincial government (who fund the service).

You need to make sure you have the support of these people to successfully implement your training programme (e.g. getting permission for time off from work for group sessions or for finances to buy books and pay for the exam).

To do that, you must clearly describe:

• what the training need is• how the training programme will

meet the need• the logistics (e.g. time off, a room to

meet in)

• what you need from the stakeholder (e.g. finances, permission, help with logistics)

• the costs involved (e.g. to buy learning materials and pay for the exams).

If you have identified the training need well, can make a good argument for why training is important, and have the support of staff and the community, you should not have too much trouble getting buy-in from your stakeholders.

Advertising

The next step is getting people to join a learning group. There are many ways of doing this:

• word of mouth• putting up posters inviting people

to join the group• handing out flyers at your facility• inviting people face-to-face.

It is best that you invite people to a preliminary meeting where you discuss what the training involves, where it will take place and any costs involved (e.g. do group members have to buy their own books). That way, people know what they are getting into before they commit themselves to the group. It would be helpful if at this meeting you describe what group learning is about and emphasise that each group member takes responsibility for their own learning.

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Participant requirements

It is also important at your first meeting that you stress any requirements you have for participants. These requirements can be:

• job category (e.g. enrolled nurse, registered nurse, CHW, medical officer etc.)

• prior experience• current responsibilities.

Some courses are better suited to some job categories than to others. Participants can be any health professional, currently employed or not.

The make-up of groups

A uniform group is a group where the members have the same or similar job categories, job descriptions, responsibilities and experience. A mixed group is the opposite: members do not have the same job categories, job descriptions, responsibilities and experience. There are advantages and disadvantages to both. In a uniform group, members will understand and be able to relate to each other more easily. In a mixed group, members will be able to share their different experiences, knowledge and skills.

It is advisable that in these courses, the groups are at least partly uniform. Staff from other job categories can be brought in to share their knowledge, skills and experience as needed.

Group size

Collaborative learning works best in small groups of 5 to 10 members. This gives every member the opportunity to contribute to the group and share their knowledge, skills and experience with the rest of the group. It also allows group members to get to know each other better, encourage each other in the group and support each other in the workplace. Collaborative learning is based on sharing, discussion and teamwork, and this happens more easily in smaller groups.

Group location

It is easier to form a group of participants in the same institution. Group members don’t have to travel to get to the groups. Group members can also support each other and share their new skills and knowledge with their fellow group members on the job.

If your institution is small and there are not many people in the same job category, you might have to invite people from other clinics or hospitals nearby. The advantage is that they will have different experiences and this can stimulate discussion and help to understand the topic more deeply.

To run the group, you will need to find a venue that everyone can reach easily. You could book one of the staffrooms or offices at your workplace for the group sessions if groups are going to be during work hours or directly before or after work hours. Make sure it has enough seating for the members of the group and enough light and fresh air.

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You could get permission to put posters and charts on the walls to make the space more interesting.

If your group sessions are after hours, you could meet in a group member’s home. Group members could take turns to host the sessions in their homes. If possible, you could have a roster for providing refreshments (e.g. tea, coffee, biscuits) for the group.

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Planning a group

Group meeting times

The first thing you need to decide on once you have formed a group is what time the group will meet. Group sessions should be at regular intervals so members can plan for them often enough to keep participants focused and on track. We recommend once a week or once every two weeks.

Although groups need to be regular, you should be flexible. People’s work schedules may change, or they may have other commitments that come up. You should find a way to communicate with all group members about changing times and venues. SMS messages are a convenient way to do this, so make sure you have everyone’s cellphone numbers.

Remember the group should decide together on a meeting time that suits everyone and fits into your work schedule. If you have 10 or more people wanting to do the course, you can split the group in two and have two different meeting times (e.g. a morning group and an afternoon group).

You will also need to get permission from the authorities at your institution if the group meeting time is during working hours.

How to get copies of the books

In South Africa• Bettercare:

visit www.bettercare.co.za or email [email protected].

• Paperight: visit www.paperight.com for your nearest outlet.

Internationally

• Online bookstores such as Amazon and Barnes & Noble.

• In the UK through TALC (Teaching Aids at Low Cost, www.talcuk.org).

• Contact us and we will send you a quote for printing and delivery from South Africa, the UK or US to your location. Prices quoted will exclude import tax. If you order over 2000 copies we will try to have books printed in your city/country and delivered to you.

Identifying resources and material

Some of the books include skills workshops. These work best if you

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have someone to demonstrate the skill to the group. There should also be an opportunity for the group members to practise the skill at the group meeting.

The first step is to identify a person who has that particular skill and is willing to demonstrate the skill. This could be an experienced co-worker, a visiting mentor or someone from a different job category. It is more convenient if the person is from the same institution as yourself, but if that is not possible, you can invite someone from a nearby health facility. When you invite someone, you need to be clear about what they have to do. Give them a copy of the skills workshop they will be covering, and remember to give them clear information about the time and place of the meeting, preferably in writing. If you like, you can give the demonstrator a small gift to show your appreciation. A card signed by the members of the group is meaningful and doesn’t cost a lot of money.

Often the skills workshops require equipment or other resources for the demonstration (e.g. medical equipment, a dummy or medical charts). Make a list of these requirements in advance and make a plan to ensure you have all the necessary resources for a successful workshop. You can delegate this task to someone in the group. Group members can take turns to get the resources together for the skills workshop.

A training budget

If you have to buy books for the group members, you will need to make a budget. Some hospitals and clinics will pay for learning materials for their staff, but you need to give them a clear budget for how much the materials will cost and any other costs you might have. If you need a formal quote for books, please contact us at [email protected] or call us at 076 657 0353, and we will give you a formal estimate. If the participants have to buy their own books, you can give them information about how much the books will cost, collect the money and order and pay for the books at once.

You might have other costs besides the books. If you want to have refreshments at your meetings, you need to put this in your budget and collect money from the members of the group. You can delegate the task of buying the refreshments to members of the group. If you want to give the resource people you invite small gifts or if you need to pay for their transport, this also needs to be in the budget.

When managing a budget, it’s a good idea to have someone other than yourself handling the finances. The group can choose someone trustworthy in the group to manage money and the training budget. Group finances should be transparent. Everyone in the group should know how much money is in the budget and how it is being spent. Keep till slips, invoices and a record of all expenses.

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How to run a group

Establishing group rules

In your first meeting, you will need to establish some group rules. It’s best if the group members decide on the rules together. Ask the group members to give you some ideas of group rules. Discuss these and write them down. Some examples could be:

• regular attendance• respect different opinions and

viewpoints• listen to others in the group• don’t interrupt or talk over other

group members• debate is good, arguing is not• prepare for group sessions• participate in group discussions

by listening and sharing.

Write the rules down on a large piece of paper and display them on the wall if possible (you can put the rules up at the beginning of the session and take them down at the end).

How the course works

In the first meeting, the group must read through the introduction carefully. Take time to discuss:

• what decentralised on-site learning is• your role in the group• how the course and book works.

How the book works

Objectives

These are listed at the beginning of each chapter. They highlight the important lessons to be learned in the chapter.

Pre- and post-tests

There is a multiple-choice test of 20 questions for each chapter provided at the end of the book. Participants do the test before studying each chapter, and again after they have studied the chapter. When both tests have been completed each participant should look up the correct answers and mark their own pre- and post test. If any answers are wrong, participants should study those sections of the chapter again and repeat the test before moving on to the next chapter. Discuss the difficult sections in the group. Each chapter needs to be studied and mastered before moving on to the next chapter.

Group members should keep track of their pre- and post-test results to track their learning. It is important that participants take responsibility for assessing their own progress through the book.

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Question-and-answer format

The theoretical knowledge in the book is presented in a question-and-answer format. This method makes learning easy and helps participants play an active role in the learning process. Participants should cover the answer for a few minutes while they think about the correct reply to the question. First thinking of the possible answer helps the learning process.

Simple flow diagrams are also used to show the correct approach to diagnosing or managing a particular problem.

Important lessons and key concepts

Important lessons and key

concepts are shown by a dotted

frame and writing in bold:

Important lessons are shown like this.

Notes

Notes, in smaller writing, give non-essential information. This is for the participants’ interest. These facts are not used in the case studies or multiple-choice tests and exam.

note Notes are shown like this.

Case studies

Each chapter ends with a few case studies. These help participants to consolidate and apply what they

have learnt. The case studies give the participant the opportunity to see a problem as it usually presents itself in the clinic or hospital. Encourage participants to try and answer each question in the case study before they read the correct answer.

Practical training

Some chapters contain “skills workshops”. These are most effective if the practical skill is demonstrated by an experienced colleague who has already mastered that particular skill. You will have to arrange a suitable time and venue for the demonstration. Different colleagues may be needed to help with the various skills workshops as a single colleague may not have all the skills. Skills workshops are not examined in the final exam, but you may want to arrange your own tests moderated by a senior medical or nursing colleague.

Final examination

When participants have finished the course, they can take a 75-question multiple-choice exam and, if they pass, receive a certificate of completion.

Establishing goals

Establish everyone’s goals for the course during the first meeting. An easy way to do this is for each person to introduce themselves and then give a brief explanation of their work day, and what they hope to learn during this course. You can then select two or three of the common goals and write them down for easy reference as the course goes on.

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It helps to motivate participants if the goals are written down on a large piece of paper or cardboard and stuck on the wall of the training room.

Each group member may like to write down their own, personal goals for the course, and keep track of how they are progressing in achieving their goal. You can use the template at the end of this guide to record your goals.

Planning for group sessions

It’s helpful to have a predictable structure for each group session. You can do this by making a simple lesson plan. A lesson plan is a list of the steps you will follow in the session. The main parts of a lesson plan are:

• an introduction that describes why the lesson is important or useful

• the learning objectives• a schedule or list showing the order

of activities• a list of resources needed for the

lesson• a description of what needs to be

prepared in advance• the time each activity should take.

You can see an example of a lesson plan on the next page.

Keep your lesson plan short and simple. You can use the lesson plan template at the end of this guide to help you plan your lessons.

Identifying and inviting resource people

Occasionally you will need to invite a co-worker to give a demonstration or a talk to the group. Get to know the various health professionals who work in the same area you are studying at your own facility and at nearby clinics and hospitals. You can ask co-workers to refer you to people who have helped them in the past or who are particularly knowledgeable. Make a note of these people and their contact details in your diary or facilitator’s file. You can use the template at the end of this guide to keep a record.

You can contact resource people via email, phone or in person. It is often better to speak to someone in person or on the phone, so you can answer any questions they might have and give them a clear explanation of what you need them to do.

When you invite someone, you need to be clear about what they have to do. Give them a copy of the skills workshop they will be covering, and remember to give them clear information about the time and place of the meeting. Write it down for them if necessary. Give the resource person a reminder phone call the day before.

If you like, you can give the demonstrator a small gift to show your appreciation. A card signed by the members of the group is meaningful and doesn’t cost a lot of money.

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Preparing for group sessions

Each member of the group studies the material that is going to be covered before the session. They also complete the pre-test. You must study the material and complete the pre-test yourself, too. The group members can make a list of questions they would like to discuss and note any sections they found difficult.

Make sure you have everything you will need in the session, for example, equipment you need for the demonstrations.

Using the multiple-choice tests

Participants do the test before studying each chapter (pre-test), and again after they have studied the chapter (post test). When both tests have been completed each participant should look up the correct answers and mark their own pre- and post test. If any answers are wrong, participants should study those sections of the chapter again and repeat the test before moving on to the next chapter.

Discuss the pre- and post-test results in the group. They will help you to identify which sections need more work.

You can photocopy the multiple-choice test answer sheets at the end of this guide.

Example lesson plan

Newborn Care Chapter 3: The routine care of normal infants

Introduction It is important to tell the difference between a normal newborn infant and an infant that needs more specialised care to prevent complications from happening.

Learning objectives The participants should be able to:Manage a normal infant at deliveryAssess a newborn infant after deliveryGive routine care to a healthy infantAdvise a mother about the care of a normal infantAppreciate the importance of the road-to-health card

Schedule 1. Discuss what has been studied before the session2. Skills workshop3. Post-test multiple-choice4. Pre-test multiple-choice for next section

Resources Qualified doctor to present skills workshop

Advance preparation Invite doctor to present and demonstrateObtain infant model or get permission and consent for demonstration on an infant in the newborn nursery

Time needed Discussion: 20 minutesSkills workshop: 20 minutes Post-test multiple-choice: 10 minutesPre-test multiple-choice (for next section): 10 minutes

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Hints and tips for successful group work

Keeping participants motivated

Group members need to stay motivated to achieve their goals. When a course runs over a long period of time, it is easy to lose motivation. Here are some ways to keep members motivated.

• Get group members to keep a learning journal. In their journal they can record what they have learnt and, more importantly, how they have applied their new knowledge and skills in the workplace. They can share these experiences with the group at the beginning or end of each session. Hearing how other people have grown is very motivational, as is seeing your own progress.

• Keep a record of the group members’ post-test scores on the multiple-choice tests. You can have a “top achiever” every week or every two weeks. Name the top achiever and let the group congratulate him or her. To make it fun, you could have a special sign that the top achiever wears that week, for example, a funny hat or a big badge.

• With the group’s permission, display the pre- and post-test scores on the multiple-choice tests on the wall of your meeting room. You could also have a weekly or bi-weekly award for the most improved participant.

• When you have a monitoring discussion, remind the group of the goals you set together at the beginning of the process. As a group, talk about how far you are in meeting those goals, and if any of those goals have changed.

Keeping it interesting

Participants stay motivated when what they are learning is presented in an interesting way and when they feel they are part of the process.

Here are some more ideas to keep participants interested.

• Create slideshows of the key points in the chapter. Include photos, images, graphs, video clips, sound bites, newspaper clippings, etc.

• Show and tell: If you can, bring examples of items discussed in the chapter, such as empty medicine containers, equipment, X-rays, etc.

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• Bring in help: You can arrange for experienced medical or nursing colleagues to visit your hospital or NGO and do demonstrations or ten-minute lessons covering a section.

• Case studies: Ask one group member each week to prepare a case study from one of their actual patients for everyone else in the group to learn from.

• Play acting: You can ask group members to play out nurse–patient scenarios described in the book, and then get feedback from the rest of the group members on what was done correctly, and what could have been done better.

Remember to include all group members in presenting information to the group. For example, the participants can take turns to present case studies from their own experience, or they can help with preparation by bringing the necessary equipment for demonstrations or identifying and inviting resource people to present to the group. Remember that each member of the group contributes to the success of the group as a whole. At the same time, they are all responsible for their own learning.

Ensuring skills are applied in the work setting

There is not much point in learning new knowledge and skills if it isn’t applied in the work setting. Here are some ways to make sure new knowledge and skills are carried over into “real life”.

• Each member keeps a learning journal or diary and writes down experiences they have had in the workplace where they had the opportunity to apply their knowledge and skills. These can be shared at the beginning or end of each session.

• The members of the group can share at the beginning or end of each session what they have noticed their colleagues doing differently after training. This also helps to develop problem-solving and decision-making skills.

• The group members can share experiences they had before training and talk about what they would do differently now that they have new knowledge and skills.

• Ask a superior or co-workers if they have noticed a change in the group members’ professional behaviour and attitudes. Emphasise that you are not “checking up on them”. You are gathering information to find out if the learning process is successful.

• If the material in the course is different to hospital or clinic policy, discuss this in the group. Try to reach a compromise after reviewing both points of view.

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Finishing off

Completing the course with an exam

When your group has worked through the entire book, they can take a formal 75-question multiple-choice examination. These exams are managed by the Perinatal Education Programme. The exam questions are taken from the multiple-choice tests in the book. The content of the skills workshops and notes will not be included in the examination.

You will need to arrange a venue for the exam and an exam manager (an invigilator). The time needed for the exam is one hour.

Participants can also take the exam on their own on a “trust” basis, but it is better to have a more formal, supervised exam.

How to request exams

Exam papers can be requested from Robyn Muller at [email protected]. Robyn will email the exam paper and answer sheet to the exam coordinator.

Give clear information about which course exam you require. It’s best to request the exam paper at least two

weeks before you are due to write the exam.

Marking completed exams

The correct answer sheet will be emailed to the exam coordinator. The exam coordinator should keep the answer sheet in a safe place until the participants have completed the exam. Mark the exams immediately and give the participants their results. Please destroy the list of correct exam answers.

Getting certificates for completed exams

Once you have written the exam, the exam paper and results need to be sent back to Robyn. She will email the certificates as PDF documents. The group facilitator can then print them out for the participants.

Please contact [email protected] when you are ready to take the exam or if you require more information.

Pass mark

Participants need to achieve at least 80% in the exam to successfully complete the course. Successful candidates will be emailed or posted a

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certificate which states that they have successfully completed that course.

CPD points

Certain courses also offer CPD points for doctors. The following courses offer CPD points:

• Maternal Care: 7 CPD points at level 2i

• Newborn Care: 7 CPD points at level 2i

• Perinatal HIV: 7 CPD points at level 2i

• Primary Newborn Care: 7 CPD points at level 2i

• Saving Mothers and Babies: 7 CPD points at level 2i

• Intrapartum Care: 7 CPD points at level 2i

• Mother and Baby Friendly Care: 7 CPD points at level 2i

• Primary Maternal Care: 7 CPD points at level 2i

• Birth Defects: 7 CPD points at level 2i

Please contact [email protected] for more information about CPD points.

Arranging a certificate-handover ceremony

Once your group has completed the course and has passed the exam, you may want to have a certificate-handover ceremony to honour the graduates. This will help to reward those who have put in many hours of hard work, and to motivate other members of staff to continue their education.

You will probably need to arrange for snacks and guests. You can print out the certificates that the group members received when they passed the exams, and have an official handover ceremony. The ceremony doesn’t have to be fancy or time-consuming – a simple handover and public acknowledgement during a morning or lunch break should be fine.

Photographs

We would love to feature photographs of your groups on our website – you can send photos of your group during your weekly sessions, while doing skills workshops, or at the certificate-handover ceremony that you may have, and we will add them to our website. Please email photographs with captions to [email protected], with your name and contact phone number.

Updating the course material

Bettercare learning materials are regularly updated to keep up with developments and changes in healthcare. Feedback from participants helps us to continuously improve our learning material. You can help by letting us know about factual or language errors, sections that are difficult to understand, and by suggesting additions or improvements to the contents. Please send any comments or suggestions to [email protected].

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Contact detailsThank you for using Bettercare materials. If you have any queries or feedback, or require assistance with using this material, please contact us.

Bettercare

Website: www.bettercare.co.za

Email: [email protected]

Phone: +27 (0)76 657 0353

Fax: +27 (0)86 219 8093

Editor-in-Chief

Professor Dave Woods

Website: www.pepcourse.co.za

Email: [email protected]

Phone/fax: +27 (0)21 786 5369

Exams

Robyn Muller

Email: [email protected]

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AcknowledgementsWe would like to thank Dr Elbeth Hoffman from Kidz Positive and Prof Dave Woods from the Perinatal Education Programme for their contribution towards this guide.

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Templates

In this section you will find:• Meeting reminder registration sheet• Goals sheet• Lesson plan template• Contact details sheet• Multiple-choice answer sheet

You can photocopy these pages for use in your group sessions and planning.

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Meeting reminder registration

Course name:

Group leader name: Position:

Phone number: Email:

Name Cellphone number Email

e.g. Lindiwe Ndaba e.g. 079 252 3408 e.g. [email protected]

1

2

3

4

5

6

7

8

9

10

11

12

13

14

Email this form to [email protected] or fax it to +27 (0)86 219 8093

I would like to receive updates on Bettercare products and courses Email SMS

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Goal setting

Goal How I can achieve it How I will know it has been achieved

Goal 1 1

2

3

Goal 2 1

2

3

Goal 3 1

2

3

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Lesson plan

Introduction

Learning objectives

Schedule

Resources

Advance preparation

Time needed

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Contact details

Name

Institution and department

Job title

Phone number

Cellphone number

Email address

Name

Institution and department

Job title

Phone number

Cellphone number

Email address

Name

Institution and department

Job title

Phone number

Cellphone number

Email address

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Multiple-choice answer sheet

Name: Date:

Course: Chapter number:

Circle the one, most correct answer to each question or statement.

1. a b c d

2. a b c d

3. a b c d

4. a b c d

5. a b c d

6. a b c d

7. a b c d

8. a b c d

9. a b c d

10. a b c d

11. a b c d

12. a b c d

13. a b c d

14. a b c d

15. a b c d

16. a b c d

17. a b c d

18. a b c d

19. a b c d

20. a b c d

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