ht.
J. Nurs. Stud. Vol. 14, pp. 1X-123.
Pergamon
Press. 1977. Printed in Great Britain.
The role of a nurse in health education as practiced in and around Church of South India Hospital, Bangalore, India* ACHAMMA CHACKO School of Nursing University of Windsor, Windsor, Ontario N9B 3P4, Canada.
Health education cannot be viewed in isolation. It must be considered only in the context of an effective health delivery system if the nurse is to achieve any success in her role as an educator. Two decades ago, India established primary health centres for every 100,000 people to cater for its 80% population in the rural area. However, it has been observed that only about 20% of the health service resources are distributed to the rural population and that the other 80% is utilized by and for the urban population. Another problem observed is that for every mile away from the Health Centre, there is a proportionate drop in attendance and that beyond 7 miles, the people hardly ever use the facilities of the centres . In order to rectify the above drawbacks, the Indian Government, in its fifth national plan, reduced the serving population to 10,000 through sub-centres around every primary health centre . Church of South India (C.S.I.) Hospital, Bangalore, believes that the ideal population coverage should not be more than 5000. With this belief it has ,evolved an effective medical out-reach programme at two rural centres, namely at Hoskote, 20 miles away and at Chennapatua, 34 miles away from the heart of Bangalore where the C.S.I. Hospital is situated. The Hoskote out-reach medical work is in a rural area with a population of 45,000 people living in 106 villages separated from one another and having poor transportation and communication systems. The primary health centre is located in the Hoskote Town of 12,000 people and this centre is staffed with a resident doctor and nurses for taking care of referrals from the sub-centres or what the C.S.I. Hospital calls the mini-centres. There are 11 such mini-centres in this area. *Paper presented at the International Conference on Health Education in Ottawa, Canada, in August 1976 by Achamma Chacko. 121
122
ACHAMMA
CHACKO
The plan of a mini-centre is quite simple and consists of a small dispensary, with accommodation for four in-patients; a community kitchen for service and for demonstration; staff quarters; a community centre for vocational and family training programmes; and a small church which is the motivating force of the whole scheme. The team in service in the mini-centre is an interdisciplinary group consisting of a pastor who is in charge of the total scheme, a nurse who is the team leader for the health care services, an agricultural extension worker, and a social worker. The people in the villages are mainly agriculture workers and about 25% are literate. The C.S.I. Hospital also believes that health teaching must filter down from top to the bottom of the skill pyramid. However, it also realizes that the medical officers (top of the skill pyramid) are so pre-occupied with curative and administrative tasks that it is becoming more obvious that in India nurses have had to assume key role in planning and delivering effective health care to the rural masses. A nurse’s role in health education, especially in a developing country, is a difficult one. Her aim should be to impart health education that would result in: a change of knowledge that results in a change in attitude that leads to a change in behaviour that would establish a change in habit and ultimately a change in custom If the nurse can achieve the above objectives, she would have fulfilled her role. The nursing care components in a mini-centre include: Preventive medicine Family planning Nutrition Minimal health care (curative) Detection of early morbidity Referral to the C.S.I. Hospital A major area of the nurse’s responsibility for the health of the community in the C.S.I. Hospital mini-centres is maternal and child health care. In this task the nurse concentrates on the antenatal, natal and post-natal care of her families. In the village situation, she must also reckon with the Dai who is the traditional birth attendant of the village. The nurse must be careful to avoid appearing to usurp the position of the Dai, but on the other hand, she must use the Dai and teach her the simple act of safe and scientific method of delivery of the baby and also the care to be given to the mother and neonate. Once the Dai realizes that the nurse is not a competitor, but a teacher and a helper, she usually proves to be one of the best multipurpose health workers to the rural community. Child health care is done effectively through the ‘Under Five Clinic’ in the health centres. The nurse must be capable of giving basic curative care so that she earns the trust, acceptance and respect of the community. As the village situation poses much limitations, the nurse must be capable of recognizing early morbidity and need for referral to higher centres. The nurse’s role in the family planning programme in the rural situation is difficult in the sense that though a large majority of the population are aware of the programme, only 17% accept methods of contraception. This disparity between knowledge and acceptance is almost unsurmountable. Therefore, the nurse will not be successful in pushing the programme by any methods of teaching, coaxing or enticing with monetary or material rewards. Instead, she must first help the parents to see that
THE ROLE OFA NURSE INHEALTHEDUCATION,
CHURCH OFSOUTHINDIA
HOSPITAL
123
the living have a fair chance of survival through immunization, nutrition, and health educational programmes which help to prevent disease, promote and maintain health. The nurse sees health teaching like a three pronged spear: (1) individual teaching, (2) group/family teaching, and (3) distribution of literature. Home visits are excellent for health education, as during this period while the nurse is in a consultation not only the mother but the other women folk of the family gather to listen and, hopefully, acquire knowledge. During these informal sessions, the nurse must be careful that she is not too technical, and help to build her teaching on the mother’s existing knowledge., Formal methods of teaching are employed in the mini-centres through ‘family education’ programmes. Twenty mothers are recruited for each training session for a period lasting between 3 and 6 months when they are taught family budgeting, simple household skills, and health maintenance. In all her teaching methods, the nurse’s role as a communicator are likely to be more successful if she can: 1. Be brief-S-10 min is all that is needed. make one or two points clear; should not confuse with too much 2. Be simpleinformation. 3. Be seen-use visual aids and/or actual tools when possible. 4. Be heard-speak loud enough to capture interest. 5. Be remembered-use local events to illustrate. The strategy that the nurse will employ for finding her true role as health educator is well illustrated in the old Chinese poem: Go to the people Live among them Learn from them Love them Start with what they know Build on what they have But of the best leaders When their task is accomplished Their work is done The people all remark “We have done it ourselves”. Old Chinese Poem The C.S.I. Hospital has also learned that they can only fulfill their mission by realising that: “If we offer only the gospel to the hungry of the world, without giving them bread to satisfy their hunger, we betray the Gospel”. (Martin Neimoller)
J. Nurs. Stud. Vol. 14, pp. 1X-123.
Pergamon
Press. 1977. Printed in Great Britain.
The role of a nurse in health education as practiced in and around Church of South India Hospital, Bangalore, India* ACHAMMA CHACKO School of Nursing University of Windsor, Windsor, Ontario N9B 3P4, Canada.
Health education cannot be viewed in isolation. It must be considered only in the context of an effective health delivery system if the nurse is to achieve any success in her role as an educator. Two decades ago, India established primary health centres for every 100,000 people to cater for its 80% population in the rural area. However, it has been observed that only about 20% of the health service resources are distributed to the rural population and that the other 80% is utilized by and for the urban population. Another problem observed is that for every mile away from the Health Centre, there is a proportionate drop in attendance and that beyond 7 miles, the people hardly ever use the facilities of the centres . In order to rectify the above drawbacks, the Indian Government, in its fifth national plan, reduced the serving population to 10,000 through sub-centres around every primary health centre . Church of South India (C.S.I.) Hospital, Bangalore, believes that the ideal population coverage should not be more than 5000. With this belief it has ,evolved an effective medical out-reach programme at two rural centres, namely at Hoskote, 20 miles away and at Chennapatua, 34 miles away from the heart of Bangalore where the C.S.I. Hospital is situated. The Hoskote out-reach medical work is in a rural area with a population of 45,000 people living in 106 villages separated from one another and having poor transportation and communication systems. The primary health centre is located in the Hoskote Town of 12,000 people and this centre is staffed with a resident doctor and nurses for taking care of referrals from the sub-centres or what the C.S.I. Hospital calls the mini-centres. There are 11 such mini-centres in this area. *Paper presented at the International Conference on Health Education in Ottawa, Canada, in August 1976 by Achamma Chacko. 121
122
ACHAMMA
CHACKO
The plan of a mini-centre is quite simple and consists of a small dispensary, with accommodation for four in-patients; a community kitchen for service and for demonstration; staff quarters; a community centre for vocational and family training programmes; and a small church which is the motivating force of the whole scheme. The team in service in the mini-centre is an interdisciplinary group consisting of a pastor who is in charge of the total scheme, a nurse who is the team leader for the health care services, an agricultural extension worker, and a social worker. The people in the villages are mainly agriculture workers and about 25% are literate. The C.S.I. Hospital also believes that health teaching must filter down from top to the bottom of the skill pyramid. However, it also realizes that the medical officers (top of the skill pyramid) are so pre-occupied with curative and administrative tasks that it is becoming more obvious that in India nurses have had to assume key role in planning and delivering effective health care to the rural masses. A nurse’s role in health education, especially in a developing country, is a difficult one. Her aim should be to impart health education that would result in: a change of knowledge that results in a change in attitude that leads to a change in behaviour that would establish a change in habit and ultimately a change in custom If the nurse can achieve the above objectives, she would have fulfilled her role. The nursing care components in a mini-centre include: Preventive medicine Family planning Nutrition Minimal health care (curative) Detection of early morbidity Referral to the C.S.I. Hospital A major area of the nurse’s responsibility for the health of the community in the C.S.I. Hospital mini-centres is maternal and child health care. In this task the nurse concentrates on the antenatal, natal and post-natal care of her families. In the village situation, she must also reckon with the Dai who is the traditional birth attendant of the village. The nurse must be careful to avoid appearing to usurp the position of the Dai, but on the other hand, she must use the Dai and teach her the simple act of safe and scientific method of delivery of the baby and also the care to be given to the mother and neonate. Once the Dai realizes that the nurse is not a competitor, but a teacher and a helper, she usually proves to be one of the best multipurpose health workers to the rural community. Child health care is done effectively through the ‘Under Five Clinic’ in the health centres. The nurse must be capable of giving basic curative care so that she earns the trust, acceptance and respect of the community. As the village situation poses much limitations, the nurse must be capable of recognizing early morbidity and need for referral to higher centres. The nurse’s role in the family planning programme in the rural situation is difficult in the sense that though a large majority of the population are aware of the programme, only 17% accept methods of contraception. This disparity between knowledge and acceptance is almost unsurmountable. Therefore, the nurse will not be successful in pushing the programme by any methods of teaching, coaxing or enticing with monetary or material rewards. Instead, she must first help the parents to see that
THE ROLE OFA NURSE INHEALTHEDUCATION,
CHURCH OFSOUTHINDIA
HOSPITAL
123
the living have a fair chance of survival through immunization, nutrition, and health educational programmes which help to prevent disease, promote and maintain health. The nurse sees health teaching like a three pronged spear: (1) individual teaching, (2) group/family teaching, and (3) distribution of literature. Home visits are excellent for health education, as during this period while the nurse is in a consultation not only the mother but the other women folk of the family gather to listen and, hopefully, acquire knowledge. During these informal sessions, the nurse must be careful that she is not too technical, and help to build her teaching on the mother’s existing knowledge., Formal methods of teaching are employed in the mini-centres through ‘family education’ programmes. Twenty mothers are recruited for each training session for a period lasting between 3 and 6 months when they are taught family budgeting, simple household skills, and health maintenance. In all her teaching methods, the nurse’s role as a communicator are likely to be more successful if she can: 1. Be brief-S-10 min is all that is needed. make one or two points clear; should not confuse with too much 2. Be simpleinformation. 3. Be seen-use visual aids and/or actual tools when possible. 4. Be heard-speak loud enough to capture interest. 5. Be remembered-use local events to illustrate. The strategy that the nurse will employ for finding her true role as health educator is well illustrated in the old Chinese poem: Go to the people Live among them Learn from them Love them Start with what they know Build on what they have But of the best leaders When their task is accomplished Their work is done The people all remark “We have done it ourselves”. Old Chinese Poem The C.S.I. Hospital has also learned that they can only fulfill their mission by realising that: “If we offer only the gospel to the hungry of the world, without giving them bread to satisfy their hunger, we betray the Gospel”. (Martin Neimoller)
