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COMMUNITY HEALTH NURSING

INSERVICE EDUCATION
PROGRAMME

SUBMITTED TO, SUBMITTED BY,

MR ANEESH KUMAR TEENA K

ASST PROFESSOR SECOND YEAR MSC NURSING


INSERVICE
GOVT EDUCATION
COLLEGE OF NURSING GOVT COLLEGE OF NURSING

KOZHIKODE KOZHIKODE
In-service education is the vehicle by which goals and the multiple
articulated means available to achieve them can be explored. It can be used to
consider and solve problems, institute and advance learning, elicit, analyse and
systematize individual ideas for group, individual or institutional betterment,
develop the idea of community agency and struggle to understand ourselves,
others and inherent relationships.
DEFINITION
In-service education is defined as a planned learning experience
provided by the employing agency for the employees.
In-service education is a program of planned learning experiences
providing opportunities within a working situation to improve the quality of
care provided for patients by correcting in or-nation and skill deficiencies of
personnel by assisting the inexperienced to acquire needed skills and attitudes,
by keeping personnel abreast of changes in health care, and by stimulating the
continuous development of occupational and personal abilities of each
employee.
AIMS
Improvement of client through upgrading the services rendered with
scientific principles
To keep in face in changing society to their needs
Acquisition of new knowledge
Improvement of performance
To develop specific skills required for practice
Improves the staff members chances for promotion
To develop right concept of client care
To maintain high standards of nursing care
To observe and bring change in staff behavior
It ensures thinking on the job, reduces mechanical action to a minimum
and promotes economy, safety and efficiency of personnel in their work
situation
It reduces turnover, absenteeism
Effective production will be observed ( in work performance)
To discover potentialities, to alert personnel in working environment
FUNCTIONS
Provision of educational activities for all employed
Induction education
Filling of gaps
Allowance of comfortable re-entry
Increase in competency
Enhancement of knowledge base
Improvement of health care delivery
Personal growth of employer

CHARACTERISTICS
It is provided with job setting
It is planned and ongoing.
It is designed to meet their demands of changing needs like scientifically,
technically, medically in respect to patient care and treatment.
In-service education mainly focus on efficiency and quality of services.
PURPOSE
Helps to improve professional competence.
Keep the nursing personnel abreast of the latest trends and development
of new techniques.
Helps to update the knowledge and skills at all levels.
Nurses can update the knowledge regarding current research and
development.
Develops interest and job satisfaction among the staff.
Encourage the employees in achieving staff development and self
confidence.
Develops leadership skills, motivation and better attitudes

GUIDELINES ON WHEN AND HOW TO GIVE IN SERVICE


EDUCATION
a) In service education programmes should be given during the regular working
day and according to service needs.
b) Effective in service education can be started with either the orientation or
skill training phase of a programme.
c) Every programme should be planned and "on-going"
d) A variety of effective teaching methods should be used.
e) Continuing education of staff should be provided in order to keep personnel
up to date by helping them to develop better understanding of modern concepts.

Those guidelines address a number of factors, include

 Context. Organisation need to look at their internal and external situation


in order to identify their needs and potential. They should also look at
what the organisation has achieved in the past and what plans it has made
for the future.
 Needs. The review will often uncover some different—and sometimes
conflicting—needs. These needs must be prioritized, a process that may
require the services of an external consultant.
 Goals. Needs then must be translated into realistic goals. Organisation
should describe these goals in full, and should include explicit
information about the role of each staff member.
 Organization and methods. The next step is to develop objectives that
define precise tasks for each participant. Then staff can work
cooperatively to devise ways to adapt their performance to the goals and
objectives.
 Resources. An inventory of staff competencies should come next. Some
organisations may have a wealth of internal resources; others may need to
incur the expense of hiring outside experts.
 Evaluation. Evaluation is an ongoing part of the organisation based in
service education process. Organisation need to keep accurate records,
document all decisions, and revisit these from time to time to monitor
progress.

COMPONENTS
Orientation skill training programme
Continuing education programme
Leadership training
Management skills development
Staff development programme

ORIENTATION SKILL TRAINING PROGRAMME


Orientation skill training programme introduces a new employee to
these basic aspects of her job. In hospital field, if any new nurses are appointed,
first the supervisor has to discuss with them the policies, procedures and
fulfilment of objectives, standing orders, and policies of institutions. Orientation
skill training has to be given for development of knowledge and skills
(cognitive, conative, affective domains). In community field orientation training
camps will be organised to school teachers, village leaders and health personnel
about the concept of health and illness, etiological factors of disease,
identification of case, prevention and treatment in order to reach Health for All.
 Centralized Orientation
 Decentralized Orientation
CENTAL ORIENTATION
 Generalized orientation
 Hospital orientation
 Orientation to nursing department
DECENTRALIZED ORIENTATION
 Orientation to nursing unit
 Orientation to the nursing team

CONTINUING EDUCATION
The activities which contribute to the development of 3 domains and
leadership, management for the nurses. These skills are very helpful as the nurse
is expected to function with the help of auxiliary personnel in her working
condition. Her competence is very much needed.
PURPOSES
• Leads to improved professional practice
• Updating knowledge and skill
• To motivate the staff to seek the latest knowledge
• To keep the nurses with the latest development of technologies.
• It develops interest, job satisfaction and confidence
TYPES
1. Centralized in service education
In nursing department, one department will held responsibility for
improvement of knowledge, skills and practice of their nursing staff. They will
devote full time for in-service education programme and its activities.
2. Decentralized programs
Encourage more general population because of the closeness of staff
relationships and physical proximity. This is planned for staff members who
work together giving care for the clients with similar conditions and share
common nursing goals.

3. Combined or co -ordinated in-service education approach


There will be central nursing in-service education department consists of
nurse in each division, who holds leadership responsibility for staff
development activities, whose time is devoted fully for teaching learning
situations. They plan, conduct, evaluate the programme and further plan their
programmes based on the need arises.
Continuing education provides the opportunity to engage in lifelong
learning that can
be organized through different channels: formal, non-formal and informal.

FORMAL EDUCATION
Formal education normally describes programmes offered by established
educational institutions such as schools, colleges and universities, where a
programme of study results in a diploma being granted.

NON-FORMAL EDUCATION
Non-formal education refers to educational programmes, short courses
and training programmes offered by different institutions including government
and non-government organizations, private enterprise and cooperatives.
Universities and colleges also offer some non-formal programmes. Formal
educational degrees and diplomas can also be obtained through equivalency
programmes. One of the major differences between the two approaches is
flexibility. For example, the curriculum and reading materials of the literacy
courses offered through non formal education are designed and selected
according to the needs of the learners. In addition, the learners themselves make
decisions about time, place and duration of classes according to their needs and
convenience. Besides, the teaching-learning process is likely to be
less authoritarian and more attuned to learner needs.

INFORMAL EDUCATION
In addition to formal and non-formal education, learning can take
place in other ways. A person can also increase his or her knowledge and skills
through self-directed learning. An individual can learn through reading,
television and radio programmes, or a close observation of activities. Some
people describe this type of learning as informal education or self-directed
learning. Regardless of whether knowledge and skills are obtained outside
formal schools through non-formal learning and self-directed learning, this
learning is most efficient when it is purposeful and planned and meets the needs
of recipients.

There are six types of CE programmes for Continuing Education Personnel

 Post Literacy Programme (PLPs)


 Equivalency Programme (EPs)
 Quality of Life Improvement Programmes (QLIPs)
 Income-generating Programmes (IGPs)
 Individual Interest Programme (IIPs)
 Future Oriented Programme (FOPs)
POST LITERACY PROGRAMMES (PLPS)

These programmes aim at maintaining and improving basic literacy,


numeracy and problem solving skills, giving individuals sufficient general basic
working skills, and enabling them to function effectively in their societies. In
every village, we may come across people who have completed literacy courses
and become neo-literates or semi-literates. We may also find some school
dropouts. Both groups need to maintain and improve the skills they have
acquired so that they do not regress into illiteracy.

The main objectives of PLPs are to:

_ maintain literacy skills and prevent learners from relapsing into illiteracy by
continuously practicing reading, writing and numeracy skills
_ improve literacy skills by acquiring higher levels of literacy
_ apply skills in daily life for the purpose of individual or community
development, such as writing letters or for a village newspaper, reading
newspapers or magazines, and calculating the expenditures for a household or
for community activities. The duration of a PLP course varies from country to
country. A PLP can be provided for a period of six months, nine months or a
year. The period depends on the needs, time, literacy skills and learning
capacity of the learners in a community.

EQUIVALENCY PROGRAMMES (EPS)

These programmes are designed as alternative ways to gain a formal


or vocational qualification. The EPs are usually structured in more flexible ways
than those used in the formal school system. In our community, there are school
dropouts and literate youth and adults who want to continue their study to
obtain educational and vocational certificates and diplomas equivalent to those
awarded by formal schools. Eps recognize the prior learning of the learners and
their experiences (including life skills). Therefore, the duration of study for
these equivalence classes is normally shorter than that in formal schools. EP
courses and their timeframe provide flexibility suited to the needs of learners.

QUALITY OF LIFE IMPROVEMENT PROGRAMMES (QLIPS)


These programmes aim at equipping learners with essential
knowledge, attitudes, values and skills to enable them to improve the quality of
life as individuals and as members
of a community. The quality of life refers to the level of well-being of a
community and the degree of satisfaction in meeting basic needs. QLIPs focus
on community development. There may be negative factors that affect the
quality of people’s life in our community:
 lack of proper health and sanitation facilities,
 no clean water,
 poor quality parenting,
 absence of cultural activities,
 weak enforcement of the laws

To help people improve the quality of life in our community, QLIPs can
offer several
Short training/orientation courses that address these problems. For example,
there might be a two-to-three-month course on family planning and parenting, a
two-week course on
Health and nutrition, or weekly sessions on environmental protection. Some
countries
Integrate QLIPs into all curricula and activities of continuing education
programmes.

INCOME-GENERATING PROGRAMMES (IGPS)


IGPs help learners to acquire or upgrade their vocational skills to enable
them to apply
in their daily lives , conduct income-generating activities. Such skills may help
them to change their vocation, improve their current career prospects, or set up
a small business in the community. IGPs can initiate income-generating
activities such as sewing, radio repair, candle and soap making, fish farming, or
gardening to help these people achieve their goals. With such
Skills, people will become more independent and flexible in how they earn
money.
To help learners to become self-employed, IGPs should focus on
entrepreneurial skills,
Including how to conduct a market survey, plan a small business, and handle
marketing and accounting. Individual Interest Promotion Programmes (IIPs)

This type of programme provides opportunities for individuals to learn


about and appreciate their social, cultural, spiritual, health, physical and artistic
interests. The aim is to promote leisure activities, life improvement and personal
development. The programme activities can be categorized into various types:
hobbies, cultural activities, self-reliance, sports and activities for personal
development. To be more specific, these activities may include reading and
writing poetry, painting, making speeches, studying local law, participating in
politics (organizing local elections), using computers, taking photographs,
traditional dance, swimming, religious meditation, or flower arrangement.
Learners can choose the activities that they are interested in.
Future Oriented Programmes (FOPs)

Through these programmes, we provide members of our community


with opportunities to acquire new skills, knowledge and techniques. With these,
they are more able to adapt themselves and their organizations to ongoing social
and technological change. An important part of planning FOPs is to have an
agreed vision of what the future should be like. The purpose of the programme
would then be to prepare learners for that future. For example, with the
widespread use of computer technology, typewriters will gradually disappear
from public use. Hence we need to organize computer courses for typists so that
they may become competent computer operators. Of course, the development of
computer skills is not limited just to typists or managers, but should be an
option for others in the community as well. In some countries, the development
of this technology is slow, while in others it is happening very rapidly.

STEPS IN CONTINUING EDUCATION


• Conduct need assessment
• Establish overall goal
• Conduct task analysis
• Specific objectives
• Resource collection
• Develop assessment strategies
• Select methods and media
• Produce materials
• Conduct formative evaluation
• Conduct summative evaluation
MANAGEMENT SKILLS AND LEADERSHIP TRAINING
For the administrators and the senior personnel, for the persons who
possess higher qualifications, who is having the chances for promotion and the
supervisors, the authorities will give in service training to obtain management
skill and leadership skills in order to supervise the institution to achieve the
targets by reaching goals and preparing the persons to solve their problems if
any need arises and to have smooth environment in their working areas.
STAFF DEVELOPMENT PROGRAMME
To meet the educational needs of nursing students, there must be provision
for regular staff development programme.
Methods of delivering in service education include forum, ward teaching,
discussion, laboratory, conferences, seminars, workshops, fieldtrips etc.
ELEMENTS OF IN-SERVICE PROGRAMS
1. Personnel

A staff must be available to aid the in-service director in carrying out the
goals of the department. Personnel for in-service education come both from
within the institution, from other departments and from outside the institution.
2. Scheduling

Scheduling of all facets of the in-service education is necessary to keep


order in the use of faculty, facilities, equipment’s and so forth. Such a
scheduling should be widely distributed so that it is well known to staff in
advance. Opportunities for in-service education must be evenly distributed and
during on duty.
TYPES OF IN-SERVICE EDUCATION
1. Orientation
Orientation consists of experiences designated to help the new worker become
proficient as soon as possible. It provides for verbal presentation of information,
physical tours, time to examine descriptive material, reports and procedure and
policy manuals and introduction of personnel to the work of the enterprise in
general.

2. On the job training


It is a miniature and simplified nursing art program, including supervised
clinical practice that provides auxiliary worker such as nurse’s aids and
orderlies with the knowledge and skills necessary to do their jobs. Refresher
programs for inactive nurses fall within on the job training.
3. Ongoing education

It is the most unstructured part of in service education. There is an ever


widening list of means of presentation, but essentially it is attuned to the adult
learners who can discriminate among the possibilities on the basis of discrening
freedom of choice. Ongoing education program should consist of parts that
contribute to a whole, such as improved clinical performance or management
the essentials of overall goals.
4. Executive development
All efforts of an ongoing program to develop management skills is a first step
in executive development. There are growing opportunities for nurse managers
to take part in executive training.
5. Patient education
The newest component of in service education is patient teaching. By
centralizing it, under the direction of in service staff, material and format can be
assembled and used in either individualized or collective way with considerable
increase in effectiveness and economy.
6. Incidental teaching
Because incidental teaching is impromptu, it is difficult to record and
include within the overall programs. However, since it is a one to one , three or
four basis and is built around a particular patient, procedures or occurrence, it
can contribute substantially to the growth of personnel. Incidental teaching will
be richer where personnel are interested enough to see that such opportunities
are identified, used and counted.
SCOPE OF INSERVICE EDUCATION
This includes activities to enhance:
Staff’s knowledge and ability as teachers, researchers, technicians,
administrators and so on
Staff’s skills as managers and supervisors
Individual’s personal development as is relevant to performing their role

GUIDELINES TO ASSIST IN DEVELOPING AND MAINTAINING AN


EFFECTIVE INSERVICE EDUCATION PROGRAM
In order to be certain that an in-service education program in
effective, it is valuable to have guidelines or operational principles which can be
used as a yardstick in planning, organizing and conducting the activities of an
in-service program. Following are such guidelines that may be considered a
"yardstick".
I. People work on problems that are significant to them. Evidences that a
problem is significant are:
1. Participants become involved emotionally and intellectually.
2. Participants view the problem as a basis for action.
3. The situation is an emergency and requires immediate solution.
II. The individuals who work on the problems are the same ones who form late
the goals and determine the methods by which goals will be accomplished.
III.A variety of opportunities and situations are developed for personnel to
relate themselves to each other.
IV. Continuous attention is given to opportunities when individuals and groups
can utilize problem-solving techniques.

CHARACTERISTICS OF GOOD INSERVICE EDUCATION


PROGRAMS
1. In-service education activities receive direction from and are related to work
the personnel are doing. The activities are based on real and specific, problems
of the workers, the patients and the community.
2. All the personnel have a significant share in planning all in-service activities
which stimulates a desirable attitude toward change.
3. Health care providers are intrinsically motivated to engage in meaningful
activities. Real self-improvement originates from within. The in-service
educator strives to develop the insights and thinking of others rather than
imposing his own.
4. Sound principles of learning are utilized: learning is growth; growth is
personal and gradual; growth takes place in a climate favoring, the development
of new perceptions that can he translated into actual practice.
5. In-service activities are an integral part of the working program. It is realized
that almost any activity that is added to the working load or workday, as an
extra, is doomed to failure. Time and money are provided for the proper
functioning of the in-service program.
6. The in-service education program is characterized by a variety of activities
designed to serve specific purposes. Participation in, and cooperative
relationships with community and state educational facilities are included in the
activities.
7. Activities of the in-service program are carefully and intelligently evaluated,
and continuously being improved.

IDEAS FOR VARIOUS TYPES OF PROGRAMS


The following list consists of suggestions for different types of programs that
might be developed:
1. Task-centered: The group works on a specific project; such as, a patient care
card or making out a report.
2. Idea-centered: Here the focus is on the clarification of concepts or
philosophy.
3. Problem-centered: This is not concerned with a specific problem but is
concentrated with how to identify, refine, and work toward the solutions of
many different problems.
4. Skill-centered: The concern here is on the development of skills that are
needed.
5. Policy-centered: Here the focus is on the development of general guides to
action and how policies differ from the implementation of policies.
6. Appreciation-centered: The stress here is on the general education cf the
participants.
7. Agenda/Program building, goal setting: The use of the group as a
"laboratory" for study, of difficulties that arise in reaching decisions concerning
the agenda or program and the planning for experimentation of new procedures.
8. Effective Chairmanship: Here there should be a rotation of the chairman role
through the group, with an analysis of the chairman behavior. To encourage
discussion, the group could use a prerecorded tape as weIl as role playing of
problem situations that require action on the part of the chairman.
9. Overcoming frustration, reducing confusion, alleviating low morale: Use the
group as a laboratory and analyze the blockage.
10. Increasing member sensitivity to feelings and perceptions of other
members: Here an exercise on perception can be used and each member
estimates each other member's view on an issue facing the group.
11. Process analysis: Here the group analyses the performance of the observer
as he practices the role of the observer. There should he a rule that member may
initiate the process analysis at any point during the meeting.

12.Orientation of new or absent members: Here the ones to be oriented and


those doing the orientation come together in a study session to plan how the
orientation will be done; they will then carry it out experimentally and then
evaluate it carefully.
13. Handling conflict and disagreement: The group meets to discuss the nature
of conflict. Previously tape-recorded episodes could be used as a basis for each
member to try to resolve the conflict -a type of analysis.
14. Dealing with "problem-members": These include the monologist, the one
who withdraws, the non-goal directed member. Here it would be valuable to
have the group analyze what features are precipitating difficult behavior
reactions. Role reversal, where "problem members “exchange places with other
group members to increase insight and empathy. The use of the "alter ego"
technique may be valuable - here unvoiced thoughts and feelings are spoken by
another member.
15. Problem solving: In this situation the steps and stages of problem-solving
are presented and discussed. A valuable tool is to tape record the group
discussion, then listen to the tape. The tape is stopped at intervals in order to
analyze and clarify the problem solving procedure.
16. Decision-making and follow through: As each decision is made, the group
stops and each member writes down his perception of the decision, then they are
compared and analyzed. A record is kept on the follow through of each
decision.
17. Evaluation: The group develops aid constructs reaction sheets to determine
the reactions of members to a specific meeting or meetings.
18. Continuing familiarity with new knowledge in specified subject areas.
19. Human growth and learning, such as "developmental tasks”, skill
development.
20. Increased skill in providing for the individual differences in patients and
personnel.
21. Improved attitudes and skills involved in co-operative action research. The
mastery of principles of co- operative group work, is not easy.
22. Greater skill in utilizing community resources.
23 .How to learn a new job.
24. The development and refinement of common values and goals. In order to
change a group's values and goals, it is necessary for the group to experience
and communicate their own values and goals.
25. The building of "professionalism": for this feeling to exist, the individual
must sense the magnitude of his/her role, the significance it has to patient care
and welfare, and to society as a whole.
EVALUATION OF INSERVICE EDUCATION PROGRAM
1. Reaction
At this stage evaluation provides information on the attitudes and opinions
of participants to the learning they have undertaken typically via evaluation
forms or comment sheets. It provides useful information to allow assist with
modifying the curriculum/ training program.
2. Learning attained
Evaluation at this stage looks at the extent to which learning objectives
have been achieved. Evaluation of learning can take place during the activity
using interactive sessions, tests and practical application and after the activity
by re-testing knowledge and skills and comparing them with pre-training
results, observing the learner’s new knowledge and skills in context.
3. Performance
Evaluation at this stage looks at the impact of a learning experience on
individual/team performance at work. Key to this level of evaluation is the need
to have agreed clear learning objectives prior to the learning experience so that
when evaluation take place there are measures to use.

4. Organizational Impact
At this level evaluation assesses the impact of learning on
organizational effectiveness and whether or not it is cost effective in
organizational terms.
Procedures/ Techniques of evaluating staff education programme
Pretest and post test
Attitude tests
Observation of skills
Questionnaires
Audio or video tapes

Knowledge
Practice
Written test/objective essay
Checklist
Rating scale
Practical test

PLANNING FOR ISE


• Broad planning by the department and committees
• Specific planning by individual
• Based on
 worker needs
 Proposed need
• Assess the achievement at the present level
• Identify the gaps between where we are now and where we want to be
STEPS IN PLANNING PROCESS
• Assess needs:
Need to realize the importance of early recognition of changes in nursing
service, technology, public demands, and patient occupancy
• Set goals and define specific objectives:
The primary goal of in-service education programme is imparting
information to change the way of person performances, think or feels
• Select Resource person: When selecting the individuals as resource
person, the attributes should be kept in mind are:
 Ability to serve as models for learners.
 Knowledge about concepts of adult learning.
 Expertise experience and clinical competence in the area to be covered.
 Should know how to communicate knowledge.
 Willing to assist in the evaluation process
 Resources: Assessing the available resources for establishing the
programme.
 Budget: Establishing a workable budget appropriate for the
 programme.
 Evaluating: Assessing the results at stated intervals, that is soon after the
programme or within one week.
 Reassessing: Checking the goals and updating the plan
 Periodically
METHODS OF IN SERVICE EDUCATION
 Ward teaching
 Discussion
 Laboratory
 Conference
 Seminar
 Workshop
 Field trip
 Job orientation
TOPICS OF ISE IN PUBLIC HEALTH NURSING
 Disaster preparedness
 STD and cervical cancer screening
 Current challenges in TB management
 Advancing public health
 Current utilization and trends in public health nursing
 Emerging reemerging disease
 National health programme
 New policy of government
 Advancing technology
 Family planning
 MCH services
 ACLS, BLS
 Epidemic control
TO WHOME ISE IS GIVING
 JPHN
 ASHA
 Skill birth attender
 Dias
 Anganwadi worker
 Volunteers
 Multipurpose health worker
 Palliative staff

FACTORS AFFECTING ISE


Cost of the health care
Manpower
Changes in nursing practice
Standards of nursing practice

PROBLEMS IN ISE
Lack of incentives
Lack of motivation
Lack of interest
Inappropriate methods and techniques
Inadequate evaluation techniques
Inadequate facility
Inadequate training
ROLE OF NURSE IN ISE
Oversee patient care
Make management and budgetary decisions
Set work schedules
Coordinate meetings
Make decisions about personnel

CONCLUSION
In service education is an organized educational programme which is
offered to train staff during their period of employment. The training is related
to the improvement of their performance.

BIBLIOGRAPHY
1. Eshita Chandra. Introduction to nursing education. India :Pee vee
publication; 2011
2. Neeraja.K.P. Textbook of Nursing Education. NewDelhi: Jaypee
publication;2007
3.Marcia Sanhope, Jeanette Lancaster. Public Health
Nursing.2nded.Canada:Mosby Elsevier;2008

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