CHAPTER 2: HANDLING ADMINISTRATIVE ARRANGEMENTS

Careful administrative planning is essential for the training to be successful. The planning steps are listed below. One or two instructors may do all of these steps, but it is advisable that the team of instructors and staff participate. Suggestions for each of these steps are provided in greater detail in this chapter.

Notice that some of the steps, such as steps 5-8, will be time-consuming only the first time this training is planned. When future courses are conducted, the same procedures and materials can be used with only minor adjustments as necessary.

A checklist for handling administrative arrangements can be found on page 30. You may wish to use it to keep track of the steps as you complete them.

Step 1. Determine the number of participants that can be trained

Step 2. Design course agenda

Step 3. Make sure adequate funds and supplies are available

Step 4. Obtain copies of training materials and references in the appropriate language

Step 5. Make any needed improvements in the facility prior to training

Step 6. Plan how participants' progress will be monitored

Step 7. Prepare and distribute a course announcement

Step 8. Select and prepare other instructors and staff

Step 1 - Determine The Number Of Participants That Can Be Trained

To effectively acquire clinical skills in diarrhoea case management, each participant should have the opportunity to observe and treat cases of different degrees of severity. At a minimum, each participant should treat one dehydrated patient during the training and observe treatment of several more. The more cases observed and treated by each participant, the more skilled that participant will become in assessing and treating the full range of diarrhoea cases.

To assure a sufficient number of cases for each participant, determine the average number of dehydrated patients expected during the time that the course will be offered (that is, during the three or four day training period). This number represents the maximum number of participants that can be effectively trained. For example, if 10 dehydrated cases are expected, ten participants can be trained. The number of participants that can be trained will be greater during the seasons when diarrhoea is more frequent. Do not schedule training when you anticipate a low number of dehydrated cases.

Step 2 - Design Course Agenda

A sample agenda is presented below. Review this agenda and decide if it suits your needs and fits within the time available to conduct the training. Detailed information on how to conduct each of the agenda sessions can be found in Chapter 3; you may wish to refer to this information as you design your agenda.

You may wish to change this agenda by omitting some of the presentations, or scheduling the presentations during the evening. Or you may wish to shorten the course to three days by scheduling longer days (e.g., until 17:30).

If everyone in your course will need training in IV therapy, you may want to schedule a session on that topic - perhaps a demonstration and a discussion. Or if only a few cases of diarrhoea come to the facility during practical work, you will need to shorten that session and add more time to conduct additional drills or additional exercises.

Do not hand out the Course Progress Check until participants have completed their work on the module "Management of the Patient with Diarrhoea" (Chapter 1 in the Participant Manual) and have heard presentations on the principles of clinical management and the management of acute diarrhoea. The Course Progress Check can be found on page 156 of this document.

The most important scheduling consideration is for practical work to begin when most patients present at the facility. The sample agenda assumes that patients would be available by 8:30. If patients are waiting earlier or if cases come who will be good for demonstration, the practical work should start as early as possible. In fact, if a very sick child comes to the facility on the first day of the course, you may want to consider asking participants to observe staff treating this child. You should then discuss what the staff person did and what happened as a result of treatment. At times when participants are not actively involved in case management, they should remain near the treatment area, in case new patients arrive or an instructor wants to discuss a patient with the group. During this time participants can read reference materials, and work on "Management of the Patient with Diarrhoea", additional exercises, or their plans for establishing proper case management in their own facilities.

Use your best judgement in adapting this agenda, taking care to allow sufficient time for each task (as listed on the Training Design Forms for each activity in Chapter 3).

Step 3 - Make Sure Adequate Funds And Supplies Are Available

Funds may be needed to support participants' travel and per diem, extra supplies, training and reference materials, special compensation for instructors, coffee and tea breaks, and other miscellaneous items.

Review the lists of supplies on page 20 and take inventory of the supplies on hand. Will these be sufficient considering the normal case load, plus the expected number of participants? Review the Training Design Forms for each activity in Chapter 3 to see if any materials need to be copied, or if any supplies need to be ordered or prepared. These materials and supplies are listed in the "Resources" column of the Training Design Forms. Supplies for Diarrhoea Treatment in the Assessment and Treatment Area

• Forms for record keeping
• Wall chart: Management of the Patient with Diarrhoea
• ORS packets of the standard size in the area (for demonstrating to mothers)
• ORS packets for 5, 10 or 20 litre and 5, 10 or 20 litre drum with cover and side tap (if number of patients is sufficient)
• Jars and flasks (commonly available sizes and one marked with volume measurements)
• Antibiotics for cholera, dysentery, and parasitic diarrhoea
• Beds or tables with wires above for hanging bottles of IV fluid
• Lactated Ringer with giving sets
• Scalp vein (butterfly) needles
• Mother's Cards, other health education pamphlets, and other materials for families on management and prevention of diarrhoea, including feeding
• Posters on preparation of ORS solution and home therapy fluid, feeding during diarrhoea, diarrhoea prevention, etc.
• Baby scales (accurate to 20 grams) Thermometers
• Glasses, cups and spoons Forms for record keeping
• Cotton and gauze Soap
• Milk powder [optional] Diapers
• Towels and other linens Waste basket or bucket
• Storage cabinet or shelves Wash basin and towel rack
• Fan(s) Chairs or benches
• Droppers and syringes
  

Step 4 - Obtain Copies of Training Materials and References in the Appropriate Language

Obtain enough copies of the "Diarrhoea Management Training Course: Participant Manual" for every participant to have a copy to use during the training and to take back to his own facility when the course is over.

The manual and the other materials can be an important source of information for participants when they return to their facilities. The materials will help participants answer questions about treatment procedures and the rationale for them. They will give credibility to the new ideas and will help to convince other physicians and staff. Participants can also use the materials when training others.

Step 5 - Make Any Needed Improvements in the Facility Prior to Training

One instructor for the Diarrhoea Management Training Course should have attended a training session at a diarrhoea training unit. During this training, a plan for improving the current diarrhoea treatment practices in your facility was prepared. This plan may have identified changes needed in operating policies, treatment procedures, training, equipment, staff and arrangement of space.

It is important to make as many of these changes as possible before hosting the training so that participants are able to observe improved case management techniques and procedures.

Step 6 - Plan How Participants' Progress Will Be Monitored

Monitoring each participant's progress during the course will allow the instructor to identify what the participant has accomplished at any point in time, and what remains to be taught. Individual attention can then be given to each participant to assure successful completion of the training.

The basic tool for monitoring is a list, or checklist, of what the participants should do. Several checklists, and ways to use them, are described below.

Self-monitoring

Each participant has a list of the activities that he or she should accomplish during the training. An example of a checklist for a participant to use in monitoring his or her own progress is on page 24. Each day the participant checks off the activities accomplished that day. Periodically, the participant discusses his or her progress with the instructor and may bring any particular needs to the instructor's attention. (For example, the participant may not have had a chance to treat a severely dehydrated patient.)

Instructor monitoring

Each instructor is assigned certain participants to monitor. The instructor learns about each participant's work by observing and talking to the participant. When a participant accomplishes an activity, the instructor makes sure the participant marks it off on his or her checklist. (See an example of an additional instructor's checklist in Annex B.)

Though this may be done informally, it is very important. The instructor is responsible for making sure that each participant has the opportunity to participate and achieve all of the training objectives. Instructors must know what skills each participant has learned in order to know what remains to be taught. If a participant is having difficulties, the instructor can give additional guidance to help the participant master the skill. If the instructor does not feel that participants will learn certain skills during regular course time, he could schedule an evening session for review or drills.

Another method for monitoring skills and knowledge is to have participants answer a set of questions before the end of the training. The students or the instructor may check the answers. Time is scheduled to teach the skills or knowledge that the questions revealed participants have not yet learned. (A set of questions on management of acute diarrhoea suggested for a progress check begins on page 156.)


SUMMARY OF CLINICAL SKILLS
Participant Name _______________________________


CLINICAL SKILLS CASE NAME AND DATE

Assess dehydration
Assess other problems
Select treatment
Teach mother to treat diarrhoea at home
Determine amount of oral fluid for first 4 hours
Administer ORS solution
Teach mother to administer ORS solution
Deal with difficulties in administering ORS
Show the mother how much ORS solution to give at home
Determine amount of IV fluid for first 3 (or 6) hours (severe dehydration) [Optional]
Give IV therapy [Optional]
Treat other problems

Plan for improving diarrhoea case management at my facility was written and discussed with an instructor:

_____ Yes _____ No
Step 7 - Prepare And Distribute A Course Announcement

Participants who are committed to learning and using the improved diarrhoea case management procedures will make the training a success.

You can take certain actions to help assure that appropriate and motivated participants will come to the training. Create the proper expectations by clearly describing what the training will accomplish and who will benefit from it. Contact nearby health centres and small hospitals that might send participants to the training and send them a course announcement. They should give a copy of the course announcement to the potential participants so that each participant will realize what will be expected.

You may also wish to send the course announcement to regional health officials.

The course announcement should cover the following points:

• Benefit to the participant -- skills the participant will learn
• What type of participant should come and why -- responsibilities and characteristics of people who can apply the skills in their work
• Purpose -- why the training is being offered
• Involvement -- that participants will work in the facility with patients and their families
• Schedule -- dates and times that participants are expected to be at the facility and the location
• Administrative information -- any additional information about accommodations, transportation and per diem
• Response -- how to register and the deadline for registering

An example of a course announcement can be found on page 26.

Sample Course Announcement
Diarrhoea Management Training Course
District Hospital
3-6 August, 1992

Who Should Attend?

Physicians, nurses, nurses' assistants, and other health staff from health centres and small hospitals where diarrhoea cases are managed who want to learn about advances in treatment of diarrhoea, including use of Oral Rehydration Therapy (ORT).

What Are the Purposes of the Training?

• To train physicians and other health workers to treat cases of diarrhoea using the most up-to-date and effective procedures, and
• To prepare participants to practice good case management in their own facilities.

What Skills Will Be Taught?

This training course develops the skill and confidence of physicians and other health workers in case management of diarrhoea, particularly the use of ORT for acute diarrhoea. Participants develop skills in the most effective techniques for assessing diarrhoea cases, treating non-dehydrated and dehydrated cases, and treating dysentery. They will also learn how to educate mothers on the management of diarrhoea at home, including advice on fluids and foods to give the child. Participants will apply these techniques with actual patients and their families who come to the facility for care.

When Will the Training Be Held?

The training will be held from 3 through 6 August, 1992. Participants should plan to begin promptly at 8:30 on 3 August, and can expect to be finished with the training by 15:00 on 6 August. All training sessions will be held at the District Hospital.

How Do Participants Register?

To register for the training, call (Name of Training Director) at (phone number), or write to the following address:

(Insert address)

All participants must be registered by 13 July, 1992.
Step 8 - Select and Prepare Other Instructors and Staff

Courses in many facilities will have relatively few participants and only one instructor to organize and conduct the training. Some facilities, however, will conduct courses with many participants. These larger courses will require additional instructors, as well as other staff (e.g., nurses or nurses' assistants), to help out in the treatment area.

The physicians and nurses who will be additional instructors should be:*

• trained in improved diarrhoea case management and have experience treating at least 25 dehydrated cases using ORT,
• familiar with the course materials as a result of successfully completing the course themselves either at their own facility or in a nearby facility,
• given adequate time to do the training,
• interested in being instructors,
• committed to use of ORT and proud that they use it,
• skilled in key training activities such as:
  
  • getting the participants' attention and keeping them alert,
  • making sure that each participant has the right materials and understands how he is to use them,
  • checking often for understanding and skill development, and providing appropriate information or feedback to increase learning,
  • encouraging participation and questions,
  • providing correct and concise answers to questions, or guiding participants to reach answers themselves,
  • guiding group activities, such as group discussions and role-plays,
  • using words that participants understand, a clear and audible voice, and training aids that help, not distract.

Other staff at the training facility who will help during practical work sessions should be:

• trained in improved diarrhoea case management and have experience treating dehydrated cases using ORT,
• given adequate time to do the training,
• committed to the use of ORT and proud that they use it.

Be sure that there will be enough instructors and experienced staff members to give each participant individual attention.

To prepare instructors for the training:

Give all instructors a copy of the "Participant Manual," Training Design Forms and any guidelines for sessions they will be teaching, and the agenda. Review the training objectives and agenda, and assign each individual to certain sessions as necessary. Discuss the training design for each activity planned. Select the individual(s) who will deliver each short presentation and provide the text for the presentation. Review the important points about being an effective instructor, including how to:

INSTRUCT

• by making sure that each participant understands how he is to work through the materials and what he is expected to do,
• by answering the participant's questions as they occur,
• by making clear any information that the participant finds confusing as he works through the course, and by helping the participant to understand the main purpose of each exercise,
• by guiding group activities, such as group discussions and role-plays,
• by promptly evaluating each participant's work and giving correct answers,
• by identifying weaknesses in the participant's skills or understanding and providing explanation or practice to correct them,
• by helping the participant to understand how to apply concepts taught in the course to practical problems, for example, to actual situations in his facility.

MOTIVATE

• by complimenting the participant on his correct answers, improvements, or progress,
• by making sure that there are no major obstacles to learning (such as too much noise or not enough light).

MANAGE

• by making sure that each participant has access to the right supplies and materials when he needs them,
• by monitoring the progress of each participant.

To prepare other staff for the training:

Be sure that the staff members who will be working closely with the participants:

• are present during each shift, each day of the course, in adequate numbers,
• are trained to give ORT and teach mothers,
• perform case management tasks correctly,
• keep adequate records to document a patient's progress (that is, adequate for participants to learn a patient's response to therapy during time participants are not there), and
• are friendly and supportive of participants, so that they will help the participants as needed, correct mistakes diplomatically, and discuss their experiences treating difficult or unusual cases.

Conduct a meeting to prepare the staff for the training. They must be informed of what the participants will be doing in the facility so that they can help and guide them. Give them an opportunity to ask questions about how the training will work and what they should do. Answer these questions carefully. The staff will have a critical teaching role.
CHECKLIST FOR HANDLING ADMINISTRATIVE ARRANGEMENTS


INITIAL PLANNING

1. Maximum number of participants determined (usually same number as average number of dehydrated patients expected during course).
   
2. Course agenda designed.
   
3. Arrangements made for obtaining adequate numbers of copies of the course materials and necessary supplies. (Necessary supplies and materials are listed on pages 20-22).
   
4. Arrangements made for securing needed funds to support participants' travel and per diem, extra supplies, training and reference materials, special compensation for instructors, coffee and tea breaks, and other miscellaneous items.
   
5. Arrangements made for making any needed improvements in the facility prior to training (that is, improvements identified by staff during a previous training session at a diarrhoea training unit).
   
6. Plans made for monitoring participants' progress throughout course.
   
7. Dates of course selected, allowing at least 4 days.
   
8. Letter sent out containing course announcement to nearby health centres and small hospitals.
   Letter:
   
   a. explains that a course will be held, and the purpose of the course.
   
   b. clearly states the number of participants to attend the course, and that these should be individuals who are responsible for managing diarrhoea cases.
   
   c. mentions the length of the course (4 days) and that individuals should plan to attend the entire course.
   
   d. describes the location and dates of the course.
   
   e. clearly states the date by which course participants should register and to whom to send the names of nominated participants.
   
9. Room for training identified (e.g., large enough to seat all participants, with tables and adequate lighting).
   
10. Other instructors selected (only if number of participants is expected to be more than 8).
    
11. Other instructors prepared for training. They:
    
    a. have copies of all necessary materials.
    
    b. know who will be giving each presentation.
    
    c. have discussed the training design and agenda, and are assigned to certain sections as necessary.
    
    d. have discussed the important points about being an effective instructor.
    
12. Other staff participating in the training briefed. They:
    a. know what participants will be doing in the facility so that they can help and guide them.
    
    b. have an opportunity to ask questions about how the training will work and what they should do.
    
13. Local authorities asked to participate in the opening ceremony and/or invited to the course, if desired.
    AT THE FACILITY, BEFORE THE COURSE BEGINS
    
14. Arrangements made for welcoming participants.
    
15. Arrangements made for adequate room for conducting the course (large room available during the course for seating all instructors, participants and visitors).
    
16. Arrangements made for meals and coffee/tea service.
    
17. Arrangements made for typing and copying of materials during the course (for example, answer sheets and list of participants).
    
18. Plans for opening ceremony (if necessary) finalized with local authorities.
    
19. Course materials and supplies organized and placed in appropriate areas (for example, slide projector and, if possible, videotape player and television).
    DURING THE COURSE
    
20. Course Directory (including names and addresses of all participants and instructors) provided to everyone.
    
21. Course photograph, if desired, made in time to be developed before course is over.
    
22. Course completion certificate prepared for each participant