IEC

INTRODUCTION
• Preservation of good health depends upon following good health practices and
avoiding those practices that are harmful to health.
• Out of the practices prevalent in a community, some are conducive to good
health, some bad to health and some are inconsequential to health.
• The aim of health education is to bring about a change in health behavior of
the people in such a manner that the harmful health practices are given up
while the good ones are reinforced.

INFORMATION, EDUCATION AND
COMMUNICATION
• IEC can be defined as an approach which attempts to change or
reinforce a set of behaviors in a “target audience” regarding a
specific problem in a predefined period. It is multidisciplinary and
client-centered in its approach
• It creates awareness, increases knowledge, changes attitudes and moves
people to change or continue their positive behavior or to adopt an
innovation.

INFORMATION
• Scientific knowledge to the people about how to maintain and
promote health
• Information is needed for day today management of the health
system
• It helps in eliminating social and psychological barrier, increase
awareness of the people so that they can perceive their health need.
• Influence the people that unfelt need becomes felt needs.

EDUCATION
• Education is the translation of what is known into desirable individual
and community behavior pattern by means of an educational process.
• Health education "A process by which people want to stay healthy ,to do
what they can individually and collectively to maintain health, and to seek
help when needed.”
• It helps to increase knowledge and to reinforce desired behavior
patterns.

COMMUNICATION
• Communication deals with transmission of information or
ideas and sharing and exchanging the same. The 3 essential
parts of a communication system are the communicator or
sender, the communicatee or receiver and the message
transacted between the two.

IEC TRAINING SCHEME
•The information, education and communication training scheme was
developed by Ministry of Health and Family Welfare with financial
assistance from USAID on 17th November 1987 in 4 Hindi speaking states
of U.P, M.P, Rajasthan and Bihar.
•The ministry of health and family welfare approved the scheme to continue
as a plan scheme under the 7th plan and made budgetary provisions as a
part of IEC Division of The Ministry.

OBJECTIVES
• The objectives of the project are to: -
a) Increase the reach of services by making visits of workers and
supervisors more predictable and regular.
b) Improve quality of services through knowledge and skill development
of workers.
c) Make supervision more oriented towards problem solving.
d) Link supervision with training levels.

Conti…
e) Concentrate on local field problems both for development of training
materials and their use.
f) Combine interpersonal communication with mass media.
g) Streamline supply systems to meet the local needs of health and family
welfare units.
h) Establish relationship between various levels and elements of the system.
i) Improve performance levels through continuous interaction with village
community volunteers

To achieve the above-mentioned objectives efforts are concentrated on 4
components:-
• Visit schedules: Villages mainly follow days rather than dates. Under IEC
scheme tour programs of health workers are drawn as weekly schedule. It is
difficult to contact every villager so to establish a link every village is divided
into units of 20 households.
• Training: Institutions based training has its own relevance but its ability to
cover all workers at regular intervals is limited. Training should not only cover
technical activities but also focus on problem solving skills of workers.
MAJOR COMPONENTS

•Supervision: There are multiple supervisors for each worker. Each
supervisor during brief visits to sub centers and primary health
centers concentrates only on 3 aspects ; records, target achievement,
new instructions.
•Monitoring and evaluation: Success of any program depends on
ability to monitor and evaluate programs adequately and accurately
and to take corrective action if necessary.
Conti…

• Information and Communication Technology is a term encompassing the full
range of teaching and learning resources encountered by the students in
higher education and nursing.
THE CONTEXT OF ICT
• Information, communication and technology is used to promote connections
between one learner and other learners, between learners and teachers, and
between a learning community and learning resources.
INFORMATION COMMUNICATION
TECHNOLOGY

1 - Learning to manage Health information
This point out that clinical education and health informatics are linked in terms of curriculum
content, process and infrastructure. The main approach is to identify eight areas of health
informatics and to identify key points for good practice. There are 8 areas:
THERE ARE MAIN 2 KEY DOCUMENTS IN THE CONTEXT OF ICT
- Communication
- Knowledge
- Data quality and management
- Confidentiality and security
- Secondary uses of clinical data and information
- Clinical service audit
- Working clinical system
- Telemedicine and tele care

2. The use of technology to support learning in colleges
The following are certain technologies used in higher education:
a) Use of whiteboard in teaching- A whiteboard (also known by the terms
marker board, dry-erase board, dry-wipe board, pen-board, and the
misnomer grease board) is a name for any glossy, usually white surface
for nonpermanent markings.
b) Using flipcharts. A flip chart is a collection of large pages which are
bound together at the top. The pages are “flipped” or brought up and
to the back as they are used.

a) Using an overhead projector : An overhead projector is a variant
of slide projector that is used to display images to an audience.
b) Using Microsoft PowerPoint presentations : Microsoft PowerPoint,
usually just called PowerPoint, is a closed source commercial
presentation program developed by Microsoft.
c) Using computer assisted instructions : computer-assisted instruction
(CAI), a program of instructional material presented by means of
a computer or computer systems.

HEALTH EDUCATION
• Acc. To WHO “Health education like general education is concerned with
changes in knowledge, feelings and behavior of people. In its most usual
forms, it concentrates on developing such health practices as are believed
to bring about the best possible state of wellbeing.

OBJECTIVES OF HEALTH EDUCATION
A. Informing People : Information is a basic right. It is also
prerequisite to proper awareness and assessment of one’s duties
and rights.
B. Motivating People : Mere information is not sufficient. After
information it is necessary to achieve the second objective, i.e.,
motivating people to adopt a certain behavior. This motivation
must be developed in them by a process of change of behavior.

OBJECTIVES OF HEALTH EDUCATION
C. Guiding into action : Motivating by itself does not
automatically lead to actual practice or behavior. Along with
motivation to drive a car, a person must have help and
guidance from an instructor.

PRINCIPLES OF HEALTH EDUCATION
There are 13 principles:-
i. The aim of the health education is to bring about the health changes in
health behavior.
ii. Health education is not an artificial teaching learning exercise.
iii. Health education should involve free distribution.
iv. Tell about only what is needed.
v. Do not give conflicting information.
vi. Try to change only what needs to be changed.

Conti…
vi. The educator should make himself acceptable.
vii. Use AV Aids when ever possible.
viii. Choose a proper means of communication.
ix. Communication must be good.
x. Health education must be planed properly.
xi. Health education should be graded.
xii. The health educator should put into practice the principles of community
organization

BEHAVIOR CHANGE
COMMUNICATION
(BCC)

BEHAVIOR
• Behavior or behavior refers to the actions or reactions of an object or
organism , usually in relation to the environment. Behavior can be conscious
or unconscious , voluntary or involuntary and innate or learned
• A behavior is something that you do; some action that you take.
Conventionally, a behavior is something that you act out physically, such as
taking a walk, or smoking a cigarette, or rolling your eyes when your
spouse is complaining. However, behaviors can be subtle, non-physical things
too.
• Thinking can be considered a behavior. Examples: infant's rooting reflex ,
human being's preparedness as infants to learn languages , Most other
behaviors are learned

Human Behavior
• Behavior is responsible for many
health problems and at the same
time solution to the health problem
• Behavior is an observable action of
an individual often in reaction to
specific circumstances or stimuli. It
is acquired and liable to change

• Behavior refers to the “Voluntary movements” and purposive acts arising out
of the decisions taken by the individual.
BEHAVIOR CHANGE
• Human behavior changes from person to person. It is as varied as one can
imagine. Change in lifestyle of the people will require that there is a change
at the mental level. And to bring about this change in the mindset or pattern
of activity, the health professionals will need to change behavior of the
masses and make them aware of the health benefits.
BEHAVIOR

HUMAN HEALTH BEHAVIOUR
• Conner and Norman define health behaviors as: any activity undertaken for the
purpose of preventing or detecting disease or for improving health and wellbeing.
• Behaviours within this definition include medical service usage, compliance with
medical regimens, and self-directed health behaviours.
• The initiation and maintenance of health behavior's result from an interaction of
social, psychological, biological, and environmental factors.
• Behaviours can be harmful to health (smoking, alcohol, sedentary lifestyle) or they
can be health promoting (regular exercise, eating habits etc).

PROCESS OF CHANGE IN BEHAVIOR
The process of change in behavior has following phases:
• Awareness : The individual becomes aware of a new idea.
• Interest : The individual shows interest in the new idea and wants to
learn more about it.
• Evaluation : The individual weighs the pros and cons of the new idea.
• Trial : The individual puts the idea on trial basis and again assess.
• Adoption : The individual adopts the practice permanently.

BEHAVIOR CHANGE COMMUNICATION (BCC)
Behavior change communication (BCC) is the process of learning that
empowers people to make decisions, modify behavior change social conditions.
BCC activities are developed based on:
• Need assessment
• Sound educational principles
• Periodic evaluation using clear set of goals and objectives
• BCC activities need to have an appropriate context in which they are
shaped. Health service providers respond to any demand that may be
created as a result of BCC activities.

TECHNIQUES OF BEHAVIOR CHANGE
Information Education Motivation
Reinforcement
Social
Pressure

WAYS TO INFLUENCE BEHAVIOR
Support
It is to provide a service support
and give people what they need,
want, or value. Hence, select message
as per their need, availability and in
advance
Legislation
Legislate, regulate, enforce with
police to force people to adopt health
promoting behaviors like following
traffic rules
Design
Set environmental and physical
context, design, engineer, availability,
distribution of infrastructure in a
way that people are enabled to take
action
Inform
Inform, advise, build awareness,
educate, encourage, persuade and
inspire people to adopt healthy
behaviors

Knowledge
In this step, one first learns
about a new behavior and
recalls messages and
understands meaning of the
messages.
Approval
One then approves of
the new behavior and
responds favorably to
messages
Intention
One then believes
this behaviors is
beneficial to them
and intends to
consult the provider.
Practice
One then
attempts new
behavior and
continues to
practice.
Advocacy
One can then promote
new behavior through
social or professional
networks as a
practitioner.
STEPS OF BEHAVIOUR CHANGE

Information
Used with the belief that
audience lacks information. It
is source dominated and one
way
Education
It focuses on applying knowledge. Skill building
techniques like demonstrations, skill practice, do
and learn are useful methods. It build
confidence and makes behaviours convenient
Motivation
It is the driving force to
achieve something. It is
used when information is
established
Reinforcement
It is used to sustain
behaviors change for
repetitive types of
behaviours. Need to be
used with variations
Social Pressure
When person in need of
health services not willing to
undergo treatment is
encouraged by near and
dear ones to avail health
services
Techniques of Behavior Change

Guiding Principles in Planning BCC Activity
• BCC should be integrated with programme goals from the start
• Formative BCC assessments must be conducted
• The target population should participate in all phases of BCC
• Stakeholders need to be involved from the design stage
• Having a variety of linked communication channels is more effective
• Pre-testing is essential for developing effective BCC materials
• Planning for monitoring and evaluation should be part of the design
• BCC strategies should be positive and action-oriented

STEPS OF BEHAVIOUR CHANGE COMMUNICATIONS
1. State programme goals
2. Involve stakeholders
3. Identify target populations
4. Conduct formative BCC assessments
5. Segment target populations-
6. Define behaviors change objectives
7. Design BCC strategy and Monitoring
and Evaluation Plan
8. Develop communication products and
train providers
9. Conduct pre-testing
10. Implement and monitor
11. Evaluate
12. Elicit feedback and modify the
programme

CHOOSE CHANNELS
• A channel is the way a message is disseminated
• Identify the range of available channels:
–Mass media–for example, television or radio spots; articles in periodicals;
or material in brochures, posters, flip charts, picture codes or comics
–In-person: by health workers, peer educators, counsellors, or other trained
personnel
–Musical or dramatic performances and community events

SOFT SKILLS
“Soft skills are a cluster of productive personality
traits that characterize one’s relationships in a
social milieu with other people”

Oral, speaking capability, written, presenting, listening
Communication
Manners, etiquette, gracious, says please and thank you, be respectful
Courtesy
Adaptability, willing to change, lifelong learner, accepts new things, adjusts,
teachable.
Flexibility
Honesty, ethical, high morals, has personal values.
Integrity
Nice, polite, sense of humor, friendly, nurturing, empathetic, has self-control,
patient, sociability, warmth, social skills.
Interpersonal Skills
Optimistic, enthusiastic, encouraging, happy, confident
Positive Attitude
Businesslike, well-dressed, appearance, poised.
Professionalism
Accountable, reliable, gets the job done, resourceful, self-disciplined,
conscientious, common sense.
Responsibility
Cooperative, gets along with others, agreeable, supportive, helpful
Teamwork
Hard working, willing to work, loyal, initiative, self-motivated, on time, good
attendance.
Work Ethic
SOFT SKILL ATTRIBUTES

- Generally used with the belief that (should be used only when)
audience lacks information
- Usually source dominated and one way
- May not directly help to change behaviors
- Could be a start but can not be the means of BCC activities
INFORMATION/AWARENESS AS A
TECHNIQUE

EDUCATION AS A TECHNIQUE
- Being able to apply knowledge
- Skill building is an integral part
- Demonstrations, skill practice, do-and learn are some of the useful methods
- Helps audience to learn the skills and build confidence
- Makes behaviors convenient

Survival is a basic urge. Hunger, Thirst, Sex are some of the other basic
urges. The driving force to achieve the urge could be called as MOTIVATION
To be used when information is established.
- Different appeals are instrumental for motivation Ex. rationale appeal,
emotional appeal, threat/fear appeal, joy/fun appeal
- Giving advantages of performance of behavior and disadvantages of not
performing behavior is important for motivation
MOTIVATION AS A TECHNIQUE

REINFORCEMENT AS A TECHNIQUE
- Technique to sustain behavior change
- Useful for repetitive types of behaviors
- Need to be used with variations
- Community based resources and mechanisms should be established to
reinforce the messages

BEHAVIOR CHANGE COMMUNICATION (BCC)
V/S
INFORMATION, EDUCATION AND COMMUNICATION (IEC)
• IEC: strategies, approaches and
methods that enable individuals,
families, groups, organizations and
communities to play active roles in
achieving, protecting and sustaining
positive behaviors appropriate to
their settings.
• BCC : is a process of working with
individuals, families ,communities and
societies to develop communication
strategies to promote positive
behaviors which are appropriate to
their settings; & provide a supportive
environment which will enable people to
initiate and sustain positive behaviors.

FRAMEWORK FOR IEC PLANNING
OBJECTIVE SETTING
Knowledge
objectives
Attitude
objectives
Behavioral
objectives
Setting
behavior
change
objectives is
important in
IEC

CHANGING CONCEPT OF HEALTH EDUCATION
Prevention of disease to the promotion of healthy lifestyle
Modification of individual behavior to the modification of social
environment in which individual lives
Community participation to the community involvement and
Promotion of individual and community self reliance

APPROACHES OF HEALTH EDUCATION
Regulatory
approach
Govt.
intervention
-acts
Service
approach
Basic health
services
Health
education
Democratic
approach
does not
order-
informed
choice
Primary
health care
Through
community
participation
and
involvement

HEALTH EDUCATION VERSUS PROPAGANDA
Propaganda: Information and
spreading systemized doctrine,
knowledge instilled (spoon feed)
in the mind, readymade, appeals
to emotion and no change in
attitude and behavior.
Health education is more than
information-skills that appeals,
train people to use judgment
before acting, knowledge
acquired thru self reliance and
behavior centered.

COMMUNICATION
• Two-way process of exchanging or sharing or shaping Ideas, feeling and
information. Part of our Normal relationship with others
• Health Education - Health Communication which is foundation of health
care system
• Ultimate goal – To bring changes in the desired direction of the person
who receive the communication
• May be : Cognitive-increase in knowledge
Affective-changing existing behavior and attitude
psychomotor-Acquiring new skills ( learning objectives)

PRINCIPLES OF COMMUNICATION
The following principles of communication should be kept in mind by all
health professionals involved in health education:
The sender’s and receiver’s
perception should be close as
possible.
The message should be of good
quality.
The communication should be 2
way.
Direct communication is more
effective.

COMMUNICATION SKILLS
• Communication skills are absolutely essential for a person to be
trainer or health educator to educate a large people in a community.
• Some skills are given below:
i. Eye Contact: - Speak to people, look into their eyes and
maintain eye contact with the audience.
ii. Speech: - Voice should be loud, slow and clear. Vary the volume,
tone and pitch of your voice.

Conti…
iii. Body Language: - Make effective use of hand movements,
gestures and facial expressions. Do not be glued to your seat.
Do not keep much distance between you and your audience.
iv. Questions: - Ask questions to get confirmatory feedback that
learning has occurred. Encourage the audience to ask questions.
v. Reinforcement: - Whenever the trainees exhibit positive
learning, reinforce it by an appreciative nod or statement

HEALTH COMMUNICATION
Functions :
1) Information
2) Education
3) Motivation
4) Persuasion
5) Counseling
6) Raising moral
7) Health development
8) Organization

ELEMENTS EFFECTIVE MESSAGE
• Good content - the message supports changes, beliefs or activities
already present in the community;
• Good message - the message is characterized by high technical
quality;
• Good channel use - the selected media has a broad reach and is
accessible to the audience; and
• Good audience knowledge - the message is relevant to, and well
accepted by, the audience.

GOOD COMMUNICATORS
Trustworthy
Engaging
Accessible
Care about what the audience cares about

QUALITIES OF GOOD LISTENER
1. Do not talk when hearing.
2. Let speaker feel that you are listening him.
3. Remove the obstacles.
4. Keep patience.
5. Do not start a debate, do not criticize.
6. Give full time to the speaker.

IF PEOPLE AREN’T LISTENING
Explore their existing understandings
Ask about constraints and barriers
Explore their attitudes and opinions
Win their trust
Use their interests to win their attention

TYPES OF COMMUNICATION
One way (didactic method)
Two way (Socratic method)
Verbal
Non-verbal
Formal and Informal
Visual
Telecommunication and Internet

CHANNELS OF COMMUNICATION
Interpersonal Communication :few participants involved . Home
contact drive, group meetings, focus group discussion, different
indoor games like ludo, jigsaw puzzle, building blocks, as well as
outdoor games, jingles, slogans, pada yatra, adopting influence
of the community and religious leaders, respected elderly person
etc. are part of interpersonal communication.

TECHNIQUES OF COMMUNICATION
• Print Media – Information booklets, flash card, posters, flip
charts, leaflets, pamphlets, newsletter/bulletins, calendars, wall
writing, newspaper, magazine
• Folk Media – Performance, attracts audience and reaches all.
(Folk songs, street plays, puppet shows/drama )
• Rural Resources – Wall painting – slogans, Exhibition, banner
display during fairs and festivals, bulletin or public notice
boards, drum beater, local entertainment artists.

• Mass Media - Providing information to large audience in a
short time. The communication process is information centered
and for awareness creation .
• Electronic Media – Message through radio, television,
documentary and short films, slide shows in cinema hall
• Traditional Media
TECHNIQUES OF COMMUNICATION

THE PROCESS
• Select behavior and audience
• Understand barriers and attitudes
• Develop messages and reduce barriers
• Build effective partnerships and identify ways for each to have
a role in the program
• Pilot test messages
• Implement and monitor

EFFECTIVE COMMUNICATION
Points to be remembered
1. Communication should be done with keeping circumstances and people in mind.
The person and circumstances change, parallel to that our communication
style should change.
2. Effective communication can never be one sided.
3. As much as you say you should hear also, and what you hear you should
understand.
4. Hearing and understanding enables you to know feelings of people ,patients
and your colleagues. Give time to others for speaking.

Conti…
Points to be remembered……
5. For effective communication you should have knowledge of the subject,
incomplete knowledge and information interferes in effective
communication.
6. Communication never should get turned into debate or criticism.
7. Similarly disputed and sensitive subjects should not form the base of
communication.
8. For effective communication you should use simple and specific language
so that participant could understand you.

GOOD COMMUNICATION
Build understanding
Engage community
members
Convey trust and
relevant expertise
Use appropriate
language
Use relevant
examples
Listen and respond
to misconceptions

IDEAL MESSAGE
• Use simple language
• Be consistent
• Three topics
–Potential losses
–Chances of losses over specific time period
–Ways to cut losses
• Say who is at risk

MAKE THE TEXT INTERESTING
Active voice Action verbs
Concrete
examples
Short
sentences
Common words
Organizing
statements
Interesting
topics

LANGUAGE
Translate materials to their language
Technical jargon may be a barrier to your audience
Ask them what they understand
What ideas do the words convey?

STORIES AND EXAMPLES
• Stories and examples
–Provide concrete imagery
–Explain how to do a task
–Explain how to overcome problems
–Demonstrate that real people can do it
Extremely helpful elements of effective communication

ASK FOR COMMITMENT
• People who make a commitment to take an action are more likely
to do so.
• They need to understand why and agree that it is worth doing.
Provide information and then ask for
their participation!

DELIVERY MEDIUMS
• Interpersonal communication
–Most effective for promoting behavior change
–Particularly with expert info sources

7 LAWS OF EFFECTIVE COMMUNICATION
Be clear in your message
Use great graphics
Be consistent and repeat often
Tell people what to do
Use varied sources
Use a stream of communication
Support people in their search for more information

BARRIERS OF COMMUNICATION
• Physiological : hearing, expression
• Psychological : Emotional, intelligence, language or
comprehension difficulty
• Environmental : Noise, invisibility, congestion
• Cultural : Illiteracy, level of knowledge, customs ,belief,
religion, attitude, SES, Cultural difference.

BARRIERS IN EFFECTIVE COMMUNICATION
1. Use of wrong medium.
2. Lake of uniformity in the communication.
3. Lack of confidence between persons
4. Misinterpretation of communication
5. Lack of attentiveness.
6. Use of wrong language.
7. Personal dispute between the participants.
8. No specific objective for communication.

MANAGEMENT
INFORMATION SYSTEM
- RECORDS AND
REPORTS

DEFINITION OF RECORDS
A record is a permanent written communication that
documents information relevant to a client’s health care
management.
A record is a clinical, scientific, administrative and
legal document relating to the nursing care given to
individual family or community.

DEFINITION OF REPORTS
• Reports are oral as written exchanges of information
shared between caregivers or workers in a number of
ways. Reports are usually written daily, weekly, monthly
or yearly.

CHARACTERSTICS OF GOOD RECORDING
AND REPORTING
Accuracy Conciseness Thoroughness Up-to-date
Organization Confidentiality Objectivity

PURPOSE OF KEEPING RECORDS
✓Communication
✓Aids to diagnosis
✓Education
✓Assessment
✓Research
✓Documentation of continuity
and justification of case
✓Auditing
✓Legal documentation
✓Individual case study

TYPES OF RECORDS
Patient’s clinical records
Individual staff records
Ward records
Administrative records with education value.

SOME OTHER RECORDS
–Family and village record
–Eligible couple and child
register
–Sterilization and IUD
register
–MCH register
–Child register
–Birth & Death register
–Sub centers/PHC register
–Reports of blood stain of
malaria and filaria
–Cumulative records

RECORD KEEPING SYSTEMS
Source Records
Nursing carders
Computerized information system

Conti…
• Source Record : In source
record, the information is
grouped according to the
source or the information
contributed by health care
department.
• Nursing Carders : In the
carders system, the
information needed for the
daily care is accessible
from the cord and it is
kept filed.

COMPUTERIZED INFORMATION
SYSTEM :
• Information can be stored in smaller areas, search and analytical
tasks can be done and information can be obtained in a faster and
efficient manner. In nursing, usage of computers can be divided into 3
major categories :
–Clinical systems
–Management information system
–Educational systems

IMPORTANCE OF RECORDS IN
HOSPITAL :
• For the individual & family :
–Records serve to document the history of the client
–Records assist in the continuity of care
–Records serve as an evidence to support or to refute the legal
questions that arise
–Records serve to recognize the health needs and can be used as a
research and teaching tool.

• For the Doctor
–Records serve as guide for diagnosis, treatment, follow up and
evolution of services.
–Records indicate progress and continuity of care.
–Records help self-evaluation of medical practice.
–Records protect the doctors in case of legal issues.
–Records may be used for teaching and research.

• For the Nurses
–Record provides with documentation of services rendered in which shows
health condition of the client
–Records provide data essential for planning and evolution of services for
further improvement.
–Records serve as a guide for professional growth
–Records enable to judge the quality and quantity of work done.
–Records serves as communication tool between staff and other members
involved in care.
–Records indicate plans for the future.

• For Authorities
– Records provide the management with statistical information necessary for
decision in regard to utilization of resources, planning for administration control
and future references
– Records furnish documentary evidences for proposals of evaluation of care in
terms of quality, quantity and adequacy
– Records help the administrator assess the health assets and needs of the
community
– Records help in making studies for research, for legislative action and for
planning budget.
– Records provide justification of expenditure of funds.

PRESERVATION OF MEDICAL
RECORDS-
•Selection of paper and ink
•Preservation of decay and rot
•Protection from insect attack
•Atmosphere pollution
•Safety measures against fire in
research room
•Implementation and humidity
control
•Care in handling
•Microfilming control register

REPORTS
DEFINITION
Reports are oral or written exchanges of information
shared between caregivers or workers in a number of ways.
Reports are usually written daily, weekly, monthly or yearly.

PURPOSES
• To show the kind and amount of services rendered over a specified
period.
• To illustrate progress in reaching goals.
• As an aid in studying health conditions.
• As an aid in planning.
• To interpret the services to the public and to the other interested
agencies.

TYPES OF REPORTS
Oral
Reports
Written
Reports

ORAL REPORTS
• Reports between the head nurse and her assistant.
• Reports between nurses who are assigned to bedside care on change of shift.
• Reports of staff members to the in-charge nurse.
• Nurse in-charge report to bedside nurses.
• Report of the head nurse to the administrative supervisor.
• Reports to clinical instructor.
• Report of the head nurse to the director of Nursing.
• Reports of the nurse in-charge to the physician.
• Reports on policy changes.

WRITTEN REPORT
• Day, evening and night
reports
• Census report
• Interdepartmental report
• Inter-agency report
• 24 hr. report
• Accident report
• Departmental reports
• Labor hours report

KEEPING RECORDS AND REPOTS
• The records and reports should be kept under safe custody.
• No individual sheet is separated from the complete record.
• Records should be kept in place, inaccessible to patients and visitors.
• No stranger is permitted to read the records.
• All records to be handled carefully.
• Protection from loss
• Filing should be done according to hospital system such as alphabetically, numerically
with index cards and geographically.
• Assess periodically to determine the use of the record and re-examine for means of
simplifications.

INTRODUCTION
• “Tele” is a Greek word meaning “distance” & “media” is a Latin word meaning
“to heal”. Time magazine called telemedicine “healing by wire”. Although initially
considered “futuristic” & “experimental”, telemedicine is today a reality is & has
come to stay. Telemedicine has a variety of application in patient care, education,
research, administration & public health. Worldwide, people living in rural &
remote areas struggle to access timely, good-quality specialty medical care.
• Telemedicine is the use of electronic information to communicate technologies to
provide & support health care when distance separates the participants.

DEFINITION
• The WHO defines Telemedicine as, “The delivery of health care
services, where distance is a critical factor, by all healthcare
professionals using information & communication technologies for the
exchange of valid information for diagnosis, treatment & prevention
of disease & injuries, research & evaluation of healthcare providers,
all in the interests of advancing the health of individuals & their
communities.”

TELEHEALTH
• Telehealth is the use of electronic information &
telecommunications technologies to support long
distance clinical healthcare, patient & professional
health-related education & training, public health &
health administration.

OBJECTIVE –
• To make high quality health care available to traditionally
underprivileged population.
• Serve the time wasted by both providers & patients in travelling
from one place to another place.
• Reduce cost of medical care.

PURPOSE OF TELE MEDICINE
For clinical services
Educational services
Administrative application

BENEFITS OF TELE MEDICINE
Reaching
more
patients
Providing
better
care
Research
and
training

TYPES OF TECHNOLOGY
Three different kinds of technology make up most of the telemedicine
applications in use today.
Store and Forward
Two-way Interactive Television (IATV)
Remote monitoring

STORE AND FORWARD
• It is used to transfer digital images from one location to another. A
digital images is taken using a digital camera, ‘stored’ & then sent
(forwarded) by a computer to another location. This is typically used
for nonemergent situations, when a diagnosis or consultation may be
made in the next 24-48 hours & send back. Teleradiology,
telepathology & tele dermatology are a few examples.

TWO-WAY INTERACTIVE TELEVISION (IATV)
• It is used when a ‘face-to-face’ consultation is necessary. The patient &
sometimes their provider or more commonly a nurse practitioner or telemedicine
coordinator (or any combination of the three), are at the originating site. The
specialist is at the referral site, most often at an urban medical center.
• Videoconferencing equipment at both locations allow a ‘real-time’ consultation to
take place. Almost all specialties of medicine have been found to be conducive to
this kind of consultation including psychiatry, internal medicine, rehabilitation,
cardiology, pediatrics, obstetrics & gynecology & neurology.

REMOTE MONITORING
• Also called self- testing or self- monitoring technique with
lots of technological & electrical interaction instruments the
medical professional can monitor patient.

OTHER TYPES OF TELE- MEDICINE
✓Tele Nursing
✓Tele Education
✓Tele Surgery
✓Tele Radiology
✓Tele Cardiology
✓Tele Pathology
✓Tele Dermatology
✓Tele Ophthalmology
✓Tele Psychiatry
✓Tele Audiology
✓Video Telephony

ELEMENTS OF TELEMEDICINE
• To provide client support.
• To overcome geographical barriers connecting users who are not in the same
physical location.
• Use of various types of information & communication technology.
• To improve health outcome.

APPLICATION OF TELEMEDICINE IN PUBLIC HEALTH
• An epidemiological Surveillance
• Interactive health communication &
disease prevention
• Health information technology
• Improve health care quality
• Prevent medical errors
• Reduce health care costs
• Increase administrative efficiencies
• Decrease paperwork and
• Expand access to affordable care

ADVANTAGES OF TELEMEDICINE:
FOR THE PATIENT
• Advanced medical facilities.
• Reduction in travel to distant referral medical centers.
• Reduction in cost of Medicare.
• Better monitoring of chronic cases.
• Tele-counseling of selected psychiatric cases .
FOR THE GROUP
• For a rural group 24 hr. advice of specialist is a great support .
• Better diagnosis of diseases due to availability of specialist opinions.

ADVANTAGES OF TELEMEDICINE:
FOR THE STATE
• Improved preventive health care measures
• Reduction in urban migration from villages due to better care.
• Early notification of communicable diseases. • reduced cost of care.
FOR THE DOCTOR
• Doctors licensed to practice all over India.
• Motivation for computer literacy among doctors.
• Maximum Utilization of resources.(save time, money &travel)

CHALLENGES
• Poor infrastructure and inadequate
regulation of telecommunications.
• Policies/protocols regulating the use of
telemedicine.
• License regulations for practicing
telemedicine.
• Literacy rate & diversity in languages
• Perspective of medical practitioners
• Patients’ fear & unfamiliarity
• Lack of basic amenities
• Financial unavailability
• Technical constraints
• Government Support
• Costs for services.
• Quality aspect

TELE-NURSING
Tele-nursing refers to the use of telecommunications and information
technology for providing nursing services in health care whenever a
large physical distance exists between patient and nurse, or between
any numbers of nurses. As a field it is part of tele-health, and has
many points of contacts with other medical and non-medical
applications, such as tele- diagnosis, tele-consultation, tele-monitoring,
tele-care etc.

DEFINITION
• The practice of nursing over a distance using telecommunication technology.
[National Council of State Boards of Nursing (NCSBN), 1997]
• Telenursing – is the delivery, management, and coordination of care and services
provided via telecommunications technology within the domain of nursing.
[American Association of Ambulatory Care Nursing (AAACN), 2004]
• Telenursing ‐is the use of telemedicine / telehealth technology to deliver nursing
care and conduct nursing practice.
(Encyclopedia of Nursing Research, 1999)

Conti…
• “Another subset of tele health that allows a nurse to deliver care through a tele
communication system. This may be simple as just calling a patient on telephone to
more elaborate systems”.
(Leadership & management for nurse administration)
• “Tele nursing is defined as the practice of nursing over distance using
telecommunications technology”.
[National Council of State Board of Nursing (NCSBN), 1997]

EXAMPLE OF TELE MEDICINE
Remote
Telemonitor
Interactive
Video
Internet
Support
Phone
Triage
Phone

USES OF TELE NURSING
• Tele-nursing has been used as a tool in home nursing. For example, people who
are immobilized or far away places, or living in difficult to reach places
• Citizens who have chronic aliments such COPD, DM, CHD etc.
• Still other applications in home care is patients after surgeries with wound
dressings, ostomies, handicapped etc. can be assisted in care with help of
telenursing.
• Telenursing help to extend the nursing service to more patients. In home care
delivery, a nurse is able reach and care for 5-7 patients, but telenursing help her
to attend more in same amount of time.

Conti…
• A common application of tele nursing is also used by call center
separated by managed care organizations which are staffed by
managed care organizations, which are staffed by nurse managers.
• To perform patient triage in emergencies through call centers.
• Expert assessment and intervention by specialist clinical nurses.
• Discharge services.
• To do counselling and guidance services.

IMPLICATION OF TELENURSING
FOR THE PATIENT
• Monitoring vital signs on daily basis at home setting and informing the
care specialist provides opportunity for early intervention.
• Reduces the number of visits to the doctor or emergency department.
• Avoids unnecessary visits to or by providers.
• Provides patient education.
• Removes geographic barrier - Nursing can be provided to remote
locations.

Conti…
FOR THE PROVIDER
• Increases the Competencies and scope of practice.
• More venue for monitoring Client safety in home care facilitates easy client
decision-making Creates.
• Professional practice environment.
• Able to provide expert and specialized care from experienced staff and care
managers.
• Able to take joint decisions regarding care by consultation with staff even at far
of places.

Conti…
FOR THE HEALTH CARE SETTING
• Initial expense up front but as health improves the system will save money.
• Decreased number of in-hospital days for patients with chronic illness who have
access to supportive telehealth.
• Decrease number of in-hospital days reduces the required number of staff
(nursing in particular).
• Remove barriers of time and distance.
• Proper training and administrative support is a vital responsibility for the
system.

APPLICATION OF TELE NURSING
Home care
Case
management
Telephonic
triage

ADVANTAGE
Increase public access
to health care
Provide access in
rural areas
Decrease wait times
Decrease unnecessary
hospital visits
Decrease Healthcare
costs
Increase continuity of
care
Increase patient compliance
with aftercare

DISADVANTAGE
Concerns with
maintaining
confidentiality
Decreased face-to-
face interaction
Risk of decreasing
quality of care
Concerns with
security
May increase
liability

LEGAL ISSUE
Maintaining patient
privacy
Verifying consent
Compliance with
HIPAA regulations
Nursing Licensure
across state lines
Maintaining
compliance with
scope of practice

ETHICAL CONCERNS
• Maintaining autonomy (identity, privacy).
• Maintaining patient’s integrity.
• Prevent harm to a patient.
FUTURE OF TELENURSING
• Ongoing development of new Technologies provides endless Possibilities in
the future of Nursing care.

DEFINITION
“The mass media are diversified media technologies that are
intended to reach a large audience by mass communication.”

MODES OF MASS MEDIA
Radio
Internet
Television
Magazine
News paper
Poster/Banner

TYPES OF MASS MEDIA
Electronic media
Print media
Outdoor media

TYPES OF ELECTRONIC MEDIA
Fax.
E-Mail
Blogging
Messaging
Multimedia
Video Chat
Social Networking.

TYPES OF PRINT MEDIA
Print Media Selection
Billboards and Posters
Newspapers and Weeklies
Consumer and Trade Magazines
Direct Mail: Letters and Postcards

TYPES OF OUTDOOR MEDIA
Billboard advertising.
Point of sale advertising.
Retail advertising.
Vehicle advertising.
Construction advertising.

ADVANTAGES OF MASS MEDIA
• The ability to reach a large proportion of the population.
• Although it is important to bear in mind that a health promotion "exhibition" will
probably only draw in people who are interested.
• The people who are motivated, and most probably not the people who are not
aware of any need for health promotion.
• Perhaps more to the point, mass media interventions are a relatively inexpensive
method of exposing the population to health information.
• The mass media can make use of ‘visually potent images' to invent a hard-hitting
and powerful message which is more often than not available to other avenues.

Conti…
• However, the role of the media in initiating widespread and long-lasting behavior change
may be overrated.
• Some communications experts have concluded that.
• Mass media may increase knowledge, they are ineffective in changing attitudes and
behavior. (MacDonald 1998.)
• Media campaigns shows that increase human capital, not promote collective action.
• These types campaigns provide individuals with knowledge about risks such as alcohol,
tobacco, drugs, diet, unsafe sex, and then hope.
• That individuals will change the way they act.

• These campaigns are governed by the idea that people need more and better personal
information.
• To navigate a hazardous health environment rather than that people need skills to better
participate in the public policy process to make the environment less hazardous.
• In the future health promotion media campaigns should seek.
• To give people a voice rather than leave them with a message.
• It should point people to solutions that benefit the entire community, not just the
individual.
Conti…

NEGATIVE INFLUENCES OF MASS MEDIA
• Proper nutrition is important for adolescents because of their body growth.
• In addition, their early dietary decisions can have,
• Lifelong health implications, e.g., obesity, poor nutrition, inadequate female
reproductive development (Davies, 1993).
• Unfortunately, adolescents are susceptible to poor nutritional habits.
• They often eat with peers, rather than family. Because they are growing
physically, they snack a lot, but the snacks are usually high in fat and calories.
• Adolescents also are very busy, and they argue they do not have the time to eat
properly.

• Mass media also provide formal and informal messages about sexuality.
• The greatest concern about the sexual information disseminated by the mass
media is that it is value laden.
• Sex is often associated with alcohol in the media. Gorgeous, sexy female models
are a constant in beer and wine advertisements that target males.
• Television shows often portray alcohol as a means to sex. In addition, alcohol is
associated with success, excitement, and good times.
• One of the most intensive areas of research has been violence in the media.
Conti…

• Although there was a battle for a number of years over whether or not
televised violence leads to subsequent aggressive behaviors,
• Most researchers contend there is a connection.
• Another area of concern is the amount of stress indirectly caused by the
mass media.
• Because early adolescence is a stressful period in life.
• Younger media consumers are more susceptible to additional stress created
by the media.
Conti…

FOLK MEDIA
• Used for moral, religious and socio-political purpose.
• They resorted to for pure entertainment.
• Packed with spontaneity, boisterousness and humor.
• It is personal, familiar credible forms.
• Their targeted people are literate and illiterates.
• It discuss the contemporary issues on its themes.
• Folk forms are religion, community, caste, culture and language/ dialect-specific
and bear values.

FOLK FORMS
• The folk theatre is impolite & vulgar.
• The secular forms replete with sexual jokes.
• It is considered improper for women to watch.
• Folk has mass appeal.
• It has the universality.
• It has enacted in urban and rural India.

FORMS OF FOLK MEDIA
Tamasha
Bhavai
Nautanki
Keertana
Yakshagana
Dashavatar
Ramlila&Rasalila
Jatra
Terukothu
Puppetry
Street Theatre

TAMASHA
• It is a lively and robust folk form of Maharashtra.
• It has over 400 years history.
• Bajirao-II popularized this folk art.
• It is a pure commercial entertainer.
• Star performers are female artists.
• They will sing popular songs along With patron.
• It had no religious or social message.
• It just deals philosophical and moral issues.

PAWADA
• It’s a Maharashtra folk ballad form.
• It has its prominence in 16th Century.
• It is dramatic in nature & dominated by tales.
• It is combination of vocal & instrumental music.
• Daph, Tuntune, Majira are being used.
• The main player indulges in dramatic gestures, describing the heroic deeds.
• It effects the whole performance.
• It doesn’t require elaborated stage costumes, stage & time.

KEERTANA
• The Keertana/ Harikatha/ Harikeertana is a kind of drama.
• One gifted artist performs & narrates the story.
• Sage Narada is believed to have invented this art form.
• 150 yrs ago it had spread from MH to Karnataka & Tamil Nadu.
• It was associated with bhakthi movement.
• Saint Kabir and Tukaram to preach the Hindu faith.

YAKSHAGANA
• It is a song of the Yaksha.
• Most popular folk drama in Karnataka.
• It has its mark in 16th Century.
• Its themes are from the Bhagavata with lot of local flavor.
• It is full of Song and repartee.
• The narrator is known as Bhagavata.
• The late Shivaram Karanth popularized this folk drama.
• Girish Karnand’s play Hayavadan employs same genre.

NAUTANKI
• Its a north Indian folk drama form.
• It gets its name perhaps from the charming rani nautanki of Multan.
• Nautanki has a simple dramatic structure.
• The themes are derived from the ancient epics and folklore (Laila majun,
Amar Singh Rathod & sultana daku).
• Music is the prime element in this art form.
• It provide a pace and tempo.
• Makkara and dholak were being used as main instruments.

DASHAVATAR
• It’s a religious folk theatre form of South Konkan.
• Priest Gore launched Dashavatar in 400 years ago.
• It is re-enactment of the ten incarnations of lord Vishnu.
• It is generally performing in temples.
• Male artists are alone allowed to perform.
• Men of a dozen different castes take part in the worship.
• The USP of this art for is Improvisation.
• The Gods, priests, social and community leaders are ridiculed.

RAMLILA AND RASALILA
• The Ramalila celebrates the story of the Ramayana.
• Rasalila focuses on the exploits of Lord Krishna & Radha.
• The Ramalila is enacted all over the North-India during Dassehara festival.
• Rasalila, performs in Gujarat, MH, Manipur & Kerala.
• Ramalila is made of cycle of plays of Rama.
• Varanasi and Ramnagar are the focal areas.
• The cast is male with boys are playing the roles.

JATRA
• It’s a folk theatre of Bengal and Orissa.
• It got the name because of its nomadic habit of its players.
• Jatra compositions focus on lives of Krishna & Radha.
• It propagate Bhakti cult and Shakti cult.
• In 18th Century, erotic elements were injected.
• Utpal Dutt has used as an instrument for political education.
• Singing interludes by the Chorus (juri), loud & high pitches.

BHAVAI
• The bhavai is the foremost folk theatre form in Gujarat.
• A stylised medieval dramatic form.
• Its performance starts with a devotional song.
• The ragas are largely classical.
• Popular musical forms (bhajans, dohas, garbas and ghazals) makes extremely
lively folk theatre experience.
• The foot work of garba & classical dance forms make it a feast.
• Ketan mehta’s film bhavni bhavai has superbly translated this folk drama.

THERUKOTHU
• In Tamilnadu, Traditional media includes Puppetry, Puravi Attam , Nizhal
Attam, Theru Koothu, Kazhai Koothu, Villupattu.
• Theru Koothu is the most popular.
• It’s a popular street theatre –Dance and Classical literary forms.
• It’s a Prose, Music and drama.
• Its believed to have evolved from Villupattu & Natakam.
• Religion and downright buffoonery mix freely in the street theatre.

PUPPETRY
• It has fascinated children and adults.
• Four styles of puppetry became a popular.
• Sutradharika-Rajasthan, Orissa, Karnataka, TN & AP.
• Red Puppets- West Bengal.
• Shadow Puppets: favorite form in AP, Karnataka, Kerala & Orissa.
• Hand Puppets: Orissa, Kerala & Tamilnadu Hand Puppets are fashioned
in Kerala Gloved puppet is familiar.

ADVANTAGES OF FOLK MEDIA
• Folk media is close to hear and minds.
• It appeal is at a personal and intimate level.
• Content & format is familiar, local, colloquial dialects are used.
• Rapport is immediate and direct.
• Barriers to communication almost non-existent.
• Flexibility in accommodating new themes.
• Current events can be discussed.

Conti…
• It’s a mix of dialogue, dance, song & moralizing.
• Folk media invite people to participation.
• Satisfy our innate need for self expression.
• Still the only mass media in country wide.
• 30 states have distinctive folk and traditional media forms.
• Film songs & other elements introduced in traditional media.
• Folk themes & formats were incorporated in Cinema & TV.
• Song& Drama Division utilizes traditional, folk & contemporary forms.

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