SANTA MARIA CATHOLIC UNIVERSITY

FACULTY OF NURSING

SECOND SPECIALTY

HEALTH EDUCATION

Dr. Catalina Ballon de Noriega

AREQUIPA - PERU

2015
HEALTH EDUCATION
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 INTRODUCTION

Nurses in their different work environments must take into consideration the educational
aspect as the pillar that will help achieve the proposed objectives in relation to the
promotion and improvement of people's health.

The EPS is an essential complement to the specialized care provided, considering the
length of stay in the hospital. Not only should information be provided, but also training on
your current problem and other problems of interest to your health. Considering that health
problems are different in each age group and complexity, educate on an individual or
group basis.

EPS, framed within primary health care, represents a new approach to healthcare in
understanding the health-disease process. In short, an educational process aimed at
empowering, promoting and educating in those factors that directly affect the population in
general and the citizen in particular.

Health education as a tool for health promotion will have to address, in addition to creating
learning opportunities to facilitate changes in behaviour or healthy lifestyles, so that people
know and analyse the social, economic and environmental causes that influence the health
of the community.

This means going beyond the traditional role that has been attributed to the EPS, which has
been limited primarily to changing risky behaviour in individuals, and has become a
powerful instrument for change.

It is therefore necessary for individuals to increase their knowledge about health and
illness, about the body and its functions, the usefulness of health services and the factors
that affect health.

In primary health care, the EPS is understood as an instrument that helps nurses to achieve
the ability to control, improve and make decisions regarding their health or illness.

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 HEALTH EDUCATION

1. Health-disease process:

It is the result of the relationship that individuals establish in their environment and is
closely linked to the type of economic and social development of each historical
moment.

Health: There are many definitions of health, but the WHO defines health not only as
the absence of disease; but as a state of complete physical, mental and social well-
being.

According to Milton Terris: Health is the state of mental, physical and social well-
being, the ability to function in society and not just the absence of disease.

Health Disease

+++ +++ +++ +++

Balance – adaptation Imbalance
Maladaptation

 Health determinants: According to Marc Lalonda they are:

- Biology: Conditioned by genetic inheritance. They are personal variables that

are not modified.
+ Age.
+ Sex.

- Lifestyles or health behaviors.

- Environment.
- Health care systems.

 Concepts of health promotion and prevention

- Disease prevention: This includes measures aimed at avoiding the onset of the
disease, such as reducing risk factors, stopping its progression and mitigating its
consequences once established.

- The levels of health prevention are related to the phases of the disease:

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 + Primary prevention: health or pre-pathogenic period are measures directed at
the healthy population and are aimed at preventing the onset of the disease by
controlling the causal agents and risk factors. Includes health promotion and
protection activities.

+ Secondary prevention: This is the pathogenic period, the actions are aimed at
sick people; the objective is early diagnosis and treatment.

+ Tertiary prevention: covers the convalescence period, including

rehabilitation and reintegration into society.

- Health promotion: It is the set of actions aimed at improving and exercising

greater control over one's own health. Health promotion focuses its actions on
caring for healthy people and the environment that surrounds and includes their
health.

+ In the *individual* through:

 Health education: promotes positive health behaviors and changing

unhealthy lifestyles.

 Preventive medicine: intervenes on communicable diseases, chronic

diseases, accidents, etc.

+ In the environment through:

 Environmental sanitation: control of environmental pollution; hygiene and

safety of school premises; hygiene of children and adults, food hygiene;
occupational hygiene, mental hygiene.

2. Conceptualization of health education:

Health education has seen significant development in recent years, not only through
educational health organizations and institutions, etc. But also communities themselves
and the individuals who comprise them have played a leading role in promoting it.

EPS is a planned and systematic process that seeks to reinforce, modify or replace
behaviors with those that are healthy at the individual, family and collective levels in
relation to the environment.

According to the World Health Organization (WHO), health information and education
activities are a process that should be aimed at increasing the capacity of individuals
and communities to participate in health action, self-responsibility in health matters and
to promote healthy behavior.

Evolution of health education

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Initially, EPS was developed in accordance with the biomedical concepts of health and
illness that were in force at the time, in which little or no importance was given to
social, cultural and psychological factors. Nowadays, community participation is
sought to identify and solve their problems in health education. We must move from
“intervention” to “participation” as a result of this, the health educator learns in
addition to teaching, just as the student teaches in addition to learning.

Objectives of health education:

The objectives of health education consider health as the heritage of the community
that is aware of and responsible for its health. They must assume health as a basic value
of the community and accept their responsibilities.
- Promote healthy lifestyle habits and inform the population about positive and
negative health behaviors.
- Help modify negative health behaviors.
- Promote new positive behaviors that are conducive to maintaining and
improving health.
- Motivate change towards positive environments that promote healthy behaviors.
- Empowering the individual to make their own and community decisions in the
health process

Purpose of health education.

It allows the transmission of information and encourages the motivation of personal

skills and self-esteem necessary to make conscious and autonomous decisions about
one's own health and that of the community. Education is not about informing, nor is it
about persuading.

Agents of health education.

They are all those people in the community who contribute to individuals and groups
adopting positive health behaviors.
Health professionals.
Education professionals.
Communication professionals.

Fields of action of health education.

The field of action of health education is the entire group community and individually.
Every individual has the right to benefit from health education, taking into account the
cultural and social reality of the different target groups that are reached by the
educational action in order to employ programs with different objectives and strategies.

The fields of action of the EPS are considered from two perspectives, either
attending to the health-disease status or to the stages of the life cycle, according to
this we can distinguish two fields of EPS,

- One aimed at the healthy population, with the capacity for self-care.
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 - Another one aimed at the sick population, geared towards health recovery.

 Health education for the healthy population:

It constitutes one of the main fields of action, since educational action is essential
for the community to recognize the determining factors of disease and develop
healthy habits and lifestyles.

In the group of children and adolescents, EPS must be carried out at school as part
of their secondary socialization, aimed at promoting health and acquiring healthy
behaviors.

For a second adult group, EPS is carried out in the workplace or in the community
itself through persuasive communication and its objective will be to promote and
protect health by changing unhealthy habits.

This delimitation allows us to distinguish three fields of action in the healthy

population: the EPS, at school, in the workplace and in the community.

 Health education for the sick population.

According to the framework of the development of the activity: hospital, health

center, home or according to the type of problem or need.

In this group, it is essential that patient and family education be carried out using
participatory methods, encouraging confirmation of the problem and influencing
therapeutic compliance to recover or improve health.

THEORETICAL MODELS OF HEALTH EDUCATION

1. Traditional models.

- Biomedical model: Unidirectional, depending on the pathology, the information is

directed to the etiological factor for the patient's acceptance of the treatment.

- Information model: It is unidirectional, in information about behaviors, (it does not

clarify values or beliefs).

- Health belief model: The beliefs of the population strongly influence decision-
making in relation to health-promoting or health-restoring behaviors, given the
individual's susceptibility to the disease, how the severity of the disease is
perceived; the potential benefit of the preventive measure, and the obstacles to the
adaptation of the recommended preventive measures.

This model does not promote behavioral change in healthy people.

2. Current models.

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- Persuasive-motivational model of a psychological nature, also known as the
attitudinal preventive model, written by (O'Neil, 1979), postulates the inclusion of
motivation as an essential element after the information process for the
achievement of certain habits. According to this, achieving a positive change in
attitudes would be followed by the development of certain behaviors that are
already reinforced and modified. The information must be true, complete, clear and
understandable. In practice, the message implies the motivational element, so the
change in knowledge would occur at the same time as the change in attitudes,
which is followed by the change in behavior. According to Harland, the phases of
the model would be:

A. Providing information: “Presentation of the message” “attention to the

message” “understanding the message”

B. Change of attitudes “acceptance or rejection of the opinion expressed”

“persistence of the change of attitude”

C. Change of conduct “change of behavior” later on, when verifying that the
information alone influences the area of knowledge but little on the affective-
intentional area; the motivating element is included, ensuring that the behavior
sought would be the element consequent to a positive attitude. It also
distinguishes between the so-called "natural or intrinsic motivations derived
from Maslow's pyramid of basic human needs, and the so-called operational or
extrinsic motivations derived from the circumstances of each stage of the life
cycle.

The change of attitude as a necessary but not sufficient element to achieve the
change of behavior which leads to a problem.

- Pragmatic or multifactorial model: Approach assumed by the WHO, today we

know that action limited to the individual does not succeed in maintaining
behaviors, even with a positive individual attitude, if social factors are not
favorable for it, therefore new trends consider among their objectives the need to
act on the needs simultaneously on the economic and social dimensions involved in
the health problem.

It is based on the intervention through persuasive communication – KAP model, in

the population, simultaneously adopting the contributions of the political,
economic, and ecological models to intervene on the social determinants of health;
they therefore have a multifactorial basis.

- Political – economic – ecological model:

This critical model blames society for health inequality, considering that the
individual is a victim of the system, considering that socio-economic and
environmental determinants influence them. These theories advocate for the most
disadvantaged classes, as poverty is the main cause of the disease. According to

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 this theory, power is concentrated in the hands of a few industrial groups that
influence the lifestyles and quality of life of the population. Environmental
modifications must be made through truly restrictive laws that protect citizens and
thus control their effects.

- Personal development and social skills model:

This model considers the decisive role that behavioral factors play not only in
prevention but also in therapeutic and rehabilitative intervention. It aims to
contribute to personal and social development, increase self-esteem, feel good in
the school, family and social environment, providing the resources, personal and
social skills necessary for the development of autonomy and responsibility in
achieving healthy behaviors.

The strategy is aimed at promoting healthy beliefs and attitudes, cognitive and
evolutionary determinants of behavior, reinforcing the individual's internal control,
behavioral determinant, enabling him or her to resist social pressures tending to
develop unhealthy habits.

HEALTH EDUCATION AS AN EDUCATIONAL PROCESS

Health education is considered a pedagogical phenomenon because it involves the

existence of a teaching-learning process.

- Teaching: Teaching activities seek to develop individual faculties to achieve the

objectives of the training action.

- Learning: It is a process that is based on personal experiences and when it is

significant, it produces a lasting change in the way people act, think and feel.

Intervention Levels in E.PS: the development of the levels of the EPS It depends on
the health problem to be addressed, the person(s) to whom it is directed and the
scenario in which it is to be implemented – executed or carried out. In which scenario
is carried out, the following contents must be considered:

 Inform people and the general population about health and illness.
 Motivate the population to change to healthier practices and habits.
 Help acquire knowledge and the ability to maintain healthy habits and lifestyles.

Areas of application of Health Education: Both the “healthy” and sick population
groups “have the right to benefit from EPS actions” whatever the environment in which
they find themselves.” Therefore, in order to reach the EPS community, the following
areas of application can be distinguished:

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 Family environment: It is an essential element because it brings together in its
environment the different population groups in their different stages of
development. Those responsible for Family Education must be considered true EPS
agents, due to the informal influence they can exert on the different family
components.

 School Environment: Its purpose is to instill knowledge, attitudes and positive

health habits during the early stages of development, aimed at health-promoting
behaviors and the prevention of the main diseases in this age group. You should try
to develop skills for adopting healthy lifestyles in adulthood.

Strategies should not be directed exclusively at students, but also at parents and
teachers so that they can also participate in the planning and development of
actions.

 Work environment: Its strategy is directed towards raising awareness among

workers about the health risks to which they are exposed due to the performance of
their work:

- Risk of physical injury due to your work

- Risk of illness from workplace toxins
- Risk of developing psychological imbalances due to the type of work
performed. The EPS aims to inform workers of the main risks and their rights in
relation to them. It also covers widespread problems in the population although
not specific to the workplace, especially preventive ones.

Managers and union representatives must also be made aware in order to achieve
sensitivity.

 Social Environment: The main objective of EPS programs In the community, it is

the promotion and protection of the Health of the "healthy" Population by
eradicating harmful knowledge, attitudes and habits.

These programs are planned based on the levels of prevention. It also involves
motivating the population to increase active participation in decision-making that
affects the health of the community.

EDUCATIONAL METHODOLOGY

For the preservation of the basic objectives of the EPS Informing the population,
inserting health as a value, promoting healthy behaviors and modifying harmful ones,
the different health agents must develop messages that are sufficiently clear and
persuasive to reach the population, the procedure by which these messages are sent to
the community is called health education methods.

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In EPS, the methodology used is of particular importance and therefore training in
methods and techniques that have proven most effective for each specific situation
should be promoted. Experience in evaluating behavior modification shows that the
common factor that modern methods and techniques have is the increasing
participation of the individual, healthy or sick, his family and the community through
practical teaching. The WHO expert committee on EPS He divided the methods into
two large groups, classifying them according to the relationship established between
the educator and the student. This is how you can tell.
1. Two-way or sociatic methods: in which there is an active exchange between the
sender and the receiver, they consist of:
 Personalized therapeutic interview,
 Group discussion

2. One-way methods: in which there is no possibility of interaction between the

sender and the receiver, so the latter cannot exchange information or clarify doubts,
are considered:
 Mass media.

Salleras: proposed another later classification based on the relationship of proximity in

time and space between both elements.

a) Direct methods: Active or integrative practical teaching in which there is a

direct relationship between the sender and receiver, both adopting an active role, is
the one that has demonstrated the greatest capacity for modifying values,
motivating attitudes and generating healthy behaviors.

In general the effectiveness of EPS methods In terms of behavior modification, it

is directly proportional to the degree of interrelation established between the
educator and the student.

Direct media
- Dialogue / interview
- Class
- Chat
- Group discussion
- Teaching techniques of practical teaching.

The different group teaching techniques are defined as the means or methods used
to encourage group interaction.
1. Techniques involving experts:
- Symposium
- Round table
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 - Expert panel, Delphi technique
- Public debate

2. Techniques in which the whole group participates:

- Focus group
- Seminar
- Guided debate
- Case study
- Phillips 66
- Brainstorming
- Role or role playing
- Whisper

Main group techniques:

1. Techniques involving experts:
- Symposium
- Round table
- Panel of experts. Delphi technique
- Public debate

2. Techniques in which the whole group participates:

- Focus group
- Seminar
- Guided debate
- Case study
- Phillips 66
- Brainstorming
- Role or role playing
- Whisper

b. Indirect Methods

"In this type of method we find a separation in time or space between educator and
student. The written or spoken word is used, utilizing different technical resources.
They constitute the so-called Mass Media. The Mass Media play an important role
in social communication, with specific functions among which the following can
be highlighted:

1. Create public opinion.

2.Raise awareness in the community on health-related issues.
3.Distribute information.

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4.Promote community participation.

Among the main advantages offered by mass media are:

- They have the capacity to reach a large number of people.
- They provide broad population coverage, with relatively low cost.
- They provide information and reinforce positive attitudes.
- They contribute to creating a positive health culture in the population.
The main limitations of these methods can be summarized as:
1. Awareness is highest at the start of information campaigns.
2. Awareness decreases or ceases at the end of the campaign.
3. Messages must be generic and cannot therefore be adapted to the level and
needs of specific population groups.
4. On their own, they are not effective in modifying behavior.
5. They must therefore be combined with direct methods of Health Education, if
it is desired to influence individual behaviors.

Indirect means:
a. Visuals
- Posters
- Press
- Brochures
- Board
- Posters
- Slides
- Transparencies
b. Audiovisuals
- Cinema
- Video
- TV
- Slideshows
c. Sonoras
- Radio
- Recordings

HEALTH EDUCATION PLANNING

Like any other activity carried out in Primary Health Care, EPS must be planned
and organised systematically (the methods used must be evaluated to ensure the
effectiveness of the activities). From the current framework in which the EPS is
circumscribed, it will deal with both the behavior of people related to the problem
and the environment in which they develop. The stages of planning in EPS are:

1. Analysis of the problem.

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2. Programming of educational activities.
3. Assessment.

Problem analysis

a) Problem identification. It arises from the analysis of the needs of the population,
and its objective is to know "where", "how", "why" health problems arise.
When selecting a problem on which we are going to act from the EPS, what
interests us is to know what are the behaviors of the individuals, groups or
communities that are involved in the problems, so that through an educational
action they can be modified, producing an improvement of the problem.

b) Identification of risk factors (RF), which we can classify, according to the

PRECEDE model:
- FR related to the behaviors of predisposing individuals.
- FR related to the environment, and which are beyond people's control
(economic, accessibility to services, media, etc.). Facilitators and
reinforcers.

c) Identification of the target group on which we are going to act. The better we
define this, the better we will be able to design an educational intervention
appropriate to its characteristics.

d) Identification of cognitive determinants: attitudes (opinions) and social

influences as perceived by the individual, and their expectations of self-efficacy
(personal capabilities). Programming of I» educational activities

The design of educational activities: depending on the problem identified - who,

what, how, when and where - must be flexible in such a way that it allows a
participatory methodology for citizens in the process of modifying their behavior.

to) Who are the educational activities aimed at? Young people who use
motorcycles, elderly people over 75 years old, etc.
b) What are we going to do? Educational objectives will explain what we want to
achieve in relation to knowledge, attitudes and abilities, skills of people, so that
we can evaluate progress and the point we want to reach.
c) How are we going to do it? Educational methods and media to be used.
d) When and where are we going to do it? Scheduling of all activities and the
place where each of them will take place (home, health center, classroom,
factory, etc.).
and) Who is responsible for each activity?
F) Material and financial resources necessary to develop the educational program.

Evaluation – Monitoring

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 The evaluation criteria for an EPS Program must be included from the beginning
and must be discussed and agreed upon with all those involved in it (the evaluation
must be done with people and not about people). Following the classic Donabedian
scheme, in the evaluation of a Program we will distinguish:

a) Evaluation of the structure, in this case, what we evaluate is the design of the
Program-analysis of the problem, educational objectives, methodology and
means to be used, timing and financial and human resources, and evaluation
criteria to be followed.

b) Process evaluation, which focuses on the assessment of the people involved in

the development of the Program, and on the fulfillment of the activities, both
the educational ones and the support ones.

c) Evaluation of results, where the impact that the Program has had on people, the
group it was aimed at and on environmental factors is assessed. Finally, it will
evaluate the improvement of health indicators and/or the resulting social
benefit.

ROLE OF THE NURSE

The role played by the Nurse is one that involves the development of all her functions, the
widely developed care, teaching and research management.

To play this role that we try to define and frame it within the scope of the EPS, we must
keep in mind what aspects underpin it and how to develop it, that is, define our function,
attitude and aptitude that are the pillars on which the role of the Nurse is based.

Regarding our function, they should be aimed at facilitating, helping, supporting,

motivating and guiding.

The EPS is the main tool used at the level of primary prevention and it is the nurse who
almost always assumes the responsibilities of the health educator. When teaching, the
nurse assesses the learning needs in relation to the health of individuals and the
community, taking into account time, formulates appropriate behavioral objectives and
takes into account available resources; designs and implements an EPS plan, emphasizing
ways to provide and maintain health and prevent illness and disability.

Nurses evaluate the effectiveness of their plans based on the influence they have on health-
related behaviors observed or maintained by the individuals or groups with whom they
work.

Our attitude must be characterized by favoring the creation of tolerant climates of

understanding that encourage communication. This is perhaps the key that will allow us to

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develop Health Education in all its aspects, playing the role that corresponds to us and that
is expected of us.

The following aspects must be taken into account:

- Maintain a natural behavior.
- Use positive language.
- Be positive in our assessments.
- Accept people and their situations.
- Avoid prejudgments and assumptions.
- To make our desire to help understood.
- Show interest, proximity and closeness.
- Promote dialogue among equals.
- Delve deeper into the research of problems and their causes.
- Try to find joint solutions.
- Being consistent between what we think, feel and express.
- Controlling feelings, emotions and phobias.
- Be willing to know how to listen.
- Pay attention to non-verbal language.
- Facilitate personal decision-making.

We must pay attention to several aspects that compromise the implementation of these
activities. What training we have, the type of Health Education we wish to carry out and
our own aptitude.

- Training: It is necessary to be prepared for:

 Working as a team.
 Develop health programs.
 Evaluation of programs and activities.
 Group formation and management.
 Knowledge and use of group techniques.

- Type of Health Education:

 Individual: scheduled consultation.
 Group: workshops, seminars, talks, etc.
 Programs: health mediators.
 Counselling or advice techniques.

Aptitude: We have seen previously how the role of nursing was based on three basic
pillars: function, attitude and aptitude. Regarding the latter, which we could define as our
professional competence and in relation to Health Education, it would be realized in the
development of certain skills:
- Dialogue and communication.
- Group management.

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- Conducting meetings.
- Resource management.
- Time management.
- Ability to synthesize.
- Adequacy of objectives.
- Help to reflect.
- Help make your own decisions.
- Equal leadership.

Problems of the Professional to be an Educator

The dynamics of the functioning and internal composition of the health team can give rise
to certain problems that prevent us from breaking away from our traditional work
organization, to the detriment of the implementation of activities related to Health
Education. Taking into account that the particularities of each center give rise to their own
dynamics and therefore to their own problems derived from them, we can point out some.
Given these difficulties that arise, it has been proposed that EPS nurses specialize in health
facilities. To carry out this role efficiently and effectively without forgetting to take into
account ethical values.

- Lack of staff.
- Workloads.
- Distribution of tasks
- Low motivation and mentalization.
- No prioritization of activity.
- Difficulty working as a team.
- Lack of support.
- Relationship problems.
- He considers Health Education to be a non-regulated and non-systematized task.

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 BIBLIOGRAPHIC REFERENCES

1. Aguaded Gómez, José I, Education and Media in the Ibero-American context. Huelva
(Spain), Editorial UIA, 1995.255 p.

2. Cabero, Julio and others, New technologies applied to education Madrid (Spain),
Editorial Síntesis, 2000. 255 p.

3. Costa, Miguel and López Ernesto, Health Education Barcelona (Spain), Editorial
Pirámide, 2000. 433 p.

4. F. J. Gutierrez. Rev Esp Sanid Penit 2004; 6: 80-83 Role of Nursing in Health
Education. QPS complex.

5. Greene, W.H. (1984): Health Education. Mexico. Interamerican

6. Home, RM (1985): Medical-Surgical Nursing. Madrid. Interamerican

7. INSALUD. (1989): Direct Nursing Care. General concepts and procedures. Madrid.
National Institute of Health

8. La Rosa Huertas, Liliana, Health Promotion Policies and Social Capital Lima (Peru),
Editorial Litografía Artística, 2002.150 p.

9. Martin Zurro, A. (1986): Primary Care Manual. Barcelona, Doyma

10. Ministry of Health of Peru, Strategic Planning of Educational Communication Lima

(Peru), Editorial Decisión Gráfica, 2002.136 p.

11. WHO. (1983): Report of a WHO expert committee: New Methods of Health Education
in Primary Health Care. Geneva. WHO

12. Pan American Health Organization, Social Communication Manual for Health
Programs Washington, DC, PAHO, 1992. 140 p.

13. Pan American Health Organization, Models and Theories of Health Communication,
Washington, DC, PAHO, 1996. 39 p.

14. Phipps, W.J. (1985): Medical-Surgical Nursing. Madrid. Interamerican

15. QMS. (1982): 7th General Work Program for the period 1984-1989. Geneva. QMS

16. Health Journal. Health Promotion and Education. Chap. 12 Saints.

17. You left San Martí. TO. (1985) Health Education. Madrid. Diaz of Santos.

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 ANNEXES

ANNEX 1

TO ANALYSE A PROBLEM WE CAN USE THE PROBLEM TREE

METHODOLOGY

It is a methodology that is carried out in a team and with members who have information
and knowledge about the problem presented.

The Problem Tree methodology allows you to explore the causes and effects of a problem
in a sequential manner.

"The problem tree methodology is a technique of the logical framework approach, which
aims to identify the substantial and direct causes of the central problem, that is, at the base
of the problem identified as central, which are the direct original causes"1.

Three stages are recognized in the application of this methodology:

1. PROBLEM IDENTIFICATION

The prioritized problem is transferred to apply the problem tree methodology, placing
the problem on the trunk.

This problem should not be described as a lack of a solution but in a clear, concrete and
specific way so as to facilitate the search for solutions.

When describing the problem, it is a common mistake to use "lack of ….". It is

recommended to write it as an existing negative state. Example

Lack of biosafety practices in the emergency service. (BADLY FORMULATED

Health personnel in the emergency service are exposed to risks of contamination by

handling materials (WELL FORMULATED)

2. LEVEL OF CAUSES

Once the formulation and writing of the prioritized problem has been verified, the
causes of the problem are found. Causes that explain the presence of the problem.

This part facilitates identifying the relationships between the recognized determinants
of the focal problem, connecting these causes according to their nature and the
influence of some on others.

Some questions can help us to search for the causes:

• Why does this problem occur?

• What is causing the problem to occur or persist?
• Why do these people experience this problem?

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 As the questions are explored in depth, the causes are explored in depth. It is
recommended to reach a second level of depth.

3. LEVEL OF EFFECTS

At the top of the tree, the main consequences that people or institutions with the
problem would have if no action was taken to solve it are identified.

The questions to guide this part are:

What would happen if there was no intervention to solve the problem with people and
institutions?

TO IDENTIFY PROBLEMS WE CAN USE:

Brainstorming technique to identify problems

Guiding questions to start brainstorming:

• What aspects make it difficult for me to provide good care?
• How does it affect! user the difficulties presented, if any?
• What makes it difficult to provide comprehensive, quality care to users?

Brainstorming is a technique used to generate many ideas in the group; it requires the
participation of the entire team spontaneously.

It is hoped that this technique will lead to new, creative and innovative ideas that can break
paradigms. Furthermore, when all team members participate, commitment and
responsibility for the activity is generated.

Participants ask for the floor to give their opinion or they can do so through cards.

When cards are not used, the ideas expressed by each team member should be recorded on
the board or flipchart. After this, try to group the opinions, looking for common ones or
those that are repeated, and try to lead the team to work towards consensus. Opinions that
are not relevant to the topic are discarded.

BRAINSTORMING STAGES:

1. PRESENTS THE TECHNIQUE AND MAKES SURE EVERYONE

UNDERSTANDS IT
2. Introduce topic 3 discuss
3. Generation of ideas
4. Review of ideas
5. Analysis and selection of ideas
6. Order the ideas

WHEN APPLYING THE BRAINSTORMING TECHNIQUE THE EPS TUTOR

MUST:

 Promote a calm and pleasant atmosphere.

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 Encourage everyone to express their opinions, to overcome the fear of speaking up.
 Set a time limit
 Avoid criticism or judgment of the ideas presented.
 Encourage all ideas presented by anyone on the team.
 Use the opinions that are presented to create new ones from them.
 Maintain a fast pace for collecting and recording ideas.
 Make sure that only one person gives their opinion at a time.

This first moment is very important because it allows us to clearly identify the institution's
problems.

PROBLEM WRITING: It is necessary to clearly formulate the problem without neglecting

some relevant aspects. The following table helps us to write the problem:

Guiding question:

What makes it difficult to provide comprehensive, quality care to users?

Where does it exist?

Nature In what aspects is the situation visible? In results, processes or inputs,
etc.?
Location In what geographic area does it occur?
Does it cover a network? microgrid or an establishment?
Magnitude How many people does it affect?
What characteristics of sex, age, education or social context does this
population have?
Finalization Does it affect everyone equally?
Can groups or populations that are directly affected be distinguished?
Permanence Is this a recent situation?
Has this been observed recently or for a long time?

AT THE END OF THIS MOMENT WE CONCLUDE CDN:

LIST OF PROBLEMS:
1
2
3
4
SECOND MOMENT: PRIORITIZATION OF THE PROBLEM.

Once the problems that the work team has concluded have been listed, they are prioritized,
since due to time constraints we could not try to solve all the problems found.

Steps to follow:

For prioritization, use the following criteria:

• Size of the group affected by the problem
• Significance of the problem in social and economic terms.
• How often does the problem arise?
• Possibility of solving it by the team
• Interest and commitment of the team to solve it

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 Each criterion is assigned a score ranging from I to 4, the priority problem will be the one
with the highest score, considering the following weighting:

1: low 2: medium 3: high 4: very high

MATRIX No. 1: PRIORITIZATION OF THE PROBLEM

PRIORITIZATION CRITERIA

Team interest
ISSUES TOTAL
Size of How often does
Possibility of and
Significance of SCORE
affected the problem solving the commitment to
the problem
group arise? problem solving the
problem

THIRD MOMENT

ANALYSIS OF THE PRIORITIZED PROBLEM

(the one with the highest score)

STEPS TO FOLLOW:
 Analyze the problem that has obtained the highest score, the others will be left for
another time.
 Prioritised problem analysis involves identifying the causes and consequences of the
problem.
 At this time, it is recommended to review documents that help us delve deeper into the
problem. This moment is known as the theorization of the problem.
 In order to determine the causes and consequences of the problem, it is necessary to
collect information from different sources. This will allow us to have greater clarity
about the problem.
 It is time to unite theory with practice, that is, what the different sources tell us in relation
to the problem.
 Present the problem in a way that is understandable and can be further explored,
determining its causes and consequences, verifying the institution's management
documents, in order to analyze the problem and formulate actions that are in line with
institutional objectives.

Prioritised Problem:

TO. CAUSES B. CONSEQUENCES C. PROPOSED SOLUTION

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FOURTH MOMENT:

FORMULATION OF SOLUTION PROPOSALS

STEPS TO FOLLOW:
 Make a list of the proposed solutions that must be within the framework of the feasibility
of being executed.
 The proposed solutions will be applied in practice and their results in solving the problem
and modifying said practice will be evaluated.
 The proposed solutions are explored and defined based on the causes found in the
problem tree, since addressing the causes is attacking the problem "at the root", which
will prevent the appearance of other related problems.
 Analysis of the causes will show that the proposed solutions may be of various kinds.
Keep in mind that not only training proposals should be stated, but also a
comprehensive approach to the problem should be considered, which is why all
proposed solutions should be stated.
 The challenge is to achieve a diversity of ideas, actions, procedures, roles, projects, and
support that can contribute to improving the current situation and that at the same time
allow progress toward the ideal situation and resolve the problem identified.
 Carefully analyze the cause that will be addressed by an educational proposal, specifying
the competencies to be strengthened or generated in its components of knowledge,
attitudes or skills and defining which population has the need.
 Specify the content, methodology, duration, schedule and material resources necessary
for the educational activity.
Guiding question:
 What causes can we directly intervene in through EPS projects in health and community
services?

At the end of this moment, the following matrix will be concluded:

MATRIX N°4: PROPOSED SOLUTIONS

PROPOSED GOAL UNIT OF FINANCING RESPONSIBLE SCHEDULE

SOLUTIONS MEASUREMENT
1 2 3 4

ANNEX 2

22
 EPS PROJECTS

If the solution proposals are of a longer duration, the EPS project is prepared using the
following formats:
EPS PROJECT
ESTABLISHMENT :
SERVICE OR UNIT :
EPS TUTOR :
DATE :

1. QUALIFICATION

Project man, who is related to the problem to be solved.

2. DESCRIPTION OF THE PROBLEM TO BE ADDRESSED

to. Specify the problem identified in the reflection meetings on daily practice. Attach
prepared matrices.

b. Describe the relationship of the problem with institutional objectives and plans
(annual operational plan, national, regional and local plans)

c. Describe the desired situation and identify the gap between the observed situation
and the desired situation, in terms of the situation to be improved and the skills that
need to be strengthened to improve said situation.

3. SPECIFY HOW YOU DIAGNOSED THE PROBLEM TO BE ADDRESSED

a. Specify what tools were used such as: surveys, suggestion box data, statistical data,
epidemiological profile, supervision reports, etc.

4. SPECIFY PROJECT OBJECTIVES

to. General objective.

b. Specific objectives.

The objectives are aimed at improving the organizational climate, health personnel
skills, user satisfaction, management, among others.

5. TARGET POPULATION

Indicate the population that will benefit from the project, indicating the number and
main characteristics.

6. DESCRIPTION OF ACTIVITIES AND INDICATORS

Activities can be in the following areas:

a. Management, coordination, implementation and others.
b. Educational activities with an adult education focus aimed at work teams or the
community.
c. Dissemination of information and educational materials, etc.

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 GENERAL RESULT SPECIFIC ACTIVITIES PROCESS
OBJECTIVE INDICATOR OBJECTIVES INDICATOR
to. to the
a.2
a.3
b. bl
b.2
b.3
c. cl
c.2
c.3

7. COST ESTIMATION

ACTIVITY DESCRIPTION DEPARTURE COST SOURCE OF

FINANCING

8. SCHEDULE OF ACTIVITIES

ACTIVITY RESPONS MONTH 1 MONTH 2 MONTH 3 MONTH 4 MONTH 5

IBLE

9. EPS TEAM THAT PREPARED THE PROJECT

LAST NAME(S) NAMES PROFESSION POST

1.

2.

ANNEX 3

FORMULATION OF THE PLAN OF AN EDUCATIONAL ACTIVITY

24
1. GENERAL DATA

• Regional Health Directorate. Network, Microgrids and/or Hospital.

• Office, Unit, service.
• Training Manager
• EPS Tutor

2. PRIORITIZED PROBLEM

Briefly describe the problem identified from the daily practice reflection meetings, as
well as its causes and consequences.

3. COMPETENCES

We conceive of competencies as informed knowledge, knowing how to do things well

(skills, abilities) and knowing how to act (attitudes), that is, a set of capacities that
allow people to perform effectively, as well as resolve problematic situations by
valuing themselves and others.

Specify the learning outcomes or competencies that participants are expected to

achieve at the end of or during the development of the educational activity.

How is a competence formulated? It is formulated in the Verb indicative mood present

tense. Example: Know, apply, manage, design, elaborate, develop, act, collaborate, etc.

In an educational activity within the EPS brand, a prior evaluation of performance

based on competencies is required to know the baseline situation.

4. TARGET AUDIENCE CHARACTERISTICS

Identify the target audience for the training, whose problem affects and who is affected
by it: professionals, technicians, administrators, etc.

• Type and total number of participants

• Type and number of health professionals to be trained (doctors, nurses, midwives,

etc.)

• Type and number of healthcare technicians to be trained (nursing technicians,

laboratory technicians, radiology technicians, nursing assistants, etc.).

• Type and number of professional administrative staff to be trained (accountants,

administrators, etc.)

• Type and number of administrative technicians to be trained (cashiers, payers, etc.

Example: Doctors (30), Nursing Technicians (40), Administrative (20)

5. CONTENTS OF THE EDUCATIONAL ACTIVITY

To achieve the defined competencies, it is necessary to specify the content in cognitive,

procedural and attitudinal aspects that will be developed during the training.

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6. EDUCATIONAL MODALITY

Indicate the modality that best suits the content and skills to be achieved.
Consider the following modalities for short-term educational activities.

• In-service training
EDUCATIONAL TALK PLAN
1. Issue
2. Goals
3. Participants
4. Resources:

Date Topic content Time Place – Audiovisual Speaker

assistance

Conclusions:
………………………………………………………………………………………………
Recommendations:
………………………………………………………………………………………………
Literature:
………………………………………………………………………………………………

ANNEX 4

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29
30
31
32
33
34
35
36
37
ANNEX 5

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