HSOA of Practical and Professional Nursing Designing a Training Programme for School Health Nurses on Guiding Adolescents in their Decision-Making about Reproductive Health in Ijebu Ode Local Government Area of Nigeria (2)

This is the continuation of the first part of the article. This second part focused on specifying procedural elements of the intervention programme which constitutes the second operation of the design phase. Programme elements are the constituents of an interven tion programme. The elements for this intervention programme were derived from the findings from the situation analysis phase of the Intervention Design and Development model of Rothmans and Thomas, and information derived from the integrative review con ducted for this purpose. The use of information, skills and training for their acquisition, environmental change strategies, policy change or enforcement strategies, or reinforcement or punishment procedures constituted an integral component of procedural elements. In effect, specifying programme elements required the creation of programme content, facilitation, training methods, and delivery formats.


Introduction
Specifying procedural elements of the intervention programme constitutes the second operation of the design phase. Findings from the study showed that school health nurses were deficient in the necessary knowledge and skills needed to guide adolescents in decision-making about their reproductive health. There was an express need to bridge the knowledge and skill gap. The examination of different types of intervention programmes that had been developed for school health nurses in their respective areas of practice led to the conclusion that a training programme was the most appropriate intervention that could assist school health nurses in guiding adolescents in making decisions about their reproductive health. Programme elements are the constituents of an intervention programme [1]. The elements for this intervention programme were derived from the findings from the situation analysis phase of the Intervention Design and Development model and information derived from the integrative review [2]. Procedural elements may include the use of information, skills and training for their acquisition, environmental change strategies, policy change or enforcement strategies, or reinforcement or punishment procedures [2]. In effect, specifying programme elements entails creating programme content, facilitation, training methods, and delivery formats.

Facilitation
Facilitation entails efforts made by an individual or a group of individuals toward getting the learning content across to the trainees using the necessary resources and inputs toward achieving this end and through motivation and encouragement [3]. The stages involved in facilitation, according to [3], are as follows: setting the learning climate, identifying learning resources, running the learning group, and closing the group.

Training methods
There are three categories of training methods: expositive, application and collaborative. Each of these approaches use different methods of conveying a message to learners [4].

Expositive approach
Expositive approach entails the absorption of fresh information from the facilitator to the learners during programme implementation. The content topics constitute the information which school health nurses will acquire. It becomes translated into knowledge. The method of passing the information is through a lecture or presentation. Lecture methods are used in obtaining factual and conceptual knowledge, orientation and attitudinal change.

Application method
This involves the active processes that learners use in carrying out technical and principle-based activities in order to build new knowledge. One fundamental means of achieving this is role play. This is a situation where participants act out roles according to case studies with which they are presented in a given situation. School health nurses would be encouraged to act out how they will provide guidance to adolescents on their decision-making about their reproductive health.

Collaborative method
Collaborative approach encompasses social aspects of learning which focus not only on knowledge but on the promotion of interpersonal relationships through interactive learning effected through discussions. Discussions are a matrix of interactive outcomes of the group members. This approach would enable school health nurses share their respective contextual experiences regarding their practice and activities toward guiding adolescents in their decision-making on reproductive health.

Managing Group Dynamics during Programme Implementation
Group dynamics occur among members in a group as a result of their interactions and role relationship [5]. Group members, over time, undergo some processes which include forming, which has to do with orientation of members toward their expectations and storming, which borders on taking on leadership roles or taking on different roles within the group. Some of the roles are negative while some are positive. Norming and performing are other processes that require more commitment to the group goals. There is cohesion among the members of the group. Transforming is the last process which encompasses disengagement after the realisation of the group goals. It is assumed that the group goals have been achieved [6]. Some characteristics are identified with group dynamics as these include participation, communication, collaboration, influence, trust, cohesiveness and empowerment [7]. In the course of the emergence of these processes there are likely to be some challenges and tensions. The group facilitator should possess the requisite skills to address them. Some of likely problems and challenges that could arise out of the group activities include pairing, scapegoating, projecting, wrecking, or the development of hidden agendas [8][9][10].

Content Development
The content for the training programme was created by carrying out content identification through the use of task analysis and topic analysis methods. Task analysis focuses on areas designed to develop specific job-related or interpersonal skills while topic analysis is suitable for topics that are largely created to provide information [4]. Put differently, the task analysis method helps in creating topics that are job-centred, focused on skills acquisition, and also help in crafting case-based situations which are analogous to real-life scenarios. Topic analysis focuses on identifying content and its elements. School health nurses require knowledge of both the decision making processes and skills by adolescents, and the possession of skills needed to carry out the guidance activities. The topics and their elements were put in modules for ease of presentation and clarity. Content developers came up with six modules with each module covering every segment of the intervention based on the outcome of findings in phases one and two of this study. In addition, a list of references was generated in order to identify the sources of information used to develop the content of the module.

Results
The following modules were created with their respective content and elements.

Module 1: Roles and Responsibilities of School Health Nurses
• School health policy • Roles of school health nurses • Responsibilities of school health nurses

Purpose of the module
• To present an overview of the National School Health Policy.
• To identify the roles and responsibilities of school health nurses based on the National Health Policy.

Study unit 1.1: Overview of national school health policy in Nigeria
The school health programme which has school health service as an integral component is policy driven. The policy stipulates what the school health programme intends to achieve, and how each of the components will be implemented. After this unit, the recipients will: • Demonstrate an understanding National School Health Policy issues surrounding the implementation of school health service.

Study unit 1.2: Role expectations of school health nurses
School health nurses are statutorily mandated to perform certain roles and responsibilities in the school health service. The role definition, expectations and performance will be determined by health programme direction and needs of each of the components states of the country. At the end of this unit, recipients will: • Describe the roles and responsibilities of school health nurses based on the policy direction of School Health Programme.

Module 2: Concept of Adolescence
• Stages of adolescent development • Theories of adolescence

Purpose of the module
• To explore the concept and the implications of adolescence.

Study unit 2.1: Overview of adolescence
Adolescents constitute a vulnerable group and their centrality to this study occasioned the development of a training programme for school health nurses as to how they (adolescents) could be effectively guided in their decision making in reproductive health by school health nurses. After this study unit, the learners will: • Describe the meaning and stages of adolescence.

Study unit 2.2: Theories of adolescence
Theories constitute the conceptual lens of explaining issues and phenomena for the purpose of clear understanding. Adolescent theories are multi-dimensional as one single theory cannot capture the features and activities inherent in the stage. After the study unit, the learners will: • Demonstrate an understanding of theories of adolescence by being able to identify and describe them.

Study unit 3.1: Reproductive health
Reproductive health is critical to adolescents, and it formed the bedrock of this study. Adolescent reproductive health needs have been acknowledge as essential toward stemming the mortality arising from this essential aspect of human life. After this unit, learners will: • Describe the historical developments of reproductive health; enumerate reproductive rights, highlight factors affecting reproductive health; and give an overview of both male and female reproductive tracts.

Study unit 3.2: Adolescent reproductive health
Adolescent reproductive health is an integral aspect of reproductive health. Poor attention and commitment to their reproductive health have largely contributed to increased mortalities among this group of individuals. After this unit, learners will: • Identify and describe components of adolescent reproductive health.
• Identify and describe factors influencing adolescent reproductive health.

Module 4: Adolescent decision making
• Decision making models • Adolescent decision-making theories • Adolescent decision-making processes in reproductive health • Decision-making skills • Factors influencing adolescent decision-making in reproductive health

Purpose of the module
• To describe decision making processes.
• To describe and delineate adolescent making processes.

Study unit 4.1: Overview of decision making process
Decision making is a necessary activity in human's life. Individuals make decisions on a daily basis which help them to operate at the optimum level of functioning. Understanding decision making process is basic to that of adolescent process. It enables one to know where the deviation lies in terms of how adolescents make their decisions.
• Identify and describe decision making models and processes.

Study unit 4.2: Adolescent decision making processes
Decision making by adolescents have been found to be critical to their reproductive health outcomes. Adolescents engage in risky behaviours which are informed by poor decision making abilities. School health nurses have a role to play toward guiding them in their decision making on reproductive health issues. School health nurses have to be effectively prepared by having a good knowledge and understanding of adolescent decision making processes as these will enable them in providing effective guidance. After this study, learners will: • Identify and describe adolescent decision making models, and their process of making decisions.

Module 5: Guidance
• Emergence of guidance • To describe guiding adolescents decision making in reproductive health.

Study unit 5.1: Introduction to guidance
This study focuses on how school health nurses can be assisted toward guiding adolescents in their decision making on reproductive health. This study unit will highlight the historical development, types, principles and conceptual perspectives on guidance. After this unit, learners will: • Demonstrate an understanding of historical development of guidance by recounting history of guidance, identifying and describing types of guidance.
• Demonstrate the knowledge of principles and perspective of guidance by being able to enumerate the principles, and describe the link of conceptual perspective to guidance.

Study unit 5.2: Process of guiding adolescents in decision making on reproductive health
Assisting school health nurses on guiding adolescents in their decision making on reproductive health is the basis of this study. School health nurses need to be equipped with the guidance skills and knowledge required for the purpose. At the end of this unit, learners will: • Exhibit expected knowledge of interpersonal skills • Demonstrate a good understanding of processes of interpersonal skills • Display an appropriate grasp of guidance process in respect of adolescents' decision making in reproductive health. • Demonstrate knowledge of application of guidance skills to decision making of adolescents in reproductive health.

Study unit 6.1: Interactions with adolescents and school teaching staff
Communication is an integral component of guidance skills, and an essential ingredient in building good relationships and interactions with adolescents which they guide in their decision making on reproductive health on the one hand, and the school academic staff with whom they have working relationship on the other. After this study unit, learners will: • Describe different types and modes of communication.
• Describe interpersonal communication need for building relationships with adolescents and teaching staff.
• Demonstrate understanding of application of communication skills in developing interpersonal relationship between them and adolescents on the one hand, and between them and school staff on the other.

Conclusion
Design phase is the link between the outcome of the phases of problem analysis and project planning, information gathering and synthesis and development and pilot testing phase. It outlines the expectations during the pilot-testing phase. A poorly designed intervention would practically, not be able to achieve its stated purpose. In effect, design is the framework of an intervention programme.