Background material by Professor Omar Hasan Kasule Sr. for the Communication Module FOM KFMC 6th and 13th October 2009
1.0 BED-SIDE VISITS
The physician-patient interaction is both professional and social. The bedside visit fulfills the brotherhood obligation of visiting the sick. The human relation with the patient comes before the professional technical relation. It is reassurance, psychological and social support, show of fraternal love, and sharing. A psychologically satisfied patient is more likely to be cooperative in taking medication, eating, or drinking. The following are recommended during a visit: greeting the patient, dua for the patient, good encouraging words, asking about the patient’s feelings, doing good/pleasing things for the patient, making the patient happy, and encouraging the patient to be patient, discouraging the patient from wishing for death, nasiihat for the patient, reminding the patient about remembrance of God. Caregivers should seek permission before getting to the patient. They should not engage in secret conversations that do not involve the patient.
2.0 ETIQUETTE OF THE PATIENT
The patient should express gratitude to the caregivers even if there is no physical improvement. Patient complaints should be for drawing attention to problems that need attention and not criticizing caregivers. The patient should be patient because illness is expiation for sins, kaffaarat, and Allah rewards those who surrender and persevere. The patient should make dua for himself, caregivers, visitors, and others because the dua of the patient has a special position with Allah. When a patient sneezes he should praise Allah and the mouth to avoid spread of infections. It is obligatory for the attendants to respond to the sneezer. The patient should try his best to eat and drink although the appetite may be low. The caregivers can not force the patient to eat. They should try their best to provide the favorite food of the patient. The believing patient should never lose hope from Allah. He should never wish for death. The patient should try his best to avoid anger directed at himself or others. Getting angry is a sign of losing patience.
3.0 ETIQUETTE OF THE CARE-GIVER
The caregiver should respect the rights of the patient regarding advance directives on treatment, privacy. access to information, informed consent, and protection from nosocomial infections. Caregivers must be clean and dress appropriately to look serious, organized and disciplined. They must be cheerful, lenient, merciful, and kind. They must enjoin the good, have good thoughts about the patients and avoid evil or obscene words. They must observe the rules of lowering the gaze and khalwat.
Caregivers must have an attitude of humbleness, They cannot be emotionally-detached in the mistaken impression that they are being professional. They must be loving and empathetic and show mercifulness but the emotional involvement must not go to the extreme of being so engrossed that rational professional judgment is impaired.
They must make dua for the patients because pre-determination, qadar, can only be changed by dua.. They must seek permission, izin, when approaching or examining patients. Medical care must be professional, competent, and considerate.
Medical decisions should consider the balance of benefits and risks. The general position of the Law is to give priority to minimizing risk over maximizing benefit. Any procedures carried out must be explained very well to the patient in advance. The caregiver must never promise cure or improvement. Every action of the caregiver must be preceded by basmalah. Everything should be predicated with the formula inshallah, if Allah wishes.
The caregivers must listen to the felt needs and problems of the patients. They should ask about both medical and non-medical problems. Supportive care such as nursing care, cleanliness, physical comfort, nutrition, treatment of fever and pain are as important as the medical procedures themselves and are all what can be offered in terminal illness. Caregivers must reassure the patients not to give up hope. Measures should be taken to prevent nosocomial infections.
4.0 ETIQUETTE OF INTERACTION BETWEEN GENDERS
Both the caregiver and patient must cover nakedness, awrat, as much as possible. However, the rules of covering are relaxed because of the necessity, dharurat, of medical examination and treatment. The benefit, maslahat, of medical care takes precedence over preventing the harm inherent in uncovering awrat. When it is necessary to uncover awrat, no more than what is absolutely necessary should be uncovered. To avoid any doubts, patients of the opposite gender should be examined and treated in the presence of others of the same gender.
The caregivers should be sensitive to the psychological stress of patients, including children, when their awrat is uncovered. They should seek permission from the patient before they uncover their awrat. Caregivers who have never been patients may not realize the depth of the embarrassment of being naked in front of others.
Medical co-education involves intense interaction between genders: Teacher-student, student-student, and teacher-teacher. Interacting with colleagues of the opposite gender raises special problems: norms of dress, speaking, and general conduct; class-room etiquette; social interaction; laboratory experiments on fellow students; Clinical skills laboratory: learning clinical skills by examining other students;
Medical personnel of opposite genders should wear gender-specific garments during surgical operations because our culture frowns on any attempt to look like the opposite gender.
Guidelines on interaction with patients of the opposite gender should be followed. Taking history, physical examination, diagnostic procedures, and operations should preferably be by a physician of the same gender. In conditions of necessity a physician of the opposite gender can be used and may have to look at the ‘awrat or touch a patient. The conditions that are accepted as constituting dharuurat are: skills and availability.
5.0 DEALING WITH THE FAMILY
Visits by the family fulfill the social obligation of joining the kindred and should be encouraged. The family are honored guests of the hospital with all the rights of a guest. The caregiver must provide psychological support to family because they are also victims of the illness because they anxious and worried. They need reassurance about the condition of the patient within the limits allowed by the rules of confidentiality. The family can be involved in some aspects of supportive care so that they feel they are helping and are involved. They should however not be allowed to interrupt medical procedures. Caregivers must be careful not to be involved in family conflicts that arise from the stresses of illness.
0910L-GROUP DISCUSSION IN A STUDY GROUP
Discussion material by Professor Omar Hasan Kasule Sr. for the Communication Module FOM KFMC 6th and 13th October 2009
1.1 Membership: Members of the study group should be of the same age groups and preferably same academic level. It is however possible to mix people of different ages and academic levels so that the young can learn from the older.
1.2 Leadership of discussion: The Naqib can lead discussion in some sessions and is also encouraged to delegate this responsibility to various members of the usra. Whoever has the responsibility for leading discussions must take 20-30 minutes preparing for the session
1.3 Start and end: Members should start by reciting surat al fatihat and should adjourn with recitation of dua kaffarat al majlis
1.4 Scheduling: Meetings of the study group should be schedules in advance. They are preferably associated with acts of ibadat. The best times are therefore: before salat al fajr, after salat al fajr, before salat al jumu’at, after salat al asr, before salat al maghrib, and between salat al maghrib and salat al isha.
1.5 Time management: The leader must make sure that all items on the agenda are covered. Time should be left at the end to deal with any other matters that may arise or to solve any problems that may arise.
1.6 Management of the discussions: The leader should make sure that all members participate. This can be achieved by being pro-active ie addressing questions to individuals or inviting them to make comments. If a member is unable to say anything or is unwilling or otherwise reluctant, the leader should not insist but should move on to the next member. Very talkative members should not be allowed to dominate the discussions. The leader should politely re-direct any speaker who veers off the topic of discussion.
1.7 Evaluation, muhasabat: Special sessions should be set aside for collective self-evaluation by members of the discussion group. The parameters of this evaluation should be agreed on by all. The evaluation could cover the group and its activities or could extend to other activities of the members. The purpose should be fostering the spirit of sharing experiences and self-criticism
1.8 The etiquette of discussion, adab al hiwaar
Members should greet one another before starting. All members should endeavour to know one another by name. Any member wanting to go out for a valid reason must obtain the permission of the leader. All members must learn to listen and not interrupt others. They must obey the instructions of the leader. Members must avoid quarrels or loud arguments. A spirit of tolerance should exist with the understanding that there could be more than one way of being right. Excessive laughing or joking should be avoided. Members should sit with proper adab.
0910L-SCIENTIFIC WRITING
Discussion material by Professor Omar Hasan Kasule Sr. for the Communication Module FOM KFMC 6th and 13th October 2009
The goal of scientific writing is clarity. The following must be observed about sentences: short concise sentences, use of personal pronouns, subject-verb agreement is a common mistake, using active and avoiding passive sentences, proper organization of parallel ideas, and proper use of parentheses.
A paragraph must start with a short and simple topic sentence that is an overview of the message contained in that paragraph. Each paragraph should convey only one message. The sentences following the topic sentence provide details and support for the topic sentence. Ideas in a paragraph should be presented in the right order with no missing steps using one of the following alternatives: least to most important, most to least important, concise to the detailed, time chronological order, problem followed by solution, or solution followed by the problem. Links and transitions such as ‘which is’ should be used when moving from one group of ideas to another to ensure continuity in the paragraph. There must be consistency in the order in which information is mentioned. If certain objects were mentioned in a certain order in the introduction, they must be mentioned in the same order all through the writing. The writer should maintain a consistent viewpoint all through the paper and not appear to be jumping from point to point. Important messages must be given emphasis.
The purpose of the title is to identify the main topic or message of the paper so as to attract readers. A good title is unambiguous, concise, and contains important words. It should contain the following: independent variable(s), dependent variable(s), the study subjects or materials, and statement of the main message like ‘to study the effect of’, ‘to determine’ etc.
The abstract is an overview of the report with a few significant details. It should be written to be read by both those who read the full paper and those who do not read the full paper. Normally the abstract should not exceed 250 words. The abstract should mirror the sections of the paper: introduction, materials & methods, results, and discussion. The present tense is used to state the research hypothesis and the answer. The past tense is used for the experiment. An abstract is accompanied by keywords that are used for indexing.
The introduction should be short. It should start with stating the research question or research hypothesis and then go on to elaborate. The transition should be from the known to the unknown and from the big picture to the detail. The introduction should mention the type of study, the study subjects or materials (substances, animals, and persons). In some cases the introduction may briefly mention the proposed experimental approach to answering the research question. Results should not be mentioned in the introduction. The introduction should state whether the work is new or original.
The aim of the materials and methods section is to describe the experimental techniques in detail sufficient for another trained scientist to replicate the procedures. The order of presentation is different for animal and clinical studies. For animal studies the order is: materials and animals, preparation, study design, interventions, methods of measurement, calculations, and data analysis. For clinical studies the order is: study subjects, inclusion criteria, exclusion criteria, study design, interventions, method of measurement, calculations, and data analysis. Independent and dependent variables should be identified. Intermediate results can be put in the materials and methods section. Final results should be put only in the results section. Details of sample size determination should be provided.
The results section presents the findings of the procedures carried out in the methods section. It should be brief and to the point. A distinction must be made between results and data. Result refers to summary information obtained from data analysis. Results of hypothesis-based studies should be in the past tense. Data of descriptive studies should be in the present tense. Data is the actual numerical information often presented in a summarized form. The result is presented followed by presentation of supporting data. Data are presented in the form of tables and diagrams (figures, bar diagrams, graphs, pie-charts, maps etc). Presentation of numerical data in text should be kept to a minimum. Only results relevant to the research hypothesis should be presented. Both negative and positive results are presented. It is considered scientific fraud to present only those results that the author thinks favor a particular hypothesis. The results section is written in chronological order. The most important results are presented before the least important. Magnitude of change should be presented as a summary statistic such as percentage change instead of presenting the raw data. Summary statistics normally used as the mean, the median, and the the proportion. The mean should be presented properly as mean +/- standard deviation or standard error of the mean (SD or SE) with units of measure indicated. Measures of effect are normally the chisquare and the t statistics. Actual p values should be given instead of indicating <0.05 or >0.05. When specifying the sample size the type of sample should be explained for example ‘the sample was 20 rats’ instead of the sample size was 20’. Emphasis can be put on some results and not others. Not all the data from the study need be reported. Citing data in the text takes less space but is more difficult to read. A topic sentence is used to give an overview. Important results are put first.
Figures used to present results must have a strong visual impact and must be simple. The following types of figures are used: line graph, scatter-gram, bar graph, histogram, and the frequency polygon. The title of the figure should reflect its contents. It must be labeled correctly. Symbols must be defined. The names of variables and units of measurement must be labeled appropriately. Tables must be properly titled and column headings clearly indicated. Footnotes, subscripts, and superscripts can be used.
The discussion section states the research hypothesis, answers it, and supports the answers using data from the current study and other studies. It provides reasons to show that the answer to the question is reasonable. It explores and explains possible sources of error and bias. It also identifies and explains differences between the study results and published results. As part of intellectual honesty it discusses the strengths as well as the weaknesses of the study and how they impact on the interpretation of the results. Issues of validity and precision are also addressed. Also discussed is whether the result is new and how important it is.
References are used to acknowledge information obtained from others. The references must be the most recent and most easily available on the subject. Review articles are better than original articles. They may be journal articles, books, PhD theses, abstracts of meetings, or conference proceedings. The reference should be put immediately after the relevant text. If there are several references in a sentence, cite each reference at the relevant point and do not wait to put all of them at the end of the sentence. References should be written using the Vancouver style which is: Author. Title. Journal Year; Volume (number): starting page – ending page.
0910L-USE OF MASS MEDIA FOR HEALTH COMMUNICATION
Discussion material by Professor Omar Hasan Kasule Sr. for the Communication Module FOM KFMC 6th and 13th October 2009
Medium | Strengths | Weaknesses |
Newsletter | ||
Magazine | ||
Newspaper | ||
Poster | ||
Radio | ||
Television | ||
Cable TV | ||
Religious Sermons | ||
Outdoor advertizing |
0910L-NATURE and PURPOSE OF NEGOTIATIONS
Backgtround material by Professor Omar Hasan Kasule Sr. for the Communication Module FOM KFMC 6th and 13th October 2009
1.0 OVERVIEW
Negotiations are pervasive: Leaders spend a lot of their time in negotiations. Daily life, public or private, revolves around negotiating with others. You may not even be conscious of being involved in negotiations. Most major decisions, private and public, are not unilateral. They involve negotiations with others to reach an acceptable consensus.
2.0 PURPOSES OF NEGOTIATIONS
Negotiation is necessary to protect your interests, and get as much advantage as possible without entering into costly and bruising confrontations. Most conflicts can be resolved through negotiation. Good negotiation turns confrontation into cooperation. Physicians must be able to negotiate with their patients and relative to agree on a treatment plan otherwise a lot of conflicts and misunderstandings will occur.
Learning negotiation skills: Negotiation skills can be learned. They can be improved by experience and discussions with experienced negotiators.
3.0 WIN-WIN NEGOTIATIONS
What is win-win negotiation?: Negotiations can be win-win in which each party leaves satisfied or win-lose in which one party leaves with a feeling of winning and the other leaves with a feeling of having lost. A win-win outcome is the best in a negotiation. It ensures that each party gets the maximum it can from the transaction, part as friends who can work together again. Both objectives and relations have to be considered. Future relationships may be lost by aggressive pursuit of objectives.
Win-win negotiation requires avoiding stereotyping the other party. Such stereotypes confuse your judgment. Win-win negotiation requires avoiding extremes. The just equilibrium is the way to negotiate. Win-win negotiation is joint problem-solving; the alternative is power negotiation using threats, intimidation, and other power tactics that will end in deadlock. Win-win negotiation focuses on positive solutions. It aims at reaching an agreement satisfactory to both sides by a process that is as painless as possible. Satisfaction could be achieved even if one party has through miscalculation compromised its interests. It is all well as long as they are not aware of their mistake.
Elements of win-win negotiation: Win-win negotiation has the following elements: separating people from the problem, looking at interests and not positions, creating options for mutual gain, getting all parties to use objective criteria, enough time to prepare for and carry out negotiations. and optimum circumstances under which negotiation is carried. The focus should be on solving problems and not on personalities. Interests and not positions should be defended. A negotiating position can be given up or changed without giving up your interests. Options for mutual gains should be vigorously explored. Win-win negotiators concentrate on objective criteria. A win-win outcome in negotiations requires enough time to prepare so that decisions and moves are well-studied and are not emotional reactions.
Alternative to win-win: If you are not interested in a win-win outcome, you have the liberty not to negotiate at all and to use other approaches to solving the problem.
