Procedures

The investigator formally requested and obtained permission to carry out the study from the administration of the Nursing Campus Maharajgunj, Institute of Medicine. The Campus Chief of the Nursing Campus was officially requested for permission to conduct the sessions. The official request letter included aim of the study, topic, and total hours required for the study. Following meeting with the Campus Chief and the Head of department PCL 2^nd year nursing students, the date, time, number of sessions for the study, and other logistics were fully preplanned and worked out. The campus administration assured to provide the necessary logistic support for taking the sessions.

Step-1 Diarrhoea in children was chosen as the topic for instruction. Based on the PCL curriculum objectives, the details of the content were worked out and a pediatrician and one senior-nursing teacher thoroughly and independently verified the content before teaching in the classroom (Appendix E). Contents were discussed with pediatric doctor, nursing teacher and health profession educationist. As some of the contents were not clearly spelt out in the existing casuals, some new concepts were added such as; types of diarrhoea, causes of diarrhoea, signs of dehydration according to seventy classification of dehydration and complication (WHO, UNICEF, 1999).

Step-2 A Total of 16 question was designed based on the standard content on childhood diarrhoea. The questions were pilot tested in the nursing students of the same level. Their feedback and comments have been incorporated in the final set of questions (Appendix F).

A pilot study was conducted in Bir Hospital Nursing Campus located four kilometers away from Maharajgunj on 14^th September 1999 to test the appropriateness of the instruments. Five Students currently studying the PCL 2^nd year were randomly selected. A total of 16 questions were administered to these students. Their knowledge on diarrhoea was pre tested. A half an hour of testing time was sufficient for the pretest. Feedback was collected from the students. The investigator, a lecturer of the nursing campus of Maharajgunj and a medical educationist reviewed and analyzed the each questionnaire. Each item was thoroughly evaluated for appropriateness, clarity and readability based on the specific comments provided by the students. The modified version of the questionnaire following then pilot test is given in (Appendix F).

Step-3 A total of three sessions, each session lasting for 90 minutes were planned. Session-1 used lecture, Session-2 used small group discussion and session-3 used lecture coupled with small group discussion ('mixed') method (Appendix I). Session-3 was split into two halves. First 45 minute for lecture and second 45 was spent minutes for small group discussion (Appendix G). All together six students were dropped out in the Pre test and Posttest due to some personal reasons. Thus a total of fifty-four students participated in the study.

Step-4 Two nursing teachers with years of teaching experiences were selected to conduct the sessions. The teachers were briefed about the objectives of the study. The teachers were also provided with the list of total objectives in relation the topic on childhood diarrhoea (Appendix E). They also prepared guidelines to conduct the sessions. One teacher conducted the lecture session, the other conducted the small group discussion (Appendix H). During the "mixed" session, the first half was conducted by the same teacher who took lecture, and the second half by the one who organized small group discussion. The teachers had prior agreement on who should deal which objectives during the first and second halves of the session. Another teacher with many years of experience was selected to observe the delivery of the lecture, small group discussion and 'mixed' methods. She was oriented for the classroom observation.

Step-5 This study was conducted on 3^rd October 1999. A total of 60 nursing students were originally selected for the intervention. The students were randomly assigned to each of the three sessions (Appendix D I). It was planned that there will be twenty female students in each of the three groups. Each group will go through just one session. During the process six students dropped from the study due to personal reasons.

Step-6 Before starting the actual intervention students were given necessary information for example, the students from lecture group were not allowed to mix up with the small group discussion group and the mixed group and vice-versa. No students were forced to participate and ethics were taken into consideration. Each group underwent intervention for about one and half-hours only.

Step-7 At the beginning of each session students were administered pre-test questionnaire on the content of childhood diarrhoea. The same sets of questionnaire were administered in the post-test following each session (Appendix B). Pre-test/Post-test results were compared for each session. Similarly, the impact of each method based on post-test results were compared among each other.