Facilitation Skills for Nurses

Using the pcrson-centered approach, facilitation in this study was conceptualised as providing opportunities for personal growth in the patient, and operationalised in a skills workshop for 40 nurses from different hospitals in Gauteng. The first objective was to evaluate the workshop and the second to ascertain its effect on the participant’s experienced performance. A combined quantitative and qualitative research design was used. The quantitative measurement (Personal Orientation Inventory, Carkhuff scales) indicated that the workshop stimulated self-actu­ alisation in terms of intrapersonal awareness, and the in­ terpersonal skills of respect, realness, concreteness, em­ pathy, as well as in terms of attending and responding behaviour. The qualitative measurement (a semi-structured interview) indicated that the participants were able to empower patients to find their own answers to difficult personal questions. The alternative hypothesis was ac­ cepted, namely that this workshop in facilitations skills significantly enhanced the intraand interpersonal char­ acteristics associated with self-actualisation and the fa­ cilitation of growth in patients. The findings highlighted the difference between the two roles of instructor and fa­ cilitator, and recommendations to this effect were formu­ lated. Opsomming Vanuit die persoonsgesentreerde benadering, is fasilitering in h ie rd ie s tud ie g ek o n se p tu a lise e r as die beskikbaarstelling van geleenthede vir persoonlike groei in die p asiën t, en g e o p e ra s io n a lise e r in ‘n vaardigheidswerkswinkel vir 40 verpleegkundiges van verskillende hospitale in Gauteng. Die eerste doelstelling was om die werkswinkel te evalueer en die tweede om die effek daarvan op die deelnemer se ervaarde prestasie te bepaal. ‘n Gekombineerde kwantitatiewe en kwalitatiewe navorsingsontwerp is gebruik. Die kwantitatiewe meting (Persoonlike Oriëntasievrealys, Carkhuffskale) het daarop gedui dat die werkswinkel selfaktualisering gestimuleer het in terme van intrapersoonlike bewustheid, en die in terp erso o n lik e vaard ighede van respek , eg theid , konkreetheid, em patie, sowel as aandaggew ingsen responderingsgedrag. Die kwalitatiewe meting ( ‘n semigestruktureerde onderhoud) het daarop gedui dat die deelnemer daartoe in staat is om pasiënte te bemagtig ten einde hul eie antwoorde op moeilike persoonlike vrae te vind. Die alternatiewe hipotese is aanvaar, naamlik dat hierdie werkswinkel in fasiliteringsvaardighede die intraen interpersoonlike kenmerke wat inet selfaktualisering en die fasilitering van groei in pasiënte geassosieer word, beduidend verhoog. Die bevindinge het die verskil tussen die twee rolle van instrukteur en fasiliteerder beklemtoon, en aanbevelings hieroor is geformuleer.

and the second to ascertain its effect on the participant's experienced performance.A combined quantitative and qualitative research design was used.The quantitative measurement (Personal Orientation Inventory, Carkhuff scales) indicated that the workshop stimulated self-actu alisation in terms o f intrapersonal awareness, and the in terpersonal skills of respect, realness, concreteness, em pathy, as well as in terms o f attending and responding behaviour.The qualitative measurement (a semi-structured interview ) indicated that the participants were able to empower patients to find their own answers to difficult personal questions.The alternative hypothesis was ac cepted, namely that this workshop in facilitations skills significantly enhanced the intra-and interpersonal char acteristics associated with self-actualisation and the fa cilitation of growth in patients.The findings highlighted the difference between the two roles of instructor and fa cilitator, and recommendations to this effect were formu lated.

Opsomming
Vanuit die persoonsgesentreerde benadering, is fasilitering in h ie rd ie stu d ie g e k o n s e p tu a lis e e r as die beskikbaarstelling van geleenthede vir persoonlike groei in die p a sië n t, en g e o p e ra s io n a lis e e r in 'n vaardigheidsw erksw inkel vir 40 verpleegkundiges van verskillende hospitale in Gauteng.Die eerste doelstelling was om die werkswinkel te evalueer en die tweede om die effek daarvan op die deelnemer se ervaarde prestasie te bepaal.'n Gekombineerde kwantitatiewe en kwalitatiewe navorsingsontwerp is gebruik.Die kwantitatiewe meting (Persoonlike Oriëntasievrealys, Carkhuffskale) het daarop gedui dat die werkswinkel selfaktualisering gestimuleer het in term e van intrapersoonlike bew ustheid, en die in te rp e rso o n lik e v aa rd ig h e d e van re sp e k , eg th e id , konkreetheid, em patie, sow el as aandaggew ings-en responderingsgedrag.Die kwalitatiewe meting ( 'n semigestruktureerde onderhoud) het daarop gedui dat die deelnemer daartoe in staat is om pasiënte te bemagtig ten einde hul eie antwoorde op moeilike persoonlike vrae te vind.Die alternatiewe hipotese is aanvaar, naamlik dat hierdie werkswinkel in fasiliteringsvaardighede die intraen interpersoonlike kenmerke wat inet selfaktualisering en die fasilitering van groei in pasiënte geassosieer word, beduidend verhoog.Die bevindinge het die verskil tussen die twee rolle van instrukteur en fasiliteerder beklemtoon, en aanbevelings hieroor is geformuleer.

Introduction
As applied to the helping professions, facilitation originated from group therapy (Raskin, 1986a(Raskin, , 1986b) ) with hospital patients (B raaten, 1986) as well as from person-centered groups used in the National Training Laboratory (NTL) tra dition (Reddy & Henderson, 1987).Today, it is applied in education (Rogers, 1982), as well as in industry and organi sations in general (Cilliers, 1996) and refers to the helper's role as a resource or indirect guider (Patrick, 1992:331-340).As a communication skill (Du Toil, Grobler & Schenk, 1998;Plas, 1996) it provides an opportunity for the client (or pa tient) to experience aspects of the self, thereby stimulating the process of personal growth and taking responsibility for reaching his/her goals (Bentley, 1994;Corey, 1990:65-66;Goldstein, 1993:273-299;Gordon, 1994:208-212;Kinlaw, 1993;W eaver & Farrell, 1997).Although sometimes con fused with instruction, facilitation differs from pedagogic and autocratic ways of instructing the patient (O 'Connor, Bronner & Delayney, 1996:320), and focuses rather on empowering the person to make use of his/her own potential to develop.The process whereby individual empowerment is facilitated is best described in humanistic psychology (Quitmann, 1985), the person-centered approach (Corey, 1990;Rogers, 1975aRogers, , 1975b;;Sklare, Kenner & Mas, 1990;Westley & Waters, 1988) and the human potential movement (Carkhuff, 1969(Carkhuff, , 1972(Carkhuff, , 1983;;Egan, 1990aEgan, , 1990b;;Ivey, 1971).This framework of fers a strong "tool" for the enhancement of personal growth amongst patients, which is directly influenced by the nurse's level of self-actualisation and helping communication skills, called nursing "for the better" .Nursing "for the worse" refers to the opposite, which leads to hindering the patient in his/ her personal learning and growth (Carkhuff, 1983).From the findings above, the general hypothesis in this study is formu lated, namely, that the nurse whose self-actualisation and helping com m unication skills are enhanced will act in an empowered way in an interactive nursing situation, and thus empower patients towards personal growth.

Facilitation
Facilitation is conceptualised as the nurse's ability to create an accommodating climate and to provide an opportunity for the release o f the patient's actualising tendency (Carkhuff, 1983;Rogers, 1973Rogers, , 1982)).This depends upon the quality of the relationship between the nurse, who is functioning on a high level o f self-actualisation with its accompanying intraand interpersonal characteristics, and the patient, who as a result, learns how to learn and thus experiences personal growth.

Knowledge
This refers to the insight into and understanding of individual and group behaviour (Rogers, 1975a(Rogers, , 1975b)).The facilitator understands the nature o f the self, of interactions between the self and others as well as the facilitation process.

S e lf-ac tu alisa tio n
This term describes a natural, dynamic and creative growth process in which the individual, while fully acknowledging his/her own responsibility, gradually develops a unique sense of integration and wholeness through self-definition and the optimisation of psychological potential, and in whom the ex pression of the actualising tendency leads to enhancem ent and enrichment of life, intrapersonally as well as interpersonally (Hirschenbaum & Henderson, 1993;Maslow, 1971;Rogers, 1982).Intrapersonal characteristics are those related to cognitive, affective and conative behaviour (Hirschenbaum & Hender son, 1993;Rogers, 1973Rogers, , 1982)).* Cognitive.Realistic, objective and flexible thinking with out inappropriate feelings such as guilt, shame, inferiority or superiority influencing the thinking process.* Affective.Sensitivity towards one's own feelings and emo tions (yet neither hypersensitive nor insensitive), which are honestly recognised, taken responsibility for and expressed in a natural and self-respectful way.This process stimulates self-knowledge, insight, a realistic self-concept characterised by self-respect, acceptance, confidence, a sense of one's own worth and a purposeful involvement in meaningful life situa tions.* Conative.Acting from an internal locus of control, in an independent, autonom ous, self-directed way, experiencing freedom of choice without feeling victimised by external forces.Interpersonal characteristics refer to the facilitator's showing an optim istic and unconditional acceptance o f and respect towards the patient, a preference for qualitative, intimate, deep, rich and rewarding interpersonal relationships, and sensiti vity, consideration and love towards others (Hirschenbaum & Henderson, 1993;Maslow, 1971).These factors allow for genuine, spontaneous, non-exploitative and responsible non verbal and verbal contact with the patient, in terms of the unique demands of each situation.This "sensitive relation ship forming" (Cilliers & Wissing, 1993) involves the initia tion of facilitative interpersonal processes and the creation of a re la tio n a l c lim a te th a t can s tim u la te c o n s tru c tiv e interactional processes between the facilitator's self and the patient, irrespective of any difference in for example gender, race or status.

The facilitation process
This process consists of two phases, namely attending, lead ing to involvement, and responding, leading to exploration.Within each, the facilitator exhibits the skills of respect, real ness, concreteness and em pathy, referred to as the core facilitative dimensions (Corey, 1990;Meador, 1975;Rogers, 1957Rogers, , 1982)).* Respect.A profound recognition and appreciation of and regard for the value of the patient as a unique person and for his/her rights as a free individual, irrespective of differences, manifesting itself in warmth, unconditional positive regard and in the quality of the attention given to the patient.* Realness.The degree of correspondence and congruence between what the facilitator says or does, and what he/she truly feels and means, existing in an honest, sincere and trans parent way, without affectations.* Concreteness.The extent to \Vhich the personal or taskrelated information that is reflected back to the patient is spe cific and factual, rather than vague or over-generalised, thus contributing towards accurate and clear communication.* Empathy.The ability to transcend one's own self-conscious ness in order to arrive at a conscious and accurate understan ding o f the patient's deepest feelings and intentions, in terms of the latter's own frame of reference, and to explicitly com municate this understanding to the patient (without prescrip tion, evaluation or assessment).

Attending with respect, leading to involvem ent
The facilitator attends to the verbal (listening to what is said and how) and non-verbal (looking at body language) behav iour of the patient, with respect for the patient's right to expe rience whatever he/she is going through, stimulating him/ her to become involved in the here-and-now of the experi ence.

Responding with realness, concreteness and em pathy, leading to exploration
The facilitator responds by reflecting the patient's observed content and feeling, for example, "what I hear you say is ...", "you seem to fe e l....", "you experience ... and that makes you feel ..." .The facilitator (1) models realness, (2) phrases the core experience in a concrete way and (3) reflects with em pa thy from the frame of reference of the patient (instead o f the facilitator's own) in "you"-language, to facilitate the patient's identification with the experience.This stimulates the patient's self expansion and growth, characterised by his/her aware ness of his/her own subjective experiencing, inner feelings, incongruities between beliefs and behaviours, the willingness to listen to and trust the self and to rely on his/her awareness.The patient's identification with the response gives the facili tator feedback on the level o f accuracy of his/her listening and looking.

Research question, aim and design
The research question is stated as follows: can the above fa cilitation characteristics and skills, be stimulated amongst nurses when operationalised in a workshop and what effect will this have on the participant's experienced nursing per formance?The aim is, firstly, to evaluate such a workshop in facilitation skills and, secondly, to ascertain its effect on the participant's experienced performance.Quantitative research is undertaken to evaluate the workshop and qualitative re search to ascertain the nurse's experience.The workshop is seen as the independent variable and the facilitating skills as the dependent variable.

Method
The workshop in facilitation skills * Aim of the workshop.This is to provide an opportunity for nurses to gain knowledge about, experience in and the skills of facilitation as defined and described above.* Module 1 -Knowledge.A short instructional, self-study and self-examination method in the form of a handout is used.The aim is to study literature on facilitation and self-actuali sation with its intra-and interpersonal characteristics, as well as the facilitation process described from the person-centered approach (Rogers, 1975a(Rogers, , 1982)).The workshop starts with a summary of this content (1 session / 1 hour).* Module 2 -Intrapersonal awareness.Encounter group ex periences with two facilitators are used (Rogers, 1975a).The aim is to provide an opportunity at the beginning of the work shop to experience the facilitation process as well as to en hance intrapersonal awareness.Next, these experiences are scheduled in between other workshop modules, providing op portunities to reflect on personal learning during the work shop (6 sessions / 9 hours).* Module 3 -Interpersonal skills.The facilitation process is operationalised (Carkhuff, 1978(Carkhuff, , 1983;;Egan 1990aEgan , 1990b) ) with the aim of practising attending and responding behav iour.Role-play in role of facilitator, in one-to-one and group situations, is used, receiving feedback from the presenters and using self m easurem ent according to the C arkhuff (1969) scales for respect, realness, concreteness and empathy (5 ses sions / 7,5 hours).* Module 4 -Revision and application.An open discussion with two facilitators is used.Revision aims to ascertain the level of learning taking place, and application aims to proc ess the workshop experience and to support the transfer of learning back to the work situation (5 sessions / 6.5 hours) * Administration of the workshop.A small group format with between eight and twelve participants and two presenters is used.The authors acted as presenters in the roles of instruc tor (in modules 1 and 3) and facilitator (in modules 2 and 4).To ensure enough time for intensive personal and interper sonal experiences, the workshop lasted 24 hours (excluding tea and lunch times), held over three working days.Table 1 contains the workshop programme.

The population and sample
The population consists of nurses from nine large hospitals in Gauteng Province, each with a three year nursing diploma and at least 5 years nursing experience.The female/male ra tio was 86%/14% with ages ranging between 24 and 65 years.A voluntary sample of 80 was drawn, and individuals were paired off according to gender and age into an experimental (N=40) and a control group (N=40).To accommodate work

Quantitative m easurem ent
Knowledge was not measured.M easuring instruments were chosen according to the personality characteristics o f the fa cilitator.For the intrapersonal characteristics the Personal Ori entation Inventory (POI) (Shostrom, 1974;Knapp, 1990) and for the interpersonal skills, the Carkhuff scales (1969) were used.Both instruments correspond conceptually with the above definitions and characteristics and are seen as the most ap propriate available for measuring these behaviours (Cilliers & Wissing, 1993).Cilliers (1996) reports high reliability and validity for the POI and Carkhuff scales in sim ilar training scenarios.The empirical hypothesis is form ulated as: partici pation in the workshop in facilitation skills, does not enhance any intra-or interpersonal characteristics associated with selfactualisation or the facilitation o f grow th in patients.

Q ualitative m easurem ent
A voluntary 30-minute, sem i-structured, tape-recorded inter view was conducted by the researchers with each participant, and transcribed.The aim o f the interview was to ascertain the long-term effect o f the workshop on nursing performance.A single question was asked, namely: "How did the work shop affect your perform ance as a nurse?".A fter this the in terviewee was encouraged to give more responses by the in terview er's summarising and reflecting on the patient's al ready given m aterial according to the person-centered ap proach (Rogers 1975b(Rogers , 1982)).The interview was analysed by means of content analysis (Strauss & Corbin, 1990), and spe cifically open coding (a process o f breaking down, exam in ing, comparing, conceptualising and categorising data).By this means the main and sub-them es and their relationships were determ ined (Jones, 1996;Kerlinger, 1986).Trustwor-Curationis thiness was ensured by having the results checked by two psychologists, to whom these techniques are well known.

Procedure
A brochure, explaining the aims and adm inistration o f the workshop, was sent to all nine identified hospitals, asking for voluntary participants am ongst nurses who fitted the above requirements o f qualification and experience.Four workshop events were scheduled.Four weeks prior to each workshop, the handout was given to every participant in the experim ental group.Before starting each workshop, the quantitative instruments were adm inis tered as a pre-m easurem ent to both the experim ental and the control groups.Then the control group went on with their daily activities w hile the w orkshop was presented to the experim ental group.Im m ediately after each workshop, the instruments were adm inistered again as a post-measurement, to both groups.The Carkhuff (1978) scales were adm inistered in two situa tions.The first was a written com m unication situation con taining typical verbal nursing questions o f a challenging na ture to which the respondent had to react and then record his/ her own spontaneous verbal reaction.The second was an in dividual role-play recorded on video, with the respondent acting as the nurse in a five minute interaction with a second person in the role o f patient, who threatens to leave the hos pital in fear o f illness and an upcom ing operation.
The quantitative data was processed collectively for all the experim ental and all the control groups.The significance of any differences between pre-and post-m easurem ent (i-test) was calculated by means o f the S AS Com puter package (S AS Institute, 1985).Each workshop participant (in the experi m ental group) was contacted three months after the w ork shop, ensuring that he/she had had enough tim e to use the newly acquired behaviour.Then the interview was conducted and analysed.

Q u antitative m easurem ent
The results of the measured intrapersonal characteristics are presented in table 2.
The POI results indicate that the w orkshop stim ulated the follow ing ch aracteristics sig n ifican tly : tim e com petence focussing on the here and now, behaviour m otivated from a sense o f inner-directedness, living according to the values of self-actualisation, flexibility in the application o f values, sen sitivity towards one's own feelings and needs and the sponta neous expression o f them, self-regard and acceptance in spite of weaknesses, the acceptance of opposites (for example good/ bad, m asculine/fem inine social roles) as non-antagonistic, acceptance o f one's own anger and aggression in an interper sonal situation, and the capacity to form warm and intimate interpersonal relationships.
The results o f the m easured interpersonal characteristics are presented in table 3.
The Carkhuff scales indicate that the w orkshop led to a signi ficant im provem ent in perform ance on all four o f the core facilitative dim ensions (respect, realness, concreteness and empathy).Thus the em pirical hypothesis was rejected.

Qualitative m easurem ent
During the interview there was no audible or visible resist ance to being part o f the m easurement.M ost participants were excited about the interview as well as about the learning ac quired during the workshop.The interview brought the fol lowing themes to the fore.1.
The roles o f instructor and facilitator differ, each with its own application.On a know ledge level, it becam e clear to the participants that the instructor focuses on content, the mechanistic level of nursing, and requires knowledge to im part knowledge to the patient.The facilitator, on the other hand, focuses on personal, behavioural processes and inter personal relationships.A high level o f self-actualisation (de fined as intra and interpersonal sensitivity, aw areness and facilitating skills) is required to provide the learning oppor tunity which enhances learning and grow th in the patient.This was also called "using the self as an instrum ent" instead of using nursing and medical equipm ent, techniques and pro cedures.2.
Self-actualisation is a life-long process.Although this workshop was too short to get to grips with all growth aspects within the self, the participants realised that they could not turn back to "where they were" .Participants were increas ingly and actively searching for more opportunities to de velop the self, their quality o f life and their facilitation skills.

3.
The facilitator listens to and responds from the point o f view of the patient.If a patient asks a question about knowl edge or content (for example, "For how long will I have to be in the hospital?"), the instructor answers the question in the instructor role by giving the correct answer.If a patient asks a question about him/herself, his/her own feelings or personal issues, the nurse in the role o f the facilitator (because there is no correct answer) reflects the content and feelings back, pro viding an opportunity for the patient to explore his/her own answer.For example, "W hat do you do when you don't want this operation / procedure and would rather just die?", is re flected by the facilitator as "You seem to be filled with fear about your immediate future" .

4.
The different roles elicit different reactions from the trainee.The instructor answering the patient's questions gives information on the cognitive level, which makes the patient dependent on the nurse.The patient often continues in this mode by asking more questions and does not learn to think for him/herself.The facilitator, neutrally reflecting what the patient is experiencing, makes the patient become aware of and think about his/her own issues and what to do about them.Participants reported that their patients did not like this style initially, because it was uncomfortable and implied introspec tion on their part.The test of the facilitator role is to resist the pressure to give solutions, and rather to trust the facilitation process and to stay in the role.Nurses reported that their pa tients said afterwards that the experience offered a great learn ing opportunity about themselves, their feelings and problem solving style.The patients added that this made the hospi talisation worthwhile, because the learning about themselves made a great impact on them and was remembered longer than the m edical aspects.This in turn empowered the nurses because they could see that they had made a difference in a patient's life.

5.
Facilitation leads to problem solving without becom ing part o f the problem.Many participants reported that they were becoming aware o f not reacting to conflict (within indi vidual patients and between them) from a personal level, but rather from a neutral, em pathic stance, thus enhancing the insight o f the patients into them selves.Again, the patients found this new growth enriching skill as powerful for the self and a relief for their own stress levels.

Discussion
The workshop enhanced the level of self-actualisation in terms of the participant's intrapersonal awareness and interpersonal skills o f respect, realness, concreteness, empathy, as well as their attending and responding behaviour.This corresponds with research findings by Rogers (1982), M eador (1975), Cilliers (1996) and Rothman, Sieberhagen and Cilliers (1998).The enhanced awareness of the self, one's own interpersonal relationships and those o f others, could be interpreted as an increase in personal maturity, personality integration and selfactualisation.Intrapersonally the facilitation w orkshop led to enhanced awareness in terms o f cognitive, affective and conative be haviour.* Cognitive.Because the nurse understands the role o f facili tator better, he/she is more inclined to listen objectively and to focus on the task of responding to a patient, without his/ her own em otional involvem ent clouding the response.* Affective.The nurse's emotional maturity and ego-strength are enhanced, as well as his/her autonom y and independence.This enhancem ent facilitates greater sensitivity and aware ness o f the nurse's own needs and feelings, a stronger self image based upon self knowledge, insight, respect, confidence and acceptance in spite o f weaknesses, the acceptance of one's own feelings (especially aggression) and the spontaneous and natural e x p re ssio n o f them , a m o v in g aw ay from rule boundness, self defeat, m oralising, rigidity, inhibition and selfmade restrictions.These changes may in future lead to more acceptance o f responsibility for the nurse's own behav iour, heightened sensitivity in the handling of their own and others' affective behaviour in a facilitating situation and the modelling o f flexibility.* Conative.The nurse's internal locus o f control is enhanced, including self motivation, inner-directedness with his/her own integrated values, needs and feelings, instead o f taking re sponsibility for the needs of others, flexibility according to the demands o f the situation instead o f rigid, compulsive and dogmatic behaviour.These changes may in future lead to stron ger self motivation in decision m aking and the modelling of such motivation in a facilitation situation.Interpersonally, the skill o f the nurse in respecting and ac cepting the patient as a valued hum an being, was enhanced (which implies the awareness o f the nurse's own frame of reference, ideas, stereotypes, prejudices and the skill to tem porarily put this aside).Also enhanced was the nurse's skill to move into the patient's frame o f reference in an honest and genuine way, to have m ore aw areness, sensitivity, under standing and acceptance o f the patient's ideas, needs and fee lings, and to com m unicate this understanding and accept ance in a concrete way by means o f reflection.His/her own empowerment facilitates em pow erm ent and the stimulation o f growth within the patient.The tendency at the beginning o f the w orkshop (in the pre-m easurem ent) to play games, manipulate and prescribe his/her own solution, diminished significantly.This will possibly lead in future to more respect ful, real and em phatic interactions in the nursing situation.

Conclusion, limitations and recommendations
This research highlights the difference between the roles of instructor and facilitator.The workshop helped the partici pant to distinguish between the roles on a cognitive level as well as in the practical nursing situation.The study suggests that facilitation skills, with their focus on self-actualisation, can be significantly enhanced am ongst nurses.After the ap plication o f the learned self-awareness and skills in the prac tical nursing situation, the participant feels em pow ered to facilitate opportunities for learning and growth amongst pa tients, which again empowers that patient to learn about him/ herself and to grow towards his/her own self-actualisation.Thus, the em pirical hypothesis is rejected in favour o f the alternative hypothesis, namely that this workshop in facilita tion skills significantly enhanced the intra-and interpersonal characteristics associated with self-actualisation and the fa cilitation o f grow th in patients.It is important to note that the choice o f the research design could have influenced the results.The sample is small in terms o f the size o f the national nursing fraternity and the absence o f a post-post m easurem ent for the quantitative, as well as the qualitative, instruments makes it unsure whether the re sults will be sustained over a long period.It is recommended that the research design be extended to include more varied samples; also that a post-post m easurem ent including real hospital ward situations, be performed.Hospital m anagem ent, training staff and nurses in general should be enlightened about the difference between instruct ing and facilitation, each with its application and different effect on the patient.Facilitator development as part o f nurs ing education and on-the-job development will stimulate the self-actualisation o f nurses as well as their helping com m u nication skills, in order to cope with the dynamic intra-and interpersonal activities within the nursing situation.On a broader level, all hospitals can make effective use o f facilita tion and its values and principles to em pow er their w ork force.

Table 1 :
The workshop programme

Table 2 :
Significance of differences between pre and post scores for the intrapersonal characteristics of facilitation as measured by the POI

Table 3 :
Significance of differences between pre and post scores for the interpersonal skills of facilitation as measured by the Carkhuff scales in the written communication and role-play situations