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Variations for "High-Need" Groups

Sometimes, you may find that in the course of conducting a nominal group discussion, the exercise becomes a cathartic experience for the participants. As they articulate deep fears, frustrations or anxieties, the discussion takes on features of being a participant-moderated support group. It may be that they have never been able to express their thoughts and feelings before in ways that they felt heard before. Often-times, participants will start to share knowledge and information that others want or need to learn about that would help them cope better with their illness, turning the discussion into a peer-led educational session.

While these phenomena may upset your well-scripted plan for the meeting, remember that the ultimate goal of the nominal group is to understand and help meet the needs of patients in health crises. If the nominal group process is somehow meeting an important immediate need for support or information, make a judgement call and be gracious enough to modify your agenda to meet those needs. You can still glean important information from the discussion that will be useful for the needs assessment, while allowing peer support and education to occur. Here are some things to remember:

1. If you sense a strong need for peer support and education during the discussion, continue to ask the questions you planned, but allow more time for telling of experiences, asking questions and information-sharing that may be spin-offs from your questions. Note down the ideas that are shared in the informal discussion, as these are equally valid.
2. Encourage them to take turns to speak so that everyone has a chance to express themselves, but also allow others to jump in with responses when appropriate and helpful. If someone has not spoken in a while, ask what that person would like to add or ask.
3. As people share with the group, continue to write their expressed fears, frustrations or questions on the flip charts, but do so without interrupting the flow of the discussion. A good facilitator should be able to "melt into the background" but still record pertinent information while the discussion is underway.
4. Prioritization of the items listed can be intrusive to a deep discussion at this point. However, it is important to try and understand what their priority issues are. You could simplify the prioritization process by asking them to pick several most important items, but not rank order them. This information is still helpful in identifying what the felt priority issues are.
5. In some extreme cases you may have to do away with the elimination of duplicate ideas and formal prioritizing process. Instead, listen carefully during the discussion for increased intensity in emotions or statements, and watch for non-verbal clues like the group nodding in affirmation. These are indicators of a strong felt need for those issues to be resolved. Underline those items on the flip charts as you make observations about what might be priority issues to them. This, however, should be done only as a last resort, as the prioritization is skewed by the facilitator's observations and perceptions.

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