Since the inception of PALSA in 2005, the vision of Lara Fairall and her team in the KTU has been to expand and persevere in the quest to contribute to improving the quality of healthcare delivered by nurses in Primary Health Care facilities. Soon after PALSA had been successfully implemented in the Free State and found to make a significant difference to health outcomes, it was expanded to PALSA PLUS to include HIV/AIDS and STIs.
However, not only did the KTU move towards expansion and improvement of PALSA PLUS, but their vision was to make it available more broadly in South Africa and the African region. After its successful implementation in the Free State, the Western Cape contracted the KTU to start PALSA PLUS training in that province. Soon after, talks began between KTU staff and relevant stakeholders at the South African National Department of Health to formulate a plan that could extend PALSA PLUS to the remaining seven provinces. In mid-2008, the Minister of Health identified 18 ‘Crisis Districts’ where interventions were needed to address key health indicators in these districts. A tender was released by the National Health department in October 2007, calling for the training of nurses on the integrated management of TB, HIV and STIs using the knowledge translation method. The whole KTU worked together to assist in the preparation of the bid for this tender. The hard work paid off, and in February 2009 we were awarded this tender!
The contract stipulates that approximately 4800 nurses should be trained in 4 districts: Amathole and Nelson Mandela Health districts in the Eastern Cape, eThekwini Health district in KwaZulu Natal, and the City of Johannesburg Health District in Gauteng. We were therefore required to work in three provinces, and mainly in urban districts.
This project has involved a whole lot of new work meaning long hours for many of us at the KTU. Bev is heading up the management of the project, while Gill has done the lion’s share of planning and initiating the training. Ruth pulled off an impressive feat of completing a National PALSA PLUS Guideline for use by all the provinces. Jani has taken on the administration of communications and bookings, and Cheryl has assisted the financial administration of the R8.9million contract. We have taken on a number of new staff to share the load, including Monwabisi Mtiyazo and Deanna Carter as trainers, Susanna Wessels for data management, Hakeem Fester to help with data capturing and Nicky Hendricks to assist with the extra admin work.
We initiated the project with talks between ourselves and the National and Provincial Health Departments. This was to introduce PALSA PLUS and to plan the way forward. We quickly put together 4 PALSA PLUS Open Days, which were held in each district. We are currently initiating Training the Trainer to Train (TtTtTs) sessions in each district to introduce the PALSA PLUS approach through the training and Guidelines. In July we shall be training the Master Trainers, followed by supported training in earnest in all districts during the rest of the year. As the TtTtTs are completed, this will release facility trainers to go out and get the districts PALSA PLUS trained!
To date, the TtTtTs have been well received and the new PALSA PLUS trainers are excited to discover the integration of the diagnosis and management of the diseases covered in the PALSA PLUS Guidelines. The innovative method of training, different to what people are used to, is also an eye opener to participants.
Feedback from some of the trainers from the Nelson Mandela District TtTtT:
“The programme was structured very well and it moved from the basis of unknown to known and was systematically paced and also allowed the group to settle.
The programme was practical and flow of information was logical.
There was never a dull moment and there was integration of learning and fun.
The training brought out the best of me.
The training brought insight to health workers in terms of diagnosis, treatment and care.
Facilitators were good and they have treated the group with respect and they have displayed a high level of professionalism.”
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NURSE EDUCATORS’ WORKSHOP 2008
November 2008
The second annual Nurse Educators’ workshop was held from the 17th – 19th November 2008 at the University of Cape Town Lung Institute. 21 nurse educators and mentors from Free State (3) and Western Cape (18) Provinces representing 3 nursing institutions were welcomed by a PALSA PLUS team comprising members from the Knowledge Translation Unit (KTU) and Beryl Green and Anneline Janse van Rensburg, two PALSA PLUS trainers from the Western Cape and Tsotsa Polinyane, the PALSA PLUS coordinator from the Free State.
During the 3-day training, the participants were:
given information on the history and development of the PALSA PLUS guideline and the use of knowledge translation implementation strategies
given the opportunity to become familiar with the guideline content
introduced to and afforded the opportunity to experience the PALSA PLUS training methodology through small group learning/facilitated by our trainers
assisted with the integration of PALSA PLUS into their curricula and mentoring programmes
afforded the opportunity to enter into discussions about PALSA PLUS
encouraged to network across training institutions and provinces
awarded certificates of attendance
The 3-day workshop this year strengthened the partnership between the KTU and nurse educators of the Western Cape and Free State provinces. Mentors were welcomed this year, as their role is crucial in integrating PALSA PLUS into practice. Their feedback was positive and they left the 3 day workshop with much enthusiasm to try out new ideas and methods of making learning fun and supportive.
The educators have taken ownership of the programme and will
continue to introduce PALSA PLUS to their colleagues
continue to integrate PALSA PLUS into their curricula
develop an evaluation tool that will integrate PALSA PLUS into their existing tools, one that will support learning and mentoring
continue to work in collaboration with the KTU to ensure integration of PALSA PLUS in both provinces
The training of nurse educators also provides an opportunity for ongoing training and mentoring of PALSA PLUS trainers by the KTU. Below are extracts from the two of the PALSA PLUS trainers who assisted in the training.
From Annie:
I must admit I was a bit anxious when Gill requested that I be part of the Nurse Educators workshop, especially since I was not involved with the previous workshop and did know what to expect. Once again the fear of the unknown! Fortunately I found myself in the company of the very supportive KTU team, in particular Gill, who creates such a safe learning environment. My additional support was my fellow trainers namely Beryl and Tsotsa. The value for me was to see true facilitation in action. My “aha” moment happened during one of the groups facilitated by Beryl. The group’s level of interaction involved to a climax when one of the members asked a question and without hesitation another group member guided her to the answer. I think the Nurse Educators workshop was a great success. I feel very positive about the future knowing that student nurses will be exposed to the PALSA PLUS guideline during their pre-graduate training!
From Beryl: It was exciting to see how this year’s nurse educator workshop built on the one run last year. We got together with the nurse educators from the Western Cape and Free State to plan how they could incorporate PALSA PLUS into what they already do. Their overwhelming response was "Why have we had to wait so long for this?" Over the 3 days the facilitators watched many of the educators and mentors experience an "aha" moment just like we did when we started on the PALSA PLUS journey. In the near future we should be getting our nursing students already trained and ready to assist us in the clinics.
Hello - you’re wel’cm! Your first time in Malawi? – Oh! You’re very wel’cm!’
This was the warm greeting that Lara Fairall and Gill Faris received during their 4 day visit to Malawi in April 2008.
The KTU PALSA PLUS introduction to Dignitas International (DI) in Malawi came from Merrick Zwarenstein (our partner in Canada, whom you have seen on our DVD, Changing Practice: The PALSA PLUS Story). As the DI website states, they are ‘a pioneering medical humanitarian organization working with communities to dramatically increase access to life-saving treatment and prevention in areas overwhelmed by HIV/AIDS’. We really saw this in action with their decentralization of ARV care to the districts and community based programmes.
In February 2008 Sandy Thompson, the DI Community Based Programme manager, and their doctor, Marion Kambanji, visited the KTU. Thanks to our Western Cape PALSA PLUS trainer, Gadijath Appolis, they experienced a PALSA PLUS training and could see a South African healthcare facility in action. After discussions with Ruth Cornick and Lara Fairall, the seeds of our partnership were watered, so ours was a follow-up visit as we wanted to see how their healthcare system works, and talk to those working on the ground in order to develop the PALM (Practical Approach to Lung health Malawi) guideline and training.
We made use of every minute of our days in Zomba. We were taken to Matawale clinic, Zomba Central Hospital, and two rural facilities, namely, Domasi Health Centre and Likangala. We also paid a visit to the District Health Office. Their health services are run by very few doctors but mostly, Clinical Officers, Medical Assistants, Nurses and Health Surveillance Assistants. Nurses in Malawi seem to be focused on maternal and child health. We learnt much from our visits and discussions; the Malawians are ahead of us in terms of decentralization of HIV care, but sadly, technology to assist in diagnosis is almost non-existent. We were saddened by the level of poverty and ill health and lack of resources. The KTU is humbled and honoured to be working alongside DI to develop PALM PLUS. 2008 is guideline preparation and hopefully the training will start in 2009!
Three clinics involved in the STRETCH programme in the Free State are the first clinics in the country to have registered nurses re-prescribing antiretrovirals (ARVs) to patients who have been stabilized on treatment.
The aim of the STRETCH, or Streamlining Tasks and Roles to Expand Treatment and Care for HIV, programme is to improve ARV treatment access and waiting times without lowering the currently high standard of care for people receiving ARVs.
STRETCH is being implemented in 3 phases in selected Free State clinics. During Phase 1 all nurses received outreach training in HIV and TB care. Phase 2 involves nurses represcribing ARVs to stable patients and started in October/ November. Phase 3 will see them initiate ARVs in selected adults and is expected to start in January 2008.
Dr Kerry Uebel who leads the project in the Free State says “Feedback from the clinics has been good. A few clinics have had difficulty getting going, some because they couldn’t get prescriptions to their hospital pharmacy and others because they weren’t sure how to identify patients who were coming up for a 6 month visit as they all had appointments at the (doctor-run) treatment site. But mostly we have discussed and found ways to solve these problems. Many patients have expressed their appreciation of STRETCH as they no longer have to travel to the treatment site and spend the whole day just to get the doctor to sign their treatment.”
The National Department of Health is looking to the project to provide answers and interventions to the question of task shifting, which is being promoted as the solution to expanding treatment access.
Knowledge Translation Unit launches PALSA PLUS documentary at Lung Health Conference
8 November 2007
The University of Cape Town Lung Institute’s Knowledge Translation Unit has launched a documentary on their PALSA PLUS programme to coincide with the 38th World Conference on Lung Health being held at the Cape Town International Convention Centre until 12 November.
South Africa’s TB and HIV epidemics are imposing escalating demands on public-sector primary care services which are staffed by nurses with minimal support from doctors. Yet undergraduate nursing curricula have traditionally not prepared nurses for independent clinical practice.
PALSA PLUS, or Practical Approach to Lung Health and HIV/AIDS in South Africa, has been developed and refined through research and hands-on experience in the Free State and Western Cape provinces. It adopts an evidence-based approach to in-service training, equipping Department of Health nurse managers as outreach trainers who in turn use concise easy-to-use guidelines and training materials to train nurses and other health care workers on-site at the clinic.
“Our training approach represents such a large departure from current practices for training and updating health workers that we felt written descriptions in research publications and reports were not able to effectively communicate this to managers, hence the film” says the Unit’s Head, Dr Lara Fairall.
To date the programme has reached 2770 nurses in 325 clinics. Research shows that it improves quality of care for TB, HIV/AIDS and respiratory diseases, and results of an economic evaluation of its cost-effectiveness will be presented at the conference.
