“There’s hope now. In the past we could only give the Bactrim and say … there’s no hope and that is it. Now at least we can say, okay, if your CD4 is this and this, you can give this and that for it. So it gives us a little option, and you can see the difference in patients. Some are being pushed in wheelchairs and are malnourished … you know, they are very sick, and then after three months the same patients walk in here and they start working again. You know, looking for work and planning their lives again. That’s making it ….
worth it.” STRETCH nurse
Knowledge translation is the new buzzword in healthcare. It defines a complex set of interactions between researchers, health services and patients to expedite the implementation of research findings into practice, to strengthen health services and improve patient outcomes. The most widely used definition was penned by the Canadian Institutes of Health Research:
In a nutshell, Knowledge Translation (KT) is about bridging the gap between what we know and what we do!
Well-developed evidenced-based clinical practice guidelines are effective tools when combined with education outreach. This strategy has been shown to change practice towards evidence-based choices.
Traditionally, training has been delivered as off-site, centralised, mostly didactic courses.
This method is known to be not highly effective in changing practice and stands in the way of rapid scale-up of training.
The KTU focuses on health systems research and on promoting the adoption of its research findings in clinical practice.
Through its research and training, the KTU engages with decision-makers, managers, doctors and nurses to improve the primary care management of priority respiratory diseases, including tuberculosis, HIV/AIDS, NIMART and STIs.
Materials are updated annually and therefore keep abreast of changes in policy and new evidence. This is a key principle of KT.
Our training approach At the KTU, PALSA PLUS and Primary Care 101 training of trainers is based on adult education principles using experiential, interactive and reflective learning.
Everyone who participates in this programme is recognised as a source of knowledge with a wealth of experience. In this way the programme promotes lifelong learning.
Educational outreach is the methodology employed to deliver the training at facilities.
Educational outreach is a knowledge translation strategy. Its use for guideline implementation is known to change the practice of health practitioners towards evidence-based choices. The KTU trains middle manager nurses as outreach trainers to provide clinic-based, interactive group training to primary care facilities in short (1–1½ hours) weekly or fortnightly sessions over several months with quarterly follow-up training sessions, allowing for application of new knowledge through the alternation of learning and practice. It expands the mentoring role of existing supervisory nursing staff and this model also minimizes disruption at heavily burdened primary care facilities and provides for rapid up-scaling and integration of the program into the health system.
Support materials are put in place to allow for repetition of and promote familiarity with the key messages. Both of these outcomes are central to educational outreach.
Time should be limited between training and clinical decision-making. This means that learning and practice should be alternated.
In educational outreach supportive relationships between trainers and staff are critical in the learning processes that take place at facilities.
Educational outreach training sessions are:
• short (1–1½ hours)
• onsite and in-service
• delivered by a trusted outsider
• face-to-face, using small groups
• interactive, using clinical cases
• multi-event interventions: 8–12 training sessions are held over a 3–4 month period.
“And you don’t have to memorise everything, because if you have your guide, you can always go back. Because you just page through and you will find whatever you are looking for. Everything is there. And it makes you work faster than it usually takes.” PALSA PLUS nurse