“Because [the guideline], it’s an eye-opener and we’ve gained quite a lot of knowledge out of it. And it’s very helpful. We can manage our patients without a doctor, without a doctor in there. So, I can recommend it.” PALSA PLUS Nurse
The PALSA PLUS programme
Practical Approach to Lung Health and HIV/AIDS and STIs in South Africa
The PALSA PLUS programme consists of an evidence-based primary health care guideline accompanied by an on-site training programme that equips nurses to diagnose and manage respiratory diseases including TB, HIV/AIDS and STIs in primary care settings.
The PALSA PLUS guideline is symptom-based and uses clinical algorithms and key messages to guide the practitioner to diagnose and manage clients appropriately.
Through a collaborative process of workshops with expert clinicians, managers and policy-makers, the PALSA PLUS guideline has been expanded and adapted to the local settings and current clinical protocols, to include the following aspects of nurse-managed client care:
Diagnosing TB in the context of a high HIV burden
Routine HIV care
Initiation and management of clients on ARVs
An approach to communicating and promoting adherence to therapy
An approach to protecting the health worker from occupational infections
Regular revision of the guideline remains current with national policies and guidelines and therefore contributes towards standardising clinical approach and improving quality of care.
PALSA PLUS training represents a substantial departure from the usual off-site training model. The training takes the form of educational outreach, a guideline implementation strategy known to change the behavior of health practitioners towards evidence-based choices.
The target of PALSA PLUS is to provide the primary health care practitioner with confidence in using the guideline in everyday practice, and application of the guidelines builds competence to appropriately manage cases in practice.
The KTU adopts a cascade model of training whereby selected facility trainers are further skilled to conduct training of facility trainers and manage the programme within their provinces. This model strengthens systems through integration into systems and practice and is conducive to rapid scale up.
PALSA PLUS therefore represents a substantial departure from the usual off-site training model and is valued by trainers and nurses alike. Working towards a nurse-led Primary Health Care system, the PALSA PLUS guideline and training approach empowers nurses to manage and treat their clients, and assists them to feel supported.
Research is integral to our unit. Pragmatic randomised controlled trials in the Free State show that PALSA PLUS is effective in changing nurse practice and in improving quality of care.
“Nurses who are consulting are coming back to me that they feel so confident seeing patients now because of the training of PALSA PLUS guideline, directing them towards proper care and treatment of clients. Also, the key messages helping them remember and communication skills helping them never to forget why they are nurses.” PALSA PLUS trainer