增强南非抗逆转录病毒药物配送能力：对PALSA PLUS护士培训项目的定性评估
Building capacity for antiretroviral delivery in South Africa: a qualitative evaluation of the PALSA PLUS nurse training programme.
作者信息
Stein J, Lewin S, Fairall L, Mayers P, English R, Bheekie A, Bateman E, Zwarenstein M
机构信息
University of Cape Town Lung Institute, George St, Mowbray 7700, Cape Town, South Africa.
出版信息
BMC Health Serv Res. 2008 Nov 18;8:240. doi: 10.1186/1472-6963-8-240.
BACKGROUND
South Africa recently launched a national antiretroviral treatment programme. This has created an urgent need for nurse-training in antiretroviral treatment (ART) delivery. The PALSA PLUS programme provides guidelines and training for primary health care (PHC) nurses in the management of adult lung diseases and HIV/AIDS, including ART. A process evaluation was undertaken to document the training, explore perceptions regarding the value of the training, and compare the PALSA PLUS training approach (used at intervention sites) with the provincial training model. The evaluation was conducted alongside a randomized controlled trial measuring the effects of the PALSA PLUS nurse-training (Trial reference number ISRCTN24820584).
METHODS
Qualitative methods were utilized, including participant observation of training sessions, focus group discussions and interviews. Data were analyzed thematically.
RESULTS
Nurse uptake of PALSA PLUS training, with regard not only to ART specific components but also lung health, was high. The ongoing on-site training of all PHC nurses, as opposed to the once-off centralized training provided for ART nurses only at non-intervention clinics, enhanced nurses' experience of support for their work by allowing, not only for ongoing experiential learning, supervision and emotional support, but also for the ongoing managerial review of all those infrastructural and system-level changes required to facilitate health provider behaviour change and guideline implementation. The training of all PHC nurses in PALSA PLUS guideline use, as opposed to ART nurses only, was also perceived to better facilitate the integration of AIDS care within the clinic context.
CONCLUSION
PALSA PLUS training successfully engaged all PHC nurses in a comprehensive approach to a range of illnesses affecting both HIV positive and negative patients. PHC nurse-training for integrated systems-based interventions should be prioritized on the ART funding agenda. Training for individual provider behaviour change is nonetheless only one aspect of the ongoing system-wide interventions required to effect lasting improvements in patient care in the context of an over-burdened and under-resourced PHC system.
背景
南非最近启动了一项全国抗逆转录病毒治疗计划。这使得迫切需要对护士进行抗逆转录病毒治疗（ART）交付方面的培训。PALSA PLUS计划为初级卫生保健（PHC）护士提供成人肺部疾病和艾滋病毒/艾滋病管理（包括ART）方面的指导方针和培训。进行了一项过程评估，以记录培训情况，探讨对培训价值的看法，并将PALSA PLUS培训方法（在干预地点使用）与省级培训模式进行比较。该评估是在一项测量PALSA PLUS护士培训效果的随机对照试验（试验参考编号ISRCTN24820584）的同时进行的。
方法
采用定性方法，包括对培训课程的参与观察、焦点小组讨论和访谈。对数据进行了主题分析。
结果
护士对PALSA PLUS培训的接受度很高，不仅涉及ART的特定组成部分，还包括肺部健康。与仅在非干预诊所为ART护士提供的一次性集中培训不同，对所有PHC护士进行持续的现场培训，不仅通过持续的经验学习、监督和情感支持，还通过对促进医疗服务提供者行为改变和指南实施所需的所有基础设施和系统层面变化进行持续的管理审查，增强了护士对工作支持的体验。与仅培训ART护士相比，对所有PHC护士进行PALSA PLUS指南使用培训也被认为更有利于在诊所环境中整合艾滋病护理。
结论
PALSA PLUS培训成功地使所有PHC护士采用综合方法应对一系列影响艾滋病毒阳性和阴性患者的疾病。在ART资金议程上，应优先考虑基于综合系统的干预措施对PHC护士进行培训。然而，针对个体医疗服务提供者行为改变的培训只是在负担过重和资源不足的PHC系统背景下实现患者护理持久改善所需的持续全系统干预措施的一个方面。
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