title: The Practical Approach to Lung Health in South Africa (PALSA) intervention: respiratory guideline implementation for nurse trainers.
abstract: OBJECTIVE
  This paper describes the design, facilitation and preliminary assessment of a 1-week cascade training programme for nurse trainers in preparation for implementation of the Practical Approach to Lung Health in South Africa (PALSA) intervention, tested within the context of a pragmatic cluster randomized controlled trial in the Free State province. PALSA combines evidence-based syndromic guidelines on the management of respiratory disease in adults with group educational outreach to nurse practitioners.
  
  
  BACKGROUND
  Evidence-based strategies to facilitate the implementation of primary care guidelines in low- to middle-income countries are limited. In South Africa, where the burden of respiratory diseases is high and growing, documentation and evaluation of training programmes in chronic conditions for health professionals is limited.
  
  
  METHODS
  The PALSA training design aimed for coherence between the content of the guidelines and the facilitation process that underpins adult learning. Content facilitation involved the use of key management principles (key messages) highlighted in nurse-centred guidelines manual and supplemented by illustrated material and reminders. Process facilitation entailed reflective and experiential learning, role-playing and non-judgemental feedback.
  
  
  RESULTS
  Preliminary feedback showed an increase in trainers' self-awareness and self-confidence. Process and content facilitators agreed that the integrated training approach was balanced. All participants found that the training was motivational, minimally prescriptive, highly nurse-centred and offered personal growth.
  
  
  CONCLUSIONS
  In addition to tailored guideline recommendations, training programmes should consider individual learning styles and adult learning processes.
authors.affiliation: School of Pharmacy, Discipline of Pharmacology, University of the Western Cape, Cape Town, South Africa.
authors.forename: A
authors.initials: A
authors.lastname: Bheekie
authors.forename: I
authors.initials: I
authors.lastname: Buskens
authors.forename: S
authors.initials: S
authors.lastname: Allen
authors.forename: R
authors.initials: R
authors.lastname: English
authors.forename: P
authors.initials: P
authors.lastname: Mayers
authors.forename: L
authors.initials: L
authors.lastname: Fairall
authors.forename: B
authors.initials: B
authors.lastname: Majara
authors.forename: E D
authors.initials: ED
authors.lastname: Bateman
authors.forename: M
authors.initials: M
authors.lastname: Zwarenstein
authors.forename: M
authors.initials: M
authors.lastname: Bachmann
mesh_terms: D004509:Education, Nursing, Continuing / Q000379:methods* / Q000458:organization & administration*; D019983:Guideline Adherence; D006801:Humans; D008171:Lung Diseases / Q000451:nursing*; D017410:Practice Guidelines as Topic; D012141:Respiratory Tract Infections / Q000451:nursing*; D013019:South Africa