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TB Nurse Care Revisited:Heartland National TB Center
Regional Perspective
Debbie Onofre RN, BSN
Texas Center for Infectious Disease
• 75 bed hospital
• One of Only 6 facilities in the country specifically designed to provide care and treatment for patients with TB
• First free-standing infectious disease hospital built in the U.S. in more than 50 years
• A Project of the University of Texas Health Center, Tylerin partnership with:
• Centers for Disease Control and Prevention• Texas Center for Infectious Disease• Texas Department of State Health Services• TB Controllers in the Heartland Region
Heartland Region13 States
• Arizona• Illinois• Iowa• Kansas• Minnesota• Missouri• Nebraska
• New Mexico• North Dakota• Oklahoma• South Dakota• Texas • Wisconsin• City of Chicago• City of Houston
Heartland’s Mission is to… …Build capacity with our partners. We will share expertise in the treatment and prevention of tuberculosis by developing and implementing: •Cutting-edge trainings•Delivering expert medical consultation•Providing technical assistance •Designing innovative educational and consultative products.
Objective
Use Awareness of Core Nursing Values to identify strategies to address and/or avoid specific case problems and challenges in the care of patients with tuberculosis
National League for Nursing
• Core Values– Caring– Integrity– Diversity– Excellence
Nurse Case Management
• Patient Centered – Cultural traditions– Personal
preferences/values– Family situations– Social circumstances– Lifestyles
Can We Provide Holistic Care?
• Nurse Shortage
• Budget Cuts
Nursing Shortage
• Forced into furloughs
• Expected to do same job with limited resources
• Nursing positions vacated/dissolved
What Does This Mean?
• No nurse to manage TB cases
• Fewer nurses dedicated to TB control
• Lack of Expertise
How Does Lack of Expertise Impact NCM?
• Impact on Nurse Case Management activities
– Delayed recognition of TB cases
– Missed opportunities to identify and treat patients & contacts
– Less expertise to manage complicated cases
Increase in Medical Consultation for 2011
• PTB (complicated by co-morbidities) 261– Extrapulmonary 305– MDR 205– XDR 34 – Pediatric 238– HIV 154
Negative Outcomes as a Result of Poor NCM
• No expertise to Identify inadequate treatment– Treatment Failures– Delayed Conversions– Acquired Drug Resistance
• MDR• XDR
Building Expertise
• Educating TB Nurses– Nurse Case Management
• Live/Stand up • Online
• Nurse Mini-Fellowships– Basic – Advance
• Conference Calls
Strive for TB NCM Excellence
• Continually promote awareness regarding core nursing values and ensure:– Caring – Integrity– Diversity– Excellence
• Remains the mainstay in TB care
Thank You!