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!