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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, Tyler in 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 Region 13 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) – Extrapulmonary 305 – MDR 205 – XDR 34 – Pediatric 238 – HIV 154 261 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!