The nurses contribution to DOTS expansion

1
Nursing in TB Control

• Presentation to Eastern Mediterranean National TB
  Programme Managers
• Gini Williams September 2002

2
Introduction

• Nurses and the DOTS strategy
• The Eastern Mediterranean Region preliminary
  survey results
• The International Picture

3
Key technical aspects of DOTS

• Case detection by smear microscopy
• Standardised short-course treatment
• Direct observation (min. initial phase)
• Recording reporting progress and cure

4
Case detection by smear microscopy

• Strategy
• Cost effective
• Identifies infectious cases
• Recorded in lab register

• Nurses role
• Education
• Documentation
• Support
• Access

5
Standardised short-course treatment

• Strategy
• 6 8 months
• Combination of drugs
• Direct observation in intensive phase

• Nurses role
• Access
• Individualised care planning
• Education
• Monitoring
• Documentation

6
Direct observation of treatment

• Strategy
• Shared responsibility
• Flexibility for the pt
• Treatment observers who are
• willing
• trained
• responsible
• acceptable to the pt

• Nurses role
• Support for pt and treatment observer
• Access/advocacy
• Education
• Monitoring
• Documentation

7
Recording and reporting

• Nurses role
• Clear, accurate and prompt record keeping
• Communication re individual and collective
  progress

• Strategy
• Systematic evaluation
• of patient progress and treatment outcome
• of overall programme performance
• Consists of
• Laboratory register
• Treatment cards
• TB register

8
Key logistical aspects of DOTS

• Dependable supply of drugs to patient
• Labs for microscopy
• Supervision and training for HCWs

9
Supervision and training

• Strategy
• Vital to ensure quality
• Who?
• District TB Co-ordinators
• Primary health care workers
• Community leaders
• Volunteers

• Nurses role
• Personal professional development
• Provision of education for patients their
  families, communities and volunteers etc

10
Key operational aspect of DOTS - Flexibility

• The range of geographical, environmental and
  cultural contexts requires flexibility in the
  implementation of technical aspects
• Nurses play a key role in providing flexible TB
  services by delivering individualised
  patient-centred care

11
The Global Plan for DOTS Expansion

• Increase access to drug treatment and care
• Mobilize society
• Build capacity
• Expand DOTS population coverage

12
Role of the nurse in DOTS expansion

• Providing services to hard to reach populations
• Raising community awareness/reducing stigma
• Improving access overall

13
A patient-centred model for TB management
ASSESSMENT
TB REGISTER
PLANNING
CLINICAL DIAGNOSIS (Microscopy)
PATIENTHOLDING
CASEDETECTION
IMPLEMENT-ATION
CASE FINDING Passive referral Active screening
EVALUATION Sputum conversion Treatment outcome
DISCHARGE
14
EMRO Survey 2002

• Developed by NAP Section of IUATLD and WHO
  EMR Office
• Sent to all NTP managers in EMRO
• 17 responses received

15
Key activities for doctors and nurses (out of 17)
16
Other nursing activities identified

• Documentation (65 n11)
• Support for treatment observers (65 n11)
• Default tracing (59 n10)
• Community health education (59 n10)
• Liaison with other services (47 n88)
• EMRO survey 2002

17
Less common nursing activities

• Research (41 n7)
• Quarterly cohort analysis (35 n6)
• Management (35 n6)
• Teaching general health staff (23 n4)
• Sputum examination (23 n4)
• Diagnosis (12 n2)
• EMRO survey 2002

18
Other points raised

• A variety of paramedical staff were mentioned
• All bar one respondent felt it would be useful
  to have handbooks outlining the roles of
  different disciplines
• Lack of training and supervision was identified
  as the most important challenge for the
  development of the nurses role in DOTS

19
 Nursing and Allied Professional Section (NAPS)
of the IUATLD

• Objectives
• To increase participation of NAPs from all
  regions of the IUATLD
• To develop regional NAP networks with
  representation in the NAP section of the IUATLD
• To reflect issues and innovations for NAPs from
  high burden countries in NAP section activities,
  international meetings and the IUATLD

20
Activities

•  Regional workshops
• January 2002 Middle East
• April 2002 Europe
• June 2002 Africa
• December 2002 Latin America
• April 2003 Eastern
• Mobilising NAPs
• - Identifying regional representatives
• Development of Regional Networks

21
Recommendations

• Increased commitment to training for nurses
  involved in TB control
• Regional nursing network to develop training and
  research opportunities
• Involvement of EMRO nurses in international
  activities