Reach the three million, A TB test, treatment and cure for all.
Of the nine million people a year who get sick with TB, a third of them do not get the TB services they deserve. The ICN TB/MDR-TB project is working to change that by providing more nurses around the world with the skills, expertise and knowledge in the prevention, care and treatment of TB. Nurses are in a unique position among health care providers to bridge the gap between health facilities and the community – the gap where many of the three million get lost. By integrating services effectively and engaging with local communities a continuum of care can be provided to ensure that everyone who experiences symptoms can access the right tests; people who have been tested will be given the results and if TB is diagnosed, will get access to the treatment they need in a way which fits into their lifestyle and takes account of their other priorities. The ICN TB Project is supported by a United Way Worldwide grant made possible by the Lilly Foundation on behalf of the Lilly MDR-TB Partnership.
We are pleased to be able to share with you the experiences of TB nurses across the world:
China: Nursing Director, Meng Guiyun from the Xinjiang Chest Hospital in Urumqi, Xinjiang Autonomous Region of the People’s Republic of China is an outstanding alumnus of the ICN Training for Transformation project in China. Director Meng attended the first ICN training in China in 2009 and returned in 2010. Since the first training she has been successful in advocating to hold several trainings for nurses and other healthcare providers in her hospital as well as in several remote areas of the province. As of 2011 she has trained more than 1,000 healthcare workers across Xinjiang on TB.
In addition, she and colleagues who also attended the training in 2009 developed a handbook on TB that was given to prison medical staff to help identify signs and symptoms of TB among prisoners as well as information on appropriate treatment. They have also carried out trainings with prison medical staff on various aspects of TB including infection control.
Following the training Director Meng implemented changes in practice and has indicated that between 2009 and 2011 the percentage of staff unable to properly name medications used to treat TB decreased from 31.7% to 3.5%. Medication dosage errors also decreased from 5.9% to 0.5% during this same time period. The hospital also showed a decrease in the patient default rate from 5.2% to 3.5%.
Moreover, after successfully advocating for changes in infection control measures, UV lights were installed in the TB wards and the hospital has made improvements in ventilation in the wards resulting in a decrease in the number of TB cases among healthcare workers in the hospital from 27 cases in 2009 to 5 cases in 2011.
In 2013, Director Meng, in collaboration with another nurse leader, developed and published a book on TB infection control and best practices of care for TB patients specifically for nurses. This book is now available for purchase across China.
Indonesia: Veteran project lead from Indonesia, Astuti Yuni Nursasi, is the ICN TB Project focal point for Indonesian National Nurses association (INNA). Since 2010 she has been involved in three workshops as co-trainer and focal point for the ICN TB Project. She has shown great initiative especially with regard to advocating the nursing role in TB management and was personally involved in the development of standards for nursing practice issued by the Indonesian National TB Programme. In October 2013, she presented on the outcomes of the training in Indonesia at the International Union Against TB and Lung Disease Global Lung Health Conference in Paris. Today, she is writing her dissertation and plans to develop a nursing model of empowering nurses, health volunteers, family and TB clients to improve TB patients’ independence in TB treatment.
Yuni participated in the Second Forum of the Stop TB Partnership in the SE Asia, Western Pacific and East Mediterranean Regions on 3-4 March 2014 and will attend Indonesia’s National Symposium of TB on 29 March 2014.
Russia: Irina Lyapina, a chief nurse of Tolyatti TB Dispensary says that the ICN TB project has changed her professional life since she was able to participate in the first Train the Trainer workshops devoted to TB/MDR-TB care in 2009. Since then Irina has trained lots of nurses not only in her dispensary, but also in general primary and hospital care. She continues to teach both nurses and students and to study herself. She is interested in expanding the nursing role in caring for TB patients and in conducting a study on depression among the patients of a TB+HIV unit and nursing interventions that might be useful in controlling depression.
Tolyatti TB Dispensary has a unit for treatment of patients infected by both TB and HIV. Before 2012 this unit provided controlled treatment of TB, but there was no special control over HIV treatment from the unit staff. Patients or their family members needed to visit the AIDS Center to receive ARV drugs but some were unable to do so due to different reasons. In 2012 nursing roles in this unit were extended in order to provide coordinated and controlled treatment of both TB and HIV. In this new system the ARV drugs are sent to the nursing post and, after proper documentation by the head nurse, are given to the patients by the ward nurses. Nurses are also responsible for providing controlled treatment and motivating patients to continue the treatment. It is well known that patients receiving both TB and HIV therapy suffer from side-effects; many develop depression. Nurses monitor the emotional well-being of patients and intervene, provide necessary support and invite specialist doctors for individual consultations. As a result, all indicators of treatment outcomes in the unit have significantly improved. Out of all patients who received treatment in 2012, 79% of discharged patients were TB bacteria negative, and in 2013 this had risen to 86%. In addition, the TB/HIV unit achieved a decrease in mortality rates.
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