1. EXCELLENCE  EXPERTISE  INNOVATION TB Nurse Care Revisited: Heartland National TB Center Regional Perspective Debbie Onofre RN, BSN

2. EXCELLENCE  EXPERTISE  INNOVATION

3. 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

4. EXCELLENCE  EXPERTISE  INNOVATION 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

5. EXCELLENCE  EXPERTISE  INNOVATION

6. 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

7. EXCELLENCE  EXPERTISE  INNOVATION 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.

8. EXCELLENCE  EXPERTISE  INNOVATION 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

9. EXCELLENCE  EXPERTISE  INNOVATION National League for Nursing Core Values –Caring –Integrity –Diversity –Excellence

10. EXCELLENCE  EXPERTISE  INNOVATION Nurse Case Management Patient Centered –Cultural traditions –Personal preferences/values –Family situations –Social circumstances –Lifestyles

11. EXCELLENCE  EXPERTISE  INNOVATION Can We Provide Holistic Care? Nurse Shortage Budget Cuts

12. EXCELLENCE  EXPERTISE  INNOVATION Nursing Shortage Forced into furloughs Expected to do same job with limited resources Nursing positions vacated/dissolved

13. EXCELLENCE  EXPERTISE  INNOVATION What Does This Mean? No nurse to manage TB cases Fewer nurses dedicated to TB control Lack of Expertise

14. EXCELLENCE  EXPERTISE  INNOVATION 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

15. EXCELLENCE  EXPERTISE  INNOVATION Increase in Medical Consultation for 2011 PTB ( complicated by co-morbidities ) 261 –Extrapulmonary 305 –MDR 205 –XDR 34 –Pediatric 238 –HIV 154

16. EXCELLENCE  EXPERTISE  INNOVATION Negative Outcomes as a Result of Poor NCM No expertise to Identify inadequate treatment –Treatment Failures –Delayed Conversions –Acquired Drug Resistance MDR XDR

17. EXCELLENCE  EXPERTISE  INNOVATION Building Expertise Educating TB Nurses –Nurse Case Management Live/Stand up Online Nurse Mini-Fellowships –Basic –Advance Conference Calls

18. EXCELLENCE  EXPERTISE  INNOVATION Strive for TB NCM Excellence Continually promote awareness regarding core nursing values and ensure: –Caring –Integrity –Diversity –Excellence Remains the mainstay in TB care

19. EXCELLENCE  EXPERTISE  INNOVATION Thank You!