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TB Notes Newsletter

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No. 1, 2010

TB EDUCATION AND TRAINING NETWORK UPDATES

Member Highlight

Janice Jespersen, BN, is Clinical Coordinator for the TB Program, Child, Youth, and Family Community Health, at the Vancouver Island Health Authority. She received a diploma in nursing in 1975 from the University of Alberta and her BN in 2004 from the University of Athabasca.

Janice Jespersen, BNHer job responsibilities include coordinating and supervising the TB outbreak response for the Health Authority in Alberni Valley, Vancouver Island, British Columbia. She has been leading a team of up to six nurses and three outreach workers in addressing a large TB outbreak in what was formerly a low-incidence area on the west coast of British Columbia. “The outbreak has been complicated by the fact that there were few services in place for the affected population, many of whom were homeless, drug-addicted, and part of a racial minority group,” she noted. “In the past year the TB cases have dramatically declined, and the team is now working on establishing a comprehensive street-level health service for this population,” Janice added.

She has recently developed a set of nursing protocols for outbreak management.  “I believe that this sort of tool is essential for nurses working in low-incidence areas who suddenly face the challenge of managing a TB outbreak,” Janice commented.  The development of this tool involved incorporating existing federal and provincial guidelines into a simple step-by-step checklist that applies these guidelines in the local situation. These protocols evolved over a 3-year period. “Our team found that capturing, defining, and refining our practice protocols was a great support to developing a unified way of operation that supports best practice. We only wish that we’d had this tool at the beginning of the outbreak!” she noted.

One of her team’s major challenges was to successfully implement treatment for LTBI within a crack cocaine community. They addressed this challenge by using the educational process to identify programming gaps, and then developed a wide-ranging set of strategies to address those gaps. (Note: An article on this initiative will appear in TB Notes No. 2, 2010.)

The majority of Janice’s 34-year nursing career has been outside of mainstream North American nursing practice; rather, she has been employed by international aid agencies in India, Pakistan, Afghanistan, and Sudan. She also worked for the U.S. government as an embassy nurse in Kazakhstan, as well as for Canadian First Nations communities in the Northwest Territories and Alberta. “In each of these positions, TB has played a role—albeit minor in some,” Janice commented. “It has been interesting to learn how, in the midst of widely divergent cultures and circumstances, there remain stark similarities in terms of TB program needs. Hopefully, by developing strong partnerships through networks such as the TB ETN, we can succeed in sharing resources, knowledge, and approaches that support stronger programming worldwide,” Janice explained.

Janice first learned of TB ETN from her colleague Lynette McElroy, who served as a consultant to Janice’s TB outbreak team for a short time and connected her to TB ETN as a resource. “I was pleased to find a network that was actively involved in connecting members to resources, dialogue, and research that could assist our team in expanding our knowledge of TB management, developing our program strategies, and challenging us to try new approaches,” stated Janice.

Janice would love to see TB ETN reach further into the international sector, particularly in developing countries, connecting people with access to knowledge, skills, and resources adapted to the unique challenges of TB in these areas.

Janice spends her leisure time sailing, kayaking, and gardening in the summer months, while in winter months, she enjoys hiking, skiing, and skating. She also enjoys more sedentary leisure pursuits such as reading, movies, and correspondence.

If you’d like to join Janice as a TB ETN member and take advantage of all TB ETN has to offer, please send an e-mail requesting a registration form to tbetn@cdc.gov. You can also send a request by fax to 404-639-8960 or by mail to TB ETN, CEBSB, Division of Tuberculosis Elimination, CDC, 1600 Clifton Rd., N.E., MS E10, Atlanta, Georgia 30333 or, if you would like additional information about the TB Education and Training Network.
—Submitted by Regina Bess
Div of TB Elimination

TB ETN Program Highlight
The Michigan Tuberculosis Nursing Certification Project

Background
Since 2005, the Tuberculosis Nurse Network of Michigan has engaged in tuberculosis (TB) public health nursing activities to strengthen the knowledge, confidence, and expertise of public health and private providers in the practice of TB case management.  The 25-plus members of the TB Nurse Network meet regularly, on a quarterly basis.  Meetings have produced networking opportunities, broadened education and case management, and provided updates of TB control activities. The network has also provided a forum for shared experiences in contact investigation, reporting, and surveillance by nurses and other infection control practitioners in tuberculosis control activities. The development of a TB Tool Kit is a direct result of this organization’s effort.

The TB Nurse Network supported the concept of designing and providing a statewide Tuberculosis Nursing Certification Course. This course would serve as a model for the State of Michigan, and for other interested state TB programs that recognize and acknowledge the expertise and education needed by clinical nursing staff practicing TB control at the local level.

Increasingly, the blending of TB nursing staff and communicable disease staff has diluted the concentrated effectiveness and proactive approaches to TB case management that TB nursing staff provided.  In addition, the loss of TB nursing expertise from the workforce as long-time nurses retire has contributed to a reduced knowledge of and experience with TB.  Moreover, a public health nurse course that embraces and advances TB nursing, and which would include a Baccalaureate and Associate Degree for nurses, is not available. At the time of development, no TB nursing comprehensive course was offered through our regional training site, or the national TB Nurse Coalition.

The state of Michigan TB control program and the American Lung Association of Michigan jointly provide education courses that include tuberculin skin testing (including train-the-trainer sessions), case management, contact investigation, and directly observed therapy.  Despite these proactive efforts, there still existed a deficit of knowledge due to lack of attendance, conflicting job demands, and recurring staff turnover.

Implementing the Michigan TB Nursing Certification Course
The collective decision of the TB Nurse Network was to extend further the offerings of the TB courses, and blend them into a 2-day symposium that would have defined candidate criteria, would use faculty from the local health departments, and, upon the learner’s successful completion, would acknowledge the learner with visible and tangible evidence of attainment of success. The attainment of certification in TB nursing will be maintained through testing on a 2-year cycle.  We recognized that elevating TB nursing to a level of advanced practice, which demands enhanced skill and knowledge beyond general communicable disease care, would require vigorous and comprehensive guidelines.

Goals of the Project
Our overall plans or expectations were to offer the class to local public health department staff and private infection control practitioner staff annually. Prior to acceptance into the course, a candidate would be required to 1) demonstrate a basic core knowledge of TB by passing the Interactive Core Curriculum, 2) possess a valid Michigan RN License, and 3) be certified as a TB skin test instructor. The curriculum would cover the topics of TB history, pathogenesis, infection control, skin testing, treatment regimens, latent and active disease, contact investigations, field safety, case management, directly observed therapy, cohort review, multidrug-resistant strains, and program evaluation strategies. We wanted the course to provide continuing education contact hours for Michigan nurses. We planned to provide a TB nursing manual/CD to attendees for future reference, and to engage knowledgeable faculty, including experienced communicable disease nurses and medical professionals, who could use their experience and expertise to fully address questions and concerns.

Our specific goals for the course were to-

  1. Support and encourage public health TB nurse confidence and expertise through the recertification process.
  2. Promote and advance the specialty of TB nursing as a vital and comprehensive skill for TB control.
  3. Partner and share resources with public health, institution of learning, nursing programs, and other organizations that share an interest in TB control.
  4. Provide a forum for the exchange of concerns, questions, demonstrations, and guidance for TB nursing.
  5. Create a public health environment that embraces and elevates TB nursing as a vital and core function of public health.

Implementation and Results
The course was held June 24 and 25, 2009, with a pre-workshop TST and Train-the-Trainer session on June 23. To be environmentally responsible, course organizers provided candidates with a CD of all the presentations and encouraged them to bring a laptop computer, so notes could be taken with each slide. For case management, DOT, and field safety subjects, discussion sessions were led by panels of experienced medical experts.

The New Jersey Global Institute supported the effort by providing speakers for the project. DJ McCabe and Lillian Pirog, TB nursing consultants, served as nursing faculty for our course; they presented on case management and pediatric TB subjects. In addition, they provided consultation on testing questions and provided attendance certificates. Other faculty presenting included the Michigan TB Control Program Manager, the State of Michigan TB Laboratory Manager, a pharmacist, police staff, nurse consultants, and a CDC Public Health Advisor.

All attendees were employed by a local health department; 7 had an associate degree, 22 had a bachelors degree, and 5 had a masters degree.  Participants’ job categories included administrator/management (5), field worker (4), clinician (10), program supervisor (4), and other (11) (disease control, TB coordinator, etc.).

All 34 attendees successfully graduated from the 2-day course, with all passing the post test each day with over 90% correct responses. Graduates were awarded 13.25 continuing education contact hours from University of Michigan School of Public Health. Evaluations were positive from the participants and reflected excellent to good remarks in all faculty and learning sessions.

The Deputy Director of the Michigan Department of Public Health presented each graduate with a certificate of completion, and a reception was held afterwards to celebrate their successful certification. Certification status is to be renewed every 2 years by testing.

In conclusion, this training proved to be successful, even beyond expectations. It started as an idea from a brainstorming session in New Jersey and took shape with the help and assistance of the TB Nurse Network and the New Jersey Global Institute and the American Lung Association of Michigan.  This training will be an annual educational opportunity in Michigan. In addition, the TB Nurse Coalition has expressed interest in learning more about this course in the coming months. It is hoped that this training will serve as an example to other states to promote TB nursing.

This training proved that a handful of caring and committed professionals can unite to support our colleagues with the best training and education we can offer. In Michigan, public health TB nurses achieved the knowledge and skills to deliver high-quality nursing services in support of TB prevention and control, and in doing so, elevated the subspecialty of TB nursing to a higher level of practice in this state.

—Submitted by Gail Denkins, RN, BS
Michigan Dept. of Community Health

TB ETN Connections Project Update

As a result of talking to new members and reviewing member registration forms, the TB Education and Training Network (TB ETN) Membership Development Workgroup found that TB ETN members wanted to be able to:

  1. Network with other TB educators
  2. Share work they had done
  3. Obtain suggestions and input from colleagues
  4. Borrow presentations and materials from others so as not to reinvent the wheel

To help meet these expectations, in August 2008 the TB ETN Membership Development Workgroup launched the TB ETN Connections Project. This project is designed to connect members who have special talents, interests, and strengths with members who would like to develop in those same areas. It was also designed to give members new to education and training access to mentors who may have resources to share. 

The areas of expertise are divided into the following six categories:

  1. Materials and products (e.g., posters, brochures, graphics, web design, e-learning)
  2. Training skills (e.g., classroom techniques, PowerPoint, games and activities, train-the-trainer techniques)
  3. Conference planning (e.g., site selection, marketing, registration, obtaining speakers)
  4. Course development (e.g., needs assessments, curriculum development, evaluation)
  5. Cultural competence (e.g., information about specific cultural groups and other populations such as jail inmates and homeless persons)
  6. Research and publication (e.g., study design, methods, data, poster presentations, publications)

If you would like to find a guide/mentor with the TB ETN Connections Project, follow these steps:

  1. Go to the TB ETN website and click on “Members Only Section” (If you are not yet a member, see below.)
  2. Log into “Members Only Section” with password
  3. Click on “TB ETN Connections Project”
  4. Locate the category you need and contact one of the persons listed as a mentor

Membership to TB ETN is open to all persons who have an interest in TB education and training issues. There is no membership fee and new members may join at any time. Go to the TB ETN website to download a membership application.

If you would like to be a mentor for the TB ETN Connections Project: 

As a mentor for the TB ETN Connections Project, you would be asked to make a small commitment to the project in terms of time and effort. Some examples include

  1. Availability and willingness to answer e-mails (within a week) and to answer phone calls (always at your convenience) from colleagues to discuss a current issue;
  2. Ability to point a colleague in the right direction or to another resource person;
  3. Willingness to share examples, samples, and humor; and
  4. A cheerful attitude and encouraging words!

How would you be connected to colleagues needing assistance?

  1. Your name, contact information, and areas of expertise will be listed on the TB ETN web site in the Member’s Only Section
  2. It will be up to the member looking for information to contact you

What if you change jobs or need to be removed from the list for any reason?

  1. Contact one of the co-chairs of the Membership Development Workgroup and ask that your contact information be updated or removed.

If you would like to help your colleagues in TB ETN by participating as a guide/mentor in the TB ETN Connections Project, contact Teresa Goss at tlg2@cdc.gov.  Ms. Goss will put you in contact with one of the Membership Development Workgroup Co-Chairs. 
In your email please include:

  1. Your name, country, and e-mail address
  2. Category of expertise
  3. 1–3 specific examples of expertise

—Submitted by TB ETN Co-chairs
Membership Development Workgroup
“I am stopping TB by sharing my knowledge.”

 

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