|
Education
Materials > Publications
> Effective TB Interviewing for Contact
Investigation > Self-Study Modules
> Module 3 > Case Presentations
Self-Study Modules for Effective TB Interviewing
Case Presentations
The following case presentations demonstrate concepts from this
module. You may review them with your supervisor if you have questions.
Case 1
Part 1 – You have been asked to conduct an interview in
the home of Sona, a 27-year-old woman who has been diagnosed with
smear-positive suspected pulmonary TB. According to her medical
record, she arrived in this country 3 months ago and has been told
by her doctor to stay at home until she is noninfectious. She speaks
English fluently. You go to her home, introduce yourself, and are
ushered inside by a man who introduces himself as Sona’s husband.
He asks you to sit down. Sona goes into the kitchen and returns
with a drink for you. The husband sits down, as you are about to
start your interview.
Should you proceed with the interview in this situation?
If so, how?
Explanation: It is important to let both individuals
know that you are there to share information with Sona. However,
the acceptable way of interviewing for this patient may be for another
individual to speak for her.
You should first professionally and respectfully indicate to Sona
and her husband that you are from the health department to discuss
an important health matter. If and when, in private, Sona agrees
that it is all right to speak openly about her TB with her husband
present, the three-way discussion may occur. Stressing confidentiality
procedures and respectfully thanking Sona and her husband for their
understanding will also exemplify your commitment to privacy.
During the interview, speak directly to Sona even if answers to
your questions are coming from another person. However, if the
husband is speaking to you, maintain eye contact with him. Try
to schedule a re-interview at a later date with only Sona present.
Part 2 – The husband answers the questions for Sona and
asks TB-related questions. He is very cooperative and lets Sona
answer questions for which he is unsure of the answer. As you build
rapport, Sona also begins to speak directly to you but does not
maintain eye contact. She also keeps her hands in her lap and speaks
softly and briefly.
How can you be sure that Sona is engaged in the discussion?
Explanation: Sona may be uncomfortable with direct
eye contact or even speaking with her husband present. You should
use open-ended questions for broader answers. You should also ask
Sona throughout the interview if she is feeling all right, and if
she has any questions. She may need to hear you state that it is
acceptable to interrupt you if she has questions or remembers anything
she or her husband forgot to tell you.
Part 3 –When you begin eliciting contact names, the husband
explains to you that he is afraid of telling you the names of any
contacts as they will be very upset. While he trusts that you will
keep Sona’s identity confidential, he fears that the contacts will
be very upset, since TB is a “killer” disease in his country of
origin.
What can you say to address the fears of Sona and her husband?
Explanation: Reassure them that you are conducting
this interview so that you can 1) help prevent the further spread
of TB, 2) provide education on the status of Sona’s treatment, 3)
answer any questions she may have about her disease, and 4) refer
priority contacts for medical evaluation, treatment if infected,
and cure if found to have disease. Let her know that you will find
out the answers to any of her questions for which you do not know
the answers.
Case 2
Part 1 – You are conducting an interview of Razia, a 21-year-old
woman who is a TB suspect. This interview is in the patient’s apartment.
She is a recent immigrant to the United States, but speaks fluent English. You
note from her medical record that she is a homemaker and lives with
her husband. He is at work during the interview. The record states
that Razia has only listed her husband as an emergency contact and
has no children. As you walk to her home, you notice that she lives
on the third floor of a multifamily house. There are two other
apartments, and you hear people inside.
As you proceed with the interview, Razia appears to understand
the purpose of the interview and the information you are providing
about her diagnosis and treatment. When you begin to elicit contacts,
Razia states no one else lives in her home, a small 3-room apartment.
However, when she gives this information is given to you, Razia’s
eye contact begins to waiver and her voice tone is quieter. Upon
questioning whether she has visitors or employment within her home,
she insists that no one else besides her husband is in her home.
Since it is obvious that Razia is not confidently providing
this information, how should you proceed?
Explanation: Since you must elicit all contacts,
ask your questions in other ways such as “Whom do you spend time
with regularly?” Razia’s priority contacts may not all be in her
home. You can also touch upon her interactions with the other apartment
dwellers by asking, “How much time do you spend with your neighbors?”
These are just the preliminary questions you should ask before looking
into other spheres of her life such as work, school, and social
activities.
Part 2 – When you ask Razia a general question about whom
she spends a lot of time with, she still insists that she spends
time at home all day until her husband arrives. When you ask about
other contacts, she mentions some other friends whom she rarely
saw during the infectious period. A few minutes later, an elderly
woman walks into the apartment without knocking. The woman speaks
to Razia in her native language and is carrying food that she leaves
on a table. Razia says something to the woman, who then leaves.
How do you approach the topic of others who spend time in
Razia’s home in light of observing the visitor who just arrived?
Explanation: It is obvious that the visitor is familiar
enough to be someone with whom Razia spends a lot of time. This
visitor is also someone who may not live with Razia, but probably
lives nearby, perhaps even in one of the other apartments in the
house.
Part 3 – You reiterate the importance of identifying priority
contacts and tell Razia that she needs to be candid about all people
with whom she spends prolonged periods of time. You then directly
ask Razia about the woman who walked into her home. Razia hesitates,
but then tells you it is her mother-in-law who lives downstairs.
She came to bring some food for her and her husband. She then mentions
that her husband’s family lives in the other two apartments. She
spends considerable time with them while she watches her sister-in-law’s
two small children 2 days a week. Razia states that she was too
embarrassed to tell you this, and that none of the family members
know that she has TB.
How should you react to Razia’s admission?
Explanation: In a nonjudgmental tone of voice, you
should thank Razia for sharing the information and tell her it must
have been hard for her to tell you this. However, it was important
that she told you about other people she spends time with, especially
any elderly or very young contacts. You now need to ask Razia some
very specific questions about who lives in the other two apartments,
how much time she spends with them, and if there are other visitors
who come to those homes while she is there. As needed, reassure
the patient that she is doing the right thing by sharing the names
of other contacts with you. It will make the contact investigation
go more smoothly and may allow these persons to be more supportive
of her. You tell her that perhaps her husband and even you can
be there while she tells them; however, this is her choice.
|
