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TB Notes 2, 2000

Nursing Update

A Brief Review: the Role of Nurses in TB Control

The following article was developed for the commemorative edition of TB Notes but we were not able to include it in that issue. Thus, we would like to share it with you in this issue.

In 1893 Lillian Wald created the field of public health nursing. Having completed her nursing training in 1891 at New York Hospital, in 1891 and 1892 she worked at New York Juvenile Asylum where her concerns regarding the homeless and the abuse of institutionalization gave birth to her advocacy role. She then entered Women's Medical College. During her first year there she was teaching a class on home care and hygiene to immigrant women in a school on Henry Street; she described this as her baptism by fire. Ms. Wald quit medical school, and in 1893 she and a classmate, Mary Brewster, moved into a Lower Eastside neighborhood and provided nursing care among the community. Neighbors came to the apartment for help on health, education, jobs, housing. This was the genesis of public health nursing. In 1912 she founded and was the first president of the National Organization for Public Health Nursing.

Florence NightingaleBased on the work and beliefs of Lillian Wald and Florence Nightingale, public health nurses developed positive relationships with people, which resulted in healthier environments and lifestyles among Screening immigramts diverse families and communities. Florence Nightingale was one of the first in the field of health care to consider that patient outcomes should be monitored in a systematic way. In 1854 she began keeping quarterly reports, which included patient care outcomes. She also supported the concept of pavilion-style architecture for hospitals so infections would be prevented by the practice of housing patients with specific diseases on separate pavilions or wings. Nurses also helped in screening for TB in newly arriving immigrants. The photo on the right is from Ellis Island in the 1890s.

Pneumothorax procedureBefore the discovery of treatments for TB and before the existence of sanatoriums, public health nurses visited patients in their homes to see how they and their families were coping with the illness. They instructed the patient and family on nutrition and rest and on the need for fresh air. When sanatoriums were introduced by Dr. Trudeau, nurses took care of the patients' day-to-day needs, tried to ensure they had rest and adequate nutrition, and addressed the many psychosocial needs that developed in such isolated settings. As surgical interventions and pneumothorax Patient follow-up in the community procedures were implemented, nurses learned how to assist with those procedures. Additionally, needed preprocedure education and postprocedure education and follow-up were provided by nurses. With the development of drug treatment, nurses learned the various treatments and their side effects and helped to monitor patients' progress. When the sanatoriums were closed, nurses continued the follow-up of these patients and their families out in the community.

Over time, the role of the nurse expanded from providing direct care to a variety of roles. The profile of nurses today is quite varied. Roles range fNurses Todayrom the still all-important bedside nurse in a hospital setting, to infection control, employee health, correctional, and school nurses, to name a few. In the public health arena, the roles of TB nurses range from clinic nurse to the generalist public health nurse, to specialist TB public health nurses, to nurses who are TB Consultants, TB Program Managers, and TB Controllers at all levels: local, state, federal, and international.

In January 1995, TB nurses attending the National TB Controllers Workshop voted to form the National TB Nurse Consultant Coalition (NTNCC). The mission of the NTNCC, which was organized as a section of the National TB Controllers Association, is to advise and support TB control officials by providing, within NTCA, a coordinated nursing perspective on issues vital to the success of TB prevention and control programs.

—Submitted by Evelyn Lancaster, RN, BSN
TB Program Manager
HIV, STD, and TB Section
Oregon Health Division

Editor's note: Every year, the Public Health Nurse section of the American Public Health Association presents the Lillian Wald Service Award to a public health nurse for exemplary public health nursing practice. In 1994, the award was deservedly given to one of our nurses in TB control: Sue Etkind, RN, TB Controller for Massachusetts.


Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination -

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