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[Narrator:] In recent years, we have made important progress towards the final conquest
of tuberculosis, to a great extent aided by newer and better hospitals and sanatoriums,
and naturally, as every health officer knows, such a hospital or sanatorium is the best
place to treat tuberculosis when it is possible.
With their elaborate equipment, constant and thorough supervision and complete facilities,
these hospitals help patients to conquer their disease.
They give more effective help because they can apply definite principles of
isolation, treatment, education and rehabilitation.
Every nurse has had some glimpse of these principles at work during her professional
training and experience. The first element of tuberculosis care is the understanding
between doctor and nurse.
This understanding is vital to successful collaboration in the care of the patient.
It is also vital to the relationship of the nurse to the patient and family; always the
doctor is responsible for making the diagnosis. The doctor also orders medication and plans treatment.
The nurse is responsible for administering the doctor's plan. She shares with the doctor
a responsibility for teaching patients and families.
Seldom can we equal at any home the effectiveness of hospital care, but we can apply a number
of the same definite principles which are familiar elements in contagious disease nursing technique.
In the scenes which follow, you'll see a typical family and a typical case for the public health
nursing compared to hospital nursing. There are both similarities and differences in this
case from the time the doctor in charge calls upon the public health nurse.
[Doctor:] Mrs. Abbott, this is Dr. Caneaux. I have another patient for you; the name is
Evans. He has a wife and has two children.
The involvement is bilateral. The sputum is positive. The family will need your usual
instruction. Will you meet me there at 11, please?
[Mrs. Abbott:] 11 o'clock, yes. Yes, I know. I'll see you then, doctor.
[Narrator:] Like the nurse in the hospital, this public health nurse will follow the doctor's
orders for treatment, but she must also pass on the responsibility for daily care to the family.
Following the doctor's orders, she will help him to explain the treatment to the family
and will teach some responsible member to follow the routine of care required for the
patient's welfare and for their own safety.
You'll see brief examples of teaching by this nurse. Keep in mind as you watch them that
she has carried over to public health service from her hospital training five proven elements
of teaching which you will see are used.
Here they are, principles of teaching that are applied in all effective education. First,
good hospital teaching is affirmative. The teacher must make far less use of don't than
of do.
Second, the item to be taught must be stated clearly in a few simple words. Keep instruction
short.
Third, the teacher must demonstrate what she has described.
Fourth, the learner must demonstrate that he fully understands the instruction.
Finally, use printed material as a reminder of your teaching. Get it from your health
department or Tuberculosis Association.
Printed material can never take the place of person-to-person teaching, any more than
a short motion picture can teach complete home nursing, but it can help make your teaching
more effective by crystallizing the details of treatment. But, when it comes to such a
problem as the patient's morale, printed material is of little use. That factor must be governed
only by the human approach.
This element of morale is so important that even before teaching this family the routine
of care, and before showing the patient how to protect his family, the nurse tries to establish
the right attitude in the patient's mind.
She chooses her words and her approach carefully, explaining simply, trying to install the will
to recover. She makes it clear that treatment is not just something we do to the patient
but something to which he must contribute.
The patient's morale is one of the determining factors in his recovery, and it controls the
extent of the protection he gives the family. With the understanding and cooperation of
the patient, the nurse's work will be more successful. She must make him believe it is
worthwhile to get well.
The next treatment principle to be transferred from hospital to home is separation of the
patient from the community. This can best be done when we remove the patient to a
tuberculosis hospital or sanatorium.
In a well-conducted hospital, separation from a community is combined with evidence that
treatment is conducted for the patient's own benefit and protection.
In the home, we must apply whatever we can of communicable disease nursing technique.
When possible, we try to assign the patient to a single, private room.
In any case, a separate bed is essential and the patient must have completely separate
equipment as well. Dishes, linens and personal needs should be kept apart.
The nurse explains this affirmatively as routine medical procedure without overemphasizing
the isolation of the patient. She persuades the patient and family that separation will
protect the patient as well as protect others from his bacilli.
She keeps a safety zone as wide as possible. Now she improvises visible barriers to symbolize
the privacy of her patient even in a one-room dwelling. Naturally it is important to protect
others from the tuberculosis bacilli, which invades every corner of the room.
These paratroopers can carry tuberculosis from patient to family, but their near relatives
carry colds and pneumonia from family to patient, too. So a relative's cold can complicate
your patient's illness dangerously.
After this is explained clearly to the patient and family, the nurse leaves this printed
remind. The public health nurse has been hailed as a shoe-leather epidemiologist. Her teaching
about infection provides a natural introduction to this part of her service,
checking the patient's contacts.
Here's a positive method of identifying all contacts, which has helped to find a lot of tuberculosis.
There represented by the square you have the patient, a circle for the wife, a line of
descent and the two children. Shade the square for a known, active case.
Put a question mark for each known contact. Does the patient have any brothers or sisters?
Show them. And here's your carrier, a sister who died of tuberculosis.
The system is simple. Modify the basic idea and it'll fit any family condition.
It's an effective aid in finding cases early enough to make treatment successful.
Now we come to our next factor of treatment; cleanliness.
Simple cleanliness helps to fight tuberculosis.
We cannot duplicate in the home complete hospital apparatus, but we can teach the value and
importance of cleanliness. No case is so primitive that soap and water cannot be used.
As a supplement to soap and water, explain the cleansing properties of sunlight affirmably
to the family. Teach the family that cleanliness helps to protect everybody.
That they as well as the patient guard themselves by practicing cleanliness. Make the family
understand how cleanliness, particularly with dishes and other objects used by the patient,
is a fundamental necessity and teach the patient, too, that his cleanliness will protect the
family. He must learn to do his part to prevent further infection of himself and others.
The use of disposable tissues must be made perfectly clear to the patient. The whole
family must understand how to handle such contaminated material. This type of instruction
shows very plainly the steps an effective teaching as they apply in the home care of
tuberculosis.
Watch now the application of these elements as we explain the disposal of contaminated
tissues to the family. First, explanation. Then, demonstration. Show the whole procedure.
Then you get participation by having the procedure carried out for you.
Now explanation, demonstration, and participation are repeated in stressing the second point
in the procedure that the family must guard themselves, too, by constant cleanliness, here
shown by washing the hands thoroughly after handling contaminated material.
And, finally now the printed reminder covers both points in the procedure.
We have purposely delayed the vital fifth principle of treatment which is rest, but
we need a foundation upon which rest will be possible and effective.
Notice how the principles of treatment form a pyramid. Confidence in medical direction
is essential in all treatment. Rest is little more than a word until we establish the opportunity
of complete separation and privacy.
A clean bed and a clean body are great helps in relaxation and rest. Remember, the family
has never seen bed rest in a tuberculosis hospital. You must explain it to them.
Bed rest means being washed and bathed and shaved in bed. Bed rest means, too, being
fed in bed; not getting up for any reason.
And most important, bed rest means a recumbent position not sitting up until the doctor prescribes that change.
Finally, bed rest means regular, daily intervals of complete relaxation;
rest for both body and mind.
The patient may shorten his illness by giving hours each day to absolute bed rest.
And it is necessary to explain gently, firmly to the family and to friends, that listening to others
is not rest.
The next important item is nutrition; not only what to eat but the balance of meals.
Talk in terms of a common sense menu which can be purchased by the patient's family with
the funds available. The question of nutrition may well be taken up in the instruction
of the second visit.
In a fresh, sterile gown, the nurse teaches the family to avoid any contamination of the
food supply. In planning a diet, assure the family that the patient makes little real
gain by being stuffed and that weight alone does not mean recovery.
Show the family how to improvise a tray and how to make the food on that tray look attractive.
The result will help to stimulate the patient's appetite and his intake of the right foods
for his needs. Yes, even a meal that's good for you can be appetizing.
Suitable recreation when medically approved is an important factor in inducing patients
to accept treatment whether in the hospital or in the home.
Your instruction to the family is not complete unless you yourself have given some thought,
and provoke in the home some thought, as to what the patient may do for recreation during
his illness, especially when he becomes sputum negative.
Now here is an example of hand work learned from an occupational therapist and taught
to the patient under the doctor's approval.
As the patient continues to make progress, his reading time may be gradually increased
and now with his recovery approaching, the public health nurse arranges for a conference.
[Mrs. Abbott:] Doctor, I came to see if the patient is ready for rehabilitation training.
Mr. Bronson is from the state agency.
[Doctor:] Yes, he should be ready to start on Mr. Bronson's plan the first of next month.
[Mr. Bronson:] Figuring on three month's training, can we put him on a job when it's completed?
[Doctor:] I believe we can count on that. Send him in for a re-check regularly while
he is training. If all continues to go well, the physical demands you describe here will
be well within his tolerance.
[Mrs. Abbott:] Thank you, doctor.
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[Narrator:] Yes, here is our ultimate goal, the final reward for patient effort, care
and thought: to get the patient back on his feet.
Back to a job suitable to his condition and the future needs of his family, to make him
a working, contributing member of the community.
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You may obtain printed material for the instruction of patient of the family from the agency that
arranged for the showing of this film.
Make yourself familiar with all of the publications available from your local Tuberculosis Association.
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