Tuberculosis nurse Competency framework for TB Prevention ... · TuBerCulosis PrevenTion, Care and...
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CLINICAL PROFESSIONAL RESOURCE Tuberculosis Nurse Competency Framework for TB Prevention, Care and Control
Transcript of Tuberculosis nurse Competency framework for TB Prevention ... · TuBerCulosis PrevenTion, Care and...
CliniCal Professional resourCe
Tuberculosis nurse Competency framework for TB Prevention, Care and Control
TuBerCulosis PrevenTion, Care and ConTrol
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Publication
This is an RCN practice guidance. Practice guidance are evidence-based consensus documents, used to guide decisions about appropriate care of an individual, family or population in a specific context.
Description
This framework has been developed in response to the Review of the Tuberculosis Nurse Workforce in England published in 2015, to support the nursing workforce deliver TB prevention, care and control.
Publication date: December 2017 Review date: December 2020
The Nine Quality Standards
This publication has met the nine quality standards of the quality framework for RCN professional publications. For more information, or to request further details on how the nine quality standards have been met in relation to this particular professional publication, please contact [email protected]
Evaluation
The authors would value any feedback you have about this publication. Please contact [email protected] clearly stating which publication you are commenting on.
RCN Legal Disclaimer
This publication contains information, advice and guidance to help members of the RCN. It is intended for use within the UK but readers are advised that practices may vary in each country and outside the UK.
The information in this booklet has been compiled from professional sources, but its accuracy is not guaranteed. Whilst every effort has been made to ensure the RCN provides accurate and expert information and guidance, it is impossible to predict all the circumstances in which it may be used. Accordingly, the RCN shall not be liable to any person or entity with respect to any loss or damage caused or alleged to be caused directly or indirectly by what is contained in or left out of this website information and guidance.
Published by the Royal College of Nursing, 20 Cavendish Square, London, W1G 0RN
© 2017 Royal College of Nursing. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording or otherwise, without prior permission of the Publishers. This publication may not be lent, resold, hired out or otherwise disposed of by ways of trade in any form of binding or cover other than that in which it is published, without the prior consent of the Publishers.
This publication is due for review in December 2020. To provide feedback on its contents or on your experience of using the publication, please email [email protected]
AcknowledgementsThe development of this framework was led by Public Health England with the support of NHS England. It was developed by Gini Williams and members of the Tuberculosis (TB) Nurse Workforce Development Writing Group including: Marie O’Donoghue, Hanna Kaur, Deborah Crisp, Grainne Nixon, Diane Fiefield, Marion Fleming and Surinder Tamne. It reflects significant input from TB nurse representatives serving on the seven TB control boards across England. It also includes extensive input from numerous nurses working in the field of TB; these provided feedback on various drafts in response to a formal presentation of the framework at a number of TB nursing/workforce network meetings. We are also grateful to Joanne Bosanquet and Helen Donovan for providing professional leadership and guidance.A list of participants and organisations that contributed to the framework is provided in the Appendix.
TB Nurse Workforce Development Writing Group equality statementPromoting equality and addressing health inequalities are at the heart of NHS England’s and Public Health England’s (PHE) values. Throughout the development of the policies and processes cited in this publication, the group have given due regard to the need to:• eliminatediscrimination,harassmentandvictimisation,toadvanceequalityofopportunity,and
to foster good relations between people who share a relevant protected characteristic (as cited under the Equality Act 2010) and those who do not share it
• reduceinequalitiesbetweenpatientsinaccessto,andoutcomesfrom,healthcareservices and in securing services that are provided in an integrated way where this might reduce health inequalities.
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Foreword 5
1: Introduction and background 6
2: How the framework can be used in practice 9
3: The framework using core and specific dimensions, levels and indicators 11
Abbreviations 26
References 27
Appendix: List of members of the writing group and responders to the framework (including individuals and TB nursing/workforce networks) 28
Contents
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This competency framework, for nurses working in the field of TB, was developed by Public Health England (PHE) and the NHS in partnership with the Royal College of Nursing (RCN) Public Health Forum. This included consultations and contributions from the patient’s perspective and a wide range of nurses working in TB. It is based on the NHS Knowledge Skills Framework which has core and specific dimensions, descriptors and indicators describing novice-to-expert level TB nursing practice. This document is in line with NHS England’s framework for nursing and allied professionals and is consistent with NICE TB guidance and the RCN’s Case Management guidance and is linked to ‘areas for action’ in the Collaborative Tuberculosis Strategy for England, 2015 to 2020.
Traditionally nurses in the UK begin their careers in TB by coming from a wide range of backgrounds and ‘learn about the job on the job’ with variations in approach to specialist training or development. This leads to dissimilarity in service delivery or an inconsistent understanding of core and specific public health and clinical components which are required to deliver robust TB prevention, care and control on an individual, community and population level.
The framework provides a clear pathway for nurses thinking about entering TB nursing and for nurses already working in TB. It can be used by nurses for their annual appraisal to support their personal and professional development. The document enables a highly competent TB nurse workforce to deliver safe and consistent high quality care on an organisational level, to support recruitment and retention, and enhance our leadership potential.
This document provides a tool for managers and commissioners to help understand the wide range of knowledge, skills, practice and leadership required for service planning. It can also be used by TB control boards for local TB workforce reviews in relation to service models and local TB epidemiology.
There are elements in the framework that are relevant to nurses and midwives not specifically working in the field of TB but who have crucial roles in making every contact count particularly:
• prompt early diagnosis of TB and early initiation of treatment
• caring for inpatients with TB or suspected TB
• treatment support for individuals with TB
• Work with under-served populations
• BCG immunisation
• latent TB infection testing and treatment programmes.
All of these are fundamental to effective control and prevention of further spread of TB and improves individual, community and population level outcomes.
Building on the competency framework national outline job descriptions are being produced and work is planned with Health Education England to address the TB education and training needs of the TB workforce.
We hope you find the Tuberculosis Nurse Competency Framework for TB Prevention, Care and Control helpful and would welcome your comments on its usefulness. Please feedback any comments to: [email protected] or [email protected]
Joanne Bosanquet, Deputy Chief Nurse, Public Health England and Helen Donovan, RCN Professional Lead Public Health Nursing
Foreword
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1. Introduction and background
This competency framework has been developed in response to the Review of the Tuberculosis Nurse Workforce in England published by the Centre for Workforce Intelligence (2015). The review complements the Collaborative Tuberculosis Strategy for England 2015-2020 (PHE and NHS England, 2015) which sets out ten key action areas, including: ‘Ensure an appropriate workforce to deliver TB control’. The competences reflect a consensus amongst TB nurses on best practice already applied in many places. The NHS Knowledge and Skills Framework (DH, 2004) is applied to establish the appropriate bandings for different levels of competency required. The RCN’s Tuberculosis Case Management and Cohort Review. Guidance for Health Professionals (RCN, 2012a, 2017) and the latest NICE Tuberculosis guideline (2016) underpin all clinical practice described.
Nurses working in TB care are supported by the RCN Public Health Forum. The work on this framework was developed through a national group pulled together through PHE and led by an independent consultant funded by NHSE.
Why do we need this framework?
To support the TB nursing workforce in reaching its full potential in delivering TB prevention, care and control, this framework demonstrates the role of the different levels of TB nursing linked to the ten evidence-based areas for action of the Collaborative TB Strategy for England 2015-2020. Currently, this is of relevance because:
• TB nurses on the seven TB control boards are now leading the new strategic role
• there is now an increased emphasis on tackling TB in the under-served groups and this will require more collaborative working
• of the new entrant latent TB (LTBI) screening initiative – this will require additional links between TB nursing services and new primary care practices; it will also increase
the numbers of people needing support through LTBI treatment.
The framework is in line with the NMC Code of Conduct (NMC, 2015) which sets out the professional standards nurses must uphold to remain on the register via a revalidation process, which takes place every three years. In addition, the NMC Code informs patients, carers and the public about what level of care they can expect from a qualified, registered nurse or midwife. It also helps employers understand how they should support staff to provide safe and effective care.
Children: family-centred approaches and safeguarding
As a field of nursing where children, young people and adults are included in the caseload, it is vital that family-centred approaches are adopted and support is sought, where necessary, from paediatric specialist physicians and nurses, and local safeguarding policies are strictly adhered to. As nurses may well be visiting people’s homes, either where a child is the patient or where children are present, it is important to consider what level of safeguarding training is required. Additional competences relating to children and young people have been produced by the RCN (2012b).
Addressing the findings of the Review of the TB Nurse Workforce
The Review of the Tuberculosis Nurse Workforce (CFWI, 2015) takes note of both these developments and the impact these may have on the TB nursing workforce. It suggests that core competences should be consistent over all services and that there needs to be a greater sense of TB nursing as a professional specialism with its own identity and career pathway. In the long term, this will need to include specific opportunities for training and professional development. This framework aims to address these aspects of the report and Table 1 below, outlines the review’s key findings.
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Table 1: How the framework addresses the workforce review findings
Findings from the Review of the Tuberculosis Nurse Workforce
How each will be addressed by this framework
There is no clearly defined career pathway into TB nursing
To outline the competences required for nurses wanting to work in TB and enable nurses and managers to identify transferable skills and competences
There are no national guidelines for TB nurses to follow that cover the competences required for different nurse bandings
To clarify the competences required for different bandings
There is mixed support by management, for example, some nurses felt well supported by management; others felt that management did not understand their role
To assist managers and nurses with recruitment, professional development and performance review, by clarifying the role and competency levels required for different bandings
There is no national network or information sharing point
To enable the development of expert roles, at a regional level, to set up and co-ordinate a national network and information sharing opportunities
There are various workload issues relating to complex TB cases, latent TB and low numbers of nurses covering large areas
To address the complexities of the TB nursing role at different levels in relation to varied caseloads and local epidemiology
The framework and the TB nursing workforce
TB specialist nursing is as much about public health as it is about clinical and nursing care. It embraces the core elements of public health nursing: inequalities, prevention and health protection across the entire population, as well as requiring sound knowledge of the physical aspects of the disease and the emotional, psychological and social impact on individuals, their families and friends. Patient caseloads cover all ages, social and cultural groups, with a huge variety of needs – managing such diverse caseloads presents a complex challenge. TB can never be treated in isolation and TB specialist nurses have to be mindful of the myriad of elements that make up patients’ daily lives. This inevitably involves working in partnership with a variety of other services and organisations.
TB nurses come from a wide range of training backgrounds before entering the specialty (such as infection control, domiciliary nursing, respiratory and infectious diseases). There is no clear pathway into the field and with no formal specialist training on offer, skills and knowledge are usually acquired in practice. This has led to
a variety of service models, as well as variations in the quality of care. A competency framework is long overdue for this specialist and complex field of nursing and is needed to ensure that TB services in England are equitable and fit for purpose, both for the nurses providing the service and the people who need it.
The breadth of the TB nurse role requires flexibility and a wide range of competences so that they can adapt to abrupt changes in workload (due to incidents/outbreaks) and/or as result of an increased number of patients with complex needs.
Geographically, TB is not spread evenly across regions, towns and cities. This means that managers, employers and commissioners can be unaware of what type and size of workforce they need in order to respond effectively to a local TB situation, including what services local TB nurses are providing and what support they need. Table 2 outlines who will find the framework useful and how it can be used in recruitment, retention, professional development and workforce planning.
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Table 2: Who the framework is for and how it can be used
Who is the framework for? What is the framework for?
Nurses Career pathway into, and through, TB nursing; consistency of banding
Wider TB workforce and other non-TB service nurses
Career pathway: standards of care
Managers Workforce planning; professional performance review; continued professional development
Employers Workforce planning; recruitment; standard job descriptions
Commissioners Background for monitoring fitness for purpose against key performance indicators (KPIs) and TB service specifications
NMC Benchmark for measuring standards of care in fitness to practice hearings
The framework in the context of nursing in general
The framework aims to present a patient and family-centred approach to care, acknowledging the importance of the Compassion in Practice: Nursing, Midwifery and Care Staff – our Vision and Strategy (Department of Health and the NHS Commissioning Board, 2012). This publication also presents six fundamental values of nursing known as the 6Cs: care, compassion, competence, communication, courage and commitment. It is in line with NHS England’s new framework for nursing and allied professionals: Leading Change, Adding Value: A framework for Nursing, Midwifery and Care Staff (2016). This new framework builds on the 6Cs by outlining 10 commitments (see Box 1) aimed at enabling nursing, midwifery and care staff to improve care and address the three main areas of concern outlined in NHS England’s Five Year Forward View (2014), namely: health and wellbeing, care and quality, and funding and efficiency.
Box 1: Ten commitments (Oxtoby, 2016)
1. Promote a culture where improving the population’s health is a core component of practice.
2. Increase the visibility of nursing and midwifery leadership and input in prevention.
3. Work with individuals, families and communities to equip them to make informed choices and manage their own health.
4. Focus on individual-centred care.
5. Work in partnership with individuals, families, carers and loved ones.
6. Actively respond to what matters most to staff and colleagues.
7. Lead and drive research for evidence in care.
8. Provide the right education, training and development.
9. Have the right staff in place at the right time.
10. Champion the use of technology and informatics to improve practice, address unwarranted variations and enhance outcomes.
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2. How the framework can be used in practice
The NHS KSF (2004) was designed to provide guidance on how to develop job descriptions and performance review tools based on an outline which identifies the dimensions of work the post covers, describes the level of competence required (level descriptors) and provides specific indicators which detail the different elements of the role in each level. Both the core dimensions and a number of specific dimensions have been adapted for the purposes of this framework, to assist in the development of post outlines in the field of TB. It is hoped that this framework will assist managers and team leaders in service planning as they develop local TB services to provide high-quality care for all those affected by TB and prevent the disease in the wider community, as well as being used in the longer term, to aid recruitment and retention in TB nursing.
The development of this framework is a response to the TB nurse workforce review in England, its applicability to TB nurse workforce in the rest of the UK would be appropriate given that its development is underpinned by the NHS KSF framework (DH, 2004), the RCN’s TB Case Management and Cohort Review. Guidance for Health Professionals (RCN, 2012a (updated in 2017)) and the NICE TB Guideline (2016).
DimensionsAccording to the KSF (DH, 2004), every post has six core dimensions and a number of specific dimensions relevant to the requirements of the post. The specific dimensions in this framework have been chosen from the KSF to reflect the complexity of TB nursing and, as such, are more than seven which is the maximum number usually recommended (RCN, 2005). The framework is linked to the Collaborative TB Strategy for England as it identifies how the areas for action recommended in the strategy, listed below, relate to the different dimensions of TB nursing. Although all core dimensions will be required for each post, the specific dimensions may vary according to how local services are
organised, the geography of the patch (urban, rural or mixed), the size and profile of the caseload and local TB epidemiology.
The Collaborative TB Strategy for England: Key areas for actionA1. Improve access to services and ensure early diagnosis.
A2. Provide universal access to high-quality diagnostics.
A3. Improve treatment and care services.
A4. Ensure comprehensive contact tracing.
A5. Improve BCG vaccination uptake.
A6. Reduce drug-resistant TB.
A7. Tackle TB in under-served populations.
A8. Systematically implement new entrant latent TB screening.
A9. Strengthen surveillance and monitoring.
A10. Ensure an appropriate workforce to deliver TB control.
NHS KSF levelsThese levels are helpful in establishing banding and pay grades. For someone new to a post, it is expected that they will achieve the level of competence required within the first year of being in post. This may take longer for someone working part time. Table 3 describes how the levels relate to different roles in TB nursing and suggests some examples as a guide. It is important to remember that, in each case, there will be posts which require a variation of dimensions with differing levels of competence and, although there is no strict association between levels and banding, Table 3 does
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suggest how the two might relate to each other. Having established the different dimensions and levels of competency required for each post, the overriding level of competence will become clearer. This, in turn, will provide a useful guide for a decision regarding banding and help to maintain consistency and equality within the field.
The framework aims to provide as broad a consensus as possible, while also recognising that teams vary according to local epidemiology, commissioning processes and geographical
factors. Services vary from large-mixed teams working in high-incidence urban areas with non-clinical and administrative support, to lone nurses working over a vast rural area, with many variations in between. This framework focuses on the level of nursing competency required according to local need and skill mix available. Even though a nurse may have a small caseload in a rural area, the level of autonomy and variety of competency and skill required by that one nurse is likely to be high and should be reflected in the banding (see Table 3).
Table 3: NHS KSF example levels and bands
Level Suggested band
Role Examples
1 5 RNs who routinely provide care to patients with suspected or confirmed TB. The role is limited to supporting senior colleagues and liaising with the TB team
Staff nurses working in accident and emergency departments, respiratory and infection control wards, HIV units or in chest clinics; practice nurses involved in new entrant LTBI screening; prison nurses; infection control nurses; health visitors; midwives and school nurses
2 5–6 RNs with a minimum level of knowledge and skills for all nurses working within the TB field
Novice TB nurses developing in the role; a member of the TB team managing standard care for people suffering with TB and participating in screening programmes
3 6–7 Specialist nurses performing, or working at, advanced level practice. They work autonomously to co-ordinate and deliver comprehensive care to patients
TB team lead, in charge of a caseload and providing enhanced case management (ECM)
4 7–8 Expert nurse/consultant with strategic input at regional or national level
Tuberculosis Control Branch (TBCB) representative; collaboration with PHE (regional and national) and NHS England; manager of TB teams over multiple sites or a large geographical area
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3. The framework using core and specific dimensions, levels and indicators
This section identifies the competences required to implement the Collaborative TB Strategy for England 2015–2020 (PHE and NHS England, 2015) and comply with the RCN’s TB Case Management and Cohort Review. Guidance for Health Professionals (RCN, 2012a) and the NICE TB Guideline (NICE, 2016). The core and specific dimensions have been taken directly from the KSF and selected for their relevance to the complex role of TB nursing. The level descriptors correspond with those in the KSF but have been adapted to relate specifically to TB prevention, care and control. As in the KSF, there is no hierarchy and one dimension is no more or less important than any other. The intention is to demonstrate how the field of TB nursing can be defined on a professional basis in line with the professional standards and competences in all other fields of nursing.
The indicators give a more detailed breakdown of the knowledge and skills required in each level for each dimension and are useful for informing job requirements and performance review. Nurses will have to demonstrate that
they meet each level of competence by meeting the indicators identified locally as being relevant for the post. For those new to a post, it should be expected that they will reach relevant indicators within the first year. Staff will develop their knowledge, skills and competence over time and this needs to be acknowledged and reflected in their pay and conditions. This can be achieved through an annual competency-based performance review process. It will not be possible to upgrade a post based simply on the performance of an individual, but recognition of an individual’s performance can enable them to improve their prospects of promotion to a higher banded post when a vacancy arises. In some cases, the levels may be higher than current expectations and in others they will be lower. This is only to be expected following the findings from the Review of the TB Nurse Workforce (CFWI, 2015) and it is anticipated that steps will need to be taken to ensure consistency across England. The framework is based on a broad consensus regarding what level of competency is required for each dimension.
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in r
esp
on
se. (
DH
, 20
04
)
•P
rovi
des
fee
db
ack
to o
ther
w
ork
ers
on
thei
r co
mm
un
icat
ion
at a
pp
rop
riat
e ti
mes
. (D
H, 2
00
4)
•K
eep
s ac
cura
te a
nd
co
mp
lete
•re
cord
s o
f ac
tivi
ties
an
d
com
mu
nic
atio
ns
con
sist
ent
wit
h le
gis
lati
on
, po
licie
s an
d
pro
ced
ure
s. (
DH
, 20
04
)
•C
om
mu
nic
ates
wit
h p
eop
le
in a
fo
rm a
nd
man
ner
wh
ich
: –
is c
on
sist
ent
wit
h th
eir
leve
l o
f u
nd
erst
and
ing
, cu
ltu
re,
bac
kgro
un
d a
nd
pre
ferr
ed w
ay
of
com
mu
nic
atin
g
•is
ap
pro
pri
ate
to it
s p
urp
ose
an
d
its
lon
ger
-ter
m im
po
rtan
ce
•is
ap
pro
pri
ate
to t
he
com
ple
xity
o
f th
e co
nte
xt
•en
cou
rag
es e
ffec
tive
co
mm
un
icat
ion
bet
wee
n al
l in
volv
ed
•en
able
s a
con
stru
ctiv
e o
utc
om
e to
be
ach
ieve
d. (
DH
, 20
04
)
An
tici
pat
es b
arri
ers
to
com
mu
nic
atio
n at
a s
trat
egic
leve
l an
d t
akes
act
ion
to a
dd
ress
th
em.
(DH
, 20
04
)
Is p
roac
tive
in s
eeki
ng
ou
t d
iffe
ren
t st
yles
an
d m
eth
od
s o
f co
mm
un
icat
ing
to
ass
ist
lon
ger
-te
rm n
eed
s an
d a
ims.
(D
H, 2
00
4)
Take
s a
pro
acti
ve r
ole
in p
rod
uci
ng
ac
cura
te a
nd
co
mp
lete
TuBerCulosis PrevenTion, Care and ConTrol
12
Dim
ensi
ons
Act
ion
area
sLe
vel d
escr
ipto
rs
1 2
3 4
pro
ced
ure
s. (
DH
, 20
04
) C
om
mu
nic
ates
in a
man
ner
th
at is
co
nsi
sten
t w
ith
rele
van
t le
gis
lati
on
, po
licie
s an
d
pro
ced
ure
s. (
DH
, 20
04
)
•C
om
mu
nic
ates
in a
man
ner
th
at is
co
nsi
sten
t w
ith
rele
van
t le
gis
lati
on
, po
licie
s an
d
pro
ced
ure
s. (
DH
, 20
04
)
•P
rod
uce
s g
oo
d q
ual
ity
wri
tten
re
po
rts,
eg
, an
nu
al s
ervi
ce
rep
ort
s; in
cid
ent
inve
stig
atio
n re
po
rts.
reco
rds
of
the
com
mu
nic
atio
n,
con
sist
ent
wit
h le
gis
lati
on
, po
licie
s an
d p
roce
du
res.
(D
H, 2
00
4)
Co
mm
un
icat
es in
a m
ann
er t
hat
is
con
sist
ent
wit
h le
gis
lati
on
, po
licie
s an
d p
roce
du
res.
(D
H, 2
00
4)
Rep
rese
nts
th
e vi
ews
of
the
TB
n
urs
ing
ser
vice
at
the
TB
CB
an
d c
on
trib
ute
s to
loca
l ser
vice
p
lan
nin
g a
nd
dec
isio
n-m
akin
g
pro
cess
es.
CO
RE
2:
Per
son
al
and
peo
ple
d
evel
op
men
t
A1,
A7,
A
8, A
10C
on
trib
ute
s to
per
son
al
dev
elo
pm
ent
by
keep
ing
up
to
dat
e w
ith
the
late
st T
B
gu
idel
ines
, an
d lo
cal a
nd
nat
ion
al
stra
teg
ies.
Dev
elo
ps
ow
n sk
ills
and
kn
ow
led
ge
in d
evel
op
men
ts
in t
he
fiel
d o
f T
B a
nd
pro
vid
es
info
rmat
ion
to o
ther
s to
hel
p t
hei
r d
evel
op
men
t.
Dev
elo
ps
on
esel
f an
d c
on
trib
ute
s to
th
e d
evel
op
men
t o
f o
ther
s b
y tr
ain
ing
fro
ntl
ine
wo
rker
s in
dir
ect
con
tact
wit
h th
ose
aff
ecte
d b
y T
B.
Dev
elo
ps
on
esel
f an
d o
ther
s in
an
y ar
eas
of
pra
ctic
e an
d n
ew
dev
elo
pm
ents
in lo
cal a
nd
nat
ion
al
TB
gu
idel
ines
an
d s
trat
egie
s.
Ind
icat
ors
Iden
tifi
es c
riti
cal i
nci
den
ts f
rom
w
hic
h le
arn
ing
will
occ
ur.
En
sure
s o
wn
sup
ervi
sio
n n
eed
s ar
e m
et a
t an
ap
pro
pri
ate
leve
l w
ith
an id
enti
fied
men
tor.
Dem
on
stra
tes
adeq
uat
e kn
ow
led
ge
of
pu
lmo
nar
y, e
xtra
-p
ulm
on
ary
and
late
nt
TB
, to
hel
p
pro
vid
e ca
re s
afel
y ac
cord
ing
to
th
e cl
inic
al s
etti
ng
(eg
, clin
ic o
r w
ard
).
Par
tici
pat
es in
loca
l net
wo
rks
and
is a
war
e o
f th
e lo
cal T
B r
ates
an
d m
anag
emen
t p
roto
cols
.
Can
des
crib
e th
e lo
cal c
on
tact
in
vest
igat
ion
and
scr
een
ing
p
roce
ss.
Dem
on
stra
tes
spec
ialis
t kn
ow
led
ge
of
mic
rob
iolo
gy,
im
mu
no
log
y an
d p
hysi
olo
gy,
as
soci
ated
wit
h T
B (
pu
lmo
nar
y,
extr
a-p
ulm
on
ary
and
LT
BI)
ca
se m
anag
emen
t, f
rom
bef
ore
d
iag
no
sis
to t
he
end
of
trea
tmen
t.
Pro
vid
es m
ento
rsh
ip f
or
nu
rses
n
ew t
o t
he
TB
fie
ld.
Mai
nta
ins
pro
fess
ion
al
dev
elo
pm
ent
thro
ug
h ac
cess
to
re
gio
nal
an
d n
atio
nal
stu
dy
day
s an
d c
ou
rses
.
Sh
ares
kn
ow
led
ge
and
bes
t p
ract
ice
tho
ug
h p
arti
cip
atio
n in
loca
l, re
gio
nal
an
d n
atio
nal
n
etw
ork
s.
Can
des
crib
e n
atio
nal
gu
idel
ines
an
d lo
cal p
roto
cols
fo
r th
e ca
re, p
reve
nti
on
, dia
gn
osi
s an
d
trea
tmen
t o
f T
B.
Dem
on
stra
tes
and
mai
nta
ins
curr
ent
exp
ert
kno
wle
dg
e an
d u
nd
erst
and
ing
of
TB
p
ath
op
hysi
olo
gy,
mic
rob
iolo
gy
and
imm
un
olo
gy
and
th
e im
pac
t o
n T
B p
atie
nts
, in
clu
din
g
tho
se w
ith
co-i
nfe
ctio
ns
and
co
-mo
rbid
itie
s.
Su
pp
ort
s an
d e
du
cate
s o
ther
m
emb
ers
of
the
mu
ltid
isci
plin
ary
team
, in
clu
din
g o
ther
nu
rse
men
tors
.
Init
iate
s an
d p
rovi
des
ski
lled
su
per
visi
on
for
mem
ber
s o
f te
am.
Acc
esse
s an
d p
arti
cip
ates
in
stu
dy
day
s/ed
uca
tio
nal
eve
nts
at
a n
atio
nal
an
d r
egio
nal
leve
l, an
d s
tays
up
to
dat
e w
ith
curr
ent
reco
mm
end
atio
ns.
Pro
vid
es e
xper
t kn
ow
led
ge
to
oth
er p
rofe
ssio
nal
s, a
gen
cies
an
d/o
r a
TS
O, i
den
tify
ing
sel
f as
p
atie
nt
advo
cate
.
Pro
vid
es e
xper
t kn
ow
led
ge
of
all a
spec
ts o
f T
B a
nd
cas
e m
anag
emen
t, in
clu
din
g a
ny
chan
ges
in r
eco
mm
end
atio
ns
in
care
, co
ntr
ol o
r p
reve
nti
on
.
Ass
esse
s re
qu
irem
ents
fo
r p
rofe
ssio
nal
dev
elo
pm
ent
amo
ng
d
efin
ed lo
cal T
B s
ervi
ces
and
id
enti
fies
op
po
rtu
nit
ies
for
thes
e to
be
met
.
Ad
voca
tes
for
pro
fess
ion
al
dev
elo
pm
ent
op
po
rtu
nit
ies
(eg
, ti
me
and
/or
cou
rse
cost
s) f
or
mem
ber
s o
f d
efin
ed T
B s
ervi
ces,
as
req
uir
ed.
Co
ntr
ibu
tes
to t
he
dev
elo
pm
ent
of
edu
cati
on
al c
ou
rses
, p
rese
nta
tio
ns,
info
rmat
ion
mat
eria
ls t
o s
up
po
rt p
rofe
ssio
nal
d
evel
op
men
t.
royal ColleGe of nursinG
13
Dim
ensi
ons
Act
ion
area
sLe
vel d
escr
ipto
rs
1 2
3 4
CO
RE
3a:
H
ealt
h, s
afet
y an
d s
ecu
rity
A3
, A4
, A
6A
ssis
ts in
mai
nta
inin
g o
wn
and
o
ther
s’ h
ealt
h an
d s
ecu
rity
by
un
der
stan
din
g T
B t
ran
smis
sio
n;
follo
win
g in
fect
ion
con
tro
l an
d
pre
ven
tio
n g
uid
elin
es.
Mo
nit
ors
an
d m
ain
tain
s h
ealt
h,
safe
ty a
nd
sec
uri
ty o
f se
lf a
nd
o
ther
s th
rou
gh
effe
ctiv
e in
fect
ion
con
tro
l an
d t
hro
ug
h in
form
ing
o
ther
s o
f sa
fe p
ract
ice
to r
edu
ce
tran
smis
sio
n.
Pro
mo
tes,
mo
nit
ors
an
d m
ain
tain
s b
est
pra
ctic
e in
hea
lth
, saf
ety
and
se
curi
ty, i
n co
llab
ora
tio
n w
ith
the
infe
ctio
n co
ntr
ol t
eam
, in
form
ing
an
d p
rom
oti
ng
ho
spit
al p
olic
ies
for
infe
ctio
n p
reve
nti
on
and
co
ntr
ol.
Mai
nta
ins
and
dev
elo
ps
an
envi
ron
men
t an
d c
ult
ure
th
at
imp
rove
s h
ealt
h, s
afet
y an
d
secu
rity
th
rou
gh
stra
teg
ic
invo
lvem
ent
in r
egio
nal
/nat
ion
al
po
licy-
mak
ing
.
Ind
icat
ors
Exp
lain
s th
e ri
sk f
acto
rs f
or
late
nt
and
act
ive
TB
in t
he
UK
.
Exp
lain
s b
asic
infe
ctio
n p
reve
nti
on
to t
he
pat
ien
t/ca
rer,
to r
edu
ce f
urt
her
sp
read
.
If a
pat
ien
t is
in h
osp
ital
, en
sure
th
e ap
pro
pri
ate
infe
ctio
n p
reve
nti
on
pre
cau
tio
ns
are
follo
wed
reg
ard
ing
iso
lati
on
in
a si
ng
le r
oo
m (
if a
dm
itte
d),
th
is
incl
ud
es: a
pp
rop
riat
e m
ask-
wea
rin
g, c
ou
gh
hyg
ien
e an
d
min
imis
ing
wai
tin
g t
imes
. (N
ICE
, 20
15)
Inst
ruct
s p
atie
nts
to
ob
serv
e in
fect
ion
pre
ven
tio
n p
reca
uti
on
s fo
r th
e fi
rst
two
wee
ks o
f tr
eatm
ent
or
un
til t
hey
are
p
rove
n to
be
no
n-i
nfe
ctio
us
(eg
, if
th
ey h
ave
mu
lti-
dru
g-r
esis
tan
t T
B (
MD
R–T
B)
or
exte
nsi
ve
pu
lmo
nar
y d
isea
se. (
NIC
E, 2
015
)
Pro
vid
es a
ccu
rate
info
rmat
ion
for
pat
ien
ts a
nd
th
eir
fam
ilies
ab
ou
t th
e ri
sks
of
tran
smis
sio
n an
d h
ow
an
y ri
sks
mig
ht
be
min
imis
ed.
En
sure
s co
lleag
ues
in d
iffe
ren
t w
ard
s an
d d
epar
tmen
ts, w
hic
h m
ay b
e u
sed
by
pat
ien
ts w
ith
po
ten
tial
ly in
fect
iou
s T
B, a
re
awar
e o
f in
fect
ion
pre
ven
tio
n an
d
con
tro
l mea
sure
s. (
NIC
E, 2
015
)
Fo
llow
s re
com
men
ded
o
ccu
pat
ion
al h
ealt
h p
olic
ies
to
pro
tect
th
emse
lves
. (N
ICE
, 20
15)
Lead
s in
cid
ent
inve
stig
atio
ns,
(eg
, in
res
po
nse
to
un
dia
gn
ose
d c
ases
in
co
ng
reg
ate
sett
ing
s –
ho
spit
al
war
ds,
pri
son
s). W
ork
s w
ith
the
org
anis
atio
n’s
med
ia t
eam
to
p
reve
nt u
nn
eces
sary
neg
ativ
e m
essa
ges
ab
ou
t T
B a
nd
th
ose
af
fect
ed, a
nd
th
e m
anag
emen
t o
f p
atie
nts
bei
ng
tes
ted
du
e to
w
ard
/sta
ff e
xpo
sure
.
Co
llab
ora
tes
wit
h h
osp
ital
an
d
com
mu
nit
y in
fect
ion
cont
rol
team
s to
en
sure
loca
l po
licie
s in
clu
de
adeq
uat
e, u
p-t
o-d
ate
TB
in
fect
ion
pre
ven
tio
n m
easu
res
and
th
at t
he
app
rop
riat
e p
eop
le
are
awar
e o
f an
d a
pp
ly t
hem
in
pra
ctic
e.
Ad
vise
s o
n in
fect
ion
pre
ven
tio
n an
d c
ont
rol i
n co
mp
lex
situ
atio
ns
ou
tsid
e o
f lo
cal p
olic
y (e
g,
last
sp
utu
m s
mea
r is
po
siti
ve,
no
co
ug
h an
d c
avit
y –
giv
es
advi
ce o
n in
pat
ien
t, o
utp
atie
nt,
co
mm
un
ity
iso
lati
on)
.
En
sure
s al
l new
tea
m m
emb
ers
follo
w o
ccu
pat
ion
al h
ealt
h p
olic
ies
for
thei
r p
erso
nal
pro
tect
ion
. (N
ICE
, 20
15)
Co
nd
uct
s ri
sk a
sses
smen
ts a
nd
d
evel
op
s st
and
ard
op
erat
ing
p
roce
du
res
for
the
del
iver
y o
f T
B
test
ing
(eg
, ph
leb
oto
my)
in n
on
-cl
inic
al e
nvir
on
men
ts.
Co
llab
ora
tes
wit
h/p
rovi
des
exp
ert
advi
ce t
o T
B d
evel
op
men
t an
d
revi
ew r
elat
ed p
olic
ies,
in li
gh
t o
f n
ew r
esea
rch
, gu
idan
ce (
eg,
infe
ctio
n p
reve
nti
on
and
co
ntr
ol
po
licie
s an
d o
ccu
pat
ion
al h
ealt
h).
CO
RE
4:
Ser
vice
im
pro
vem
ent
A1,
A3
, A
6, A
7,
A8
, A10
Mak
es c
han
ges
wit
h o
wn
pra
ctic
e an
d o
ffer
s su
gg
esti
on
s fo
r im
pro
vin
g p
ract
ice,
in
line
wit
h T
B g
uid
elin
es a
nd
st
rate
gie
s.
Co
ntr
ibu
tes
to t
he
imp
rove
men
t o
f se
rvic
es in
lin
e w
ith
TB
g
uid
elin
es a
nd
str
ateg
ies.
En
cou
rag
es f
eed
bac
k an
d
sug
ges
tio
ns
fro
m s
ervi
ce u
sers
. A
pp
rais
es, i
nte
rpre
ts a
nd
ap
plie
s su
gg
esti
on
s, r
eco
mm
end
atio
ns
and
dir
ecti
ves
to im
pro
ve s
ervi
ces
Wo
rks
in p
artn
ersh
ip w
ith
oth
ers
to d
evel
op
, tak
e fo
rwar
d a
nd
ev
alu
ate
dir
ecti
on
, po
licie
s an
d
stra
teg
ies
bas
ed o
n T
B g
uid
elin
es
and
str
ateg
ies.
TuBerCulosis PrevenTion, Care and ConTrol
14
Dim
ensi
ons
Act
ion
area
sLe
vel d
escr
ipto
rs
1 2
3 4
bas
ed o
n T
B g
uid
elin
es a
nd
st
rate
gie
s.
Ind
icat
ors
Dis
cuss
es w
ith
line
man
ager
, w
ork
tea
m, T
B t
eam
th
e ch
ang
es
that
nee
d t
o b
e m
ade
to t
hei
r o
wn
pra
ctic
e an
d t
he
reas
on
s fo
r th
em. (
DH
, 20
04
)
Pas
ses
on
con
stru
ctiv
e vi
ews
and
idea
s o
n im
pro
vin
g s
ervi
ces
for
use
rs a
nd
th
e p
ub
lic t
o t
he
app
rop
riat
e p
erso
n. (
DH
, 20
04
)
Ale
rts
line
man
ager
, wo
rk t
eam
, T
B t
eam
wh
en d
irec
tio
n, p
olic
ies
and
str
ateg
ies
are
adve
rsel
y af
fect
ing
use
rs o
f th
e se
rvic
e o
r th
e p
ub
lic, e
spec
ially
th
ose
th
at
may
be
jeo
par
dis
ing
th
e sa
fety
o
r co
nfi
den
ce o
f th
e p
atie
nt
or
thei
r fa
mily
.
Ref
lect
s o
n cl
inic
al p
ract
ice
and
p
atie
nt
ou
tco
mes
to
iden
tify
ar
eas
for
po
ten
tial
imp
rove
men
t an
d s
har
es t
hes
e w
ith
the
app
rop
riat
e te
am m
emb
ers
to d
iscu
ss h
ow
th
ese
cou
ld b
e ap
plie
d.
Att
end
s w
eekl
y m
ult
idis
cip
linar
y te
am (
MD
T)
mee
tin
gs
to d
iscu
ss
new
cas
es, p
oss
ible
cas
es
that
did
no
t at
ten
d, c
om
ple
x ca
ses
and
co
nta
ct/o
utb
reak
in
vest
igat
ion
s. (
DH
, 20
04
)
Co
ntr
ibu
tes
to lo
cal p
olic
y d
iscu
ssio
ns
to e
nsu
re t
hat
it is
fit
fo
r p
urp
ose
an
d r
elev
ant
to t
he
pra
ctic
e en
viro
nm
ent
and
th
ose
p
rovi
din
g c
are.
Iden
tifi
es a
reas
fo
r im
pro
vem
ent
and
lead
s o
n in
terv
enti
on
s to
im
pro
ve s
ervi
ces
in li
ne
wit
h:
•an
alys
is o
f o
utc
om
es a
nd
ev
alu
atio
n o
f co
ho
rt r
evie
w
•ad
van
ces
in t
ech
no
log
y
•u
pd
ates
in T
B m
anag
emen
t g
uid
elin
es.
Mo
nit
ors
ro
ute
s u
sed
by
pat
ien
ts a
cces
sin
g t
he
serv
ice
and
dev
elo
ps
pat
hway
s to
p
rom
ote
rap
id a
cces
s to
en
sure
ea
rly
dia
gn
osi
s an
d t
reat
men
t co
mm
ence
men
ts.
Co
ntr
ibu
tes
to d
iscu
ssio
ns
on
reg
ion
al a
nd
nat
ion
al p
olic
ies
and
g
uid
elin
es.
Dem
on
stra
tes
lead
ersh
ip a
t a
reg
ion
al a
nd
nat
ion
al le
vel t
o
ensu
re p
roto
cols
can
be
app
lied
sa
fely
an
d t
o a
hig
h st
and
ard
.
Su
pp
ort
s T
B t
eam
s ac
ross
a
def
ined
loca
l are
a to
dev
elo
p t
he
serv
ice
in li
ne
wit
h ad
van
ces
in
tech
no
log
y an
d u
pd
ates
in T
B
case
man
agem
ent
pra
ctic
e an
d
gu
idel
ines
.
Co
ntr
ibu
tes
to n
atio
nal
po
licy
and
gu
idel
ines
to
en
sure
re
com
men
dat
ion
s su
pp
ort
hig
h-
qu
alit
y p
atie
nt-
cen
tred
car
e.
CO
RE
5:
Qu
alit
yA
2, A
3,
A6
Mai
nta
ins
the
qu
alit
y o
f th
eir
ow
n w
ork
in li
ne
wit
h T
B
gu
idel
ines
.
Co
ntr
ibu
tes
to q
ual
ity
imp
rove
men
ts in
lin
e w
ith
TB
g
uid
elin
es a
nd
str
ateg
ies.
Act
ivel
y se
eks
to im
pro
ve q
ual
ity
in li
ne
wit
h T
B g
uid
elin
es a
nd
st
rate
gie
s.
Dev
elo
ps
a cu
ltu
re t
hat
imp
rove
s q
ual
ity
in li
ne
wit
h T
B g
uid
elin
es
and
str
ateg
ies.
Ind
icat
ors
Aw
are
of,
and
imp
lem
ents
, lo
cal
pro
toco
ls o
n T
B c
on
tro
l an
d
pre
ven
tio
n in
th
e cl
inic
, ho
spit
al
or
com
mu
nit
y en
viro
nm
ent.
Info
rms
colle
agu
es w
ho
are
u
naw
are
of
thes
e p
roto
cols
an
d r
aise
s co
nce
rns
wit
h lin
e m
anag
er if
th
ey a
re n
ot
follo
wed
.
Has
a s
ou
nd
kn
ow
led
ge
of,
and
ap
plie
s, lo
cal T
B p
roto
cols
, p
olic
ies
and
gu
idel
ines
.
Is a
war
e o
f h
ow
th
ese
rela
te t
o
nat
ion
al g
uid
elin
es, i
ncl
ud
ing
h
ow
an
d w
hy t
hey
may
dif
fer.
Rai
ses
con
cern
s w
ith
line
man
ager
wh
en g
uid
elin
es a
nd
p
roto
cols
are
no
t b
ein
g f
ollo
wed
, as
sess
es r
easo
ns
beh
ind
wh
at
is h
app
enin
g a
nd
su
gg
ests
so
luti
on
s.
Ass
esse
s th
e se
rvic
e ac
cord
ing
to
TB
gu
idel
ines
an
d s
trat
egie
s,
iden
tifi
es a
reas
req
uir
ing
im
pro
vem
ent
and
pla
ns
to m
ake
imp
rove
men
ts.
Res
po
nd
s to
co
nce
rns
and
idea
s fr
om
oth
er m
emb
ers
of
the
MD
T.
Pri
ori
tise
s im
pro
vem
ents
bas
ed
on
po
ten
tial
fo
r ch
ang
e in
ter
ms
of
reso
urc
es, m
oti
vati
on
and
se
rvic
e o
rgan
isat
ion
.
Wh
ere
po
ssib
le, a
pp
lies
a p
rob
lem
-so
lvin
g a
pp
roac
h to
id
enti
fy t
he
pro
ble
m, p
lan
an
inte
rven
tio
n an
d e
valu
ate
the
resu
lts.
Mai
nta
ins
go
od
co
mm
un
icat
ion
wit
h M
DTs
an
d s
up
po
rts
them
in
thei
r ef
fort
s to
ad
dre
ss c
on
cern
s an
d m
ake
imp
rove
men
ts.
En
cou
rag
es a
sci
enti
fic
app
roac
h w
ith
a cl
ear
des
crip
tio
n o
f th
e p
rob
lem
, a b
asel
ine
mea
sure
men
t o
f an
y m
easu
rab
le in
dic
ato
rs,
a p
lan
ned
an
d lo
cally
ag
reed
in
terv
enti
on
and
a d
ate
set
for
eval
uat
ion
.
Men
tors
a t
eam
mem
ber
to
wri
te
up
th
e re
sult
s an
d p
ub
lish
es
the
rep
ort
in a
n ap
pro
pri
ate
pu
blic
atio
n o
r su
bm
its
for
pre
sen
tati
on
at a
mee
tin
g o
r co
nfe
ren
ce.
royal ColleGe of nursinG
15
Dim
ensi
ons
Act
ion
area
sLe
vel d
escr
ipto
rs
1 2
3 4
Fee
ds
fin
din
gs
into
loca
l p
roto
cols
, po
licie
s an
d g
uid
elin
es.
En
sure
s fi
nd
ing
s ar
e fe
d b
ack
to
the
TB
CB
an
d in
to T
B g
uid
elin
es
and
str
ateg
ies
CO
RE
6:
A1,
A3
, A
4, A
6,
A7,
A8
Act
s in
way
s th
at s
up
po
rts
equ
alit
y an
d d
iver
sity
wh
ich
enab
les
acce
ss t
o s
ervi
ces
for
all
peo
ple
aff
ecte
d b
y T
B.
Su
pp
ort
s eq
ual
ity
and
val
ues
d
iver
sity
th
rou
gh
sup
po
rtin
g
EC
M a
nd
ou
trea
ch.
Pro
mo
tes
equ
alit
y an
d v
alu
es
div
ersi
ty t
hro
ug
h E
CM
an
d
colla
bo
rati
ve w
ork
ing
, to
en
sure
ac
cess
ible
pre
ven
tio
n st
rate
gie
s.
Dev
elo
ps
a cu
ltu
re t
hat
pro
mo
tes
equ
alit
y an
d v
alu
es d
iver
sity
at
a st
rate
gic
leve
l to
ad
dre
ss t
he
nee
ds
of
un
der
serv
ed p
op
ula
tio
ns
(US
Ps)
.
Ind
icat
ors
Dem
on
stra
tes
awar
enes
s o
f o
wn
bel
iefs
, val
ues
an
d li
mit
atio
ns.
Dem
on
stra
tes
awar
enes
s an
d r
esp
ect
for
cust
om
s an
d
bel
iefs
an
d h
ow
th
ese
infl
uen
ce
a p
atie
nt’
s at
titu
des
an
d
un
der
stan
din
g.
Rec
og
nis
es a
nd
ack
no
wle
dg
es
lifes
tyle
ris
ks, i
ncl
ud
ing
su
bst
ance
mis
use
an
d p
oo
r liv
ing
co
nd
itio
ns.
Dem
on
stra
tes
awar
enes
s o
f d
iffi
cult
ies
and
ch
alle
ng
es f
acin
g
un
der
serv
ed/h
ard
to
rea
ch
pat
ien
ts.
Dem
on
stra
tes
awar
enes
s o
f th
e n
eed
s o
f T
B p
atie
nts
w
ith
co-i
nfe
ctio
ns
and
co
-mo
rbid
itie
s.
Has
aw
aren
ess
of
the
po
ssib
le
imp
act
of
trau
mat
ic e
ven
ts (
eg,
tort
ure
an
d m
igra
tio
n), s
ub
stan
ce
dep
end
ency
an
d m
enta
l hea
lth
on
the
pat
ien
t’s
com
mu
nic
atio
n,
abili
ty t
o m
ake
dec
isio
ns
and
fo
rm r
elat
ion
ship
s.
Dem
on
stra
tes
an u
nd
erst
and
ing
o
f cu
ltu
ral,
soci
al a
nd
beh
avio
ura
l fa
cto
rs in
det
erm
inin
g h
ow
TB
te
stin
g, i
nfe
ctio
n an
d d
isea
se
are
per
ceiv
ed b
y in
div
idu
als
and
th
eir
care
rs.
Iden
tifi
es f
acto
rs, i
ncl
ud
ing
ex
per
ien
ce o
f h
ealt
h an
d s
oci
al
care
in o
ther
co
un
trie
s, c
ult
ura
l tr
adit
ion
s, b
elie
fs, a
nd
rel
igio
us
ho
liday
s, t
hat
may
cre
ate
bar
rier
s to
acc
essi
ng
th
e h
ealt
h an
d
soci
al c
are
syst
em in
th
e U
K a
nd
ac
cep
tin
g T
B d
iag
no
sis
an
d t
reat
men
t.
Ap
plie
s kn
ow
led
ge
of
the
role
of
cult
ura
l, so
cial
an
d b
ehav
iou
ral
fact
ors
in d
eter
min
ing
th
e d
eliv
ery
of
TB
ser
vice
s.
Is a
ble
to
ass
ess
and
res
po
nd
to
th
e im
pac
t o
f tr
aum
atic
eve
nts
(e
g, t
ort
ure
an
d m
igra
tio
n),
sub
stan
ce d
epen
den
cy a
nd
m
enta
l hea
lth
on
the
pat
ien
t’s
com
mu
nic
atio
n, a
bili
ty t
o m
ake
dec
isio
ns
and
fo
rm r
elat
ion
ship
s.
Wo
rks
to e
nsu
re t
hat
TB
ser
vice
s ta
ke a
cco
un
t o
f cu
ltu
ral,
soci
al
and
beh
avio
ura
l fac
tors
wh
ich
det
erm
ine
ho
w T
B t
esti
ng
, in
fect
ion
and
dis
ease
are
p
erce
ived
by
ind
ivid
ual
s an
d t
hei
r ca
rers
.
Iden
tifi
es a
nd
en
gag
es w
ith
pat
ien
ts w
ith
dif
ficu
lt a
nd
ch
alle
ng
ing
beh
avio
urs
an
d
ensu
res
thei
r n
eed
s ar
e m
et.
Co
llab
ora
tes
wit
h co
mm
issi
on
ers,
lo
cal a
uth
ori
ty d
epar
tmen
ts
(su
ch a
s p
ub
lic h
ealt
h, h
ou
sin
g,
envi
ron
men
tal h
ealt
h an
d s
oci
al
care
) an
d lo
cal T
SO
s to
en
sure
th
e lo
cal T
B e
pid
emio
log
y is
un
der
sto
od
an
d s
ervi
ces
org
anis
ed in
su
ch a
way
to
en
sure
p
rom
pt
refe
rral
an
d a
deq
uat
e tr
eatm
ent
for
peo
ple
aff
ecte
d
by
TB
.
Hea
lth
and
wel
lbei
ng (
HW
B):
Co
mp
eten
ces
spec
ific
to
pat
ient
-cen
tred
pre
vent
ion,
dia
gno
sis
and
tre
atm
ent
of
TBH
WB
1:
Pro
mo
tio
n o
f h
ealt
h an
d
wel
lbei
ng
an
d
pre
ven
tio
n o
f ad
vers
e ef
fect
s o
n h
ealt
h an
d
wel
lbei
ng
A4
, A5
, A
6, A
8C
on
trib
ute
s to
pro
mo
tin
g
TB
aw
aren
ess
and
red
uci
ng
tr
ansm
issi
on
by
bei
ng
ab
le t
o
exp
lain
th
e ra
tio
nal
e b
ehin
d T
B
pre
ven
tio
n m
easu
res,
su
ch a
s B
CG
an
d s
cree
nin
g h
igh
-ris
k g
rou
ps.
Pla
ns,
dev
elo
ps
and
imp
lem
ents
ap
pro
ach
es t
o p
rom
ote
T
B a
war
enes
s an
d r
edu
ce
tran
smis
sio
n an
d d
iag
no
stic
d
elay
.
Pla
ns,
dev
elo
ps,
imp
lem
ents
an
d e
valu
ates
pro
gra
mm
es
to p
rom
ote
TB
aw
aren
ess
and
red
uce
tra
nsm
issi
on
and
d
iag
no
stic
del
ay.
Pro
mo
tes
TB
aw
aren
ess
and
re
du
ces
TB
tra
nsm
issi
on
thro
ug
h co
ntr
ibu
tin
g t
o t
he
dev
elo
pm
ent,
im
ple
men
tati
on
and
eva
luat
ion
of
rela
ted
po
lices
.
TuBerCulosis PrevenTion, Care and ConTrol
16
Dim
ensi
ons
Act
ion
area
sLe
vel d
escr
ipto
rs
1 2
3 4
Ind
icat
ors
Dem
on
stra
tes
awar
enes
s o
f co
mm
on
bel
iefs
an
d a
ttit
ud
es
asso
ciat
ed w
ith
TB
.
Ass
esse
s th
e p
atie
nt’
s b
asic
un
der
stan
din
g o
f T
B
tran
smis
sio
n, p
rese
nta
tio
n an
d
trea
tmen
t.
Pro
vid
es a
pp
rop
riat
e m
ater
ials
ac
cord
ing
to
th
e p
atie
nt’
s in
form
atio
n n
eed
s –
refe
rrin
g
mo
re c
om
ple
x q
ues
tio
ns
to a
n ap
pro
pri
ate
mem
ber
of
the
TB
te
am.
Act
ivel
y su
pp
ort
s an
d e
mp
ow
ers
the
pat
ien
t to
ach
ieve
th
e b
est
po
ssib
le h
ealt
h o
utc
om
es
acco
rdin
g t
o t
hei
r p
erso
nal
ci
rcu
mst
ance
s.
Iden
tifi
es n
eed
fo
r, an
d
faci
litat
es a
cces
s to
, sp
ecia
list
sup
po
rt g
rou
ps
such
as
AA
, TB
A
lert
an
d s
mo
kin
g c
essa
tio
n se
rvic
es.
Off
ers
gu
idan
ce a
nd
ap
pro
pri
ate
sup
po
rt t
o p
atie
nts
reg
ard
ing
lif
esty
le c
han
ges
wh
ile t
akin
g
TB
med
icat
ion
(eg
, sm
oki
ng
, n
utr
itio
n, a
lco
ho
l).
Ed
uca
tes
and
pre
par
es p
atie
nts
fo
r te
sts
as w
ell a
s tr
eatm
ent.
(D
H, 2
00
4)
Has
co
mp
reh
ensi
ve k
no
wle
dg
e o
f th
e ra
ng
e o
f T
B e
du
cati
on
reso
urc
es a
vaila
ble
an
d
inco
rpo
rate
s th
ese
into
pat
ien
t ca
re p
lan
s.
Ad
apts
TB
hea
lth
pro
mo
tio
n st
rate
gie
s th
at c
ou
ld b
e u
sed
w
ith
pat
ien
ts a
nd
in t
he
wid
er
com
mu
nit
y (e
g, W
orl
d T
B D
ay
even
ts).
Iden
tifi
es a
nd
su
pp
ort
s p
atie
nts
w
ho
se c
ho
ices
may
imp
act
thei
r tr
eatm
ent
ou
tco
me
and
ad
vers
ely
affe
ct t
he
wid
er c
om
mu
nit
y.
Un
der
stan
ds
the
crit
eria
ag
ain
st w
hic
h p
atie
nts
jud
ge
the
effe
ctiv
enes
s o
f h
ealt
h in
terv
enti
on
s in
ord
er t
o d
eliv
er
effe
ctiv
e p
atie
nt
edu
cati
on
.
Iden
tifi
es a
nd
wo
rks
to a
dd
ress
g
aps
in e
du
cati
on
al s
up
po
rt
req
uir
ed b
y p
atie
nts
, wh
eth
er it
is
in la
ng
uag
e, c
on
ten
t o
r fo
rmat
.
Hel
ps
to p
lan
loca
l hea
lth
pro
mo
tio
n ac
tivi
ties
in
colla
bo
rati
on
wit
h ap
pro
pri
ate
hea
lth
and
so
cial
car
e ag
enci
es,
pri
mar
y ca
re c
olle
agu
es, p
riso
ns
and
TS
Os,
to
incr
ease
rec
og
nit
ion
and
ref
erra
l of
po
ssib
le T
B c
ases
fo
r in
vest
igat
ion
(RC
N, 2
012
) an
d
red
uce
dia
gn
ost
ic d
elay
.
Ale
rts
dec
isio
n m
aker
s to
issu
es
that
will
aff
ect
hea
lth
and
w
ellb
ein
g a
nd
may
har
m e
ffo
rts
to m
anag
e T
B. (
DH
, 20
04
)
Off
ers
con
stru
ctiv
e so
luti
on
s to
ta
ckle
th
ese
issu
es a
nd
pro
du
ces
clea
r an
d c
on
cise
arg
um
ents
fo
r d
ecis
ion
mak
ers
that
ou
tlin
e th
e b
enef
its
of
imp
rovi
ng
hea
lth
and
w
ellb
ein
g a
nd
th
e ri
sks
of
no
t d
oin
g s
o. (
DH
, 20
04
)
Dra
fts
inp
uts
to
po
licy
do
cum
ents
th
at a
re c
on
sist
ent
wit
h ev
iden
ce
and
str
ateg
ic p
rio
riti
es a
nd
h
elp
dec
isio
n m
aker
s m
ove
fo
rwar
d (
DH
, 20
04
) (e
g,
po
licie
s to
imp
rove
up
take
of
BC
G v
acci
nat
ion
(NIC
E, 2
015
),
imp
lem
ents
LT
BI p
rog
ram
mes
(P
H &
NH
SE
, 20
15),
or
add
ress
es
com
ple
x n
eed
s to
US
Ps.
(P
H &
N
HS
E, 2
015
)
Eva
luat
es t
he
imp
act
of
po
licie
s o
n im
pro
vin
g t
he
hea
lth
and
w
ellb
ein
g o
f th
e p
op
ula
tio
n co
nce
rned
. (D
H, 2
00
4)
HW
B2:
A
sses
smen
t an
d c
are
pla
nn
ing
to
m
eet
hea
lth
and
wel
lbei
ng
n
eed
s
A5
, A6
, A
7, A
8A
ssis
t in
th
e as
sess
men
t o
f p
eop
le’s
em
oti
on
al, p
hysi
cal,
soci
al a
nd
psy
cho
log
ical
nee
ds
in r
elat
ion
to t
hei
r re
spo
nse
to
th
e d
iag
no
sis
and
th
eir
po
ten
tial
fo
r co
mp
leti
ng
tre
atm
ent.
Co
ntr
ibu
tes
to t
he
asse
ssm
ent
of
peo
ple
’s e
mo
tio
nal
, phy
sica
l, so
cial
an
d p
sych
olo
gic
al n
eed
s in
rel
atio
n to
th
eir
resp
on
se t
o
the
dia
gn
osi
s an
d t
hei
r p
ote
nti
al
for
com
ple
tin
g t
reat
men
t, a
nd
p
lan
nin
g h
ow
to
mee
t th
ose
n
eed
s.
Ass
esse
s p
eop
le’s
em
oti
on
al,
phy
sica
l, so
cial
an
d p
sych
olo
gic
al
nee
ds
in r
elat
ion
to t
hei
r re
spo
nse
to
th
e d
iag
no
sis
and
th
eir
po
ten
tial
fo
r co
mp
leti
ng
tr
eatm
ent
and
dev
elo
ps,
mo
nit
ors
an
d r
evie
ws
care
pla
ns
to m
eet
spec
ific
nee
ds.
Ass
esse
s co
mp
lex
emo
tio
nal
, p
hysi
cal,
soci
al a
nd
psy
cho
log
ical
n
eed
s in
rel
atio
n to
th
eir
resp
on
se t
o t
he
dia
gn
osi
s an
d
thei
r p
ote
nti
al f
or
com
ple
tin
g
trea
tmen
t an
d d
evel
op
s, m
on
ito
rs
and
rev
iew
s ca
re p
lan
s to
mee
t sp
ecif
ic n
eed
s.
Ind
icat
ors
Dem
on
stra
tes
an u
nd
erst
and
ing
o
f th
e h
olis
tic
nee
ds
of
pat
ien
ts
wit
h T
B a
nd
th
eir
fam
ilies
.
Wit
h g
uid
ance
, co
mp
lete
s h
olis
tic
and
clin
ical
pat
ien
t as
sess
men
t to
incl
ud
e p
sych
o-
Un
der
take
s in
itia
l in
terv
iew
w
ith
each
new
ref
erra
l to
th
e T
B s
ervi
ce a
nd
tri
ages
as
app
rop
riat
e. (
RC
N, 2
012
)
Un
der
take
s h
olis
tic
pat
ien
t as
sess
men
t, in
clu
din
g
Su
per
vise
s an
d m
on
ito
rs t
riag
e fo
r al
l ref
erra
ls. (
RC
N, 2
012
)
Has
ad
van
ced
ass
essm
ent
skill
s,
to in
clu
de
phy
sica
l ass
essm
ent
and
rea
din
g o
f a
ches
t x-
ray,
ac
cord
ing
to
loca
l pro
toco
ls.
Iden
tifi
es c
om
ple
x n
eed
s an
d
dev
ises
an
app
rop
riat
e ca
re p
lan
in c
olla
bo
rati
on
wit
h th
e p
atie
nt
and
th
e va
rio
us
agen
cies
an
d
serv
ices
wh
o n
eed
to
be
eng
aged
to
ad
equ
atel
y m
eet
the
nee
ds
iden
tifi
ed.
royal ColleGe of nursinG
17
Dim
ensi
ons
Act
ion
area
sLe
vel d
escr
ipto
rs
1 2
3 4
soci
al f
acto
rs, r
isk
fact
ors
an
d
co-m
orb
idit
ies
usi
ng
sta
nd
ard
d
ocu
men
tati
on
.
Acc
ura
tely
rec
ord
s fi
nd
ing
s an
d m
akes
ap
pro
pri
ate
onw
ard
re
ferr
al t
o T
B a
nd
oth
er s
ervi
ces.
Iden
tifi
es a
ny b
arri
ers
to
com
ple
tin
g t
reat
men
t an
d,
wh
ere
nec
essa
ry, p
rovi
des
or
sup
ervi
ses
dir
ectl
y-o
bse
rved
th
erap
y (D
OT
).
psy
cho
-so
cial
fac
tors
, co
-mo
rbid
itie
s an
d in
terp
reta
tio
n o
f re
sult
s; a
ccu
rate
ly r
eco
rds
fin
din
gs
and
any
ref
erra
ls m
ade.
Take
s p
arti
cula
r ca
re in
ass
essi
ng
ea
ch p
atie
nt
for
any
po
ten
tial
ris
k fa
cto
rs f
or
MD
R-T
B a
nd
ref
ers
for
app
rop
riat
e te
sts.
(N
ICE
, 20
15)
Iden
tifi
es k
no
wle
dg
e, li
fest
yle
cho
ices
, cu
sto
ms
and
bel
iefs
th
at m
ay le
ad t
o m
isse
d c
linic
ap
po
intm
ents
an
d/o
r n
on
-ad
her
ence
wit
h T
B m
edic
atio
n.
Is f
amili
ar w
ith
crit
eria
fo
r st
and
ard
an
d E
CM
, an
d
un
der
take
s a
risk
/nee
ds
asse
ssm
ent
pri
or
to id
enti
fyin
g
pat
ien
ts r
equ
irin
g E
CM
(in
clu
din
g
DO
T).
(D
H, 2
00
4; N
ICE
, 20
15)
Ass
esse
s h
ou
sin
g c
ircu
mst
ance
s o
f ea
ch p
atie
nt,
pre
fera
bly
du
rin
g
a h
om
e vi
sit,
an
d w
ork
s w
ith
the
MD
T t
o a
dd
ress
any
ho
usi
ng
p
rob
lem
s w
hic
h ar
e lik
ely
to
adve
rsel
y af
fect
a p
atie
nt’
s ab
ility
to
acc
ess
inve
stig
atio
ns,
at
ten
d c
linic
an
d c
om
ple
te
trea
tmen
t. (
DH
, 20
04
)
Pro
vid
es a
dvi
ce o
n th
e p
rod
uct
ion
of
loca
l ass
essm
ent
pro
toco
ls
wit
h re
fere
nce
to
NIC
E g
uid
ance
. (N
ICE
, 20
15)
Exe
rcis
es p
rofe
ssio
nal
jud
gem
ent
and
use
s cr
itic
al a
pp
rais
al w
hen
m
akin
g h
ealt
h as
sess
men
ts.
Au
ton
om
ou
sly
pla
ns,
co
-ord
inat
es
and
mo
nit
ors
car
e fo
r p
atie
nts
re
qu
irin
g E
CM
.
Iden
tifi
es h
ou
sin
g is
sues
an
d
liais
es w
ith
rele
van
t lo
cal h
ou
sin
g
agen
cies
an
d s
ervi
ces
on
beh
alf
of
ind
ivid
ual
pat
ien
ts t
o a
dvo
cate
fo
r m
ore
sta
ble
ho
usi
ng
.
Co
-ord
inat
es t
he
del
iver
y o
f ca
re
pla
ns
acro
ss t
he
case
load
an
d
feed
s-in
rel
evan
t in
form
atio
n to
su
pp
ort
wid
er s
ervi
ce p
lan
nin
g.
(DH
, 20
04
)
Mo
nit
ors
th
e im
ple
men
tati
on
of
care
pla
ns
and
mak
es c
han
ges
to
bet
ter
mee
t p
eop
le’s
co
mp
lex
hea
lth
and
wel
lbei
ng
nee
ds.
(D
H,
200
4)
Iden
tifi
es h
ou
sin
g is
sues
wh
ich
imp
act
on
the
del
iver
y o
f ef
fect
ive
TB
ser
vice
s ac
ross
th
e ca
selo
ad a
nd
rai
ses
thes
e w
ith
loca
l ho
usi
ng
au
tho
riti
es, b
oth
d
irec
tly
and
th
rou
gh
hea
lth
and
w
ellb
ein
g b
oar
ds.
HW
B3
A3
, A5
, A
6, A
7R
eco
gn
ises
an
d r
epo
rts
situ
atio
ns
wh
ere
ther
e m
igh
t b
e a
nee
d f
or
pro
tect
ion
for
the
pat
ien
t, t
hei
r fa
mily
, fri
end
s o
r co
mm
un
ity.
Un
der
stan
ds
the
risk
s p
ose
d b
y T
B in
dif
fere
nt
situ
atio
ns
and
co
ntr
ibu
tes
to p
rote
ctin
g p
eop
le
at r
isk.
Imp
lem
ents
asp
ects
of
a p
rote
ctio
n p
lan
acco
rdin
g t
o t
he
risk
iden
tifi
ed a
nd
rev
iew
s it
s ef
fect
iven
ess.
Dev
elo
ps
and
lead
s o
n an
ove
rall
pro
tect
ion
pla
n ac
cord
ing
to
th
e ri
sks
iden
tifi
ed.
HW
B3:
In
dic
ato
rsId
enti
fies
pat
ien
ts a
t ri
sk o
f n
on
-ad
her
ence
an
d c
asca
des
co
nce
rns.
Is a
war
e o
f, an
d f
lag
s u
p t
o
spec
ialis
t n
urs
es, p
atie
nts
wh
o
may
hav
e p
rob
lem
s at
ten
din
g
for
follo
w-u
p in
vest
igat
ion
s an
d
Fo
llow
s u
p a
ll p
oss
ible
new
ca
ses
(pri
ori
tisi
ng
th
ose
kn
ow
n to
hav
e sp
utu
m s
mea
r p
osi
tive
p
ulm
on
ary
TB
), p
eop
le w
ith
po
siti
ve in
terf
ero
n g
amm
a re
leas
e as
say
(IG
RA
) an
d
con
tact
s th
ose
wh
o f
ail t
o a
tten
d
Pla
ns
and
ris
k as
sess
es
com
mu
nit
y si
tuat
ion
s to
incl
ud
e:
•cl
ust
er in
vest
igat
ion
•o
utb
reak
man
agem
ent
•T
B in
cid
ent
man
agem
ent
and
in
vest
igat
ion
wit
h th
e P
HE
.
Wo
rks
in p
artn
ersh
ip w
ith
oth
ers
to id
enti
fy a
nd
ass
ess:
– t
he
nat
ure
, lo
cati
on
and
ser
iou
snes
s o
f ri
sks
•th
e p
rob
lem
s th
at n
eed
to
be
add
ress
ed
TuBerCulosis PrevenTion, Care and ConTrol
18
Dim
ensi
ons
Act
ion
area
sLe
vel d
escr
ipto
rs
1 2
3 4
trea
tmen
t.
Exp
lain
s co
nta
ct-t
raci
ng
pro
cess
an
d p
rovi
des
rea
ssu
ran
ce,
esp
ecia
lly a
rou
nd
co
nfi
den
tial
ity.
Co
llate
s in
form
atio
n o
n p
oss
ible
co
nta
cts
wh
ile p
rote
ctin
g
pat
ien
t p
riva
cy.
an a
pp
oin
tmen
t (R
CN
, 20
12)
for
inve
stig
atio
n, D
OT
or
follo
w u
p.
Has
kn
ow
led
ge
of
mic
rob
iolo
gy
and
rad
iolo
gy
as d
eter
min
ants
o
f le
vels
of
infe
ctiv
ity
and
es
tab
lish
es in
fect
iou
s p
erio
d.
Dem
on
stra
tes
sen
siti
vity
re
gar
din
g t
he
imp
act
of
TB
, d
isea
se r
epo
rtin
g a
nd
co
nta
ct
inve
stig
atio
n.
Take
s h
isto
ry o
f re
gu
lar,
spo
nta
neo
us
and
infr
equ
ent
acti
viti
es, w
ith
awar
enes
s o
f cu
es
and
ski
lled
co
mm
un
icat
ion
to
elic
it r
elev
ant
info
rmat
ion
.
Arr
ang
es s
cree
nin
g a
nd
co
nta
ct
inve
stig
atio
n ac
cord
ing
to
NIC
E
gu
idel
ines
(R
CN
, 20
12; N
ICE
, 20
15)
and
wit
h kn
ow
led
ge
of
crit
eria
fo
r cl
ose
an
d e
xten
ded
co
nta
cts.
Rec
ord
s an
d c
olla
tes
ou
tco
mes
o
f co
nta
ct in
vest
igat
ion
in p
atie
nt
reco
rds
and
fo
r co
ho
rt r
evie
w.
(RC
N, 2
012
)
Co
nsu
lts
sen
ior
nu
rse
colle
agu
es
to in
terp
ret
ou
tco
mes
of
con
tact
in
vest
igat
ion
as n
eces
sary
.
Car
ries
ou
t ri
sk a
sses
smen
ts in
co
ng
reg
ate
faci
litie
s.
Inte
rpre
ts o
utc
om
es o
f co
nta
ct
inve
stig
atio
ns
and
an
alys
es
req
uir
emen
ts f
or
exte
nd
ed
con
tact
inve
stig
atio
ns.
Co
nsu
lts
and
ref
ers
to P
HE
ap
pro
pri
atel
y.
•th
e fa
cto
rs t
hat
mig
ht
be
cau
sin
g t
he
pro
ble
ms
•p
rio
riti
es
•le
gis
lati
ve, p
olic
y an
d
pro
ced
ura
l req
uir
emen
t. (
DH
, 20
04
)
Co
llab
ora
tes
wit
h ap
pro
pri
ate
par
tner
s to
dev
elo
p a
pro
tect
ion
pla
n, i
ncl
ud
ing
sp
ecif
ic a
ctio
ns
req
uir
ed b
y w
ho
m a
nd
wh
en. (
DH
, 20
04
)
Mai
nta
ins
an o
ng
oin
g a
ccu
rate
re
cord
of
risk
s an
d in
terv
enti
on
s,
and
eva
luat
es e
ffec
tive
nes
s o
f in
terv
enti
on
pla
ns.
(D
H, 2
00
4)
HW
B4
: E
nab
lem
ent
to
add
ress
hea
lth
and
wel
lbei
ng
n
eed
s
A3
, A6
, A
7H
elp
s p
eop
le m
eet
dai
ly h
ealt
h an
d w
ellb
ein
g n
eed
s, in
clu
din
g
adh
eren
ce t
o m
edic
atio
n.
En
able
s p
eop
le t
o m
eet
on
go
ing
h
ealt
h an
d w
ellb
ein
g n
eed
s to
m
ake
a fu
ll re
cove
ry f
rom
TB
.
En
able
s p
eop
le t
o m
eet
spec
ific
an
d c
om
ple
x n
eed
s in
rel
atio
n to
h
ealt
h an
d w
ellb
ein
g, t
o m
ake
a fu
ll re
cove
ry f
rom
TB
.
Em
po
wer
s p
eop
le t
o r
ealis
e an
d
mai
nta
in t
hei
r p
ote
nti
al f
or
hea
lth
and
wel
lbei
ng
by
advo
cati
ng
p
atie
nt-
cen
tred
ap
pro
ach
es t
o
stra
teg
ic p
lan
nin
g.
Ind
icat
ors
Invo
lves
th
e p
atie
nt
and
th
eir
fam
ily in
th
e ca
re p
lan
nin
g
pro
cess
.
Ag
rees
a s
uit
able
env
iro
nm
ent
to m
eet
pat
ien
ts t
o a
sses
s th
em
and
del
iver
car
e, a
ckn
ow
led
gin
g
Dis
cuss
es t
he
imp
ort
ance
of,
and
id
enti
fies
bar
rier
s to
, att
end
ing
fo
r te
sts,
kee
pin
g a
pp
oin
tmen
ts
and
tak
ing
TB
med
icat
ion
.
Ap
plie
s sp
ecia
list
kno
wle
dg
e o
f th
e va
riab
les
that
aff
ect
a
Dem
on
stra
tes
exp
ert
skill
s to
en
gag
e p
atie
nts
wit
h co
mp
lex
nee
ds
in t
he
dia
gn
ost
ic p
roce
ss
and
th
e re
leva
nt
trea
tmen
t p
athw
ay: T
B, D
R-T
B o
r LT
BI.
Infl
uen
ces
loca
l au
tho
rity
an
d
Rev
iew
s ke
y p
erfo
rman
ce
ind
icat
ors
, su
ch a
s u
pta
ke o
f LT
BI t
reat
men
t an
d t
reat
men
t o
utc
om
es, t
o a
sses
s th
e ab
ility
of
pat
ien
ts t
o a
cces
s se
rvic
es a
nd
re
mai
n o
n th
e tr
eatm
ent
pat
hway
.
royal ColleGe of nursinG
19
Dim
ensi
ons
Act
ion
area
sLe
vel d
escr
ipto
rs
1 2
3 4
thei
r in
div
idu
al n
eed
s.
Dem
on
stra
tes
awar
enes
s o
f th
e va
riab
les
that
aff
ect
a p
atie
nt’
s ad
her
ence
.
Pro
vid
es s
up
po
rt a
nd
in
form
atio
n to
th
e p
atie
nt,
car
ers
and
fam
ily.
Wo
rks
wit
hin
an
agre
ed
fram
ewo
rk t
o g
ive
pat
ien
ts
info
rmat
ion
on
adh
eren
ce
pat
ien
t’s
adh
eren
ce a
nd
tai
lors
in
cen
tive
s an
d e
nab
lers
to
th
e in
div
idu
al, w
ith
a cl
ear
agre
emen
t an
d w
ritt
en d
etai
ls o
f w
hat
can
b
e ex
pec
ted
an
d w
hen
. (R
CN
, 20
12)
Dev
elo
ps
and
ag
rees
car
e p
lan
wit
h p
atie
nt
and
wo
rks
wit
h ap
pro
pri
ate
par
tner
s to
su
pp
ort
p
atie
nts
on
the
TB
tre
atm
ent
pat
hway
acc
ord
ing
to
th
eir
nee
ds.
(R
CN
, 20
12; N
ICE
, 20
15)
Dem
on
stra
tes
kno
wle
dg
e o
f th
e st
rate
gie
s to
imp
rove
pat
ien
t ad
her
ence
.
Rec
og
nis
es s
ign
s th
at p
eop
le o
n se
lf-ad
min
iste
red
tre
atm
ent
may
n
ot
be
adh
erin
g t
o t
reat
men
t.
(RC
N, 2
012
)
pu
blic
hea
lth
par
tner
s to
pro
vid
e in
div
idu
alis
ed c
are
pac
kag
es
to s
up
po
rt a
dh
eren
ce t
o t
ho
se
oth
erw
ise
inel
igib
le t
hro
ug
h es
tab
lish
ed g
ove
rnm
ent
syst
ems.
(R
CN
, 20
12)
Bu
ilds
spec
ialis
t sk
ills
and
kn
ow
led
ge
to m
anag
e ca
ses
in
det
enti
on
cen
tres
an
d p
riso
ns,
w
hen
th
ere
is n
o r
eco
urs
e to
p
ub
lic f
un
ds,
wit
h co
mp
lex
co-m
orb
idit
ies,
su
ch a
s m
enta
l h
ealt
h p
rob
lem
s an
d/o
r su
bst
ance
d
epen
den
cy a
s re
qu
ired
.
Co
ntr
ibu
tes
to n
atio
nal
gu
idel
ines
an
d lo
cal p
roto
cols
to
su
pp
ort
h
igh
qu
alit
y p
atie
nt-
cen
tred
car
e an
d c
ase
man
agem
ent.
Iden
tifi
es p
ote
nti
al b
arri
ers
and
w
ork
s w
ith
colle
agu
es t
o d
evel
op
st
rate
gie
s to
ad
dre
ss t
hem
.
Lob
bie
s at
a lo
cal a
nd
reg
ion
al
leve
l fo
r T
B s
ervi
ce s
pec
ific
atio
ns,
to
incl
ud
e p
roce
sses
to
pro
vid
e su
pp
ort
fo
r p
eop
le w
ith
com
ple
x h
ou
sin
g a
nd
so
cial
nee
ds.
HW
B5
: P
rovi
sio
n o
f ca
re t
o m
eet
hea
lth
and
w
ellb
ein
g
nee
ds
A3
, A6
Un
der
take
s ca
re a
ctiv
itie
s to
m
eet
an in
div
idu
al’s
hea
lth
and
w
ellb
ein
g n
eed
s an
d s
up
po
rt
them
th
rou
gh
TB
tes
ts a
nd
tr
eatm
ent.
Un
der
take
s ca
re a
ctiv
itie
s to
m
eet
the
hea
lth
and
wel
lbei
ng
n
eed
s o
f in
div
idu
als
wit
h a
gre
ater
deg
ree
of
dep
end
ency
fr
om
bef
ore
dia
gn
osi
s u
nti
l th
e en
d o
f tr
eatm
ent.
Pla
ns,
del
iver
s an
d e
valu
ates
ca
re t
o m
eet
peo
ple
’s c
om
ple
x h
ealt
h an
d w
ellb
ein
g n
eed
s fr
om
b
efo
re d
iag
no
sis
un
til t
he
end
of
trea
tmen
t.
Pla
ns,
del
iver
s an
d e
valu
ates
car
e to
mee
t p
eop
le’s
co
mp
lex
hea
lth
and
wel
lbei
ng
nee
ds
and
en
sure
s lo
cal,
reg
ion
al a
nd
nat
ion
al
stra
teg
ies
sup
po
rt p
atie
nt-
cen
tred
car
e.
Ind
icat
ors
In a
war
d e
nvir
on
men
t, is
th
e n
amed
nu
rse
for
an in
div
idu
al
pat
ien
t an
d t
hei
r ca
rer/
fam
ily.
Eva
luat
es t
he
psy
cho
log
ical
im
pac
t o
f a
TB
dia
gn
osi
s o
n p
atie
nts
an
d t
hei
r fa
mili
es a
nd
su
pp
ort
s th
em t
o d
eal w
ith
stig
ma
and
an
xiet
y.
Rec
og
nis
es r
efer
ral p
athw
ays
– o
ccu
pat
ion
al h
ealt
h, a
nti
-T
NF
scr
een
s (a
nd
oth
er a
reas
ca
rin
g f
or
peo
ple
wh
o a
re
imm
un
oco
mp
rom
ised
), G
P a
nd
se
lf-re
ferr
als,
as
wel
l as
con
tact
tr
acin
g, n
ew e
ntr
ant
scre
enin
g
Pro
vid
es c
ase
man
agem
ent
for
stan
dar
d T
B c
ases
incl
ud
ing
D
OT,
ho
listi
c as
sess
men
t, c
on
tact
in
vest
igat
ion
, car
e p
lan
nin
g, a
nd
su
pp
ort
an
d d
ocu
men
tati
on
. (R
CN
, 20
12)
Pro
vid
es c
ase
man
agem
ent
of
peo
ple
on
LTB
I tre
atm
ent
incl
ud
ing
ed
uca
tio
n, a
sses
smen
t,
care
pla
nn
ing
, tre
atm
ent,
d
ocu
men
tati
on
and
rep
ort
ing
of
trea
tmen
t o
utc
om
es. (
RC
N, 2
012
)
Ab
le t
o a
rtic
ula
te in
terv
enti
on
s th
at d
iffe
ren
tiat
e b
etw
een
stan
dar
d a
nd
EC
M.
Pro
vid
es E
CM
fo
r p
atie
nts
wit
h co
mp
lex
psy
cho
soci
al a
nd
clin
ical
n
eed
s eg
, th
ose
wit
h N
RP
F,
mu
ltip
le c
om
orb
idit
ies
imp
acti
ng
o
n tr
eatm
ent
and
ad
her
ence
.
Act
ivel
y en
gag
es in
par
tner
ship
-w
ork
ing
req
uir
ed t
o s
up
po
rt
pat
ien
ts o
n a
TB
tre
atm
ent
pat
hway
.
Kn
ow
led
ge
of
care
pat
hway
an
d
inte
rven
tio
ns
to a
dd
ress
co
mp
lex
psy
cho
soci
al n
eed
s o
f p
atie
nts
w
ith
susp
ecte
d, o
r co
nfi
rmed
, TB
(E
CM
).
Pro
vid
es h
igh
est
po
ssib
le q
ual
ity
of
care
to
th
ose
wit
h th
e m
ost
co
mp
lex
nee
ds.
Ad
voca
tes
for
the
TB
ser
vice
sp
ecif
icat
ion
to s
up
po
rt p
atie
nt-
cen
tred
cas
e m
anag
emen
t.
Mo
nit
ors
cas
e m
anag
emen
t ac
ross
th
e ca
selo
ad, s
up
ervi
ses
and
su
pp
ort
s st
aff
faci
ng
p
arti
cula
r d
iffi
cult
ies.
Iden
tifi
es o
ne
-off
or
recu
rrin
g
pro
ble
ms
and
ad
dre
sses
th
ese
wit
h th
e ap
pro
pri
ate
colle
agu
es;
esca
late
s th
e re
spo
nse
to
invo
lve
tru
st m
anag
emen
t, a
s n
eces
sary
,
TuBerCulosis PrevenTion, Care and ConTrol
20
Dim
ensi
ons
Act
ion
area
sLe
vel d
escr
ipto
rs
1 2
3 4
and
cu
sto
dia
l in
stit
uti
on
s.
Su
per
vise
s d
irec
tly
ob
serv
ed
ther
apy.
Arr
ang
es a
nd
pro
vid
es D
OT
in
a w
ay w
hic
h is
pra
ctic
able
an
d a
ccep
tab
le f
or
the
pat
ien
t co
nsi
der
ing
a v
arie
ty o
f p
oss
ible
o
pti
on
s, s
uch
as
com
mu
nit
y-b
ased
DO
T; t
he
invo
lvem
ent
of
allie
d h
ealt
h an
d s
oci
al s
ervi
ces;
ex
ten
ded
clin
ic h
ou
rs. (
RC
N,
2012
)
Iden
tifi
es a
nd
wo
rks
wit
h lo
cal
par
tner
s (b
oth
new
on
es a
nd
th
ose
alr
ead
y w
ork
ing
wit
h th
e p
atie
nt)
to
su
pp
ort
TB
pat
ien
ts
thro
ug
h tr
eatm
ent
com
ple
tio
n,
such
as
pri
mar
y h
ealt
h ca
re,
ho
usi
ng
, dru
g a
nd
alc
oh
ol t
eam
s.
Iden
tifi
es in
div
idu
als
wh
o f
all
ou
tsid
e o
f st
and
ard
pat
hway
s/p
roto
cols
an
d r
efer
s o
n ap
pro
pri
atel
y (e
g, p
reg
nan
cy).
Ref
ers
pat
ien
ts t
ran
sfer
rin
g
ove
rsea
s to
loca
l hea
lth
care
p
rovi
der
s, v
ia P
HE
an
d m
akes
ar
ran
gem
ents
to
ob
tain
th
e tr
eatm
ent
ou
tco
me.
Ch
ang
es s
up
ervi
sio
n ar
ran
gem
ents
bas
ed o
n p
atie
nt
pro
gre
ss (
eg, t
ran
sfer
s p
atie
nts
w
ho
hav
e d
emo
nst
rate
d g
oo
d
adh
eren
ce f
rom
DO
T t
o S
AT
).
(RC
N, 2
012
)
En
sure
s th
at a
nyo
ne
wh
o
refu
ses
DO
T, is
aw
are
of
thei
r re
spo
nsi
bili
ties
an
d e
licit
s th
e p
atie
nt’
s in
ten
tio
ns
reg
ard
ing
th
eir
trea
tmen
t, w
hic
h ar
e re
cord
ed in
th
eir
nu
rsin
g a
nd
m
edic
al r
eco
rds.
(R
CN
, 20
12).
If
, aft
er a
ll at
tem
pts
, th
e p
atie
nt
refu
ses
trea
tmen
t, t
he
nec
essa
ry
pu
blic
hea
lth
inte
rven
tio
ns
are
init
iate
d.
Pro
vid
es e
xper
t le
vel a
dvi
ce o
n th
e m
anag
emen
t o
f p
atie
nts
wit
h co
mp
lex
nee
ds
wh
o f
all o
uts
ide
stan
dar
d d
iag
no
stic
pat
hway
s/p
roto
cols
an
d in
flu
ence
s tr
eatm
ent
pla
ns
spec
ific
to
th
e p
atie
nt’
s n
eed
.
Un
der
stan
ds
and
uti
lises
ap
pro
pri
ate
inte
rven
tio
ns
to
sup
po
rt T
B p
atie
nts
wit
h co
mp
lex
psy
cho
soci
al n
eed
s.
En
sure
s ef
fect
ive
refe
rral
of
pat
ien
ts r
equ
irin
g s
pec
ialis
t su
pp
ort
ser
vice
s.
if a
sit
uat
ion
aris
es w
hic
h b
eco
mes
un
safe
fo
r p
atie
nts
an
d/
or
staf
f.
Hig
hlig
hts
rel
evan
t is
sues
to
th
e T
BC
B a
nd
/or
oth
er
org
anis
atio
ns
wh
ich
may
be
able
to
hel
p a
dd
ress
a p
arti
cula
r re
curr
ing
bar
rier
to
eff
ecti
ve c
ase
man
agem
ent.
HW
B7:
In
terv
enti
on
s an
d t
reat
men
ts
A3
, A5
, A
6, A
8A
ssis
ts in
pro
vid
ing
in
terv
enti
on
s an
d/o
r tr
eatm
ents
fo
r T
B.
Co
ntr
ibu
tes
to p
lan
nin
g,
del
iver
ing
an
d m
on
ito
rin
g
inte
rven
tio
ns
and
/or
trea
tmen
ts
for
dru
g-s
ensi
tive
TB
an
d L
TB
I an
d a
ny a
dve
rse
dru
g e
ffec
ts, a
s ap
pro
pri
ate.
Pla
ns,
del
iver
s an
d e
valu
ates
in
terv
enti
on
s an
d/o
r tr
eatm
ents
fo
r al
l fo
rms
of
TB
an
d L
TB
I, w
hen
th
ere
are
com
ple
x is
sues
an
d a
ny
adve
rse
dru
g e
ffec
ts.
Pla
ns,
del
iver
s an
d e
valu
ates
in
terv
enti
on
s an
d/o
r tr
eatm
ents
in
com
ple
x si
tuat
ion
s an
d m
on
ito
rs
inte
rven
tio
ns
and
/or
trea
tmen
ts
for
the
wh
ole
cas
elo
ad.
Ind
icat
ors
Dev
elo
ps
kno
wle
dg
e o
f th
e p
har
mac
oki
net
ic a
nd
p
har
mac
od
ynam
ics
pro
per
ties
Dis
tin
gu
ish
es b
etw
een
dif
fere
nt
trea
tmen
t p
athw
ays
and
ris
k as
sess
men
ts f
or
LTB
I, p
ulm
on
ary
Exp
ert
kno
wle
dg
e o
f th
e p
har
mac
oki
net
ic a
nd
p
har
mac
od
ynam
ics
pro
per
ties
of
Mo
nit
ors
tre
atm
ent
in c
om
ple
x ca
ses
and
su
per
vise
s o
ther
s.
Su
per
vise
s an
d s
up
po
rts
staf
f in
royal ColleGe of nursinG
21
Dim
ensi
ons
Act
ion
area
sLe
vel d
escr
ipto
rs
1 2
3 4
of
firs
t lin
e d
rug
s u
sed
to
tre
at
TB
an
d L
TB
I.
Un
der
stan
ds
the
pri
nci
ple
s o
f ac
cou
nta
bili
ty in
med
icin
es
man
agem
ent.
Kee
ps
accu
rate
rec
ord
s.
Can
exp
lain
th
e b
enef
its
and
any
ad
vers
e d
rug
eff
ects
of
stan
dar
d
med
icin
es u
sed
to
tre
at T
B a
nd
LT
BI t
o p
atie
nts
, car
ers
and
o
ther
hea
lth
care
pro
fess
ion
als.
Ad
vise
s th
e p
atie
nt
wh
o t
hey
sh
ou
ld c
on
tact
if p
rob
lem
s ar
ise.
En
sure
s th
e tr
eatm
ent
pla
n is
un
der
sto
od
an
d is
bei
ng
fo
llow
ed b
y p
atie
nt/
care
r.
Ass
esse
s fo
r co
mp
licat
ion
s o
r ad
vers
e ef
fect
s as
soci
ated
w
ith
TB
dru
g t
her
apy
that
m
ay im
pac
t o
n th
e p
atie
nt’
s ab
ility
to
ad
her
e to
tre
atm
ent
– re
assu
res
the
pat
ien
t an
d r
efer
s ap
pro
pri
atel
y.
Do
cum
ents
an
d r
epo
rts
adh
eren
ce is
sues
.
and
ext
ra-p
ulm
on
ary
TB
.
Has
kn
ow
led
ge
of
the
ph
arm
aco
kin
etic
an
d
ph
arm
aco
dyn
amic
s p
rop
erti
es o
f d
rug
s u
sed
to
tre
at L
TB
I, d
rug
-se
nsi
tive
TB
an
d r
esis
tan
t T
B.
Mo
nit
ors
an
d e
valu
ates
th
e re
spo
nse
to
tre
atm
ent,
d
ocu
men
tin
g r
eso
luti
on
of
sym
pto
ms,
bac
teri
olo
gic
ex
amin
atio
ns
and
oth
er c
linic
al
mak
ers
bas
ed o
n th
e si
te o
f d
isea
se.
Exp
lain
s th
e b
enef
its
and
any
si
de
effe
cts
to t
he
pat
ien
t an
d
care
rs, d
isti
ng
uis
hin
g b
etw
een
mild
an
d s
ever
e ad
vers
e ef
fect
s.
Pro
vid
es a
dvi
ce w
ith
in
com
pet
ence
, an
d a
cco
rdin
g
to lo
cally
ag
reed
pro
toco
ls, t
o
dis
con
tin
ue
and
re
-co
mm
ence
tr
eatm
ent,
mak
ing
ap
pro
pri
ate
refe
rral
s an
d a
ccu
rate
ly
reco
rdin
g a
ny t
reat
men
t ch
ang
es.
Man
ages
mild
ad
vers
e ef
fect
s (e
g, t
ho
se w
hic
h ar
e se
lf-lim
itin
g
or
can
be
relie
ved
wit
h o
ver-
the
-co
un
ter
rem
edie
s) b
y p
rovi
din
g
sup
po
rt a
nd
ad
vice
on
self-
man
agem
ent.
Esc
alat
es a
dh
eren
ce is
sues
p
rom
ptl
y an
d a
pp
rop
riat
ely,
an
d f
ollo
ws
up
any
on
e w
ho
fa
ils t
o a
tten
d a
n ap
po
intm
ent
acco
rdin
g t
o lo
cal R
TS
pro
toco
ls.
Info
rms
loca
l TB
lead
or
spec
ialis
t o
utr
each
tea
ms
if p
atie
nt
do
es
no
t re
turn
to
car
e. (
RC
N, 2
012
)
Dem
on
stra
tes
abili
ty t
o a
dju
st
dru
gs
use
d t
o t
reat
LT
BI,
dru
g-
sen
siti
ve a
nd
res
ista
nt
TB
.
Pro
vid
es a
dvi
ce o
n in
terp
reta
tio
n o
f m
icro
bio
log
ical
rep
ort
s an
d
trea
tmen
t re
gim
ens.
Bas
ed o
n th
e lo
cal m
od
el,
un
der
take
s d
uti
es, i
ncl
ud
ing
n
on
-med
ical
pre
scri
bin
g o
r th
e d
evel
op
men
t o
f p
atie
nt
gro
up
d
irec
tio
ns.
Ad
vise
s o
ther
mem
ber
s o
f th
e M
DT
on
TB
med
icin
es
man
agem
ent,
incl
ud
ing
any
co
nce
rns
reg
ard
ing
su
pp
lies.
Wo
rks
wit
h th
e lo
cal d
rug
s an
d t
her
apeu
tics
co
mm
itte
e to
d
evel
op
pro
toco
ls a
nd
sh
ared
-ca
re g
uid
elin
es.
Fac
ilita
tes
lear
nin
g d
evel
op
men
t o
f p
rofe
ssio
nal
s (i
ncl
ud
ing
nu
rse
team
) th
rou
gh
no
n-m
edic
al
pre
scri
bin
g.
Ap
plie
s ev
iden
ce b
ase
in
pre
scri
bin
g p
ract
ice.
Mak
es r
efer
ral t
o m
edic
al
pre
scri
ber
wh
ere
app
rop
riat
e/o
ut
of
sco
pe.
Dem
on
stra
tes
abili
ty t
o a
rtic
ula
te
the
evid
ence
bas
e fo
r d
rug
th
erap
y an
d c
han
ges
pat
ien
t ca
re
acco
rdin
gly
.
Pro
vid
es s
har
ed c
are
safe
ly,
wh
en r
equ
ired
(eg
, MD
R-T
B c
ase
man
agem
ent)
.
Has
th
e au
tho
rity
to
rec
om
men
d
chan
ges
to
oth
er m
edic
atio
n re
gim
es (
eg, m
eth
ado
ne
and
lia
ises
wit
h ap
pro
pri
ate
serv
ices
ac
cord
ing
ly.)
clin
ical
dec
isio
n-m
akin
g r
egar
din
g
chan
ges
in t
reat
men
t.
En
sure
s ap
pro
pri
ate
leve
l of
kno
wle
dg
e o
n th
e p
har
mac
oki
net
ic a
nd
p
har
mac
od
ynam
ics
of
anti
-T
B m
edic
atio
n is
att
ain
ed a
nd
m
ain
tain
ed b
y le
ss e
xper
ien
ced
te
am m
emb
ers.
Fla
gs
up
any
co
nce
rns
reg
ard
ing
d
rug
su
pp
lies
to t
he
app
rop
riat
e au
tho
riti
es.
Kee
ps
abre
ast
of
dru
g
dev
elo
pm
ents
in t
he
wid
er T
B
fiel
d.
Mo
nit
ors
th
e ap
plic
atio
n o
f p
ub
lic h
ealt
h la
w a
nd
co
ntr
ibu
tes
to lo
cal,
reg
ion
al a
nd
nat
ion
al
pro
toco
ls w
ith
reg
ard
to
invo
kin
g
the
law
.
TuBerCulosis PrevenTion, Care and ConTrol
22
Dim
ensi
ons
Act
ion
area
sLe
vel d
escr
ipto
rs
1 2
3 4
trea
tmen
t an
d in
terv
enti
on
s fo
r st
and
ard
an
d E
CM
, acc
ord
ing
to
th
e p
atie
nt’
s n
eed
s, t
hro
ug
ho
ut
the
inve
stig
atio
n an
d t
reat
men
t p
athw
ay.
Mai
nta
ins
accu
rate
d
ocu
men
tati
on
, in
clu
din
g t
he
dec
isio
n-m
akin
g p
roce
s
Inst
igat
es a
mu
ltia
gen
cy m
eeti
ng
to
ass
ess
the
req
uir
emen
t to
in
voke
pu
blic
hea
lth
law
.
Un
der
stan
ds
the
leg
al f
ram
ewo
rk
for
Par
t 2a
ord
ers
acco
rdin
g
to a
gre
ed lo
cal p
roce
sses
an
d
pro
toco
ls, a
nd
can
pre
sen
t a
clin
ical
cas
e fo
r th
e co
urt
s.
HW
B8
: B
iom
edic
al
inve
stig
atio
n an
d
inte
rven
tio
n
A3
, A5
, A
6, A
8U
nd
erta
kes
task
s to
su
pp
ort
b
iom
edic
al in
vest
igat
ion
s an
d/o
r in
terv
enti
on
s.
Un
der
take
s an
d r
epo
rts
on
bio
med
ical
inve
stig
atio
ns
and
/o
r in
terv
enti
on
s, a
nd
liai
ses
wit
h la
bo
rato
ry s
ervi
ces
as
app
rop
riat
e.
Pla
ns,
un
der
take
s, e
valu
ates
an
d
rep
ort
s b
iom
edic
al in
vest
igat
ion
s an
d/o
r in
terv
enti
on
s; li
aise
s w
ith
lab
ora
tory
ser
vice
s as
ap
pro
pri
ate.
Pla
ns,
un
der
take
s, e
valu
ates
an
d r
epo
rts
com
ple
x b
iom
edic
al
inve
stig
atio
ns,
an
d b
uild
s a
stro
ng
wo
rkin
g r
elat
ion
ship
wit
h la
bo
rato
ry s
ervi
ces.
Ind
icat
ors
Dem
on
stra
tes
awar
enes
s o
f p
ulm
on
ary
and
ext
ra p
ulm
on
ary
TB
pre
sen
tati
on
.
Des
crib
es s
tan
dar
d d
iag
no
stic
s re
com
men
ded
to
pri
mar
y ca
re
as p
er N
ICE
gu
idel
ines
.
Fo
llow
s d
irec
tio
ns
on
the
sele
ctio
n an
d u
se o
f d
iag
no
stic
an
d a
sses
smen
t to
ols
an
d t
he
loca
l pro
toco
ls a
vaila
ble
to
id
enti
fy la
ten
t an
d a
ctiv
e T
B.
Ab
le t
o e
xpla
in t
he
bas
ic
inve
stig
atio
ns
for
late
nt
and
ac
tive
TB
:
• A
FB
sm
ear
mic
rosc
op
y an
d
cult
ure
•ch
est
X–r
ay
• tu
ber
culin
ski
n te
st/
Man
tou
x
•IG
RA
.
Req
ues
ts IG
RA
blo
od
tes
ts
and
exp
lain
s ac
tio
ns
bas
ed o
n re
sult
s.
Un
der
take
s IR
(ME
)R t
rain
ing
an
d r
equ
ests
a c
hes
t X
–ray
ac
cord
ing
to
ag
reed
TB
p
roto
cols
.
Ass
esse
s ea
ch n
ew p
atie
nt
refe
rred
to
th
e T
B s
ervi
ce a
nd
o
rder
s an
d r
eco
rds
the
resu
lts
of
app
rop
riat
e te
sts
pri
or
to t
he
pat
ien
t se
ein
g a
phy
sici
an. (
NM
C,
2015
)
Inte
rpre
ts r
esu
lts
of
inve
stig
atio
ns
use
d t
o d
iag
no
se
acti
ve o
r la
ten
t T
B in
fect
ion
and
to
ref
er f
or
spec
ialis
t ad
vice
if
app
rop
riat
e.
Un
der
stan
ds
blo
od
bo
rne
viru
s te
sts
and
th
e im
plic
atio
ns
of
a p
osi
tive
res
ult
fo
r T
B
man
agem
ent.
Co
nd
uct
s an
d in
terp
rets
fin
din
gs
of
visi
on
test
ing
(S
nel
len
and
Is
hih
ara)
.
Rec
og
nis
es a
nd
rep
ort
s an
y ab
no
rmal
fin
din
gs.
Has
kn
ow
led
ge
of
test
s d
uri
ng
th
e tr
eatm
ent
ph
ase
and
tim
ely
refe
rs t
o M
DT
to
pre
ven
t d
elay
s w
ith
trea
tmen
t d
ecis
ion
s.
Co
nsu
lts
the
mu
ltid
isci
plin
ary
team
to
inte
rpre
t cl
inic
al r
epo
rts
Exp
lain
s re
sult
s o
f in
vest
igat
ion
s u
sed
to
dia
gn
ose
act
ive
or
late
nt
TB
infe
ctio
n an
d r
efer
s fo
r sp
ecia
list
advi
ce in
co
mp
lex
case
s.
Su
pp
ort
s o
ther
hea
lth
pro
fess
ion
als
in in
terp
reta
tio
n o
f d
iag
no
stic
tes
t re
sult
s, a
s re
qu
ired
.
Des
crib
es a
nd
ord
ers
the
app
rop
riat
e te
sts
req
uir
ed t
o
dia
gn
ose
an
d m
on
ito
r p
atie
nts
re
ceiv
ing
tre
atm
ent
for
dru
g-
sen
siti
ve a
nd
dru
g-r
esis
tan
t T
B.
Can
rec
og
nis
e ab
no
rmal
an
d
un
exp
ecte
d f
ind
ing
s an
d t
akes
ap
pro
pri
ate
acti
on
.
Mai
nta
ins
go
od
co
mm
un
icat
ion
wit
h la
bo
rato
ry s
ervi
ces
to
hig
hlig
ht
urg
ent
spec
imen
s an
d
ensu
res
pro
mp
t fe
edb
ack
of
resu
lts
wh
ich
mig
ht
be
of
con
cern
.
Co
ntr
ibu
tes
to, a
nd
mo
nit
ors
, lo
cal p
roto
cols
reg
ard
ing
th
e o
rder
ing
of
test
s, c
olle
ctio
n o
f sa
mp
les
and
fee
db
ack
of
resu
lts.
Wo
rks
wit
h th
e M
DT
an
d li
aise
s w
ith
lab
ora
tory
ser
vice
s to
en
sure
th
at a
ny is
sues
wh
ich
aris
e th
at c
ause
del
ays
in t
he
dia
gn
ost
ic p
roce
ss (
eg, s
low
fe
edb
ack
of
resu
lts,
insu
ffic
ien
t sa
mp
les
or
po
or
do
cum
enta
tio
n)
are
iden
tifi
ed a
nd
dea
lt w
ith
pro
mp
tly.
En
sure
s p
roce
ss is
in p
lace
an
d
mai
nta
ined
to
allo
w p
rom
pt
com
mu
nic
atio
n o
f re
sult
s,
esp
ecia
lly t
ho
se w
hic
h n
eed
u
rgen
t fo
llow
-up
.
Kee
ps
up
to
dat
e w
ith
adva
nce
s in
d
iag
no
stic
pro
cess
es in
th
e w
ider
T
B f
ield
.
royal ColleGe of nursinG
23
Dim
ensi
ons
Act
ion
area
sLe
vel d
escr
ipto
rs
1 2
3 4
Has
su
ffic
ien
t kn
ow
led
ge
to
con
du
ct v
isio
n te
stin
g (
Sn
elle
n an
d Is
hih
ara)
.
Co
mp
lete
s al
l req
ues
t fo
rms
clea
rly
and
acc
ura
tely
.
ou
tsid
e o
wn
kno
wle
dg
e.
Gen
eral
co
mp
eten
ces
for
effe
ctiv
e m
anag
emen
tG
EN
ER
AL
6:
Peo
ple
m
anag
emen
t
A10
Su
per
vise
s th
e w
ork
of
peo
ple
w
ho
may
no
t b
e fa
mili
ar w
ith
TB
m
anag
emen
t p
roto
cols
.
Pla
ns,
allo
cate
s an
d s
up
ervi
ses
the
wo
rk o
f th
e T
B c
ase
man
agem
ent
team
.
Co
-ord
inat
es a
nd
del
egat
es w
ork
; re
view
s p
eop
le’s
per
form
ance
w
ith
in t
he
TB
cas
e m
anag
emen
t te
am.
Pla
ns,
dev
elo
ps,
mo
nit
ors
an
d r
evie
ws
the
recr
uit
men
t,
dep
loym
ent
and
man
agem
ent
of
the
TB
cas
e m
anag
emen
t w
ork
forc
e.
Ind
icat
ors
Ad
vise
s an
d s
up
ervi
ses
less
kn
ow
led
gea
ble
co
lleag
ues
on
safe
pra
ctic
es f
or
the
pre
ven
tio
n,
dia
gn
osi
s an
d t
reat
men
t o
f T
B, a
cco
rdin
g t
o t
hei
r ro
le a
nd
re
spo
nsi
bili
ties
.
Rep
ort
s n
egat
ive
atti
tud
es,
stig
mat
isin
g b
ehav
iou
r o
r p
oo
r p
ract
ice
wh
ich
may
aff
ect
a p
atie
nt’
s tr
ust
or
con
fid
ence
in
the
serv
ice
and
lead
s th
em n
ot
to p
arti
cip
ate
in t
he
dia
gn
ost
ic
or
trea
tmen
t p
roce
ss.
Par
tici
pat
es in
pee
r su
pp
ort
an
d
revi
ews
to e
nsu
re a
ny c
on
cern
s w
hic
h af
fect
s th
e te
am’s
ab
ility
to
pro
vid
e g
oo
d q
ual
ity
case
m
anag
emen
t, a
cro
ss t
he
case
load
, is
add
ress
ed p
rom
ptl
y.
If w
ork
ing
alo
ne,
est
ablis
hes
p
eer
sup
po
rt a
nd
rev
iew
s w
ith
app
rop
riat
e n
urs
es f
rom
oth
er
dep
artm
ents
.
En
sure
s w
ork
load
is e
ven
ly
dis
trib
ute
d a
mo
ng
tea
m
mem
ber
s, a
cco
rdin
g t
o t
he
com
ple
xity
of
the
case
s an
d
geo
gra
ph
ical
loca
tio
n o
f th
e ca
ses.
Su
per
vise
s ca
se lo
ad t
o e
nsu
re a
ll ca
ses
are
cove
red
an
d a
ssig
ned
ap
pro
pri
atel
y.
En
cou
rag
es p
rom
pt
rep
ort
ing
of
issu
es a
ffec
tin
g s
om
eon
e’s
abili
ty
to c
arry
ou
t ca
re a
s p
lan
ned
, ad
dre
sses
issu
es a
nd
rea
ssig
ns
wo
rk if
nec
essa
ry.
Dem
on
stra
tes
abili
ty t
o d
evel
op
ef
fect
ive,
har
mo
nio
us
team
s w
ith
shar
ed v
alu
es a
nd
res
pec
t fo
r al
l mem
ber
s an
d is
cap
able
of
reso
lvin
g c
onf
licts
.
Co
ntri
bu
tes
to t
he
dev
elo
pm
ent
of
rele
vant
KP
Is w
hic
h w
ill b
e u
sed
to
mo
nit
or
the
per
form
ance
of
the
team
.
En
gag
es, e
mp
ow
ers
and
insp
ires
te
am t
o m
eet
shar
ed g
oal
s an
d
KP
Is.
Un
der
take
s p
erfo
rman
ce r
evie
ws,
d
evel
op
s th
e ro
les
of
dif
fere
nt
team
mem
ber
s in
an
effe
ctiv
e o
rgan
isat
ion
al s
tru
ctu
re a
nd
ac
cord
ing
to
ser
vice
req
uir
emen
ts.
Imp
lem
ents
eff
ecti
ve s
ucc
essi
on
pla
nn
ing
.
Dep
uti
ses
for
a se
nio
r n
urs
e.
In c
on
sult
atio
n w
ith
rele
van
t o
ther
s, d
evel
op
s cl
ear
pla
ns
for
the
recr
uit
men
t, d
eplo
ymen
t an
d m
anag
emen
t o
f p
eop
le t
o
pro
vid
e p
atie
nt-
cen
tred
TB
cas
e m
anag
emen
t an
d p
reve
nti
on
serv
ices
, in
a g
iven
are
a an
d
acco
rdin
g t
o lo
cal T
B s
ervi
ce
spec
ific
atio
ns.
(D
H, 2
00
4)
Imp
lem
ents
an
d m
on
ito
rs
met
ho
ds,
pro
cess
es a
nd
sys
tem
s fo
r re
cru
itin
g, d
eplo
yin
g a
nd
m
anag
ing
peo
ple
to
pro
vid
e p
atie
nt-
cen
tred
TB
cas
e m
anag
emen
t an
d p
reve
nti
on
serv
ices
incl
ud
ing
:
•p
erfo
rman
ce r
evie
ws
•id
enti
fica
tio
n o
f cu
rren
t p
rob
lem
s o
r is
sues
•p
red
icti
on
of
futu
re n
eed
s an
d
asse
ssm
ent
of
cap
acit
y to
mee
t th
em. (
DH
, 20
04
)
Pro
vid
es a
pp
rop
riat
e su
pp
ort
to
oth
ers
to im
pro
ve t
hei
r kn
ow
led
ge
and
un
der
stan
din
g o
f p
eop
le m
anag
emen
t. (
DH
, 20
04
)
Dep
uti
ses
for
a se
nio
r n
urs
e.
TuBerCulosis PrevenTion, Care and ConTrol
24
Dim
ensi
ons
Act
ion
area
sLe
vel d
escr
ipto
rs
1 2
3 4
GE
NE
RA
L 7:
C
apac
ity
and
ca
pab
ility
A1,
A7,
A
8, A
10S
ust
ain
cap
acit
y an
d c
apab
ility
o
f co
lleag
ues
to
fo
llow
loca
l TB
m
anag
emen
t p
roto
cols
.
Fac
ilita
tes
the
dev
elo
pm
ent
of
cap
acit
y an
d c
apab
ility
of
the
case
man
agem
ent
team
an
d
tho
se s
up
po
rtin
g t
hem
.
Co
ntr
ibu
tes
to d
evel
op
ing
an
d
sust
ain
ing
cap
acit
y an
d c
apab
ility
o
f th
e ca
se m
anag
emen
t te
am
and
oth
er s
take
ho
lder
s in
volv
ed
in m
eeti
ng
th
e b
road
er n
eed
s o
f p
atie
nts
.
Wo
rks
in p
artn
ersh
ip w
ith
loca
l C
CG
s, t
he
reg
ion
al T
BC
B a
nd
P
HE
, to
dev
elo
p a
nd
su
stai
n ca
pac
ity
and
cap
abili
ty.
Ind
icat
ors
Iden
tifi
es h
ealt
h, s
oci
al a
nd
vo
lun
tary
sec
tor
staf
f w
ith
an
inte
rest
in T
B.
Est
ablis
hes
a w
ork
ing
re
lati
on
ship
wit
h M
DT
an
d h
as
iden
tifi
ed p
eop
le t
o c
on
tact
fo
r ad
vice
.
Iden
tifi
es o
pp
ort
un
itie
s to
join
ef
fect
ive
net
wo
rkin
g g
rou
ps.
Dem
on
stra
tes
awar
enes
s o
f th
e ro
le a
nd
fu
nct
ion
of
Pu
blic
H
ealt
h E
ng
lan
d.
Dem
on
stra
tes
awar
enes
s o
f sp
ecia
list
ou
trea
ch a
nd
reg
ion
al
TB
tea
ms.
Att
end
s w
eekl
y M
DT
mee
tin
gs
to
dis
cuss
new
cas
es, p
oss
ible
cas
es
wh
o d
id n
ot
atte
nd
, co
mp
lex
case
s an
d c
on
tact
/ou
tbre
ak
inve
stig
atio
ns.
(R
CN
, 20
12)
Mai
nta
ins
and
exp
and
s m
ult
iag
ency
wo
rkin
g.
Fo
ster
s cl
ose
wo
rkin
g
rela
tio
nsh
ips
wit
h h
ealt
h, s
oci
al
and
vo
lun
tary
sec
tors
.
Max
imis
es t
he
use
of
effe
ctiv
e n
etw
ork
ing
acr
oss
so
cial
an
d
hea
lth
care
bo
un
dar
ies.
Att
end
s an
d p
arti
cip
ates
in
reg
ion
al n
etw
ork
.
Has
a c
olla
bo
rati
ve r
elat
ion
ship
w
ith
Pu
blic
Hea
lth
En
gla
nd
an
d
un
der
stan
ds
thei
r ro
les
and
re
spo
nsi
bili
ties
.
Mak
es a
nd
rec
eive
s re
ferr
als
fro
m m
ult
iag
ency
par
tner
s (e
g,
reg
ion
al T
B t
eam
s, o
ffen
der
h
ealt
h, s
ub
stan
ce m
isu
se s
ervi
ces
and
oth
er h
ealt
h an
d s
oci
al c
are
org
anis
atio
ns)
.
Ap
plie
s cl
inic
al-d
ecis
ion
mak
ing
sk
ills
wit
hin
th
e cu
rren
t n
atio
nal
g
uid
elin
es.
Org
anis
es w
eekl
y M
DT
mee
tin
gs
to d
iscu
ss n
ew c
ases
, po
ssib
le
case
s w
ho
did
no
t at
ten
d,
com
ple
x ca
ses
and
co
nta
ct/
ou
tbre
ak in
vest
igat
ion
s. (
RC
N,
2012
)
Dem
on
stra
tes
hig
h le
vel d
ecis
ion
-m
akin
g s
kills
wh
en g
uid
ance
is
un
clea
r o
r n
ot
avai
lab
le.
Dem
on
stra
tes
auto
no
mo
us
pra
ctic
e.
Dev
elo
ps
colla
bo
rate
wo
rkin
g
pra
ctic
es w
ith
mu
ltia
gen
cy
par
tner
s (e
g, r
egio
nal
TB
tea
ms,
L
on
do
n M
ob
ile x
–ray
un
it, f
ind
an
d t
reat
, off
end
er h
ealt
h,
sub
stan
ce m
isu
se s
ervi
ces.
Dev
elo
ps
new
wo
rkin
g
rela
tio
nsh
ips
wit
h h
ealt
h, s
oci
al
and
vo
lun
tary
sec
tors
.
Infl
uen
ces
loca
l ser
vice
pro
visi
on
by
TB
nu
rsin
g le
ader
ship
an
d
par
tici
pat
es in
mu
ltid
isci
plin
ary
pro
ject
s.
Init
iate
s n
ew n
etw
ork
ing
o
pp
ort
un
itie
s th
rou
gh
mee
tin
g
peo
ple
wo
rkin
g a
t re
gio
nal
leve
l in
oth
er s
pec
ialis
t ar
eas.
(R
CN
, 20
04
)
Co
ntr
ibu
tes
to t
he
agre
emen
t o
f lo
cal T
B s
ervi
ce s
pec
ific
atio
ns.
Wo
rks
wit
h o
ther
s to
iden
tify
an
d a
gre
e an
an
alys
is o
f th
e cu
rren
t p
osi
tio
n, a
nd
an
tici
pat
ed
futu
re d
eman
ds,
wh
ich
mak
e it
n
eces
sary
to
bu
ild c
apac
ity
and
ca
pab
ility
to
co
mp
ly w
ith
loca
l se
rvic
e sp
ecif
icat
ion
s an
d n
atio
nal
T
B s
trat
egie
s an
d g
uid
elin
es.
Wo
rks
wit
h o
ther
s to
pro
du
ce
pla
ns
that
are
like
ly t
o b
e ef
fect
ive
in m
eeti
ng
th
e p
urp
ose
o
f ca
pac
ity
and
cap
abili
ty
dev
elo
pm
ent
giv
en t
he
curr
ent
po
siti
on
and
usi
ng
inn
ova
tive
so
luti
on
s, w
her
e ap
pro
pri
ate.
(D
H,
200
4)
Neg
oti
ates
wit
h o
ther
s to
pu
t in
p
lace
res
ou
rces
an
d m
ech
anis
ms
to im
ple
men
t an
d s
up
po
rt
effe
ctiv
e ca
pac
ity
and
cap
abili
ty
dev
elo
pm
ent.
(D
H, 2
00
4)
Eva
luat
es t
he
effe
ctiv
enes
s o
f ca
pac
ity
and
cap
abili
ty
dev
elo
pm
ent
to m
ake
adju
stm
ents
as,
an
d w
hen
, th
ey
are
nec
essa
ry, i
n ag
reem
ent
wit
h o
ther
s. (
DH
, 20
04
)
royal ColleGe of nursinG
25
Dim
ensi
ons
Act
ion
area
sLe
vel d
escr
ipto
rs
1 2
3 4
Info
rmat
ion
and
kno
wle
dg
e (I
K)
IK 1
In
form
atio
n co
llect
ion
and
an
alys
is
A6
, A7,
A
8, A
9C
olle
cts,
co
llate
s an
d r
epo
rts
rou
tin
e an
d s
imp
le d
ata
info
rmat
ion
.
Gat
her
s, a
nal
yses
an
d r
epo
rts
dat
a an
d in
form
atio
n su
ffic
ien
t fo
r lo
cal c
oh
ort
rev
iew
.
Gat
her
s, a
nal
yses
, in
terp
rets
an
d p
rese
nts
ext
ensi
ve a
nd
/or
com
ple
x d
ata
and
info
rmat
ion
for
loca
l co
ho
rt r
evie
w, s
ervi
ce
eval
uat
ion
and
lob
byi
ng
pu
rpo
ses.
Pla
ns,
dev
elo
ps
and
eva
luat
es
met
ho
ds
and
pro
cess
es f
or
gat
her
ing
, an
alys
ing
, in
terp
reti
ng
an
d p
rese
nti
ng
dat
a an
d
info
rmat
ion
for
loca
l co
ho
rt
revi
ew, s
ervi
ce e
valu
atio
n an
d
lob
byi
ng
pu
rpo
ses.
Ind
icat
ors
Att
end
s an
d c
on
trib
ute
s to
co
ho
rt r
evie
w.
Dem
on
stra
tes
awar
enes
s o
f, an
d
assi
sts
wit
h, t
he
no
tifi
cati
on
of
acti
ve T
B c
ases
.
Dem
on
stra
tes
awar
enes
s o
f ad
dit
ion
al lo
cal d
ocu
men
tati
on
syst
ems
for
TB
, su
ch a
s en
han
ced
TB
su
rvei
llan
ce (
ET
S)
and
/or
the
Lon
do
n T
B R
egis
ter
(LT
BR
).
Has
so
un
d k
no
wle
dg
e o
f al
l d
ocu
men
tati
on
and
rep
ort
ing
re
qu
irem
ents
fo
r ef
fect
ive
case
m
anag
emen
t.
Arr
ang
es n
oti
fica
tio
n o
f n
ew
case
s an
d r
eco
rds
ou
tco
mes
of
all a
ssig
ned
pat
ien
ts t
hat
hav
e st
arte
d t
reat
men
t. (
RC
N, 2
012
)
En
sure
s al
l in
form
atio
n o
n as
sig
ned
pat
ien
ts r
equ
ired
fo
r co
ho
rt r
evie
w is
co
llect
ed a
nd
en
tere
d c
orr
ectl
y. (
RC
N, 2
012
)
Par
tici
pat
es in
co
ho
rt r
evie
w
mee
tin
gs.
En
sure
s al
l new
cas
es a
re n
oti
fied
an
d t
reat
men
t o
utc
om
es a
re
reco
rded
an
d r
epo
rted
. (R
CN
, 20
12)
Mo
nit
ors
an
d a
nal
yses
ro
ute
s o
f re
ferr
al in
ord
er t
o in
form
ta
rget
ed a
war
enes
s ra
isin
g a
nd
ca
se f
ind
ing
act
ivit
ies.
(R
CN
, 20
12)
Un
der
stan
ds
and
imp
lem
ents
co
ho
rt r
evie
w a
nd
en
sure
s al
l in
form
atio
n re
qu
ired
is c
olle
cted
an
d e
nte
red
co
rrec
tly.
(R
CN
, 20
12)
An
alys
es K
PI,
acti
vity
an
d c
oh
ort
re
view
dat
a an
d d
evel
op
s ac
tio
n p
lan
s to
imp
rove
per
form
ance
an
d p
atie
nt
exp
erie
nce
.
Su
pp
ort
s ju
nio
r co
lleag
ues
to
p
rep
are
and
pre
sen
t at
co
ho
rt
revi
ew m
eeti
ng
s.
Wri
tes
up
key
fin
din
gs
for
pre
sen
tati
on
and
/or
pu
blic
atio
n.
Kee
ps
up
to
dat
e w
ith
PH
E
fin
ger
tip
s d
ata
for
the
loca
l are
a.
Co
llate
s an
d a
nal
yses
co
ho
rt
revi
ew a
nd
oth
er d
ata,
su
ch a
s th
e P
HE
fin
ger
tip
s d
ata
(CF
WI,
2015
) u
pta
ke o
f p
erfo
rman
ce o
f LT
BI
scre
enin
g a
nd
tre
atm
ent
serv
ices
.
Iden
tifi
es c
urr
ent
issu
es a
nd
fu
ture
nee
ds,
an
d id
enti
fies
p
oss
ible
so
luti
on
s. (
DH
, 20
04
)
En
sure
s th
at u
sers
of
dat
a an
d in
form
atio
n an
alys
is a
nd
p
rese
nta
tio
n, a
re g
iven
th
e ap
pro
pri
ate
sup
po
rt in
th
eir
effe
ctiv
e u
se. (
DH
, 20
04
)
Use
s o
wn
kno
wle
dg
e, s
kills
an
d e
xper
ien
ce t
o in
flu
ence
th
e in
form
atio
n co
llect
ion
and
m
anag
emen
t o
f o
ther
s. (
DH
, 20
04
)
Ch
airs
co
ho
rt r
evie
w m
eeti
ng
s.
Wri
tes
up
key
fin
din
gs
for
pre
sen
tati
on
/pu
blic
atio
n;
enco
ura
ges
an
d s
up
po
rts
oth
ers
to d
o t
he
sam
e.
TuBerCulosis PrevenTion, Care and ConTrol
26
BCG – Bacillus Calmette-Guérin vaccine
CCG – Clinical commissioning group
DOT – Directly observed therapy
ECM – Enhanced case management
GP – General practitioner
GPN – General practice nurse
HIV – Human immunodeficiency virus
IGRA – Interferon Gamma Release Assay
KSF – Knowledge and Skills Framework
KPI – Key performance indicators
LTBI – Latent tuberculosis infection
MDR-TB – Multi-drug resistant tuberculosis
MDT – Multidisciplinary team
NHS – National health service
NHSE – National Health Service England
NICE – National Institute of Health and Clinical Excellence
NMC – Nursing and Midwifery Council
PHE – Public Health England
RCN – Royal College of Nursing
RTS – Return to service
SAT – Self-administered treatment
TB – Tuberculosis
TBCB – Tuberculosis Control Board
TSO – Third sector organisation
USP – Underserved populations
Abbreviations
royal ColleGe of nursinG
27
Centre for Workforce Intelligence (2015) Review of the tuberculosis nurse workforce. CFWI: London.
Department of Health (2004) The NHS Knowledge and Skills Framework (NHS KSF) and the Development Review Process. London: DH
Department of Health and the NHS Commissioning Board (2012) Compassion in practice: Nursing, midwifery and care staff – our vision and strategy. Available at: www.england.nhs.uk/wp-content/uploads/2012/12/compassion-in-practice.pdf Accessed 20 May 2017
National Institute for Health and Care Excellence (2016) Tuberculosis. NICE guideline (NG33). Available at: www.nice.org.uk/guidance/NG33 Accessed 20 May 2017
NHS England (2014) Five year forward view. Available at: www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf (accessed 20 May 2017)
NHS England (2016) Leading change, adding value: A framework for nursing, midwifery and care staff. Available at: www.england.nhs.uk/wp-content/uploads/2016/05/nursing-framework.pdf (accessed 20 May 2017)
Nursing and Midwifery Council (2015) The Code. Professional standards of practice and behaviour for nurses and midwives. London: NMC. Available at www.nmc.org.uk (accessed 20 May 2017)
Oxtoby K (2016) The 10 commitments: what they mean to nursing. Nursing Times 112 (26), 16–18
Public Health England and NHS England (2015) Collaborative Tuberculosis Strategy for England 2015–2020. London: PHE and NHSE
Public Health England. TB Strategy Monitoring Indicators. Online resource available at: http://fingertips.phe.org.uk/profile/tb-monitoring (accessed 20 May 2017)
Royal College of Nursing (2005) NHS Knowledge and skills framework outlines for nursing posts: Guidance for nurses and managers in creating KSF outlines in the NHS. London: RCN. Available at: www.rcn.org.uk/publications (accessed 20 May 2017)
Royal College of Nursing (2012a) Tuberculosis case management and cohort review: Guidance for health professionals. London: RCN.
Royal College of Nursing (2012b) Core competences for nursing children and young people. London: RCN. Available at www.rcn.org.uk/publications (accessed 20 May 2017)
Royal College of Nursing (2017) Tuberculosis case management and cohort review: Guidance for health professionals, 2nd edition. London: RCN. Available at: www.rcn.org.uk/publications
References
TuBerCulosis PrevenTion, Care and ConTrol
28
Appendix
Members of the writing group
Gini Williams Consultant, TB Alert supported by NHS England and Public Health England
Marie O’Donoghue Lead TB Clinical Nurse Specialist, Imperial College Healthcare NHS Trust
Hanna Kaur TB Lead, RCN Public Health Forum and TB Lead Nurse, Birmingham and Solihull TB Service
Deborah Crisp Lead TB Nurse Specialist, Community TB Team (Coventry and Warwickshire), West Midland TB Board Lead TB Nurse Representative
Grainne Nixon Health Protection TB Lead and workforce lead, Public Health England North West
Diane Fiefield Senior Health Protection Specialist Nurse, Public Health England North West
Marion Fleming Health Protection Nurse, Cumbria and Lancashire Health Protection Team, Public Health England North West
Surinder Tamne Senior Nurse TB Specialist, National Infection Service Public Health England
List of members of the writing group and responders to the framework (including individuals and TB nursing/workforce networks)
Professional guidance
Joanne Bosanquet Deputy Chief Nurse, Public Health England
Helen Donovan Professional Lead for Public Health Nursing, Royal College of Nursing
Individuals who provided feedback on the Competency Framework
Lynn Altass National TB Strategy Programme Manager, NHS England/Public Health England
Christine Bell TB Co-ordinator, Manchester TB Unit, Manchester University NHS Foundation Trust, North West England TB Control Board Lead TB Nurse Representative
Katherine Bintley TB Nurse Specialist, St Helier Hospital, Carshalton Also London TB Control Board Deputy Lead TB Nurse Representative
Alison Blake Lead Nurse for Community TB Service, Cornwall Partnership NHS Foundation Trust Also South of England TB Control Board Lead TB Nurse Representative
Joanne Branthwaite TB Team Lead, County Durham and Darlington NHS Foundation Trust
Mel Burden Former Patient and Infection Prevention and Control Nurse Specialist, Royal Devon and Exeter Hospital
Fiona Cook Community TB Staff Nurse, Newcastle upon Tyne Hospitals NHS Foundation Trust
Susan Dart Senior TB Nurse, Barts Health NHS Trust London TB Control Board Lead TB Nurse Representative
Lois Dexter TB Nurse Specialist, Nottingham University Hospitals NHS Trust
royal ColleGe of nursinG
29
Helen Durkan Lead TB Nurse, Mile End Hospital, Whipps Cross Hospital, London
Claire Green TB Nurse, Heart and Lung Unit, Torbay Hospital South of England TB Control Board Lead TB Nurse Representative
Pat Goodman TB Specialist nurse, Arthur Blackman Clinic, St. Leonards on Sea Also South of England TB Control Board Lead TB Nurse Representative
Deborah Harrison Lead TB Nurse Specialist, Southern Derbyshire Derby Hospitals Foundation Trust
Tracey Langham Respiratory and TB Team Leader, Royal Berkshire NHS Foundation Trust Also South of England TB Control Board Lead TB Nurse Representative
Amanda Middleton Tuberculosis Clinical Nurse Specialist, Cobridge Community Health Centre, Cobridge
Cathy Mullarkey Senior Specialist Health Visitor TB Liaison, The Reginald Centre, Leeds Also Humber and South Yorkshire TB Control Board Lead TB Nurse Representative
Celia Proudfoot Clinical Nurse Specialist, Countess of Chester Foundation Trust NHS Hospital, Chester
Nuala Whitehead Senior Nurse Respiratory Medicine, Lead Nurse/Service Manager, Portsmouth TB Service Also South of England TB Control Board Lead TB Nurse Representative
Central England TB Nurse Forum
London TB Workforce Development Group
Yorkshire and Humber TB Nurse Forum
30
The RCN represents nurses and nursing, promotes excellence in practice and shapes health policies
RCN Onlinewww.rcn.org.uk
RCN Direct www.rcn.org.uk/direct
0345 772 6100
Published by the Royal College of Nursing20 Cavendish Square
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020 7409 3333
December 2017 Review date: December 2020
Publication code: 006 193
