Documentary Cites New York RNs Dedication to Caring for TB Patients
Tuesday June 2, 2009
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In the first half of the 1900s, America had more than 600 sanatoriums from coast to coast.
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Nurses not only had primary responsibility for care of patients, but they also risked their lives in the battle against one of the deadliest diseases of all time. Despite the risk, however, nurses consistently rose to a higher purpose. In the first half of the 1900s, America had more than 600 sanatoriums from coast to coast.
Tens of thousands of consumptives, as TB victims were called, were sent to the isolation of these distant hospitals for years in hopes of being cured. No effective drugs existed. Fresh air, bed rest, and healthy food were seen as the best chance to recover, along with various types of surgery.
One hundred years later, progress has been made in fighting the bacteria responsible for TB. Several antibiotics, including isoniazid and rifampicin, remain effective in treating the disease. But like the sanatoriums of 100 years ago, patients suspected of having and those diagnosed with TB are still isolated in medical facilities.
Immediately upon entering New York City’s Bellevue Hospital, patients presenting with TB symptoms are taken to one of the 13 negative pressure rooms in the facility’s TB unit and started on antibiotics. With one of the largest TB units in the state, Bellevue has treated 12 TB patients in the first six months of 2009, says Adlin Wilson, RN, BSN, senior director of nursing.
Patients remain on the TB unit sometimes for months, until they produce three consecutive sputums that test negative for TB. Upon discharge, they are educated on how the disease is spread and the vital importance of completing their drug therapy, Wilson adds.
In the early 1900s, it was known TB was an airborne disease easily spread through a cough or a sneeze. The nursing staff was vulnerable since most nurses lived on sanitorium grounds. Rhode Island State Sanatorium on remote Wallum Lake, near the Massachusetts and Connecticut borders, was one of several sanatoriums profiled in the movie. The medical staff at the sanitorium was well-versed in precautions, but the threat of being infected was ever-present.
“Keep up your bodily resistance by having regular meals, keeping regular hours, and by getting plenty of rest,” the Wallum Lake superintendent wrote to his nursing staff in 1941. “If you feel ill or indisposed or have any signs of a cold, obtain medical advice at once. Never let any illness drag along.”
That advice continues to resonate among TB nurses today. At Bellevue, TB nurses are educated about the importance of a good diet and maintaining a healthy immune system to prevent infection, Wilson says.
Alison Brehm, RN, MSN, director of employee health at New York University’s Langone Medical Center, adds nursing professionals are required by the state health department to undergo TB screening annually. Langone’s high-risk nurses, who work in the emergency department and on the units with negative pressure rooms where TB patients are treated, receive TB testing twice a year.
Brehm, who treated TB patients while working as a home health nurse, adds anyone who provides direct care to TB patients wears N95 protective masks. When fitted properly, the masks prevent 95% of the particles from entering the mouth and nasal passages, Further, individuals who perform more invasive procedures wear gloves and gowns.
Although such measures protect modern nurses, the limited precautions available to 1920s-era nurses weren’t nearly as effective. Many nurses became TB victims and died like many of the patients for whom they cared. But others, such as Nita Worthington, a graduate of New York City’s Bellevue Hospital School of Nursing, the nation’s first, recovered and went back to TB nursing. Other TB nurses found their vocation as young TB patients; moved by the compassion and care they had received as they returned to health, they joined the cause.
In the documentary, vintage photographs and motion-picture footage of nurses in old-fashioned white uniforms abound. What the images do not capture is the passion the nurses brought to their care. Nursing, they believed, only began with the physical. During the movie, an actress read part of the typewritten notes of nurse Katherine J. Densford of the Wallum Lake staff in the 1940s about a lecture she delivered at the sanatorium.
One passage eloquently captures the dedication of a TB nurse in this terrible time of epidemic: “Nursing care depends on the spirit of the nursing service. It should be a sort of religion to tuberculosis nurses to give the necessary physical care, to care for the mental requirements of the individual, and to provide an atmosphere, and environment meeting adequately the spiritual needs of the patient — that he will be comfortable, contented, and happy.”
That mind-body philosophy, which is widely recognized as critical to a patient’s outcome today, also was exemplified in a lecture given by Wallum Lake nurse Leah M. Blaisdell in her lecture “Tuberculosis Nursing is Mental Nursing!” It speaks to the role nurses played in addressing patients’ justifiably profound fears at having a disease that killed so many millions before effective drugs were developed — often through an excruciatingly painful and protracted death.
“Fear can make a person forget an appointment for a diagnostic clinic,” Blaisdell told the nursing staff. “Fear of economic strain on his family can make a patient condemn a good sanatorium, its foods, its beds, even its nurses. ... Any of these fears and others may upset the appetite, slow up digestion, hinder assimilation, and cause the person to lose interest in ‘taking the cure’ so necessary to speedy recovery.
“From beginning to end — from tuberculin tests, which uninformed patients may fear, to complete cure and the protection of others — the mental and emotional factors of all concerned should have equal attention with the physical factor. Only in that way will even a dent be made in the tuberculosis patient.”
Today’s nurses continue to provide mental and emotional care, as well as cater to their patients’ societal needs. Wilson says the education received by nurses about how the disease is spread and can be managed is incorporated into treatment. This outreach helps patients and families manage the physical, mental, emotional, and societal components of the disease.
Because TB patients require such multifaceted, dynamic care, Bellevue’s nurses cite above-average job satisfaction, Wilson adds.
“In our TB unit, we have high staff retention — our nurses don’t leave,” she explains. “When you speak to them, they say they love working there because they know exactly what’s going on with their patients.”
TB no longer is an epidemic in the U.S. but still remains a grave public health risk, as recently publicized cases confirm. In addition, nurses remain important in battling this ancient scourge. Nurses have advanced awareness about TB, its spread, and treatment that has helped erase some of the societal stigma attached to having a potentially deadly disease.
“Over the years, as more people become educated about it, I don’t think there are as many concerns about getting it,” says Sandra Hardy, RN, MA, infection prevention control nurse at NYU Langone. “You will still have some people who have that fear regardless of how you explain it, but it has gone down as you continue to educate people.”
G. Wayne Miller is a journalist and filmmaker. Robin Huiras, a freelance writer, contributed to this report. To comment, e-mail editorNY@nursingspectrum.com.
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