Validation of evidence-based clinical practice guideline: Nursing intervention for newly diagnosed pulmonary tuberculosis patients at community setting

Available online 31 January 2012

Peer review under responsibility of Alexandria University Faculty of Medicine.

Figures & data

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(1) What are the assessment methods of newly diagnosed patient with pulmonary tuberculosis?

(2) What are the risk factors resulting in defaulting in patient with pulmonary tuberculosis?

(3) How do nurses diagnose health needs and problems in newly diagnosed patient with pulmonary tuberculosis?

(4) What are the principles of pulmonary tuberculosis treatment?

(5) What are the best measures to prevent pulmonary tuberculosis among contacts patient with pulmonary tuberculosis?

(6) What are the best measures to control pulmonary tuberculosis?

(7) What is the role of nurse in managing the newly diagnosed pulmonary tuberculosis?

(8) What are the components of educational program for patient with pulmonary tuberculosis and contacts?

(9) Does follow-up of newly diagnosed patient with pulmonary tuberculosis increase the adherence of treatment?

(10) What are the nutritional requirements of patient with pulmonary tuberculosis?

(11) What is the nursing role in implementing the DOTS strategy?

(12) How to increase the adherence of newly diagnosed patient with pulmonary tuberculosis to treatment?

(13) What are the types of nursing records that are used in chest out patients’ clinics?

(14) What are the infection control measures to be followed to prevent spreading of tuberculosis infection?

(15) What is the ethical aspect of pulmonary tuberculosis management?

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http://www.pubmed.gov	http://ovidsp.tx.ovid.com
Science direct: http://www.sciencedirect.com	Center for Review and Dissemination (CRD) at: http://www.york.ac.uk/ins/crd/
Wily Blackwell: http://onlinelibrary.wiley.com/	http://search.ebscohost.com/
WHO: http://www.who.net	CDC: http://www.cdc.gov
Scottish Intercollegiate Guidelines Network at: http://www.sign.ac.uk/	Cochrane Library, Database of Systematic Reviews: http://www.3.interscience.wiley.com/cgi-bin/mrwhome/106568753/Hom
National Institute for Health and Clinical Excellence (NICE) at: http://www.nice.org.uk	National Electronic Library for Health at: http://www.libararyies.nelh.nhs.uk/guidelinesfinder/
National Guideline Clearinghouse at: http://www.guideline.gov

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Rating	Description
++	All or most of the criteria have been fulfilled
+	Some of the criteria have been fulfilled
−	Few or no criteria fulfilled

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Numerical prefix	Study designs
1	For systematic review or meta analysis or randomized control trials (RCTs)
2	For cohort and case control studies
3	For case report series
4	For expert opinion/logical argument/common sense

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Level of evidence	Type of Evidence
1++	High quality meta analysis systematic reviews of randomized control trials with a very low risk of bias
1+	Well conducted meta-analysis systematic reviews or randomized control trials with a low risk of bias
1−	Meta-analysis, systematic reviews, or randomized control trials with a high risk of bias
2++	High quality systemic reviewers of case-control or cohort studies with a very low risk of bias and a high probability that the relationship is causal
2+	Well conducted case-control or cohort studies with a low risk of bias and a moderate probability that the relationship is causal
2−	Case-control or cohort studies with a high risk of bias and a significant risk that the relationship is not causal
3	Non-analytic studies, e.g., case reports, case series
4	Expert opinion

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Grade	Recommendation
A	At least one meta-analysis, systematic review, or RCT rated as 1++. And directly applicable to the target population, or a body of evidence consisting principally of studies rated as 1+, directly applicable to the target population and demonstrating overall consistency of results
B	A body of evidence including studies rated as 2++, directly applicable to the target population and demonstrating overall consistency of result, or extrapolated evidence from studies rated as 1++ or 1+
C	A body of evidence including studies rated as 2+, directly applicable to the target population and demonstrating overall consistency of result, or extrapolated evidence from studies rated as 2++
D	Evidence level 3 or 4, or extrapolated evidence from studies rated as 2+

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Serial	Recommendation statements	Grading
1	Assessment
1.1	Assessing patient health condition
1.1.1	Obtain essential information about patient's socio-demographic data, surrounding environment and lifestyle	C
1.1.2	Assess the present and past health history	C
1.1.3	Obtain information about patient's knowledge and perception about tuberculosis	C
1.1.4	Ensures that patient complete the required diagnostic measures	B
1.2	Assessing patient's contacts health condition
1.2.1	Assess the patient's contacts health condition	D
2	Nursing diagnosis
2.1	Identify the patient's health needs and problems	D
2.2	Identify the contacts’ health needs and problems	D
3	Nursing care plan
3.1	Plan to coordinate the ongoing care and services of clinical visits for specimen collection	D
3.2	Plan to treatment regimen and visit schedule	D
3.3	Plan for identification of treatment obstacles	D
3.4	Plan for patient's motivation to increase adherence to anti-TB medication	D
3.5	Plan for patient's health education	D
3.6	Plan for health education of contacts	D
3.7	Plan to coordinate the ongoing care and services of referral and follow up	D
3.8	Plan for monitoring and evaluation of patient's progress	D
4	Implementation of care plan
4.1	Treatment
4.1.1	Implement the schedule of the prescribed treatment	B
4.1.2	Conduct daily visit at the first two months for observed treatment	D
4.1.3	Conduct weekly visit during the complementary four months to receive a day observed dose and take the dose for the rest of the week	D
4.1.4	The nurse should provide motivation and incentives to increase the treatment compliance	D
4.2	Health education
4.2.1	Implement health educational program for patient	D
4.2.2	Implement health educational program for care provider	D
4.2.3	Implement health educational program for contacts	D
4.3	Follow up and referral
4.3.1	Monitor the patient health condition monthly	B
4.3.2	Check blood sugar level for patient with co-morbid disease diabetes mellitus	C
4.3.3	Report the social workers about the patient who dropped out an appointment of treatment or follow up	D
4.3.4	Ensure that social workers conduct a home visit for the dropped out patient or conduct it by herself (according to policy)	C
4.4	Documentation and reporting
4.4.1	Ensure that all patients’ data is complete	D
4.4.2	Recording data of each visit and all procedures performed to the patient by using the appropriate format	D
4.4.3	Communicating the patient condition with other relevant health care providers	D
4.4.4	Information of patients and contacts should be considered confidential information	C

Table 1 Calculation of the minimum and maximum possible dominos scores of the present guideline according to the “AGREE Instrument”.

Domains	Scores	Academic nursing staff (n = 3)	Academic medical staff (n = 3)	Practitioner nurses (n = 6)	Practitioner physicians (n = 7)
Scope and Purpose (three items)	Maximum	36	36	72	84
	Minimum	9	9	18	21
Stakeholder involvement (four items)	Maximum	48	48	96	112
	Minimum	12	12	24	28
Rigor of development (seven items)	Maximum	84	84	186	196
	Minimum	21	21	42	49
Clarity and presentation (four items)	Maximum	48	48	96	112
	Minimum	12	12	24	28
Applicability (three items)	Maximum	36	36	72	84
	Minimum	9	9	18	21
Editorial independence (two items)	Maximum	24	24	48	56
	Minimum	6	6	12	14

Table 2 Knowledge's scores of nurses regarding tuberculosis and nursing role.

Items	Total scores	Nurses’ scores	Level of knowledge
Nature of the disease	6.00	4.2 ± 1.3	Good >65%
Manifestations	7.00	3.7 ± 0.9	Fair (50–<65%)
Treatment regimen	4.00	2.5 ± 1.1	Fair (50–<65%)
Treatment side effect	12.00	2.6 ± 0.8	Poor (<50%)
Nursing role in managing of tuberculosis patient	18.00	1.02 ± 0.8	Poor (<50%)

Table 3 Distribution of nurses according to the identified tasks performed them in managing newly diagnosed tuberculosis patients at out-patient chest clinics.

Task	Number 28	%
Obtain demographic information	28.00	100.00
Obtain vital signs and baseline weight	0.00	0.00
Obtain past and present health history	00.00	00.00
Identify the patients’ knowledge and perception about TB	00.00	0.00
Identify barriers to adherence in taking TB medication	00.00	0.00
Assess the contact for tubercles infection	17.00	60.70
Monitoring and follow up by bacteriology test or change in urine color	14.00	50.7
Observe for side effects or medication reactions	0.00	00.00
Providing education about TB to health care providers	06.00	21.00
Notification system if pt missed appointments of medication	06.00	21.00
Assess patient satisfaction with the services or care	0.00	00.00
Monitor the patient medical records	0.00	00.00
Assure patient confidentiality	0.00	00.00

Table 4 Distribution of newly diagnosed tuberculosis patients (n = 36) according to their expectations about nursing intervention.

Items	Number	%
Accurate timing of medication	18	50
Nurse as link between patient and physician	16	44.4
Continuous follow-up	12	33.3
Proper communication	8	22

Table 5 Appraisal scores (%) of the guideline according to “Scottish Intercollegiate Guidelines Network (SIGN) System “domains by different appraisers.

Agree instrument items	Scores% of domains				Overall score%
	Academic nurses	Academic physicians	Practitioner nurses	Practitioner physicians
Scope and purpose	77.7	62.9	72.2	73.0	71.5
Stakeholder involvement	66.6	77.7	69.4	53.5	66.8
Rigor of development	76.2	70.1	73.0	66.6	71.5
Clarity and presentation	50.0	66.6	76.4	66.6	64.4
Applicability	67.3	65.3	68.5	61.9	65.8
Editorial independence	90.0	88.0	93.0	91.0	90.5

Table 6 Distribution of appraisers according to their overall assessment of the guideline.

Appraisers	Items
	Strongly recommended for use in practice		Recommended for use in practice
	Frequency	%	Frequency	%
Academic nursing staff number = 3	2	66.6	1	33.3
Academic medical staff number = 3	2	66.6	1	33.3
Practitioner nurses number = 6	5	83.3	1	16.6
Practitioner physicians number = 7	5	71.4	2	28.5
Total number of appraisers = 19	14	73.6	5	26.3