Developing nursing practice as part of the collaborative TB control programme, Tomsk, Siberia.

Setting: Review of nursing practice, identification of training needs and implementation of training for nurses working in the Tomsk Oblast' Tuberculosis Services (TOTBS), Russia.

Objective: Preparation of TOTBS nurses for the implementation of a WHO-style TB control programme in January 1997.

Methods: Nursing services and training needs were assessed through observation visits to a number of institutions providing care for TB patients, semi-structured interviews, and discussions at staff meetings. Training sessions focused on the WHO DOTS strategy, patient education and default tracing. An evaluation visit focused on nurses' attitudes and levels of treatment completion.

Results: Out of a total of 165 TB cases notified in Tomsk Oblast' between January and March 1997, 53 were started on DOTS on an ambulatory basis. Five patients who defaulted returned to treatment within five days (range 2-5) and no patients were lost to follow up. Improved compliance was attributed to better patient education offered by nurses and a reliable supply of medication. Quarterly reports continue to show satisfactory levels of treatment completion.

Conclusions: Obstacles to the development of nursing practice included resistance to change and low morale due to enormous workloads, no pay and staff shortages. Motivation improved through the setting of achievable targets.