Title : Nursing interventions for stress in patients with isolated pulmonary tuberculosis
Abstract:
Background: The incidence of Tuberculosis (TB) in Japan in 2023 was 8.1 cases per 100,000 persons. Patients with active TB require hospitalization in isolation with an average length of hospital stay of 42.1 days. This makes inpatient treatment extremely stressful for the patient. Furthermore, although patients experience stress due to the disease itself, nursing interventions to address patient stress have not been adequately studied.
Objective: To elucidate nursing interventions to address the stress of patients with pulmonary TB in isolation.
Methods: The research design was qualitative using an inductive approach. Semi-structured interviews were conducted with three nurses working in the TB ward at Hospital X. In the interviews, the subjects were asked to speak freely about the “characteristic stresses that hospitalized pulmonary TB patients experience” and the “nursing interventions performed in response to the stress experienced by patients.”
In the analysis, portions of the verbatim transcripts that mentioned “patient stress” and “nursing interventions for stress” were extracted. Code names that faithfully represented the meanings were assigned, and multiple codes were classified and categorized by examining similarities and differences. Throughout the process, discussions were held with researchers who were experienced in qualitative research to improve validity.
This study was approved by the Ethics Review Board of the Osaka City University Graduate School of Nursing.
Results:
- Stress in Patients with Pulmonary TB in Isolation: The analysis of nurses’ perspectives on the stress experienced by pulmonary TB patients in isolation revealed 35 subcategories and 6 categories: having TB, isolation, long-term hospitalization, social reintegration, infecting others, and prejudice.
- Nursing Interventions to Treat Stress in Patients with Pulmonary TB: Nursing interventions to address the stress of patients with pulmonary TB in isolation led to the extraction of 31 subcategories and 5 categories: communication, environmental efforts, providing correct knowledge, multidisciplinary cooperation, and intervention difficulties.
Discussion: The nurses communicated with the patients, and by building trusting relationships, they empathized with the patients’ pain and dealt with their stress, such as by taking the time to listen.
To address the stress of isolation, the nurses attempted to improve the treatment environment as part of their environmental interventions. These efforts may help support patients with TB who experience high stress due to long hospital stays and closed environments. However, difficulties and limitations were also noted, as nurses found it challenging to intervene in social issues such as social reintegration and prejudice.
Conclusion: The nurses in the TB ward were attuned to the patients’ concerns through communication and worked to improve the environment to ensure that patients were comfortable, even in isolation. Pulmonary TB patients in isolation are unable to go outside, making it difficult for them to release stress. Nurses also found it difficult to intervene in social issues such as social reintegration.
