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Videotapes teach how to be assertive with the health care system

ANN ARBOR—University of Michigan nursing researchers have developed videotapes that teach patients with tuberculosis how to assert themselves in a medical setting and get the individualized care they need.

" Tuberculosis has re-emerged as a potent threat to public health in part because the rigorous TB medical regimen requires exceptionally self-disciplined patients who will swallow large pills up to three times a day for a full year," says Susan Boehm, U-M associate professor of nursing.

" To get through the treatment, TB patients really need to be supported by health care professionals, but instead, they often feel frustrated by busy physicians and nurses who see them as 'cases' or 'diseases,'" adds Patricia W. Coleman-Burns, assistant professor of nursing. " The upshot is that patients become non-compliant. They disengage from a system that doesn't seem to care about them and quit treatment-a very dangerous response. "

About 25 percent of patients with full-blown TB stop taking their pills before they should. And some 33 percent of those who are infected but asymptomatic do not complete their preventive treatment.

" The public health consequences are serious. Between 1985 and 1990, there was an increase of 15.8 percent of reported cases of TB in the United States, and new strains of drug resistant TB have emerged," Boehm says.

Troubled by the statistics and the human consequences, Boehm and Coleman-Burns have developed four videotapes that demonstrate how to be firm with the nurse and make the system respond. Each tape features a different patient-an African American grandmother who wants to spend time with her grandchildren, a young white woman who wants to start a family, a middle-aged African American man who runs into a transportation problem on the day of his appointment, and a young white man who wants his name pronounced correctly. While each character is unique, all of them are scared; frustrated by the busy, impatient nurse; struggling with side effects; and ready to quit treatment.

Patients who watch the tapes will learn how to confront the nurse firmly and request that they be called by their correct names. They also will find the gumption to insist that the nurse give them undivided attention during their meetings. They will see how it helps to make lists of questions and ask them all, no matter how " stupid" they may seem, and how to bring up their lifestyles and needs, so they can be considered in the treatment.

" Nurses who watch the tapes will learn about the negative behavior cues they may be sending and how to send positive ones that encourage patients to stick to their medical plan," Boehm adds. " Most studies show that patient appointments last an average of just 12 minutes, so it is important for nurses to make sure the time is well spent. "

" The tapes will be useful tools for just about any health care worker who wants patients to thrive- physicians, nurses, social workers. They also will help family members who want to advocate for patients. And the patients don't have to have TB," adds Coleman-Burns. "Virtually any patient with a chronic or long-term disease needs to develop these skills. "

To obtain the tapes, contact Jack Adcox, Health Sciences Consortium, 201 Silver Cedar Court, Chapel Hill, N.C., 27514-1517, or call him at (919) 942-8731.