Understanding the Relational Work of TB Nurses in Public Health: Intrusion, Welcome, and the Skill of Involvement

Thursday, 15 July 2010: 9:10 AM

Amy C. Bender, RN, MN, PhD
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada

Learning Objective 1: The learner will gain insight into the everyday nature of TB nursing relationship skills.

Learning Objective 2: The learner will critically reflect on the moral tensions of control and care in the surveillance role of TB nurses.


Trusting relationships, professionals’ attitudes, and support have been identified as considerations in TB control, but in-depth examination of these claims is lacking. The relationship is cited as foundational in public health nursing, yet nurses’ relational skills required in TB programs of public health are so taken-for-granted that they are often rendered invisible as part of the success of these population-focused interventions. This study’s purpose was therefore to understand TB nursing relationships, not according to theoretical ideal or generalization, but rather as they are immediately lived.


This interpretive phenomenological study was carried out with nine nurses and 24 clients in the TB program of Toronto Public Health. Data collection involved observation of 101 usual nursing visits and 16 interviews with nurses and clients. Thematic analysis was utilized to produce interpretive outlines of thematic categories, themes, and subthemes.

Results: ‘Welcome intrusions’ represents the resulting overall theme. Nurses intruded as they enacted surveillance, yet also made efforts not to intrude. They also engaged in a ‘welcomed’ socializing-with-purpose. In ‘welcoming-intruding’, three themes were evident: ‘getting through the door’, ‘doing TB but more than that’, and ‘beyond a professional’.  Together the themes point to the skill of involvement in two domains of TB practice – providing comfort and enacting surveillance – as a frame for understanding TB nurses’ relational work.

Addressing the skill of involvement helps to answer theory-practice gaps between TB guidelines and everyday control-care nursing situations. Implications include scrutiny of such guidelines for their attention to TB nursing as relational work first, and organizations’ attention to professional development initiatives addressing the skill of involvement.