Today’s modern world of travel makes health and healthcare a global issue. Although TB rates are decreasing in the United States, the disease is becoming more common in many parts of the world. In addition, the prevalence of drug-resistant TB is increasing worldwide. (Herchline, 2013) Persons can become infected by inhaling the TB germs when someone else sneezes, coughs or even spits. Once infected with the germ, there is a 10% chance of the TB becoming active causing illness.
Persons with active TB will have symptoms like a cough with possible sputum or blood, fever, chest pains, weakness, night sweats and weight loss. These symptoms can be mild for months which often delays treatment and results in exposure to others. Persons with compromised immune systems have a greater chance of the TB becoming active and causing illness. Tuberculosis can be cured with treatment and can be prevented as well. Places where humans are in close contact are the most high risk areas. Slums, prisons and jails, or even hospitals are examples of high risk environments.
Persons who live with or interact with someone who has active TB, those who live in nursing homes or homeless shelters, immigrants from countries with high TB incidence rates, alcoholics and intravenous drug users, Persons with HIV or AIDs and persons who come into contact with high risk groups are more at risk for TB. The World Health Organization (WHO) reports that tuberculosis (TB) deaths are second only to (HIV) and acquired immune deficiency syndrome (AIDs) from a single infectious agent.
They point out that 1. 3 million died from TB in 2012 and that 95% of deaths from TB occur in low and middle income countries. The WHO indicates that TB is the cause of death for 25% of persons with HIV and that all countries surveyed have multi drug resistant TB (MDR-TB). (WHO, 2013) Analyzing the natural history of a disease involves the use of the epidemiological triangle (Smith 166) The epidemiological triangle consists of a susceptible person or host, the environment and the causative agent. We can visualize
this triangle as a closed system that becomes open and vulnerable when there is a change in any of the triangles sides, or factors. The change in one of the factors may cause a change to occur in the person’s balance of health. Person or host consideration includes current health or history of health issues, where and how the person lives, genetic predisposition, immune system, the body’s defenses and the person’s behaviors. All are examined for potential to health changes. The environment refers to anything that is not a part of self for the person.
This could be other persons or animals that the person comes into contact with. Examples of causative agents that potentially have an impact on a person’s health include genetic or psychological factors, chemicals, nutrition or physical and biological factors. Social determinants of health are conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality of life outcomes and risks. (Healthy People. gov, 2013) Health begins at home and extends to all areas that we live, work, play and socialize.
It is important to live a healthy life by eating healthy meals, regularly exercising, receiving immunizations and screening tests, and having healthcare available to us when we are sick. Our health is also partly determined by our access to economic and social opportunities. Available resources and support systems that we have access to influence health as well, safety in the areas we live and work in, the quality of the education we get, whether or not we breathe clean air, eat healthy food and drink clean water impacts our health.
The health of a population is often determined by the circumstances in which people live, which are conditioned by social policies and economic forces that are usually beyond an individual’s control (CSDH, 2008). Nearly one third of the world’s population is infected with TB. It is a leading infectious cause of death worldwide, causing more than 2 million deaths each year (CDC, 2011f). (Smith 195) Controlling the spread of TB is globally important because transmission to others can cause devastating consequences of transference to anyone the infected one is around including healthcare workers.
Treatment of TB can be lengthy and require supervision of compliance. Some TB strains are drug resistant and very expensive to treat. Exposure can occur in clinics where the sick are waiting for healthcare. Nurses have been a part of controlling community disease but initially were responsible only for prevention through cleanliness and fresh air. Hygiene education was and still is a primary role for the nurse in controlling communicable diseases. The modern community health nurse has responsibilities in primary prevention methods.
Duties include immunizations, prophylactic measures for risk reduction for persons who have had exposure when a method is available for the disease, and education. Immunization includes education and monitoring the patient for 15 to 20 minutes following the vaccine in case there is a reaction. Written documentation is provided to the patient’s records and is also kept for the clinic or organization providing the vaccination is kept to comply with the National Vaccine Compensation Act. Nurses also work to increase the public’s awareness of risks and behavior modification.
Instructing care providers on how to properly eliminate bacteria or viral agents and self-protective measures is important in preventing the spread of disease. Secondary prevention is used in identifying disease as early as possible to optimize treatment effectiveness and achieve the best outcome for the patient. Early treatment also serves to prevent the disease from spreading to others. Antibiotics are one type of secondary prevention. Other secondary prevention measures are contact tracing and follow up.
Screening and case finding is done by community health nurses acting as case finders to identify new cases of a disease and provide treatment as soon as possible. Follow up on persons who may have been exposed to a communicable disease beginning with those with the most intimate contact is performed by the community health nurse. The most intimate contact is considered level I; level II and III are those with decreasing levels of contact. With confirmation of illness, the community nurse may administer or observe the administration of medication and educate, oversee treatment and provide support for care providers.
In some cases, the nurse may be tasked with monitoring compliance with treatment and obligated to initiate legal action or even act as a witness during court proceedings when encountering a noncompliant patient. Tertiary prevention is the prevention of dysfunction after an illness. Because resolution of most communicable disease happens quickly, tertiary prevention is less often a part of the community nurses role. Health care delivery systems can work together in a variety of ways by sharing information and best practices as well as
committing to research and development of treatments. Eliminating tuberculosis will require financial support and shared information technology. Policies that contain and treat communicable illnesses are important as well. There is renewed focus and cooperation among countries and other organizations. Working together will decrease the risk of all. The Center for Disease Control (CDC) is working to eliminate TB in the United States through maintaining control of the disease, accelerating the decline, developing tools for diagnosis as well as treatments.
They have engaged in global efforts to prevent and control TB and worked to mobilize support through leadership contacts in high risk groups. The CDC also monitors their efforts progress. The Bill and Melinda Gates Foundation is investing in the development of better vaccinations and more effective drug treatments. They also focus on creation of new diagnostic tools, new approaches in control through reimbursement, improving access and efficiency and reducing costs.
The foundation also advocates for political commitment and funding, creating partnerships between governments, institutions and pharmaceutical and biotechnology industries. The Stop TB Partnership works through the World Health Organization to eliminate TB. The Stop TB Partnership is leading the way to a world without tuberculosis (TB), a disease that is curable but still kills three people every minute. Founded in 2001, the Partnership’s mission is to serve every person who is vulnerable to TB and ensure that high-quality treatment is available to all who need it. (Stop TB Partnership, 2013)