Tuberculosis: Communicable Disease in Healthcare

Introduction

There are numerous health conditions and illnesses that have plagued society for many years. The severity of communicable diseases differs, with some being declared pandemics. Tuberculosis (TB) is among the bacterial communicable diseases affecting the lungs, kidneys, and brain. According to reports by Alameda County Public Health Department (2018), TB affects more than nine million people annually around the world. TB is mainly transmitted from one person to the other through the air, making it one of the fastest spreading diseases. The world health organization (WHO) report (2021) affirms that TB holds the ninth position among the leading causes of death globally. One of the United Nations’ strategic development goals is to end the TB epidemic by 2030. Nurses are in the frontline of TB treatment as they are often in direct contact with patients, implying that it impacts them in several ways.

TB’s Impact on Nursing Practice

Over the years, TB treatment has been a medical prescription for six months which can be extended to nine months if the patient’s symptoms persist. According to Fadare et al. (2020), nurses’ challenges are mainly attributed to direct treatment administration and follow-up activities. Nurses are key players in TB management, treatment, care, and support. Treating TB patients has posed several challenges to medical practitioners and governments. These problems range from resource strain, high infection rates among healthcare workers, and the development of Multidrug-resistant TB (MDR TB).

Work Overload

In every healthcare institution, nurses are employed to deal with all medical cases presented at the facility. However, sometimes there is a mismatch between the number of patients and the hospital staff. In the case of an undesirable nurse-patient ratio, nurses face work overload (Fadare et al., 2020). The risk of TB infection increases with an increase in the TB burden placed upon nurses in health facilities. According to research done by Matakanye et al. (2019), settings with a high TB burden increase the risk of Latent TB infection (LTBI) among nurses. The research which was done on nurses in Limpopo, South Africa, reveals that nurses are overworked. The overload leads to nurses’ anxiety, helplessness, and vulnerability to a wide range of illnesses. It follows that when nurses are overworked, performance is lowered, making it harder to eliminate the pandemic.

Limited Resources

For effective disease handling, human resources need to be backed up by sufficient material resources, including infrastructure and technological tools. Matakanye et al. (2019) report that Limpopo province faces poor infrastructure for primary healthcare. Although the data was collected from South African nurses, it can be replicated in many health systems globally. Fadare et al. (2020) contribute to the discussion on resource availability by showing that protective equipment has remained a challenge for both nurses and patients in many healthcare institutions. Inadequate and poorly equipped isolation wards and lack of training have also contributed to nurses’ challenges, as shown by Fadare et al. (2020). Regardless of the present challenges, the healthcare sector has been dealing with the TB pandemic with several new and old tactics that have helped lower the incidence rates.

Another major challenge associated with TB prevalence is the lack/inadequate financial and political commitment of leaders in the countries with the greatest TB burden. As shown by the WHO (2021) report, there has been a sharp increase in HIV-related TB cases. Ending the pandemic, therefore, means that governments have to lower HIV- infection rates, a factor that calls for political and financial commitment. TB control requires financial contribution for the purchase of medication, test kits, and facilitating research (WHO, 2021). TB can be prevented through awareness and advocacy for healthy practices, early testing, and medication adherence.

Healthcare Systems’ Response to TB

For many years, TB management and care have depended on drugs administered to patients. However, as noted by Fadare et al. (2020), there have been challenges with patients’ adherence to medication, a factor that has significantly limited recovery. For this reason, the healthcare system adopted the Directly Observed Treatment Short-Course (DOTS) to enhance medication adherence. DOTS entails direct monitoring of patients by healthcare practitioners who seek to ensure that patients take their medication as prescribed (Fadare et al., 2020). This method has proved effective in many cases despite having a few challenges. Some reported problems include stigmatization and a high need for additional staff.

Failing to complete the regimen has been a major limitation to ending the TB epidemic. The nurses’ role in aiding medication adherence has been shown by Fadare et al. (2020), whereby DOTS proved effective in helping patients complete their regimen. The main challenge in this situation is the shortage of staff to watch patients. TB can be prevented if nurses, social workers, and community leaders educate members of society on healthy eating habits, hygiene, and medication.

The healthcare system has taken a keen interest in preventing relapse by ensuring that medical officers follow up on patients. Administering medication is preceded by creating a positive attitude towards patients that helps create a conducive environment for care. Once the patients have begun their treatment process, healthcare officers keep a record and follow up to ensure the medication is not interrupted (Matakanye et al., 2019). To ensure that patients do not discontinue their medication, doctors facilitate education among patients at all levels of society.

With regard to education, it is important to note that many people do not understand TB’s transmission and prevention. Therefore, education in communities should be prioritized as a means of ending the pandemic. As illustrated by Alameda County Public Health Department (2018), physical contact through handshake and sharing food lead to fast transmission of TB. Communities need to be educated on the need to minimize unnecessary physical contact, especially with people showing signs of TB. Families should also be taught the importance of seeking urgent medical care when they notice the slightest signs of TB. In many cases, TB patients start by self-medicating at home, an issue that has largely contributed to the high rates of infection (Cates et al., 2016). In addition, communities need to be taught that TB is curable and preventable.

Cultural, Ethical, and Social Issues affecting TB Patients

Since TB has a significant impact on society, patients are affected by social and ethical issues developed by society. One of the social issues is social distancing and isolation. TB is spread mainly through contact and, therefore, infected persons are expected to avoid contact with other members of the community. Isolation is a difficult issue in many societies, especially Africans who believe in constant contact between closely related persons. Communication is a key ethical issue that affects patients and medical practitioners. As outlined by Matakanye et al. (2019), medical officers are expected to clearly communicate all conditions to the patients to enable them to take the medication with consent. In regard to cultural issues, society needs to understand that TB affects all people and stop stigmatizing patients. Patient supervision also raises an ethical issue, as shown by Fadare et al. (2020). Patients need privacy, and DOTS interferes with this freedom, thereby raising an ethical concern about the treatment.

In the research done by Cates et al. (2016), contact investigations are one of the methods that can aid in eliminating TB spread. The article published in the OVID database reveals an ethical and social issue in TB treatment. Although contact investigation is crucial, many patients may consider it an infringement of their privacy. Many TB patients may be unwilling to discuss their contacts as they fear for their acquaintances.

Lastly, different cultures view TB differently, and this may create ethical issues between nurses and patients, as shown by Cates et al. (2016). In areas where TB is not common, the understanding and positive approach may be lacking, creating a cultural issue. In some areas, people may associate TB with HIV-positive patients leading to discrimination in caregiving. This raises an ethical and cultural issue because nurses are expected to impartially serve all patients. However, aligning some people’s beliefs with expectations may be difficult.

Policy Statement

To facilitate effective TB management and attain SDG’s goal of ending the pandemic by 2030, several steps should be followed. First, education institutions need to partner with the healthcare sector for enhanced research. As shown by Fadare et al. (2020), the MDR-TB has remained a huge healthcare challenge. Research is needed to establish effective treatment methods through enhanced technological solutions. Second, community education and empowerment should be enhanced to ensure that patients seek medical attention as early as possible to facilitate treatment. Third, nurses need to adopt an open communication model with patients.

Communication is a crucial part of every mitigation and treatment process. For this reason, nurses should openly communicate about patients’ challenges to enable them to provide the best medical care and support. TB is a global pandemic, and therefore all sectors of society should be involved. From diagnosis to treatment, nurses are required to embrace open communication. To begin with, patients need to be told the tests done and be advised on available treatment options. In essence, communication is essential in all steps of TB treatment and prevention programs.

The Impact of Information Technology and Data on TB’s Treatment

Digital health technologies have significantly influenced medical care for patients globally. TB’s management has been improved through technologies such as electronic directly -observed treatment (eDOT). As opposed to the physical monitoring of patients, EDOT has facilitated remote observance and guidance for patients, thereby limiting costs and stigmatization, as shown by Lee et al. (2020). Video-observed therapy and SMS have also made it easier for patients to connect with healthcare personnel and communicate their health issues. These technologies have positively impacted nurses’ perspectives on TB treatment. Mobile apps have also helped nurses remotely monitor their patients’ treatment process and medication, a factor that has contributed to a positive attitude among nurses. Lee et al. (2020) affirm that patients using mHealth were conveniently treated and completed their medication. This shows that scientific data analysis and technological advancement have helped enforce medication adherence among patients and improved nurses’ response and performance.

Conclusion

TB has contributed to a significantly large number of deaths globally. Many countries have established TB control units in their healthcare institutions to mitigate the spread and severity of the disease. Being among the leading causes of death, nurses have been under pressure, especially in cases with a high TB burden. Some of the challenges affecting nurses include the risk of infection due to insufficient personal care equipment and work overload. The policy on TB management should be guided by ethical and social considerations that promote open communication and eliminate stigma.

References

Alameda County Public Health Department (2018). Tuberculosis (TB). Web.

Fadare, R., Akpor, O., Ifechukwude, I., Richard D, A., & Bello, C. (2020). Nurses’ safety in caring for tuberculosis patients at a teaching hospital in Southwest Nigeria. Journal of Environmental and Public Health, 2020, 1-9. Web.

Lee, Y., Raviglione, M. C., & Flahault, A. (2020). Use of digital technology to enhance tuberculosis control: Scoping review. Journal of medical Internet research, 22(2), e15727. Web.

Matakanye, H., Ramathuba, D. U., & Tugli, A. K. (2019). Caring for tuberculosis patients: Understanding the plight of nurses at a regional hospital in Limpopo province, South Africa. International journal of environmental research and public health, 16(24), 4977. Web.

WHO (2021) Tuberculosis (TB). Web.

Cates, J., Trieu, L., Proops, D., & Ahuja, S. D. (2016). Contact investigations around mycobacterium tuberculosis patients without positive respiratory culture. Journal of public health management and practice: JPHMP, 22(3), 275–282. Web.