Reduction of Tuberculosis in Brockton, Massachusetts

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Table of Contents

Introduction
Nursing interventions
Community interventions
Summary
References

Introduction

Deterioration of healthcare standards is a challenge that mainly affects the homeless people in Brockton. This population is susceptible to different infections like tuberculosis. The Healthy People 2020 Objectives seek to reduce and eliminate cases of preventable diseases like tuberculosis. The other objectives include reduction of infections of contagious diseases and development of vaccinations through an increase in the number of people vaccinated for these disorders. My objectives for this paper are to examine ways of reducing tuberculosis infections in Brockton City through improvement of education programs, the quality of healthcare for the homeless and community health care nurses in the fight against tuberculosis.

The target communities are the homeless individuals in Brockton. Brockton is a city in the United States located within the Plymouth County of Massachusetts. According to the 2010 United States Census Report, Brockton City had a population of about 93,810 people. It is the seventh largest city within Massachusetts and locals call it the “City of the Champions”. Increasing poverty levels, unemployment and high cost of housing are factors that lead to the increase of homeless people in the city of Brockton. A considerable percentage of people live in the streets and emergency shelters. These people include children of school going age and the elderly (Schaffer et al, 2010). In 2011, The United States Department of Housing and Urban Development reported that there were about 16, 664 homeless people in Massachusetts. Tests and treatment plans for people with various infectious disorders in Brockton can be adopted by the US government. Homeless people operate within a poor environment where they share limited resources like drinks, needles and food (Lashley, 2010).

Tuberculosis (TB) is a contagious airborne disease. The disease develops from the mycobacterium tuberculosis bacterium. The bacterium attacks vital body organs like the lungs, brain and kidney. TB infects people through the breathing process. This aspect makes the disease very infectious. Tuberculosis can be a fatal disease if not properly treated. It is one of the leading diseases in the United States (World Tuberculosis Report, 2013). In addition, the World Health Organization reports that about 3 million people die each year from tuberculosis in the world. In the year 2011, about 8.7 million people had TB infections. This figure was inclusive of 1.1million HIV patients. In addition, the rate of TB infection in the world stands at about 2.2% per year (World Health Statistics 2013, 2013). Literature review

Tuberculosis (TB) can be described as a disorder of the disadvantaged. The social and economic statuses of the disadvantaged people in the society make them susceptible to the condition. This fact is because tuberculosis bacteria thrive in poor social conditions. This paper examines the prevalence of tuberculosis, causes of the condition, current research on the topic and intervention measures to curb the problem.

Tuberculosis usually affects the respiratory organs. It is a contagious disease. The US acknowledged it towards the end of the 19th Century. The disease manifests itself in diverse forms. It can take the form of pulmonary TB, TB of the joints or bones, scrofula and tubercular meningitis or lupus. The disease has a complex etiology.

Community interventions in Brockton City name five categories of tuberculosis that affect different types of animals may be the most common ones. Two categories of the mentioned ones affect human beings. These types include the human and bovine forms of tuberculosis. Bacillus mycobacterium may be the primary cause of tuberculosis. Scientists have discovered the existence of different types of tuberculosis. The probability of a healthy person getting infected with TB is 10% throughout his lifetime.

TB spreads through people with active TB infections. After infection, the mycobacterium settles in the air sacs of the lungs. It also settles in the lung passages and the immune systems. This aspect affects the healthy functioning of the respiratory system. The probability of getting TB infection can be high when an individual is within an environment of a TB outbreak. Most individuals at risk of TB infections comprise of the homeless, elderly, drug addicts and people who spend time in rehabilitation facilities.

A number of conditions that may activate inactive TB include cancer, diabetes, disorders that attack the immune system, malnutrition, pregnancy, kidney disease, a long term use of steroids and radiotherapy. Various symptoms of TB include weight loss, coughing or sneezing that lasts longer than 2 weeks, release of yellow, green or bloody sputum during coughing, fatigue, chills, chest pain, night sweats, and loss of appetite, fever and shortness of breath.

In nursing and community interventions, diagnosis of tuberculosis occurs through a skin test that allows a health practitioner to assess the patient’s immune response to the mycobacterium. In addition, a health worker or nurse can carry out a skin test that entails facilitating an infection in the forearm. After 2 to 3 days, the doctor examines the test. In case of a swelling, the doctor declares it positive and links it to a TB infection. A doctor can also perform chest x-rays or analyze sputum samples in the medical lab.

Communities in Brockton City mainly treat TB through the administration of antibiotics. The patient may be hospitalized to avoid infecting other healthy people. This fact is because TB is contagious and an airborne disease. Nurses can use 3 or 4 antibiotics can treat TB for the initial 2 months. In addition, an additional 2 antibiotics can be taken for a period of about 4 to 7 months. Certain patients may need to control TB for even up to 12 months. Common antibiotics include ethambutol, rifampin, isoniazid, and pyrazinamide. An acute shortage of human resource personnel and lack of efficient nursing planning in curbing TB may be significant challenges facing the fight against TB. The lack of involvement of nursing experts in drafting health care policies and poor management of the work environment constitute further challenges to the fight against TB. The relatedness of HIV/AIDS to tuberculosis further complicates the fight against TB. Additional challenges that derail the fight against TB include the changing nature of the disease’s clinical presentation and its development in the laboratory. These aspects increase the need for improved diagnostic examination (Bringe et al, 2010).

Numerous community and nursing based challenges delay the current treatment plans for TB in Brockton. The complexity of the treatment and duration of TB dictate the nature of problems the disease may pose to medical practitioners. The long duration of TB treatment leads to high rates of non-adherence among patients. It also causes failure and relapse of the treatment because of suboptimal response. The emergence of resistance of the tuberculosis bacterium to antibiotics is also a significant concern for TB management. It leads to a continuous spread of the disease in the victim. In addition, TB treatment has adverse effects as a result of anti-TB drugs. An increasing trend of multidrug-resistance is on the rise in the US. This trend increases concerns in the management of TB.

Nursing interventions

Primary interventions on TB include monitoring sputum changes in suspected patients and vital signs of TB and teaching patients and families the objectives and techniques of TB infection management. Secondary interventions may comprise of campaigns on hand washing, covering mouth during coughing or sneezing and quarantine measures for the patients. Other secondary measures include teaching patients the purpose and significance of taking prescribed medications (Spiva et al, 2013).

Nurses can conduct TB clinics to increase awareness of the disease. Tertiary interventions by nurses may include carrying research on TB, contribution to public TB policies, direct care and patients’ education on TB and provision of healthcare advice. Certain approaches on TB intervention do not apply to my community of homeless individuals in Brockton City. The reason is that most of my target population lacks access to TB information and treatment. A need to restructure TB intervention approaches to incorporate disadvantaged people in the society is necessary.

Different agencies that regulate the prevalence of tuberculosis should be created in Brockton City. A community nurse should be the leading agent of tuberculosis control. Four fundamental roles of a nurse in the management of tuberculosis may be adopted. These roles include promoting health, preventing sickness, restoring shape and reducing body activity. The nursing functions are fundamental in controlling the TB pandemic. Proper investment in training and education programs for nurses is crucial in supporting the reduction of TB (Koushambhi, 2012).

The American Thoracic Society plays a crucial role in the control of tuberculosis. It provides services to populations at risk of TB infections. The agency is also essential in advocacy initiatives to regulate the spread of TB. A number of problems may comprise of poor diagnoses and treatment of active TB.

The World Health Statistics 2013 (2013) provides valuable data for the control of TB. The institution focuses on setting policies that guide the control and management of diseases in the United States. The challenges of this agency include late reporting of TB by medical staff in different locations. Certain opportunities in the vaccination process may not be assessed. Vaccination can help in reducing TB among children in America (World Tuberculosis Report, 2013). The Infectious Diseases Society of America is also a crucial agency in the regulation of TB. It has the mandate of controlling infectious and contagious diseases in the United States. The agency has top ranking medical practitioners in the field of infectious diseases. The challenges of this agency may include delay in the diagnosis of TB. The agency may lack the capacity to conduct efficient investigations and responses to TB outbreaks.

Medical professional organizations are also essential agencies in the control of TB. They carry out functions related to education and mentorship of medical officers and health experts on the control of the disease. The agencies can provide leadership on medical practice and regulation of TB through their involvement in the endorsement of guiding frameworks (Allinger et al, 2008).

Medical and biotechnology plants can be necessary in the management of TB. They develop the basic outfits for identification, treatment and prevention of tuberculosis. The challenges of these agencies comprise their failure to provide drugs in time to fight bacterium resistance.

Community interventions

The primary community intervention involves reviewing the vaccination policy for tuberculosis to include the disadvantaged and poor in the society. A renewed focus on TB education should be initiated to address the problem. However, challenges like lack of adequate human resource and research capacity to develop modern medication are proving to be crucial in the fight against TB.

The secondary community intervention underscores facilitating campaigns against infectious diseases like TB. A taskforce that formulates policies on TB control is investigating possible interventions that may be used in Brockton City. The community also advocates for leaders to increase allocations and identify stakeholders to enhance TB control and build the capacity of the society to control the epidemic.

The community members and other stakeholders consider adopting various forms of recommendations in regard to nursing and community interventions and control of TB. Set priorities that focus on regulating TB infections must be constituted by the relevant authorities. A TB control program can form part of the nation’s top development agendas. TB control agencies should improve records and data on TB in order to benefit from the medical information and research on TB (American Lung Association, 2009). Improvement of research on TB to discover new findings that can provide a basis for medical interventions should be enhanced. At a tertiary level, the community intervention involves improvement of decision making in TB intervention programs and enhancement of the treatment plans to align with transformations of causative bacterium. In addition, TB agencies should lay emphasis on the disadvantaged members of the society like the homeless in cities (Center for Disease Control &Prevention, 2009).

Tuberculosis community nurses and other healthcare practitioners may be essential in the management and care of TB. However, different concerns like the lack of effective training for nurses and their representation in the drafting of strategic decisions on the control of TB ought to be instituted (Schaffer et al, 2010). The competence of nurses in controlling tuberculosis may be examined by relevant medical authorities in Brockton City. Community nurses can be essential in promoting adherence to TB treatment, managing the side effects of TB treatment, training and supervision of direct observation therapy supporters and expanding the scope of practice in relation to TB management (Healthy People 2020, 2013). In addition, nurses can strengthen advocacy, communication and social mobilization towards TB care (Barnes, 2008).

In conclusion, the level of prevention and treatment of TB among homeless individuals in Brockton City is still low. Most individuals within the city risk contacting TB infections. A high percentage of tuberculosis incidences in the United States occur among the homeless individuals. The medical fraternity of Brockton City should prioritize research on TB (Brockton CHNA 22, 2013). This fact can also be essential to the social development of the society. This paper serves as a practical framework for the identification and control of TB for health care practitioners. Slow and insensitive diagnostic techniques continue to reduce the global control of TB. Other challenges in the fight against TB include differentiating the link between HIV/AIDS and TB, inadequate early TB detections and the complexity of the TB bacterium (Belcher et al., 2012). The need to reduce TB infections among the homeless in Brockton City and the world should be prioritized. Strategies to overcome the challenge involve promotion of the use of direct observable treatment strategies. In addition, new programs to reduce infections and a global plan to control TB should be adopted by medical agencies. Furthermore, the need to assist developing countries to implement TB control strategies, and design innovative approaches in controlling TB should be integrated (Arcangelo & Peterson, 2013). Five fundamental elements in the management of TB are currently in use in Brockton City. These elements include provision of microscopy services, supply of efficient drugs, political commitment and efficient TB surveillance and monitoring systems. It is essential for the United States to promote the prevention campaign against TB among the homeless population. The government can lead this campaign through nursing intercessions that may include assessment, TB symptom control and education about the condition.

Summary

Tuberculosis (TB) remains one of the significant challenges among homeless persons in the United States. This paper outlines the prevalence of TB among homeless individuals in Brockton City. It outlines the causes, treatment and relevant literature on the condition. The paper explores the current interventions on TB and their relevance to reducing it among the homeless population in Brockton City. This paper affirms the objectives of the Healthy People 2020 Initiatives. It demonstrates that the objectives emphasize on reduction of contagious infections and improvement in the administration of vaccinations. The study explores the functions of various medical units in the management and prevention of TB in the US. The research observes the need to revise TB control policies to include the homeless population in the city of Brockton. Sanitation in the society should be improved to cater for the homeless population. In addition, introduction of ultraviolet devices in Brockton can be essential in the control and prevention of TB among the homeless people in Brockton.

References

Allinger et al. (2008).Predictors of adherence to latent infection therapy in Latino Immigrants. Journal of Communal Health Nursing, 24(3), 1919-198.

American Lung Association. (2009).Tuberculosis skin test fact sheet. Web.

Arcangelo, V.P., & Peterson, A. M. (2013). Pharmacotherapeutics for an advanced practice: A practical approach (3rd Ed.). New York, NY: Lippincott Williams & Wilkins Barnes.

Barnes, P.J. (2008). Emerging Pharmacotherapies for COPD. CHEST, 134(3), 1278-1286.

Belcher et al. (2012). Education-Service Partnership to Promote Best Practices in a Latent Tuberculosis Infection Program. Public Health Nursing, 29(1), 62–70.

Bringe et al. (2010).A service learning curriculum for faculty. Michigans Journal of Community Service Learning, 2(1), 112-122.

Brockton CHNA 22. (2013).Oral Health in our community: Update on Brockton report.

Center for Disease Control &Prevention. (2009).Treatment options for latent tuberculosis infection. Web.

Healthy People 2020. (2013). The Vision, Mission, and Goals of Healthy People 2020. Web.

Koushambhi, B. (2012). Understanding the Gender Aspects of Tuberculosis: A Narrative Analysis of the Lived Experiences of Women with TB in Slums of Delhi. Journal of Health Care for Women International, 33(1), 3-18.

Lashley, M. (2010). A targeted testing program for tuberculosis control and prevention among Baltimore City’s homeless population. Public Health Nursing, 24(2), 34-39.

Schaffer et al. (2010).The Henry Street consortium population-based competencies for educating public health nursing students. Public Health Nursing, 28(2), 78-90.

Spiva et al. (2013). Original Research: Hearing the Voices of Newly Licensed RNs: The Transition to Practice. American Journal of Nursing, 113(11), 24-32.

World Health Statistics 2013. (2013). World Health Organization.

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