How to write a nursing paper on Epidemiology and Nursing Research (Solved)

How to write a nursing paper on Epidemiology and Nursing Research (Solved)

Worldwide, developed and developing countries are facing the burden of communicable diseases with significant effects on the world economy. Communicable diseases are illnesses that result from infection, presence, and growth of pathogens in humans or other animals. These diseases are caused by common agents including bacteria, fungi, viruses, protozoa, and parasites among many others. Likewise, the transmission of these agents occurs through several ways like direct contact with infected persons, taking contaminated food, contact with inanimate objects, or inhalation through the air. This discussion focuses on tuberculosis as one of the common communicable diseases worldwide.

Description of the Disease

Tuberculosis (TB) is a bacterial disease that mostly affects the lungs but can also affect other body systems like the brain, kidneys, or spine. The disease affects individuals across all populations and about 33% of the population worldwide is infected with the disease (World Health Organization (WHO), 2021). However, not everyone who is infected gets to develop the disease. It is observed that about 10% of the infected individuals fall ill with those with compromised immunity having a greater risk (WHO, 2021). Examples include those with HIV, malnutrition, diabetes, or chronic tobacco smokers.

Tuberculosis is caused by a bacteria called Mycobacterium tuberculosis that mostly affects the lungs. The germs are spread through the air and inhaled into the lungs where they cause the disease. Although the disease is infectious, it does not spread easily and may require very close contact with infected individuals to acquire the disease (Centers for Disease Control and Prevention (CDC), 2016). Tuberculosis is transmitted through the air, not by surface contact. Transmission of the disease occurs when an infected person releases germs into the air through coughing, sneezing, or laughing. The person then must inhale droplet nuclei containing the bacteria into the lungs to be infected. Most individuals can fight the bacteria and stop it from growing making it inactive. About 10% of the US population has this inactive form of TB that can later become active depending on the immune status of the individual.

Most people have latent TB throughout their lifetime, but for some, the bacteria become active when the immune system becomes weakened. When a person develops the disease, commonly observed is cough, fever, and night sweats that do not raise alarm to many. The result is increased transmission to others and about 10% to 15% of the people get infected with contact with individuals with an active disease yearly (CDC, 2016). The signs and symptoms of the disease include coughing for more than three or more weeks, coughing blood or mucus, chest pain especially when breathing, unintentional weight loss, fever, night sweats, chills, and fatigue. The disease can also affect other body systems like the spine leading to symptoms like back pain.

Treatment of tuberculosis requires taking several drugs for a period of six to nine months. The drugs approved as first-line for treatment for TB include isoniazid (INH), rifampin (RIF), ethambutol (EMB), and pyrazinamide (PZA) (CDC, 2016). The Centers for Disease Control and Prevention (CDC) recommends treatment with INH, RIF, PZA, and EMB during the intensive phase that lasts for 8 weeks. The continuation phase includes the use of INH and RIF for 18 weeks and this makes the recommended regimen for newly diagnosed individuals (CDC, 2016). While most patients recover after treatment, drug-resistant TB might make it difficult to treat leading to the use of alternative measures. Multidrug-resistant TB involves resistance to more than one anti-TB drug and at least INH and RIF drugs (CDC, 2016). Treatment of MDR TB is complicated and inappropriate treatment may result in life-threatening results.

Effective management of TB requires attention to potential structural, metabolic, vascular, and infectious complications. Complications of the disease include joint damage, spinal pain, and meningitis that causes intermittent headaches for several weeks (CDC, 2016). Liver and kidney problems may be observed due to altered metabolism while advanced stages of the disease may cause heart problems. TB-related sepsis is a life-threatening complication that often results in death due to limited management approaches.

Demographic Information

Tuberculosis occurs in every part of the world and about one-quarter of the world’s population has the disease. Individuals affected with the disease have a lifetime risk of 5% to 10% of falling ill (WHO, 2021). The World Health Organization reports that about 95% of the cases and deaths occur in developing countries. These statistics are related to the proper availability of diagnostic instruments and drugs for the management of the disease. Additionally, a lack of effective preventive measures may increase the incidence and mortality rates in these countries. While the disease affects individuals across all age groups, people who are infected with HIV are 18 times more likely to develop active TB (WHO, 2021). The risk of the disease is greater in individuals suffering from other diseases that compromise their immune systems. Other populations at risk include malnourished individuals, alcohol, and tobacco smokers.

The prevalence of TB varies regionally with most cases observed in Africa, the West Pacific, and eastern Europe. These regions are plagued with factors that contribute to the spread of the disease including an increased number of co-morbid diseases. Recent reports indicate that approximately 22% of the world’s population is infected with TB. In 2020, the largest number of cases were observed in South-East Asia (43%) followed by Africa (25%), and the West Pacific with 18% (WHO, 2021). Additional reports indicate that 86% of new cases occurred in 30 high TB countries from the mentioned regions.

In the United States, 7174 cases were reported in 2020 with an estimated 13 million individuals living with latent TB (WHO, 2021). However, there is a substantial decline in the number of cases in the country and other parts of the world. Globally, the rate of infection has fallen by 2% with a cumulative reduction of 11% from 2015 to 2020. Regarding the mortality and morbidity rates, TB is the 13th leading cause of death and the second leading infectious disease after COVID-19. About 1.5 million people died from the disease last year out of the estimated 10 million illnesses.

Determinants of Health

Addressing the determinants of health is important to the control of TB. These determinants fall into different categories including policymaking, social factors, health services, individual behavior, and biology and genetics. Social determinants are among the key risk factors for TB. For example, poor ventilation, overcrowding in homes and workplaces are among the factors that lead to the development of the disease (Hargreaves et al., 2011). Poverty, malnutrition, and hunger mostly observed in developing countries may predispose individuals to TB. Access to healthcare services is another determinant that affects the treatment of the disease. Individuals with TB symptoms always face barriers that lead to delayed diagnosis and treatment of the disease. They may face challenges with transport to healthcare facilities alongside the fear of the stigmatization that impairs treatment. In some countries, the close association of TB with HIV acts as a structural barrier to inequality in opportunities for treatment (Hargreaves et al., 2011). Lastly, individual behavior like smoking, drug use, and alcohol intake may lead to infection and impaired treatment.

Epidemiological Triad

Agent. The causative microorganism for TB is Mycobacterium tuberculosis, an acid-fast bacillus that reproduces slowly. The primary effect of the bacteria is in the respiratory system but can also affect the heart, kidneys, and brain.

Host. The host in this case is a human that gets the disease through respiratory exposure. Person-to-person transmission occurs through droplets with vehicles being coughing, sneezing, or talking. Factors related to the host that affect transmission include smoking, alcohol intake, and the immunocompromised.

Environment. Environmental factors affecting disease transmission and treatment include overcrowding, poor housing, and socio-economic factors like poverty and social class. Additionally, access to healthcare and the level of education can affect the disease process.

Role of PHN

Public health nurses are in an ideal position to identify, report, and provide treatment including follow-up for TB cases. The public health nurse is responsible for identifying TB cases through screening and isolating infected individuals. The nurse should assess the risk factors like HIV that are associated with the disease and screen patients for symptoms. Through community outreach programs, the nurse can be able to find individuals that have signs and advice on seeking treatment. The public health nurse has the responsibility of collecting data about TB including cases, treatment, and defaulters, and reporting the information to the local or regional public health department (Cole et al., 2020). Regarding the collection and analysis of data, the PHN should keep records of patients seeking treatment, those that have completed treatment, and defaulters. Other information that may require analysis includes successful treatment rate and MDR-TB patients that require special attention. To ensure follow-up with all patients, the PHN should electronically keep registries of patients including diagnostic results, treatment plan, and dosage of medications (Cole et al., 2020). These records should be regularly reviewed and follow-up through appointments or phone calls made.

Conclusion

Worldwide, developed and developing countries are facing the burden of communicable diseases. Tuberculosis is among the diseases that continue to cause ill health and deaths across many populations. Effective management of this disease requires early diagnosis and timely treatment using the right drugs. Addressing determinants of health like social factors and health services also provides a platform to effectively control the disease. While working towards disease management, the PHN has a responsibility in identification, managing treatment, reporting cases, and planning follow-up for TB cases.

 

References

Centers for Disease Control and Prevention. (2016). Tuberculosis: Treatment for TB disease. https://www.cdc.gov/tb/topic/treatment/tbdisease.htm

Cole, B., Nilsen, D. M., Will, L., Etkind, S. C., Burgos, M., & Chorba, T. (2020). Essential components of a public health tuberculosis prevention, control, and elimination program: Recommendations of the advisory council for the elimination of tuberculosis and the national tuberculosis controllers association. MMWR. Recommendations and Reports : Morbidity and Mortality Weekly Report, 69(7), 1–27. https://doi.org/10.15585/mmwr.rr6907a1

Hargreaves, J. R., Boccia, D., Evans, C. A., Adato, M., Petticrew, M., & Porter, J. D. (2011). The social determinants of tuberculosis: From evidence to action. American Journal of Public Health, 101(4), 654–662.

https://doi.org/10.2105/AJPH.2010.199505

World Health Organization. 2021). Tuberculosis.

https://www.who.int/news-room/fact-sheets/detail/tuberculosis

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