THE COMMUNITY

AN EPIDEMIC IN THE COMMUNITY

RESOURCES

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

 

WEEKLY RESOURCES

Tuberculosis Treatment for Mexican Americans – ProQuest

· Zuñiga, J. A., Muñoz, S. E., Johnson, M. Z., & Garcia, A. (2014). 

Tuberculosis Treatment for Mexican Americans Living on the U.S.-Mexico Border
Links to an external site.

. 
Journal Of Nursing Scholarship, 46(4), 253-262. http://doi.org/10.1111/jnu.12071

· Stanhope, M., & Lancaster, J. (2020). 
Public health nursing: Population-centered health care in the community (10th ed.). Elsevier.

· Chapter 6, “Environmental Health” (pp. 121-148)

· Chapter 13, “Epidemiology” (pp. 269-298)

· Chapter 14, “Infectious Disease Prevention and Control” (pp. 299-332)

· Chapter 15, “Communicable and Infectious Disease Risks” (pp. 333-355)

· Chapter 17, “Community as Client: Assessment and Analysis” (pp. 370-394)

· McKenna, M. (2015). 

What do we do when antibiotics don’t work anymore?
Links to an external site.

 [Video]. TED conferences. https://www.ted.com/talks/maryn_mckenna_what_do_we_do_when_antibiotics_don_t_work_any_more
Note: The approximate length of this media piece is 17 minutes.
Maryn McKenna is a journalist who specializes in public health, global health, and food policy. She describes how bacteria and viruses are mutating in response to new antibiotics at an alarming rate.

 

· TEDx Talks. (2014, October 20).
 

Will the poor always be with us?
Links to an external site.

 [Video]. YouTube. https://www.youtube.com/watch?v=yHQes6P5XnQ
Note: The approximate length of this media piece is 10 minutes.
Jim Yong Kim talks about his vision of transformation for development, drawing on his personal experience as an activist and AIDs researcher. He shares why ending poverty is possible in our lifetimes and concludes that the poor will not always be with us.

To prepare for this Discussion, visit the CDC Wonder site in this week’s resources. Investigate the incidence and prevalence of TB in your community. What information did you find? Analyze how your community compares to county, state, or national data for the same topic. Was the incidence and prevalence of each higher or lower than you expected?

Consider the following scenario: This is Debbie’s first year working as a nurse at the local health department in a rural county. Most of her days are spent in the clinic seeing clients who often do not have health insurance.

Over the past month, Debbie has noticed that several young Hispanic men have come to the health department, each diagnosed with tuberculosis. Debbie is concerned about what the outbreak of tuberculosis among the migrant workers could mean for the community. Through a community health profile, Debbie identifies the group of migrant farm workers as being at highest risk for contracting tuberculosis.

Using the Epidemiologic Triangle concept, consider the relationship among causal agents, susceptible persons, and environmental factors. 

Post your response to the following:

· As a BSN-prepared community health nurse, what steps should Debbie take next?

· Considering economic and social considerations within the community, what are the primary, secondary, and tertiary interventions that Debbie might use in managing this outbreak?

· Can similar interventions be applied to your community and its TB prevalence?

· What considerations need to be addressed within your community that are different form Debbie’s community?

Support your response with references from professional nursing literature.

Notes Initial Post: This should be a 3-paragraph (at least 350 words) response. Be sure to use 
evidenceLinks to an external site. from the readings and include 

in-text citationsLinks to an external site.

. Utilize 

essay-levelLinks to an external site.

 writing practice and skills, including the use of 

transitional materialLinks to an external site.

 and 

organizational framesLinks to an external site.

. Avoid quotes; 
paraphraseLinks to an external site. to incorporate evidence into your own writing. A 

reference listLinks to an external site.

 is required. Use the most 

current evidenceLinks to an external site.

 (usually ≤ 5 years old).

Read two or more of your colleagues’ postings from the Discussion question.

Respond to at least two colleagues. Your responses should be substantial and should contribute to the Discussion. Support with evidence, if indicated.

Enter the discussion thread on 3 separate days. Write at least two posts to two separate peers.

Jamie Crawford

YesterdayMar 6 at 4:52pm

Manage Discussion Entry

Tuberculosis (TB), is often a medical term and disease that many hear about but can’t quite explain what it is and how it manifests, nor do many understand how it spreads so quickly once an outbreak or a confirmed diagnosis has occurred. “Tuberculosis is caused by a bacterium called Mycobacterium tuberculosis. The bacteria usually attack the lungs, but TB bacteria can attack any part of the body such as the kidney, spine, and brain.” (Centers for Disease Control and Prevention, 2022).

 

There are many signs and symptoms that someone may have with TB; some are cough, chest pain, weakness, fatigue, and decreased or no appetite. Tuberculosis is spread through the air by an already infected person by coughing, sneezing, and spitting. It can then be inhaled by another not infected person and cause them to become infected quickly. TB is spread to those whom we are in close contact with, meaning you won’t necessarily become infected if you are out in the community setting and someone may happen to have it. “TB isn’t spread easily outdoors because air flows freely and sunlight kills the TB bacteria.”(Whatcom County Health Department, 2020). Understanding the disease and disease process that is being identified and researched is crucial in implementing changes needed to decrease the number of outbreaks and spread among the vast number of communities in which we live.

For Debbie since she has already identified a group of individuals who are affected by TB. Her next steps would be to identify and implement interventions (primary, secondary, and tertiary) that would assist her in managing the outbreak. A primary intervention would be to educate the population affected. One key element to this intervention would be to provide those with materials and references that they can understand; many of our Hispanic population who are migrant workers have English as their second language, so providing them with materials that they can understand is key. I know this first hand as my mother-in-law is a Hispanic migrant worker and this is her main frustration with the healthcare system-language barriers, and informative materials not readily available in her native language. A secondary intervention would be to offer testing and provide testing and the education on why it is important to be tested and how it will be performed. Inform the select population on the importance of why the testing is done and how this may benefit the overall outcome. Finally, we reach the tertiary intervention, and this would consist of follow-through care post-test results, discussing treatment options for those positively infected, providing resources to help the men obtain the medication needed to successfully complete the treatment regimen, and showing support and compassion in guiding them to a healthy recovery. Many times, our migrant populations are scared of the unknown and the fear of medical disease processes. Education and compassion are essential in reducing the reoccurrence of many diseases, such as tuberculosis.

Many of the same interventions can be applied to my community and its TB prevalence. I don’t believe there would be many variances between Debbie’s community and mine, as it should be very similar in all communities. In my community, we have a vast number of immigrant individuals and families ranging from all stages of socioeconomic status, so to me, as medical professionals, when we are readily available to preemptively provide the education and resources available to our communities as a whole it will produce a better outcome and lower the numbers of diseases that may arise. Having affordable healthcare available so all family members can have annual health exams, providing options for resources to help fund treatment and medication costs, and lastly, as I said before, just being compassionate and willing to take the time with our patients that in itself can change the outcome of many people who are already dealing with a medical crisis.

 

CDC.Wonder.2020. 

http://wonder.cdc.gov/Links to an external site.Links to an external site.

Centers for Disease Control and Prevention.(2022, May 3).
How TB spreads. Centers for Disease Control and Prevention. Retrieved March 6, 2023, from 

https://www.cdc.gov/tb/topic/basics/howtbspreads.htmLinks to an external site.

U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Whatcom County Health Department. (2023, March) Retrieved from 

https://www.whatcomcounty.us/3221/tuberculosis-TBLinks to an external site.

 Reply

Csilla Orban Bonacci

Tuberculosis is a terrible disease.

 

It is mostly found in Eastern Europe, Latino countries, Russia, Asians, and non-US-born immigrants.  It manifests with cachexia, night sweats, cough that lasts longer than 3 weeks, and in the end stages blood in the sputum. The person becomes weak and unable to function as it does affect the whole body. 

I live in Florida and based on the CDC Wonder cases of tuberculosis (TB) in Florida vary from year to year. I was surprised to see though that 500 cases of TB were identified in Florida in 2021. Lake County where I live seems to have had less than 0.5%, but Miami leads in those cases. In Miami, in 2021 they had 103 cases and Lake County had 4 cases only. Hillsborough, Duval, Broward, Palm Beach, and Orange County are the next cities and counties that have high incidents of TB in Florida (CDC Wonder, 2020)

    According to the data more Hispanics, Asians, Pacific Islanders, and other non-US-born patients are likely to be found with TB. However, efforts to reduce the number of incidents are common (Filardo et. al. 2022).

     To manage the high incidence of TB cases I believe in our case Debbie could apply some measures such as primary, secondary, and tertiary interventions.

Primary interventions would be focused on prevention such as the administration of vaccines such as BCG which is given in other countries to babies. Also, advise travelers to not stay in close and long contact with others in crowded spaces. Healthcare personnel needs to wear N95 masks when working with a potentially infected population. Keep sick people behind closed doors to avoid infecting healthy ones. Educating the public about the symptoms of illness and encouraging them to seek help right away is important. Often people will write off a cough as a cold, but it might be TB (Harries et.al, 2020). The nurse here has a very important role when it comes to educating the public on the signs and symptoms of tuberculosis.

 

     Secondary prevention would be testing and screening of the suspected infected population. Encouraging people to not be afraid of a stigma or put off being checked out while understanding the gravity of this illness is something she could add to her plan. Also, explaining that not seeking help when they think they might have been exposed is putting them and their family at risk.

 

Tertiary intervention would be appropriate for those who have a positive result. Treatment with antibiotics long term is the treatment for tuberculosis. Pills are taken in front of the healthcare worker to ensure compliance. And again, the nurse needs to educate the patient that it is imperative he/she finishes the treatment even if it is long or the illness can progress and even cause death. One of the things that patients worry about as immigrants is the lack of insurance. They worry about paying for these pills. Nurses should inform them that this is free. Tuberculosis treatment is free at the health department. During this phase, Debbie should gauge the understanding of the patient of what the treatment entails such as commitment, testing, and follow-ups. 

    Since in my community, the prevalence of these incidents is low I believe primary, secondary, and tertiary interventions is are suitable. We should not let our guards down especially considering the high influx of immigrants in the state of Florida. Florida is very crowded and has many vacationers and as crowds grow so does the risk of contracting TB. Even though only 13 cases of TB were found in total in Lake County in the past 5 years, the health department is on the watch. People are mobile. They move from one area to another and all it takes is just one infected person to move from one area to another and bring the infection with them to a healthy area. Collaboration with surrounding areas is crucial in stopping the spread of an outbreak.

I believe that the interventions here in Lake County are like what Debbie should apply. We do have a large population of immigrants here and unfortunately coming from a low socio-economic status many have not been to a doctor in a while. I believe what we should also encourage that is different here is well-being checkups. We should not wait until TB surfaces but encourage everyone to go to their yearly check-ups. A provider can help identify something someone might have brushed off as “no big deal”. Setting them up with a social worker to help them apply for insurance, a discount, or charity to be able to see a provider, as well as directing them to clinics that accept non-citizens should be something that is implemented in the clinics. 

 
 
 

References

CDC.Wonder.2020. 

http://wonder.cdc.gov/Links to an external site.

Filardo TD, Feng PJ, Pratt RH, Price SF, Self JL. Tuberculosis – United States, 2021. MMWR Morb Mortal Wkly Rep. 2022 Mar 25;71(12):441-446. doi: 10.15585/mmwr.mm7112a1. PMID: 35324877; PMCID: PMC8956339.

Harries AD, Kumar AMV, Satyanarayana S, Thekkur P, Lin Y, Dlodlo RA, Khogali M, Zachariah R. The Growing Importance of Tuberculosis Preventive Therapy and How Research and Innovation Can Enhance Its Implementation on the Ground. Trop Med Infect Dis. 2020 Apr 16;5(2):61. doi: 10.3390/tropicalmed5020061. PMID: 32316300; PMCID: PMC7345898.