3820 Scholarly Reflection

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Centennial College *

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W2021

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Nursing

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Nov 24, 2024

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The impact of infectious diseases can be felt around the world, with respiratory tract infections ranked as a leading cause of death globally (WHO, 2020). In addition to their effect on health, infectious diseases impact entire societies, causing significant economic losses and affecting political systems (Fonkwo, 2008). Tuberculosis (TB), is a disease caused by infection of the bacilli Mycobacterium tuberculosis (MTB). The bacteria is a non-motile, aerobic, and rod- shaped agent (Sia & Rengarajan, 2019). MTB most commonly presents itself in the upper lobes of the lungs. However, the infection can progress to other systems such as the kidneys, spine and nervous system. TB is an airborne pathogen and can be transmitted through the air of an infected individual (Sia & Rengarajan, 2019). Infection can occur when a healthy individual inhales airborne particles, typically introducing the bacteria to the lungs first. Only TB within the respiratory system is contagious, while other infected systems cannot transmit and cause infection to others (Carvalho et al., 2018). TB has been in existence prior to the creation of antibiotics, yet it is still a disease without a cure. The same treatments for TB have been recycled for the last 40 years (podcast cite). With TB, resistance and reinfection are common concerns due to the bacteria's ability to adapt and evolve to medications. It surpasses HIV and AIDS as a leading cause of death by infectious disease. As of 2016, 10.7 million cases have been reported globally, and TB has been the cause of 1.7 million deaths (Carvalho et al., 2018). Immunocompromised individuals are the most susceptible to developing the disease. A history of conditions such as HIV, cancer, diabetes, or renal disease predisposes to illness from the bacteria. Alcohol or tobacco use and environmental contaminants such as fungi influence susceptibility (Singh et al., 2019). However, patients infected with MTB may be asymptomatic with latent TB (LTB). Other strains of TB infection can include rifampicin-resistant TB (RR-

TB), multiple drug-resistant TB (MDR-TB), and extensively drug-resistant TB (XDR-TB). Each strain requires either a single-line treatment or second and third-line treatments, due to high resistance to most available medications (Singh et al., 2019). Modifiable lifestyle factors, a history of current medical conditions, and a TB-positive patient within a household puts individuals at higher risk for drug-resistant TB. Clinical manifestations of TB can vary across individuals, and the severity of their infected strain. The most common symptom is a persistent non-remitting cough, followed by weight loss, fever and night sweats (Sia & Rengarajan, 2019). TB is ranked as the deadliest infectious disease worldwide (Foster, 2020). According to the WHO (2021), approximately a quarter of the world’s population has a TB infection; most of which have a latent form where they are not yet experiencing symptoms and are non-infectious. In 2020 it was reported that approximately 10 million people will become ill with the disease worldwide, amongst all demographics. It is a curable disease, however, research for treatments remains largely unchanged and underfunded. In many populations around the world, there is a lack of access to adequate and consistent treatment. Although regular TB is declining, drug- resistant TB is on the rise, which poses a threat to everyone, as treatment is becoming less and less effective due to the resistance in bacteria continuing to grow. In 2020, only 1 in 3 individuals with drug-resistant TB accessed treatment. The WHO also states that low- and middle-income countries, which account for 98% of reported TB cases, severely lack funding, with only 41% of the global target spent two years ago. In the podcast, Doctor Amrita Ronnachit describes TB as a disease of socioeconomic inequality, affecting the poor and impoverished who do not have a voice ( cite podcast ). However, as resistance rises, MDR-TB will continue to become an increasingly widespread problem and a significant health security threat. Listening to the podcasts was difficult at times—the impact on communities who have

not been fortunate enough to have received the same protection as those in developed countries is devastating, and the suffering experienced by individuals with the disease is almost incomprehensible to us here in Canada. As nurses, no matter where we are in the world, the increasingly dangerous TB crisis has an impact on our values, beliefs, and philosophies. Fahrenwald (2005), outlines five core nursing values: human dignity, integrity, autonomy, altruism and social justice. In the context of TB in the present day, the role of nurses relates to all five values to some degree. Nurses need to maintain their integrity by acting in accordance with the latest standardized treatment guidelines for TB and abiding by an appropriate code of ethics. In conjunction, it is important to understand the impact of treatment on the population that you are interacting with—how it will affect their lives and finances while keeping in mind and empathizing with the fact that the toxic drugs used in treatment generally cause more suffering than the illness has been affecting the patient when it is initially identified. This often involves difficult conversations with clients to ensure that they are informed of the risks and healthcare recommendations according to their situation. Autonomy and the right to self-determination must also be respected, even if patients make difficult decisions to terminate their treatment plans. The increasingly large incidence of drug-resistant TB makes the spread of TB a global threat. Nurses play a role in advocating for and educating the public about the need for funding in research and for more effective means of treatment in communities around the world to uphold the moral and humanistic principles of nursing. Listening to patient narratives that emphasize the difficult experience of XDR-TB treatment highlights the importance of quality of life and compassion during patients’ experience of care. This reminds us of a clinical placement event where one surgical patient was notified of having cancer with a poor prognosis and would be offered palliative care. The patient left the

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same day instead of receiving treatment for their surgery, or cancer. Like in the gruelling treatment associated with TB cases, patients can demonstrate an aversion to the healthcare system. We realize that in some clinical situations, patients may choose to terminate treatment in favour of their current quality of life despite probable death, as opposed to a diminished quality of life through medical treatment when survival is not necessarily guaranteed. While nurses respect patients’ autonomy, we equally have a respect for life, which involves medical treatments, and includes considerations of quality of life (College of Nurses of Ontario, 2019). We spend the most time with patients and have opportunities to engage with their emotions and lived experiences. Through these close encounters, we can anticipate their needs and identify which areas need change and advocacy (Abbasinia et al., 2020). For example, with TB, aspects of lived experience including medication side effects, survival rate, level of emotional support, and quality of life could be addressed to promote treatment adherence, prevent discontinuation of care and improve outcomes in cases involving XDR-TB. Locally, nurses can assess the experience and mental impact of care on patients. Globally, nurses can analyze and compare experiences from our own communities to other localized areas with different health challenges, helping to develop solutions such as more holistic care in the case of TB. Overall, looking at health through a global lens and acknowledging different experiences of a disease can aid in improving health in localized areas. The two podcasts were quite powerful in providing a unique perspective outside of the biological point of view, on the continued existence of TB in the world. When thinking about healthcare, society typically focuses solely on aspects such as hospitals and primary care. However, healthcare involves many critically important aspects that are beyond this scope. This includes the various social determinants of health that impact individuals in innumerable ways.

As future nurses, we will be front-line workers who witness socioeconomic impacts on individual health firsthand. Hence, nurses must advocate for the injustices and inequalities we witness. We must use our inside perspective from the experiences we observe our patients undergo to attempt to alleviate negative aspects of health care, by advocating for better facilities, policies, more access to care, greater levels of community resources in communities of need, etc. In a study by Carlsson et al. (2014) regarding nursing roles in TB treatment adherence in Burundi, a small poverty-stricken country in Africa, it was found that nurses are critical resources to the success of TB adherence and treatment. However, it was also found that for their work to be better facilitated for increased adherence, the socioeconomic factors that are social determinants to health for the individuals of the country, must be eliminated (ie, transportation issues, lack of nutritional support). Hence, as concluded in this study, policy changes must be made on a broader level to help mitigate these systemic issues which act as a barrier to TB treatment adherence in this country; however, this cannot be successful without the active advocacy of nurses for their patients based on their experiences and knowledge. It is also critical that nurses ensure that they place patient-centred care at the forefront when working with individuals of such vulnerable populations for the treatment and elimination of TB. By doing so, nurses must cater treatments and plan solutions in a manner that addresses the multitude of unique challenges posed by TB, which requires a specialized approach. The critical impact of TB calls for multi-sectoral policy change and increased global funding and awareness. Nurses play an integral role in treatment, education, and advocacy around the world with the eventual goal of complete eradication. References Abbasinia, M., Ahmadi, F., & Kazemnejad, A. (2020). Patient advocacy in nursing: A concept

analysis. Nursing Ethics, 27 (1), 141–151. https://doi.org/10.1177/0969733019832950 Carlsson, M., Johansson, S., Eale, R.-P. B., & Kaboru, B. B. (2014). Nurses’ roles and experiences with enhancing adherence to tuberculosis treatment among patients in Burundi: A qualitative study. Tuberculosis Research and Treatment , 1–9. https://doi.org/10.1155/2014/984218 Carvalho, A. C., Cardoso, C. A., Martire, T. M., Migliori, G. B., & Sant’Anna, C. C. (2018). Epidemiological aspects, clinical manifestations, and prevention of pediatric tuberculosis from the perspective of the end TB strategy. Jornal Brasileiro De Pneumologia , 44 (2), 134–144. https://doi.org/10.1590/s1806-37562017000000461 College of Nurses of Ontario. (2019). Practice standard: Ethics. https://www.cno.org/globalassets/docs/prac/41034_ethics.pdf Foster, L. (2020). 5 of the world’s deadliest infectious diseases. World Economic Forum. https://www.weforum.org/agenda/2020/04/covid-19-infectious-diseases-tuberculosis- measles-malaria/ Sia, J. K., & Rengarajan, J. (2019). Immunology of mycobacterium tuberculosis infections. Microbiology Spectrum , 7 (4). https://doi.org/10.1128/microbiolspec.gpp3-0022-2018 Singh, R., Dwivedi, S. P., Gaharwar, U. S., Meena, R., Rajamani, P., & Prasad, T. (2019). Recent updates on drug resistance in mycobacterium tuberculosis. Journal of Applied Microbiology , 128 (6), 1547–1567. https://doi.org/10.1111/jam.14478

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3820 Scholarly Reflection

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