Impact of Tuberculosis on Care Quality
Tuberculosis poses significant effects on the quality of care services offered to patients and the populations. To begin with, its diagnosis may be challenging since it requires unique confirmatory laboratory work-ups such as sputum microscopy and molecular assays which may delay diagnosis and management thus compromising the quality of care (Subbaraman et al., 2020). Also, the complexity of TB treatment affects the quality of care since it requires multiple antibiotics for several months making it difficult for patients and healthcare providers to ensure compliance and manage the possible medication interactions leading to incompliance. Moreover, inadequate infection control initiatives like the use of personal protective equipment can lead to an increase in hospital-associated TB infections that may affect the quality of care as a result of high patient turnover, staff shortage, and medication shortage.
Additionally, stigma, social isolation, and discrimination associated with TB infection hinder infected individuals from seeking treatments or adhering to the medications. It will eventually result in delayed management, treatment failure, development of drug-resistant strains, and raised chances of spread leading to outbreaks (Subbaraman et al., 2020). Availability of affordable, easily accessible, and quality tuberculosis care is still challenging particularly in poverty-stricken settings such as the urban homeless population. The supporting evidence aligns with my experience in the nursing practice since I have witnessed patients who delay seeking care due to stigma and social isolation associated with the infection.
Impact of Tuberculosis on Patient Safety
Tuberculosis poses a significant effect on patient safety since it is a highly contagious infectious condition that is transmitted through coughing, sneezing, and proximity to an infected person. Tuberculosis symptoms may be unspecific mimicking other upper respiratory conditions like flu and pneumonia. Therefore, it might be misdiagnosed retarding initiation of diagnosis and treatment hence leading to deterioration of patient health condition, progression to life-threatening complications like respiratory failure, and increased risk of spread to others (WHO, 2022). Moreover, adverse drug reactions from tuberculosis treatment can also endanger patient safety. Typically, the management of tuberculosis encompasses numerous drugs prescribed for a prolonged period and some of them have serious complications such as hepatotoxicity and peripheral neuropathy which compromise patient safety by causing discomfort and harm (WHO, 2022). Consequently, the patient might discontinue medications leading to treatment failure and further transmission endangering the safety of the population.
Treatment of tuberculosis has led to the emergence of multidrug-resistant TB (MDR-TB) and extensive drug-resistant TB (XDR-TB) that impact patient safety because they are challenging to manage requiring prolonged admission and expensive medications (Khawbung., 2021). Notably, TB is associated with numerous psychological effects such as stigma, discrimination, and worry of infecting loved ones and the community. Tuberculosis is known to affect the homeless population due to inaccessibility to healthcare facilities and other social determinants of health leading to negative health outcomes and continuous transmission within the society. In my practice, I have experienced TB patients with drug-resistant tuberculosis requiring prolonged hospital stay with mechanical ventilation.
Impact of Tuberculosis on Cost Considerations
Globally, tuberculosis presents a high economic burden to both patients and the healthcare sector in terms of direct or indirect financial implications. An infected individual has to incur the direct cost of medical expenses including diagnostic tests, medications, hospital bills, and follow-up care (Moreira et al., 2020). It is crucial to note that tuberculosis is often associated with long hospitalizations and duration of medications which is expensive, especially in the case of drug-resistant tuberculosis necessitating second-line drugs. Additionally, the management of tuberculosis-related complications and side effects of medications like peripheral neuropathy further aggregate the direct cost implications of tuberculosis (Moreira et al., 2020).
On the other hand, indirect financial implications result from reduced productivity and loss of income due to hospitalization or debilitation of individuals infected with tuberculosis. In the healthcare system, tuberculosis presents a lot of cost challenges, particularly in resource-limited areas such as the homeless population where the cases of tuberculosis infections are rampant. TB control programs such as screening, treatment, monitoring, and mitigation initiatives are costly since the system has to invest in infrastructure, personnel, and medication, especially in cases of drug-resistant strains (Moreira et al., 2020). In my nursing practice, I have experienced the catastrophic nature of financial consequences of tuberculosis care particularly in settings where insurance does not cover and the patient has to pay out of pocket driving them into poverty.
State Board Nursing Practice Standards and Government Policies
Research
The research was conducted to assess the effectiveness of nursing standards and government policies in addressing the impact of tuberculosis (TB) on the quality of care, patient safety, and cost considerations within the Indonesian healthcare system (Oktamianti et al., 2021). The study emphasizes the incorporation of the Directly Observed Treatment (DOT) strategy into hospital accreditation by the government as a way of encouraging hospital engagement in TB control initiatives. The findings showed that the proportion of TB case findings in hospitals increased from 26.4% in 2015 to 46.3% in 2018 (Oktamianti et al., 2021). This indicates an improvement in reporting of tuberculosis cases and control efforts within hospitals hence promoting delivery of quality care and patient safety with reduced cost implications to both patients and the hospitals.
Policies
The state board of nursing standards and organization or government policies guide my nursing actions regarding tuberculosis management to ensure quality care, patient safety, and cost consideration through various ways. Firstly, it outlines protocols for screening, detecting, treating, and controlling tuberculosis infection through sufficient patient assessment and accurate interpretation of diagnostic results (WHO, 2022). These standards and regulations also ensure patient safety by mandating infection regulation measures like the use of negative pressure isolation rooms, proper ventilation, and adequate utilization of personal protective equipment to prevent infection spread. Emphasizing targeted screening programs among high-risk residents and subsidizing the cost of TB diagnosis and medications allows the delivery of cost-effective healthcare tuberculosis services.
The nursing scope is guided by a combination of local, state, and federal policies that significantly impact the quality of care, patient safety, and financial implications on individuals and the healthcare system especially when it comes to the management of tuberculosis. For instance, local health organizations may formulate guidelines, infrastructures, and resources for periodic screening of high-risk groups such as the homeless population, HIV-positive patients, and those living in congested environments. These measures allow early detection and management of infection thus improving the quality of care and patient safety. State regulations such as nurse scope rules govern the licensing of nurses involved in TB care and ascertaining adherence to standardized TB management and intervention protocols to ensure the provision of optimal and secure care. On the other hand, federal agencies such as the Centre for Disease Control and Prevention (Sterling et al., 2020) outline regulations and resources for TB control measures. For instance, it provides evidence-based screening tools, diagnostic tests, treatment, and follow-up protocols that must be adhered to by all healthcare providers. Proper allocation of resources and funding at all levels and compliance with the regulations and policies reduce the financial consequences to patients and the healthcare system.
Proposed Strategies
Various strategies may be implemented to promote quality of care, enhance patient safety, and reduce costs to the system and individual including preventive initiatives and timely diagnosis through targeted screening sessions, outreach programs to raise awareness on predisposing factors, presentation, and prevention of TB, and ensuring accessibility of affordable diagnostic tests. Another strategy encompasses implementing consistent evidence-based treatment protocol recommended by the WHO to ensure standard and effective treatment of all cases. Adherence support is achieved through comprehensive educational sessions and the provision of support services such as digital adherence technologies directly observed therapy and counseling services (Jerene et al., 2023). Additional strategies include proper resource allocation and cost reduction measures. It can be achieved by prioritizing resource allocation to evidence-based TB control measures aimed at promoting patient outcomes and reducing the rate of transmission. Policymakers should also advocate for more federal funding and comprehensive social insurance for TB management. Additionally, there is a need to investigate other approaches to delivering healthcare services such as telehealth technology (Guo et al., 2020) and mobile clinics. Other strategies include multidisciplinary collaboration including nurses, physicians, community leaders, and public health agencies, and implementing infection control measures like the use of PPEs.
Effectiveness of the Strategies
Research was conducted to test the clinical and cost-effectiveness of telemedicine technologies like video directly observed therapy (VDOT) in improving tuberculosis management, patient safety, and reducing cost implications (Guo et al., 2020). The study involved about 405 participants. The findings showed that there were increased rates of drug compliance and early recognition of adverse drug reactions since the technology allowed brief linkage between the patient and healthcare providers thus improving patient safety and quality. The strategy was cost-effective for the patient no transportation cost was incurred.
Sources of Benchmark Data
To formulate an effective plan for tuberculosis management it is paramount to recognize credible and relevant sources for benchmark data on the quality of care, patient safety, and cost consideration regarding the condition. Healthcare organizations such as the World Health Organization (WHO) provide extensive data via its worldwide and nationwide tuberculosis reports concerning recovery rates, infection rates, death rates, and annual healthcare expenditures on TB management (WHO, 2021). The National Tuberculosis Controllers Association and Centre for Disease Control and Prevention (CDC) is another source that provides information and metrics for TB specifically for the United States like surveillance details, treatment procedures, and research results (Sterling et al., 2020).
Regulatory agencies such as the Joint Commission are responsible for certifying healthcare facilities in the United States’ performance and quality data for benchmarking purposes as they provide resources for monitoring and promoting optimal care and patient safety (Joint Commission, 2022). Internal organizational data about tuberculosis management like patient records, treatment modalities, and follow-up services can be analyzed to determine the organizational quality of care, patient safety, and potential areas for improvement. Insurance claims and billing system data shed light on the cost of managing tuberculosis patients and the healthcare expenditure on mitigation measures, diagnosis, and treatment of tuberculosis.
Part 2: Report Experience During the First Two Hours Practicum
In the course of my two-hour practicum, I met with an urban homeless population susceptible to or already infected with tuberculosis. The population consists of men, women, children, and people living with disabilities among others with different cultural and ethical settings. I comprehensively explained the population health problem focusing on the raised chances of tuberculosis transmission within the community that might lead to outbreaks if not effectively mitigated. Additionally, I presented some of the obvious predisposing factors such as congested living conditions in the shelters, limited sanitation and hygiene facilities like toilets, and comorbidities like substance use and HIV/AIDS.
By engaging with the populations, I learned about their living situations, struggles with tuberculosis as an infectious disease, and barriers to healthcare access such as transportation costs, lack of insurance coverage, stigma, and discrimination associated with TB. The majority of the population was familiar with the symptoms, complications, and need for prompt management, however, resource constraints were hindering them from seeking services like screening. Most of them though indicated concerns for their health and that of their loved ones, especially children emphasizing the need for urgent interventions to address TB within the population.
Evaluating evidence-based practice (EBP) documents and websites strengthened the relationship linking homelessness and susceptibility to TB, and the significance of tailored measures to deal with the problem. Moreover, I mastered successful fruitful approaches like mobile TB clinics, outreach programs, and collaborative care strategies focusing on the preferences of homeless populations.
In the process of analyzing the impact of leadership, collaboration, communication, change management, and policy, I partnered with stakeholders like community leaders, healthcare practitioners, and representatives from the population. Lack of confidence, limited knowledge of tuberculosis, and competing priorities like food, shelter, and safety issues are some of the barriers encountered. Initially, most people were unconvinced about the importance of tuberculosis as they were overburdened by other concerns. Therefore, to overcome the barriers, I utilized leadership skills to encourage collaborative efforts and ensured clear and culturally competent communication to convince them to recognize the population’s health concerns. Change management skills fostered necessity by demonstrating the impact of tuberculosis on the population in case of an outbreak and leveraging for policies promoting access to healthcare services within this population.
Based on discussions, I refined my definition of the population health problem to incorporate barriers to accessing TB screening, diagnosis, and treatment services and the essential for culturally competent and collaborative care. Instead of focusing on presenting the problem and solutions only, I would have actively recognized and dealt with barriers to implementing the solutions by comprehensively evaluation the needs of the community.
References
Guo, P., Qiao, W., Sun, Y., Liu, F., & Wang, C. (2020). Telemedicine technologies and tuberculosis management: a randomized controlled trial. Telemedicine and e-Health, 26(9), 1150-1156. https://doi.org/10.1089/tmj.2019.0190
Jerene, D., Levy, J., van Kalmthout, K., van Rest, J., McQuaid, C. F., Quaife, M., … & Fielding, K. (2023). Protocol: Effectiveness of digital adherence technologies in improving tuberculosis treatment outcomes in four countries: a pragmatic cluster randomized trial protocol. BMJ Open, 13(3). https://doi.org/10.1136%2Fbmjopen-2022-068685
The Joint Commission. 2022. Available from: https://www.jointcommission.org/standards/national-patient-safety-goals/hospital-national-patient-safety-goals
Khawbung, J. L., Nath, D., & Chakraborty, S. (2021). Drug-resistant Tuberculosis: A review. Comparative immunology, microbiology, and infectious diseases, 74, 101574.
Moreira, A. D. S. R., Kritski, A. L., & Carvalho, A. C. C. (2020). Social determinants of health and catastrophic costs associated with the diagnosis and treatment of tuberculosis. Jornal Brasileiro de Pneumologia, 46, e20200015. https://doi.org/10.36416/1806-3756/e20200015
Oktamianti, P., Bachtiar, A., Sutoto, S., Trihandini, I., Prasetyo, S., Achadi, A., & Efendi, F. (2021). Tuberculosis control within Indonesia’s hospital accreditation. Journal of Public Health Research, 10(3), phr-2021. https://doi.org/10.4081/jphr.2021.1979
Sterling, T. R., Njie, G., Zenner, D., Cohn, D. L., Reves, R., Ahmed, A., … & Belknap, R. (2020). Guidelines for the treatment of latent tuberculosis infection: recommendations from the National Tuberculosis Controllers Association and CDC, 2020. American Journal of Transplantation, 20(4), 1196-1206. https://doi.org/10.1111/ajt.15841
Subbaraman, R., Jhaveri, T., & Nathavitharana, R. R. (2020). Closing gaps in the tuberculosis care cascade: an action-oriented research agenda. Journal of clinical tuberculosis and other mycobacterial diseases, 19, 100144. https://doi.org/10.1016/j.jctube.2020.100144
World Health Organization. Global Tuberculosis Report 2021. Geneva: World Health Organization; 2022
World Health Organization. (2022). WHO operational handbook on tuberculosis: module 4: treatment: drug-susceptible tuberculosis treatment.
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