Running head: TUBERCULOSIS AS PUBLIC HEALTH ISSUE 1

Tuberculosis

Name

Institute Affiliation
TUBERCULOSIS AS PUBLIC HEALTH ISSUE 2

Tuberculosis as Public Health Issue

Summary

Tuberculosis is a critical universal health concern that demands responses from the nurse

community practitioners to improve its control. The report explores the epidemiology of

tuberculosis in the United Kingdom, describes the role of community health nurses in promoting

health, and recommends the health promotion model for the nurses. In 2014, 6520, cases were

documented in the UK, with a rate of 12 per 100,000 population. High rates in the United

Kingdom are located in large cities such as London, with its rate being high among people

residing in the most deprived regions of the United Kingdom. London had the highest percentage

of cases (39%) and the highest rate of TB (43.9 cases per 100,000) in 2014. Most of the TB cases

in the UK are connected to the foreign-born with TB occurring around 20 times among the

foreign-born when compared to the UK-born population. Amongst cases reported during 2014

for which the country of birth is recorded, 59% were born in South Asia and 24% in sub-Saharan

Africa. The main role of the nurse community practitioners is to plan the actions, coordinate with

various stakeholders, and evaluate the control and preventive strategies for TB infected incidents.

It is also the community health nurse’s responsibly along with other health care workers to report

the presence of TB to the correct officials. In high-risk populations, screening should be offered

to contribute to prevention. The nurse practitioners can attain their roles by using the Health

Promotion Model to encourage healthy lifestyle and understand the major factors of health

behaviours as the foundation for developmental counselling and to advance healthy living.

Pender's theory help nurse practitioners to look at aspects that impact health behaviour.
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Introduction

Tuberculosis (TB) is a significant global public health that calls for a high approach at

both local and national levels. TB is an infectious mycobacterial disease that can affect any part

of the body but most commonly affects the lungs. It is spread when someone with lung (or

laryngeal) TB expels respiratory droplets that contain TB bacilli, most commonly by coughing,

which is one of the typical symptoms of lung TB. The disease can cause severe weight loss and

historically has been referred to as “consumption.” TB is one of the most ancient infections

known to man, and there is molecular evidence that the microorganism that causes. The evidence

in the Egyptian mummies (Daniel 2006), as well as the biblical references in Leviticus 26:16 and

Deuteronomy 28:22, demonstrates the existence on earth for more than 17 thousand years

(Rothschild et al. 2001). More recently, particularly in the 17th and 18th Centuries, the disease

burden from TB was high in industrialised countries, including the United Kingdom (Story et al.

2007).

The report explores the epidemiology of tuberculosis in the United Kingdom, describes

the role of community health nurses in health promotion and recommends the health promotion

model for the nurses. This entails an assessment of the local and national health data to

determine health needs and priorities for TB cases. The report is then followed with a discussion

of the roles of community health nurses and their responsibilities in promoting health and

safeguarding adults at risk in relation to TB. The report also recommends Pender’s Health

Promotion Model as a tool for nurses to use in their roles as well as their responsibilities in

preventing adults at risk of TB. Finally, the report concludes with the rationale of this study and

describes the overall implication.

Epidemiology of TB in the United Kingdom

Tuberculosis is a notifiable public health issue in the United Kingdom, and all incidents

are recorded using the Public Health England’s Enhanced Tuberculosis Surveillance (ETS)

system. The aim of ETS is to provide ongoing, detailed information on the epidemiology of TB,

including for subgroups of the population. Reports to ETS are collated at sub-national levels by

regional offices of the Health Protection Agency (HPA) and are then sent to the national HPA

TB team for data cleaning, after which data are returned to local areas and used for national and

international reporting and epidemiological analysis.

Figure 1: The prevalence of Tuberculosis in the UK from 2000-2014.

Source: Public Health England, 2015

The TB cases in the UK have been growing since the mid-1980s, and this has continued

into the new Millennium, as figure 1 depicts. The most marked growths have been in urban

regions and in young men. In 2014, 6520 incidents were documented in the UK with a rate of 12

per 100,000 population. Although this demonstrates a decrease when compared to 2013, it not an
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overall change since 2000. TB is no longer endemic in England but is concentrated in major

urban cosmopolitan areas. London had the highest percentage of cases (39%) and the highest rate

of TB (43.9 cases per 100,000) in 2014. The North West region had the fourth highest regional

incidence and incidence rate in 2014. Most of the TB cases in the UK are connected to the

foreign-born with TB occurring around 20 times among the foreign-born when compared to the

UK-born population. The pattern appears to remain unchanged for a number of decades. The

proportion of TB cases that are foreign-born varies by region with the highest proportion being

in London (85%) and foreign-born cases form a majority of TB case reports in every English

region with the exception of the South West (47%). Amongst cases reported during 2014 for

which the country of birth is recorded, 59% were born in South Asia and 24% in sub-Saharan

Africa.

Role of Nurse Community Practitioners

The nurse community practitioners have important roles in preventing, ensuring patient

adherence to treatment, and educating about TB. The role of nurse community practitioner

entails coordinating with health care professionals as well as the community. The nurse collects

various data, such as infected patients, and the collected data is used to monitor trends in the

disease process. It is important the community nurse understands the proper treatment and ensure

that the TB patients adhere to medication. The community nurse must also understand the

treatment plan to use when caring for infected patients. As such, the main role of the nurse is to

plan the actions, coordinate with various stakeholders, and evaluate the control and preventive

strategies for TB infected incidents.

Health Promotion Model

The nurses who have a significant role in changing behaviours and achieving a healthy

lifestyle can use Pender’s Health Promotion Model to ensure tuberculosis prevention, care, and

treatment. The nurse needs to give a high focus on medication adherence when it comes to

tuberculosis treatment, which demands people are developing proper behaviours. Pender

describes health-promoting behaviours as consistent activities that must become a critical part of

an individual’s lifestyle (Sevinc & Argon, 2018). Specifically, adherence to medication can be

perceived as a health-promoting behaviour. Pender’s framework discusses the significance of

cognitive processes in controlling behaviours as it addresses the complex bio-psychological

activities that motivate patients to improve their health behaviours. The Health Promotion Model

describes attributes related to personal experience, immediate behaviour, and behaviour specific

impacts. The main components in the model include: 1) immediate competing preferences and

demand; 2) commitment to action plan; 3) behaviour related effect; 4) situational influences; 5)

interpersonal influences; 6) prior associated behaviour; 7) self-efficacy; 8) perceived barriers; 9)

perceived benefits; and 10) personal factors (Pender, n.d). The reason for the focus on these

components is their applicability in understanding attributes that determine behaviours.

Specifically, the power of this framework does not limit the community nurse to interventions

that are focused on reducing the risk of the illness. Provided the concerns generated by

tuberculosis for the patients such as disabilities, family dysfunction, emotional conflicts, and

high treatment costs, promoting optimum health as well as regaining health are of significant

importance to the TB patients. Therefore, TB patients should have adequate skills and

understanding about the disease, and the relevance of completing TB treatment needs to impact

through health promotion efforts.

Conclusion
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Tuberculosis is a critical global health concern that demands an approach from the nurse

community practitioners to improve its control. High rates in the United Kingdom are located in

large cities such as London, with its rate being high among people residing in the most deprived

regions of the United Kingdom. The rate of tuberculosis also appears to higher among people

born outside England than those who were born in the UK. Nurse community practitioners are

often responsible for skin testing, reading, and referral. The practitioners should understand

people at risk of infection and prompt screening health centres to allow for early diagnosis in

high-risk regions. Besides, the nurse community practitioners must appreciate the peculiarity of

tuberculosis infection and the mode of its transmission. Identifying the individual’s contact with

TB will enable the nurse practitioners to recommends preventing therapy and limit the spread of

the infection. Finally, nurse practitioners can use the Health Promotion Model to advance healthy

lifestyle and to understand the major factors of health behaviours as the basis of developmental

counselling.
TUBERCULOSIS AS PUBLIC HEALTH ISSUE 8

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