Tuberculosis is one of the easily spread diseases that have a high prevalence among communities, especially in low-income communities, where the health qualities are low compared to other areas. There were a total of 9025 cases of Tuberculosis that had been recorded in the United States alone by 2018. The incidence rate was 2.8 per 100000, which was a decline by 1.3% from the previous year but none the less still high (WHO, 2019). This being a developed country where there are high standards of medical technology, and improved strategies of health indicate that Tuberculosis's issue is high (WHO, 2016). Through "the end TB strategy," the world health organization, the world health organization plan to ensure a 90% decline in incidence, which will also traduce Tuberculosis's mortality rate. TB is among the top 10 causes of deaths globally, with the number of patients who succumbed to the disease being 1.5 million in 2018 alone (WHO, 2019). Significantly, there is a high and rising number of reported cases in prisons, considering that there are high populations in the jails.
Essentially, there are growing numbers of individuals incarcerated and those passing through these facilities every year. This fact suggests a high likelihood of individuals from the community being admitted with while infected and hence infecting others. There is a necessity to address the spread of this disease concerning male prisons' contributing factors where populations are higher than in female incarceration facilities.
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Problem Statement
There is a higher infection rate with Tuberculosis in male prisons, which are either undiagnosed or diagnosed while late. This fact indicates that most of the patients do not receive treatment in time, causing more spread and deaths.
The change proposal aims at identifying the various contributing factors to the spread of TB in incarceration facilitates. One of the factors is the low levels of reporting of health issues in prisons. In most cases, the prison patients do not get diagnosed or tested due to the lack of proper health facilities or plans within these facilities. It is essential to consider that inmates who require health care services have to get a permit or court order to get transfers to proper health facilities away from prisons (CDC, 2012). These protocols in cases where the risk of deterioration of health or death are high hinder achieving quality health services. Hence, the purpose of the proposal is to identify impediments to the achievement of quality healthcare services and identify ways to ensure safety and quality in healthcare service.
Figure 1: Mass Incarceration VS TB Incidence
Courtesy: Proceedings of the National Academy of Sciences of the United States of America
Additionally, the proposal aims at discovering the loopholes in community health. Despite there being developed medical technology in America, there still cases of low health services and turnout. Due to the spread of the over the counter-culture, patients have reduced response to seeking professional health services. Also, the presence of online sites that educate patients on symptoms of various diseases and their treatment has caused the growth of self-prescription, which has caused more harm than good. For instance, the symptoms of Tuberculosis are similar to those of common cold in the first stages, and hence self-diagnosis and prescription can cause late treatment (WHO, 2019). Essentially, this proposal also aims at creating a plan to improve patient care at the community level through education of community members on diseases such as Tuberculosis and ensuring availability and accessibility of the healthcare services to all.
All these goals are related to the reduction of the spread of Tuberculosis in men's prison facilities. For instance, educating the community members about Tuberculosis symptoms will reduce the number of prisoners being admitted into the facilities with the disease. Additionally, accessibility availability of health services in the facilities will ensure early detection and treatment of TB cases.
PICOT Question
What measures need to be taken to reduce the spread of Tuberculosis in all-male correctional facilities?
Literature Search
The literature search strategy for this study involved identifying the critical questions relating to the problem statement. In essence, the items are crucial in establishing a specific line of thought that is being pursued. Essentially, the questions are vital in identifying the issues that need to be addressed to ensure accuracy. For instance, asking what measures are required to control the TB infection rate is crucial is essential in ensuring searching for materials about past standards that have been applied elsewhere, such as in communities.
On the other hand, keywords such as Tuberculosis, statistics, and prevalence were applied as a strategy. There are various sources of information concerning Tuberculosis from multiple studies done in the parts. The use of the keywords was critical as it helped pinpoint relevant details on the number of cases reported and the population in the precincts. Additionally, phrases such as "cases of TB in prisons" were utilized to emphasize details.
Another essential technique was using timeframes in the search for needed literature—this technique involved searching for recent study reports, statistics, and nursing theories. The essence of this strategy is to ensure the information used in the analysis is relevant. With the quickly changing events in the medical world, there is a need to utilize up to date information. For instance, statistics from 10 years ago may not represent the actual occurrence in the present. None the less, this information from the past for example the incidence rate of TB in 1998, can be used as a point of reference to understand the changes that have occurred over the last 22 years. Specifically, there is a need to use recent literature to ensure that the analogy does not seek to analyze issues that have been solved in the past and find current solutions for current problems.
Additionally, there was a consideration of the source and its credibility. For instance, the reliance on statistical information from the world health organization is critical as the source is believable, and their data is based on scientific research. Therefore, information from credible sources was referred to ensure that conclusion on the spread of Tuberculosis in prisons and its mitigation is based on facts.
Evaluation of Literature
According to the world health organization, prisons hold an approximate population of 8-10 million people. However, it is essential to note that the number of individuals passing through these facilities every year is 4- 6 times this estimated number, indicating that these facilities are overcrowded. Essentially, based on this information, it is clear that these prisons are likely to be unhealthy places since they are against the health guidelines for the prevention of infectious diseases such as TB. The TB level in these jail facilities is 100 times more than cases reported among the civilian populations. In essence, the prison tuberculosis cases diagnosed and recorded account for 25% of any country's tuberculosis burden (WHO, 2019). This fact indicates that the number of individuals in these scantly ventilated cells is a leading cause of higher disease rates.
Further, according to the American journal of public health, all-male facilities register higher populations that those meant for female convicts with the highest population in female facilities being 157 (Lambert et al., 2016). This fact is crucial as it indicates a higher risk in all-male facilities. The existence of other terminal illnesses such as HIV/ AIDS is a contributing factor to TB's spread as the immune systems of the patients in jail are weak (CDC, 2012). The poor ventilation, malnutrition and the cold also contribute to infections such as kidney issues, lung problems, and heart disorders, all of which are related to Tuberculosis. This article significantly indicates that the prevention of the spread of other diseases through sensitization and the provision of healthy meals could help prevent the spread of TB.
Figure 2: Relationship between HIV/AIDS and TB
Courtesy: Avert.org
Applicable Change
The needed change is the implementation of nursing interventions, which include stationing more nurses in the facilities. Essentially, nurses should be assigned to patients for treatment within the facilities. Professional help will ensure there is a focus on the use of prescribed medicine by the inmates and develop the inclination towards reporting symptoms. This intervention involves educating the inmates on symptoms and carrying out screening on entry and continually to detect infections in time. The theory that is applicable in this case is the nursing process theory, as there is a need to supply nursing help based on need (Lambert et al., 2016).
Implementation Plan
One of the ways of implementing the strategies is through setting up of health facilities within correctional institutions. These facilities will be stocked with medical supplies and a resident nurse assigned besides placing other nurses for on-call services. Also, the facilities will set policies to ensure mandatory checkup programs for all inmates every month.
It is essential to depopulate the facilities through the reintegration of some of the offenders to the communities. This intervention involves various institutions, including courts and the probation office, to ensure that populations in the institutions decrease to reduce contact and overcrowding in cells. The cells' structure needs to be changed through the addition of ventilation, which will make sure there is aeration.
These interventions will have various outcomes. For instance, mandatory monthly checkups will ensure more diagnoses and sensitization of the inmates. Additionally, setting up health dispensaries will provide more reporting of symptoms in the time and treatment of TB and the detection of terminal illnesses such as HIV/ AIDS and diabetes to ensure health management. These dispensaries should be equipped with screening systems to test all infectious diseases. Also, there will be the establishment of quarantine facilitates to ensure the prevention of spreading infectious diseases that could impede immunity; hence, the outcome will be a reduction in TB and other related disorders.
Creation of Intervention Plan
The intervention plan was developed considering the studies carried out in prison facilities where through written sources and observations, it was indicative that the cells are poorly ventilated. On the other hand, WHO's statistical data indicates that all-male prisons are overpopulated and hence the need to treat them as communities that need a health facility. From the evidence that other infections and terminal illnesses are spreading in the all-male facilities, the only feasible intervention is to ensure that there is the placement of screening systems at the entry points and in the dispensary to detect new inmates with these diseases quarantining and immediate treatment.
Plan for Evaluating Intervention
There will be a weekly follow up of inmates diagnosed with TB to ensure that they are following the recommended dietary plan and that they are improving. The nurses will do this follow-up within the facility. The follow-up activities will be accompanied by recording patient health details. These activities will indicate the nursing intervention's effectiveness in ensuring that infections do not recur after treatment. On the other hand, there will be the involvement of external consultants such as public health officers and policy experts to evaluate the condition of the cells and the process of creation and establishment of policies. This measure will determine how well the health requirements such as proper ventilation have been implemented and the reduction it spread of TB concerning these measures. The involvement of policy consultants will also help discover the inmates' response to policies such as mandatory screening.
Figure 3: Recovery Follow-Up Plan
| Patient number | First week | Second week | Third week | Fourth week |
| Test results | ||||
| Drug Administered | ||||
| Nurses comment on progress |
Potential Barriers
One of the potential hindrances to implementing the interventions is the lack of enough funds to expedite the process. Essentially, interventions such as ensuring proper vent0ilation require redesigning of the cells while the administration depends on government funding to implement such changes not initially planned for. Essentially, due to the need for involvement of other agencies to ensure the availability of funds, the issue of bureaucracy may emerge, causing the process to take too long as all signatories in various agencies must be involved.
The high crime rates are also a potential barrier since the rise of the number of capital offenses means an increase in the prison population. Essentially, despite policies such as the administration of fines to avoid jailing petty offenders and the implementation of parole, there is an overwhelming number of criminals being sentenced to lengthy jail terms. This fact indicates that it is challenging to depopulate all-male facilities when crime rates are going up. Negative response or attitude towards the policies such as screening is a barrier to diagnosis and treatment.
The issue of shortage of funds can be solved by forming partnerships with a non-governmental organization to ensure sponsorship of projects such as the addition of ventilation and supply of medical equipment and drugs. These partnerships will also reduce bureaucracy, which is synonymous with government agencies. It is also essential to establish a multi-agency approach to depopulation like the police force and the courts to ensure collaboration with the community to reduce crime rates. Non-governmental organizations can also provide a reduction of the crime rate by empowering men financially and sensitizing them against crime. This move will ensure there are fewer capital offenses hence fewer incarcerations. The implementation of policies should involve educating inmates on the importance of health measures and implemented through procedures such as regular checkups, which will ensure they view the policies as helpful (CDC, 2012). This way, they will be more receptive to the changes.
Appendix
Figure 1: Mass Incarceration VS TB Incidence
Figure 2: Relationship between HIV/AIDS and TB
Figure 3: Recovery Follow-Up Plan
References
CDC. (2012, September 1). Tuberculosis(TB) . Retrieved from Center for Disease Control and Prevention: https://www.cdc.gov/tb/topic/populations/correctional/default.htm
Lambert, L. A., Armstrong, L. R., Lobato, M. N., Ho, C., France, A. M., & Haddad, M. B. (2016). Tuberculosis in Jails and Prisons: United States, 2002−2013. American Journal of Public Health, 106 (12), 2231-2237. doi:https://dx.doi.org/10.2105%2FAJPH.2016.303423
WHO. (2019). WHO consolidated guidelines on drug-resistant tuberculosis treatment. doi:https://www.ncbi.nlm.nih.gov/books/NBK539515/
WHO. (2016, April 19). Tuberculosis in Prisons . Retrieved from World Health Organization: https://www.who.int/tb/areas-of-work/population-groups/prisons-facts/en/
