Acquiring a nursing license means taking on a higher level of responsibility in healthcare settings. Regardless of the facility where one works, duties are assigned to registered nurses, while other tasks are delegated to the additional team members. According to Cherry & Jacob (2017), a nursing care delivery model “details the way work assignments, responsibility, and authority are structured to accomplish patient care; depicts which health care worker is going to perform what tasks, who is responsible, and who has authority to make decisions” (p. 365). In the scenario given, Glenda Miller is the charge nurse, with the help of one registered nurse (RN), one licensed practical nurse (LPN), one nursing assistant (UAP), and one unit secretary. In the facility, there are eight patients that have different care needs; therefore it is necessary to consider what nursing care delivery model is the best for the setup. With consideration that there is only one registered nurse in addition to the charge nurse, the nursing care delivery model ideal for the situation is the functional nursing care model.

The functional nursing care model suggests that staff members be given specific tasks for a group of patients, not each given individual tasks (Cherry & Jacob, 2017). The duties are assigned to the team members based on they can legally perform. Evaluation, assessment, and/or teaching patients are the responsibility of the RNs. Depending on the ordered oral and IV medications, the RN can assign LPNs to give them. Routinely, UAPs can perform patient care activities including patient hygiene tasks and vital signs. Staffing assignments are made in order to best meet the patient population needs by providing competent and safe care all while staying in one’s scope of practice (Cherry & Jacob, 2017).

In room 502, Mr. A. is ventilator dependent. His physical state requires him to have frequent assessments, including vital signs and lab draws. The RN is responsible for the initial assessment to establish a clear baseline. Following the functional care nursing model, the RN delegates tasks to the interprofessional team to arrange services from respiratory therapy for ventilatory maintenance, physical therapy for range of motion exercises and movement to prevent complications, and nutritional support for the correct dietary plan to ensure progressive rehabilitation (Cherry & Jacob, 2017). An LPN can monitor the status of the ulcer present on Mr. A’s sacral region and then notify the nurse in charge if there is a change in size or shape. If needed, the RN can conduct additional evaluation and assessments. LPNs can also implement therapeutic techniques to keep Mr. A. calm if he becomes frustrated or anxious and can manage tube bolus feedings with the understanding that they must alert the RN if the tube is clogged or not working properly. The nursing assistant can be given the responsibility of turning the patient every two hours to help keep the pressure off the ulcer on Mr. A’s sacral region in order to promote healing and prevent a worsening condition (Potter, Perry, Stockert, and Hall, 2013) .  The nutritional nurse should be made aware of the ulcer so that changes can be made in Mr. A’s diet by increasing calories and protein to aid in wound healing.

Mrs. B, in room 503, has a central line for total parenteral nutritional therapy (TPN) and is currently on forty days of antibiotics for the treatment of osteomyelitis. The RN should perform an initial assessment on Mrs. B. and place her on fall precautions because she is dehydrated and of older age (Potter, Perry, Stockert, and Hall, 2013). Following the initial assessment, the RN should assign a nutritional support nurse, occupational therapist, respiratory therapist and social worker to be a part of the care of this patient. Due to Mrs. B’s hydration status, an LPN can get the labs drawn so that electrolyte levels can be monitored. While monitoring, the RN can delegate the administration of the TPN therapy to the LPN. Following universal safety precautions, the UAP can be responsible for the routine morning care, turning the patient every two hours and assisting her with ambulating to the restroom. If Mrs. B is stable enough to move, the UAP can assist Mrs. B out of bed. If Mrs. B is too unstable to get out of bed, the UAP should report her instability to the RN in order for further assessment to be done. The respiratory team is needed for the breathing treatments ordered, so that consistent respiratory assessments are performed. A nutritional support nurse needs to be involved in the care of Mrs. B. due to her dietary status. The nutritional support nurse is responsible for creating a diet plan that is ideal for Mrs. B with consideration that she is on TPN and also receiving the medication for her osteomyelitis, as well as provide adequate dietary information that will ultimately have a positive impact on Mrs. B’s healing. Social work will be involved to discuss with the daughter the potential options for rehabilitation treatment after hospital discharge. Talking with a social worker about the different options available for Mrs. B can assist her daughter’s anxiety to be eased. Additionally, occupational therapy will complete an evaluation of Mrs. B’s physical state and limitations to help formulate a decision on whether she needs to transfer to a nursing facility or not.

Mr. C. in room 504 requires a registered nurse, medical social worker, nursing assistant and unit secretary for his care needs. He has been scheduled to leave the hospital today and to transfer to a rehabilitation hospital. Mrs. Miller will delegate typing up the discharge instructions to the unit secretary that will then need to be taught to the patient and caregiver by the RN. Assisting Mr. C. with hygiene care and gathering his personal items before leaving the hospital is performed by the UAP in addition to taking routine vital signs. Medications are given by the LPN or RN depending on the type of medications scheduled. However, only the RN is permitted to assess and document the patient’s response to the medication (Cherry & Jacobs, 2017).

Mr. D in room 507 will need an RN, an LPN, and a UAP. The patient is receiving TPN and multiple antibiotics. Since the LPN works under the supervision and instruction of the nurse, he or she may be delegated to administer the antibiotics, depending on state guidelines for that facility. Also depending on state guidelines, the LPN may initiate and maintain TPN infusion under the direct supervision of the RN (Cherry & Jacobs, 2017). Mr. D presents with vancomycin-resistant enterococcus in his urine. Before any medication is administered, it is the RN’s responsibility to coordinate with the physician the patient’s lab results to make sure the patient is receiving the correct medication. The RN is responsible for managing the pulsavac care, as it is important to understand wound care and proper dressing application to make sure the equipment works optimally. Updating the care plan with any changes observed from the treatment the patient receives is the responsibility of the RN. Routine activities including vital signs, assistance with toiletry, and activities of daily living are once again assigned to the UAP (Potter, Perry, Stockert, and Hall, 2013).

In room 508, Mr. E. needs the care of an RN, an LPN, UAP, respiratory therapist, and speech therapist. Mr. E is supposed to start weaning from the ventilator which requires a respiratory therapist and RN present. Not all weaning sessions are successful, and therefore the appropriately trained and licensed staff members need to be in attendance for safety measures. In addition, Mr. E has orders to begin ambulating in the hall twice a day. Although UAPs are permitted to ambulate patients, Mr. E would need an RN present because he is not considered stable with his current respiratory state (Cherry & Jacob, 2017). Following state guidelines, continuous tube feedings and IV antibiotics for Mr. E. can be delegated to the LPN; otherwise, the responsibility belongs to the RN. Assessing Mr. E for a PICC line is solely within the scope of practice of the RN. Lastly, Mr. E’s pharyngeal speech evaluation is performed by speech therapy and he or she is additionally able to assist him in choosing alternative communication techniques if needed (Cherry & Jacob, 2017).

An RN, UAP, occupational therapist and physical therapist are all needed for the care of Mrs. F. in room 509. Presenting the inability to move her right extremities is the result of her having a cerebrovascular accident three days ago. With Mrs. F. currently having an IV infusing in her left arm, and her blood pressure elevated at 170/100, an RN is needed to assess the IV site initially and to monitor her unstable blood pressure. Total care, including personal hygiene and feeding is delegated to the UAP. Mrs. F. will also be assigned an occupational therapist to help her work on ADLs and attempt to improve the inability to perform her own personal care independently. Mrs. F’s husband at the bedside is emotional and concerned about the state of his wife. When families are present in the healthcare setting, often times they may feel useless and not know what role they can play to help their loved ones. In the situation with Mrs. F., the RN can teach the husband how to assist his wife with range of motion exercises so he can play an active part in her care. With the assistance of physical therapy, the orders can be carried out to help improve Mrs. F’s physical state. Depending on how the husband reacts to the RN’s suggestion of him taking part in the care, a chaplain may or may not be needed for emotional support.

For Mr. G in room 510, a respiratory therapist, physical therapist, speech therapist, nutritional support nurse, and a medical social worker in addition to an LPN, UAP, and unit secretary are needed for his care. Patients requiring multiple levels of care inter-professional care members (Weiss & Tappen, 2015). After 24 hours off the ventilator, Mr. G. is doing well and is on track to be discharged in five days if he continues to do well without the ventilator. The respiratory therapist administers respiratory treatments every four hours to support Mr. G’s ability to breathe without the ventilator (Potter, Perry, Stockert, & Hall, 2013). According to Potter, Perry, Stockert, & Hall (2013), being on a ventilator can result in muscle wasting and difficulties with speech. Therefore, Mr. G may need a consult with physical therapy and speech therapy. In order to make sure Mr. G is weaning off of TPN properly, getting adequate feedings through his PEG tube, and receiving enough nutrients for his nutritional needs, a nutritional nurse is appointed (Marquis & Huston, 2015). Throughout his entire stay, none of Mr. G’s family has come to visit him. Unfortunately, the family of Mr. G has collectively decided to place him in a nursing home. With the presenting situation, the RN should advocate for Mr. G, and ask the unit secretary to get in contact with the social worker in order for options to be discussed and Mr. G’s thoughts and wishes to be heard. The LPN will give Mr. G his scheduled medications and update his chart accordingly. Taking vital signs and ambulating Mr. G will be performed by the UAP (Potter, Perry, Stockert, & Hall, 2013). Furthermore, the RN will assess, evaluate, and teach Mr. G. as indicated (Weiss & Tappen, 2015). When all the tasks have been dispersed to the appropriate nursing staff, Mrs. Miller is in charge of making sure that all assignments and delegated tasks are completed in a safe and effective manner (Cherry & Jacob, 2017).

Mrs. Miller is responsible, as the charge nurse, for the new admission of Mr. H who will be coming from the ICU and arriving to room 511 during her shift (Marquis & Huston, 2015). Mrs. Miller will communicate with the nurse taking care of Mr. H to acquire patient report, history, and progress. The unit secretary will handle secretarial duties between units. When Mr. H. gets to the room, the RN will assume responsibilities of assessing, evaluating, and teaching Mr. H while delegating the usual tasks to the LPN and UAP (Weiss & Tappen, 2015).

Although it may seem straightforward to assign roles to individuals what is legally applicable to them, multiple factors should be considered. In order for a nurse to delegate a task to a staff member, he or she must be confident that the staff member is competent. At the end of the day, the registered nurse is responsible and accountable for the care of all of the patients (Cherry and Jacob, 2017). The nurse is responsible for assessing whether a staff member is competent for the roles assigned by evaluating their knowledge and ability to carry out the role safely and effectively. In addition, laws and regulations vary by location and the nurse practice act for the state one practices in must be considered prior to delegating tasks to team members. The policies and procedures manual of the facility one works for must also be familiarized well enough by the registered nurse to be able to abide by the standards and delegate appropriately (Cherry & Jacob, 2017).

Following the functional nursing care delivery model, the eight patients assigned to the charge nurse Mrs. Miller are given the care that is needed in the most efficient and safe manner. With the consideration that the patients in the facility require similar tasks that can be completed by the same team member, it is more useful and efficient to use the functional nursing care model where tasks are assigned for a group of patients versus individual patients being assigned staff members (Cherry & Jacob, 2017). Working as a team with the application of the functional nursing care delivery model for the scenario given, is more effective and ultimately the most ideal solution.

References

• Cherry, B. & Jacob, S. R. (2017).
  
  
  
  Contemporary nursing: Issues, trends, & management,
  
  7th ed. [South University]. Retrieved from https://digitalbookshelf.southuniversity . edu/#/books/9780323390224/
• Marquis, B. L., & Huston, C. J. (2015).
  
  Leadership roles and management functions in nursing: Theory and application
  
  (8th ed.). Philadelphia: Lippincott Williams & Wilkins.
• Potter, P. A., Perry, A. G., Stockert, P., & Hall, A. (2013).
  
  Fundamentals of nursing
  
  (8th ed.). St. Louis, MO: Mosby.
• Weiss, S. A., & Tappen, R. M. (2015).
  
  Essentials of nursing leadership & management
  
  (6th ed.). Philadelphia: F.A. Davis Company.

The purpose of this paper is to inform and educate the reader of the mechanisms that make up the respiratory disease called tuberculosis. This paper addresses the history, the study of the disease, and how it affects the health of the human population and its environmental welfare. This study’s intent is to examine and consider the epidemiology triad, symptoms, diagnostic test, isolation, treatment, Koch’s Postulates, investigation, surveillance, and eradication associated with this respiratory infectious disease.

The Epidemiology of Tuberculosis

Tuberculosis (TB) is a highly contagious disease that if not treated, can be fatal. This infection is known for initiating in the lungs, however it has the potential to affect any and all of the body. The tubercle bacillus or Mycobacterium tuberculosis is the bacterial microorganism the causes TB (Schiffman, 2010). Scientist have traced tuberculosis as far as 2400 BC in spinal fragments of Egyptian mummies and 750 BC in bones found in South American (Medical News, 2010). Throughout the years of discovery of this disease, there have been many names associated with TB: white plague, consumption, dread disease, and the king’s evil. The 19th century, the genesis of the industrial revolution conflicted with a deadly outbreak of tuberculosis that killed one out of every seven individuals infected with the bacterial infection in Europe. Eventually this contagious illness spread to the United States as the large cities became overpopulated (Endreszi, 2009).

Present day, worldwide, there is more than 2 billion infected with TB. In 2007, there was “1.77 million” TB related deaths (World Health Organization [WHO], 2009). Our society has so many potential areas of increased risk for the development of tuberculosis. The Center for Disease Control (CDC) reports that in 2009 there were “11,540 tuberculosis (TB) cases reported in the United States” which is a decrease of 4.2% in 2008 (Center for Disease Control, 2010). Risk of continuation of TB involve HIV illnesses, immigration of persons from areas with high incidence of TB, and the transmission of TB in high risk environments, such as homeless shelters, hospitals, and correctional facilities. These same environments are now reporting multi-drug resistant TB (MDR TB) and extensively drug resistant TB (XDR-TB) with an increase in death rates. MDR TB accounts for “5%” of the reported TB cases,”27 countries” make up “85% of all MDR TB cases,”(WHO, 2009) and 58 countries have been confirmed to have XDR-TB (WHO, 2010). The intention of this study is to examine the epidemiology of TB, Koch’s postulates, surveillance, control, and eradication measures related to tuberculosis.

Epidemiology Triad

The “epidemiological triad” is a tool that consists of an agent, host, and an environment used to explain the spread of disease throughout a community, to identify points of intervention to prevent transmission, and to guide epidemiologic investigations (McMurray, 2007). The agent in this study is Mycobacterium tuberculosis; an acid fast aerobic rod that reproduces slowly and is hypersensative to heat and ultraviolet light. TB primarily effects the respiratory system, however, it can also effect the pericardium, lymph nodes, menges, kidneys, intestines, bones, joints, and reproductive organs (The Merk Manual, 2010). Tuberculosis, a leading worldwide infectious disease killer, killed 1.7 million in 2009. However, “the TB death rate has fallen by 35% since 1990″(WHO, 2010).

The transmission of the Mycobacterium tuberculosis is spread from person to person by airborne droplets with vehicles being coughing, sneezing, and talking. The smaller the droplet, the longer it can linger in the air after the infected person has left the area, allowing incease probablity of inhalation by another person. Passing TB from a family member or co-worker is more likely than a stranger in a store or on the street (Reichler, Reves, and Bur, 2002). Mycobacterium tuberculosis (infectious disease agent) is readily spreaded to susceptible humans (host) through respiratory exposure in communal settings or public gatherings (environment). Individuals with impaired immunities, such as with diabetes mellitus, cancer, corticosteroid therapy, and HIV/AIDs are at greatest risk for acquiring the bacterium infection. In 2008, some Harvard Epimiology students conducted an analysis of 13 separate studies in regards to diabetic patients and the potential elevated risk for TB. Their analysis found that it is prevelant to focus on diabetics as high risk with potential decrease in TB if diabetes can be controlled(Jeon and Murray, 2008). Although, peoples with healthy immune systems are susceptible if exposed for a long period of time, for example healthcare workers. Healthcare staff are continuously exposed to illness in hospital and extended living facilities, which places these professionals at risk for TB. Early detection and treatment of the active infected person is the key to prevention of transmission of tuberculosis in the healthcare setting (Smeltzer, Bare, & Hinkle, 2007). External factors such as the environment can influence the affects of the organism. There are many environments factors that induce the susceptibility of the body for TB, such as: ethnic/racial minority, impoverished, homeless, overcrowded housing, prison systems, and immigrants. The denisity of the bacterium in the air also dictates the potential risk for aqcuiring tuberculosis (Smeltzer, Bare, & Hinkle, 2007).

Symptoms

Latent tuberculosis refers to an individual that has been exposed to the bacterium and can carry the organism in the lungs without any symptoms of tuberculosis. This person can have a positive skin test, a normal chest x-ray, and a negative sputum smear. This individual will not feel sick. A person with active TB can have any, all, or none of the following symptoms: feeling tired all the time, weight loss, loss of appetite, chronic cough, fever, hemoptysis, and or night sweats. This person will have amphoric breath sounds, the chest may exhibit dullness on percussion, and increased tactile fremitus with crackles can be aucultated after coughing. These individuals often feel ill and can easily spread TB to others. The skin test on this person will be positive, and they may have an abnormal chest x-ray and or a positive sputum smear (Center for Disease Control [CDC], 2010).

Diagnostic Test

Several diagnostic studies are available to be performed to determine if Mycobacterium tuberculosis is present. First, the Mantoux skin is performed by injecting 0.1ml of PPD agent subdermally making a wheal to ensure an accurate reading. Errythema and palpable wheal. 5mm is considered a positive reading. Of course, a positive skin test does not always mean the person has active TB and the person could have been exposed in the past. Once a person tests positive with the Mantoux test, he or she should obtain other methods to determine possible exposure. A new test, Quantiferon TB gold blood test is now being used in many hospitals. This test is reportedly for valid than the skin test. A sputum sample is collected after a positive skin test to perform an acid-fast bacilli (AFB) for culture. This culture will determine if Mycoacterium is present in the donor of the sample. The third study requires a chest x-ray to be completed. The x-ray will be viewed for fibrous masses and possible lesions or inflammation related to infection the the upper lobes. A medical evaluation for TB must include a complete history, chest x-ray, and physical examination (Steadman’s Medical Dictionary, 2006). Patients that are probable extended care facility residents much have these tests performed prior to placement. Anytime a patient has an active case, that patient must be contained and specific treatment initiated to prevent an outbreak of the disease.

Isolation

A confirmed tuberculosis or a susptected confirmation of the disease warrents isolation of the individual to prevent further transmission to others. The following are several control methods to decrease the risk of contamination. The first is an inititiation of AFB precautions immediately for all patients with confirmed or suspected of active TB and who may be infectious. AFB rooms are a single private room with special ventilation systems. Ultraviolet lamps or other methods may be used to supplement ventilation. The second measure is to set up a personal protective equipment (PPE) station outside the room. This station provides N95 disposable particular respirators that each person needing to enter room is required to don prior to entrance into room. These mask require a FIT test to ensure correct size is used for each person. The third measure, is isolation precautions should be continued until there is a decrease in the organisms on a sputum smear or clinical evidence of decreased infection. Fourth measure, if any evidence of medication resistance keep AFB precautions ongoing until there is a negative sputum smear. Special precautions should also be initiated when inducing a cough for smear sample (Smeltzer, Bare, & Hinkle, 2007).

Treatment

Initiating treatment without delay is the only way TB can be cured. Specialized treatment is based on whether TB is an active disease or only an infections. Someone who has been infected but does not have the disease may require preventive therapy only. This preventive therapy is designed to kill the germs that have the potential to cause harm. Preventive therapy is usually a prescription for a daily dose of isoniazid, which is an inexpensive tuberculosis medication. This preventive therapy last for nine months, with periodic checkups to ensure the medication is being taken correctly. Active TB cases require treatment with effective drugs, such as: isoniazid, rifampin, pyrazinamide, and ethambutol (WHO, 2009). The treatment regiman entales an initial two month treatment phase followed by a continuation phase. The continuation phase is suggested to last four months for the majority of patients but can be extended to seven for a total of nine months. All TB medications should be taken together instead of divided doses (Center for Disease Control, 2003). Taking the medications correctly is very important due to if taken incorrectly patient can become sick and the TB will be more difficult to cure as it becomes drug resistant. Multi-drug resistant TB (MDR TB) is extremely dangerous as the bacteria becomes resistant to the medication used to treat the TB, which makes the treatment ineffective. MDR TB is generally due to the organism becoming restistant to the isoniazid or rifampin, which are the two most important anti-TB medications. Directly oserved therapy (DOT) is utilized to ensure that the patients adhere to the therapy set up for them. DOT is active when a designated person watches the patient swallow each dose of medication. This is a recommend practice for all patients due to unable to determine who will be compliant and who will not (WHO, 2008).

Koch’s Postulates

“In 1890, the German physician and bacteriologist , Robert Koch, released his celebrated criteria for judging” if a specific bacteria is the actual cause for a specific disease (Medicine Net, 2010). Dr. Koch, over one hundred years ago, developed the definitive association of Mycobacterium tuberculosis and the actual tuberculosis disease. The knowledge of the extensive make up of the bacterias, their actions to the body, their life cycles, and their transmission from person to person has been studied and observed by scientist over the last century. The tubercolusis bacteria was used by Koch in formulating “Koch’s postulates,” the systematic series of steps proved a specific organism was indeed the cause of the specific disease (Guyer, nd).

Koch’s postulates are as follows:

The bacteria must be present in every case of the disease.

The bacteria must be isolated from the host with the disease and grown in pure culture.

The specific disease must be reproduced when a pure culture of the bacteria is inoculated into a healthy susceptible host.

The bacteria must be recovered from the experimentally infected host.

In order to find “fulfillment” of Koch’s postulates it is still a requirement for associating an infectious agent with a disease (Medicine Net, 2010).

Investigation

Every state is required to report active TB cases and suspected cases to the health department by the clinician, infection control nurses, or by the pharmacies when the TB medications are dispensed. Laboratories are also required to report all positive TB smears and cultures. Early reporting is vital to the control of tuberculosis and provides the clinicians access to the resources of the health department for assistance in case management and contact investigation. Health departments routinely conduct contact investigations for all cases of active pulmonary tuberculosis to identify secondary cases of active TB and latent TB infection. This action will eleminate a TB epidemic by initiating therapy as needed during these investigations. Investigations are categorized by the amount of exposure to TB the person obtained. Health department staff notify exposed contacts so that the contact is scheduled for a PPD. A follow up test is recommend three months from the initial test or last exposure. All positive contacts are provided a chest xray, as well as young children and immunocompromised contacts to determine whether they have active TB (Reichler, Reves, and Bur, 2002).

Surveillance

Public health surveillance “is the ongoing, systematic collection, analysis, interpretation, and dissemination of health data” (CDC, 2010). As for any surveillance system, it is a tool for enhancement. This type of tool is to ensure timely detection of the exposure to TB. Nurses, generally the first contact with the health care system, may find themselves tracking and alerting the proper authorities and initiating disease containment programs. The concepts of epidemiology, early detection, and surveillance should be considered (Veenema & Toke, 2006).

World Health Organization 2008 guidelines to reduce TB transmission:

Routine surveillance of reported cases and monitoring outcomes of treatments should be a first line of evaluating epidemiology and control.

All programs should be strong in the performance of the systems used for reporting TB cases so the data reflects accurately the true incidence of TB and its trends. The evaluation process should be supported by appropriate operational research studies.

The analysis of disaggregated surveillance data should be encouraged so as to draw out the maximum information of the TB epidemic and the impact of control measures.

Appropriate computer software should be developed and implemented to improve routine recording and reporting.

Implementation of these specific guidelines prevents a tuberculosis outbreak from occurring. Tracking of infected individuals requires continuous monitoring through clinics and other healthcare facilities. Factors important to monitoring include the person’s age, the area they reside, and other factors to record and report to community.

Eradication

In 2006, the World Health Organization (WHO) launched the new Stop TB Strategy, a global plan to stop TB. More than twenty-two million patients have been treated under direct observation therapy-based services, since the initial launch. Over 500 groups and organizations have come together to achieve this goal. The strategy consists of plans to reduce TB prevalence by fifty percent when compared to 1990 and total eradication by 2050 (World Health Organization, 2006). In the pursuit to eradicate tuberculosis, there are six components of the stop TB strategies implemented by the World Health Organization.

These are the outlines listed below:

Pursue high quality DOTS expansion and enhancement.

Address TB/HIV MDR/XDR- TB and other challenges.

Contribute to health systems stregthening.

Engage all healthcare providers.

Empower people with T B and community.

Enable and promote research.

Currently, TB is not a candidate for eradication efforts: eradication is defined as the achievement of a status whereby no further cases of a disease occur anywhere and control measures are unnecessary. As long as the epdicemic of untreated HIV infection exist and until a concerned effort is made to control TB in all countries, tuberculosis will increase despite optimal application of currently available TB control technologies (Mississippi Department of Health, 2010).

Conclusion

Since 1953, when the first national report came out, tuberculosis cases have been on a decline. “In total, 13,779 TB cases were reported in the United States in 2006. This represents a 3.1% decline in the rate since 2005” (Center for Disease Control, 2007). The TB infection rate for foreign born people was 9.5 times greater than U.S. born people. Screening foreign born persons as they enter in the U.S. will allow the person to benefit from therapeutic and preventative measures and greatly reduce the risk of spreading the infection to others. These measures will include identifying and completely treating all persons who have active TB, contact investigation to evaluate all persons in contact with TB patient to determine TB infection or disease for appropriate treatment, and screening the populations at high risk for TB to locate persons infected with TB to provide complete therapy in prevention of the investion from progressing to active, infectious disease (Centers for Disease Control, 2010). The CDC indicates that providers need training so they will “think TB” in the first place and become more familiar with the advantages of collaborating with the health department. Public health staff should find more effective strategies to assure that providers are current and remain current with new guidelines for the diagnosis and treatment of TB (American Journal of Infection Control [AJIC], 2007).

Literature Review

There has been lots of research done to study addiction. There are many faces of addiction, there is alcohol dependency, drug addiction, and even a combination of both. Any form of addiction like the ones listed will have an effect on loved ones; “The health of family and friends affected by another person’s substance use and/or gambling is an undervalued health issue” (Wood & Tirone, 2013). Their lives will be affected by addiction, even if they are not the ones with the addiction themselves. There has been a lot of qualitative research done on those with addiction. There is a lack of research being done on those who love and care for people with addictions. We have seen how love plays a role in nurses who work with those being treated for their addictions, we can see how parenthood changes when a child suffers from addiction. We can see how families change; “Addiction can devastate the lives of people and their families” (Owens, 2015). It changes family dynamics and can ruin family relations. What is not known, however, is how these carers particularly significant others cope in everyday life and the strain that loving and caring for someone with an addiction places on them. There has been documentation and research done in the past over the burden of being a caregiver, but most of this research is on caring for someone with a chronic health condition. As it is not often documented that those who love and care for someone with addiction are aware and label what their loved one has as an addiction, it is important to note what makes addiction and how it can be ignored for fear of the connotation of that label.

There is a core of love that the nurses can give to patients that helps in their treatment process. To be able to give such love to strangers is one thing; to see someone you know and love in that situation is different, and we do not know much about it (Thorkildsen, Eriksson, & Råholm, 2015). A similar style of study was done about how peer mentorship affects those hospitalised for substance use disorders.  Having peer mentorship allowed patients to form meaningful connections that they can rely on during a time when they are in a dark place, and often feel misunderstood (Collins, et al., 2019). There has also been research done regarding the caring needs that those with addiction desire and need. There are many themes that come across when they speak of care, meaning, life, connectedness (Wiklund, et al., 2008). Many of the themes need to be bolstered by someone else, from someone who cares about the individual which is who research in the past has not focused on. There has been research in the past on “concerned significant others”, but not a lot has been said about the impact that their significant others addiction has for them (Wood & Tirone, 2013). In fact, most of the time their needs are not even considered; “Most research and treatment focuses on the concerned significant others ability to support the persons recovery who is harmfully involved, prioritizing the health of the person harmfully involved over the concerned significant others” (Csiernik, 2002).

Research Question

What is it like to love and care for a loved one suffering from addiction?

The aim of the study is to shed light on what it is like for someone tasked with caring for a loved one suffering from addiction, and how that influences their own lives and their choices.

Method

The method that makes the most sense for this project is IPA or Interpretative Phenomenological Analysis. This is because the IPA method is used to explore the participants own experiences (Willig, 1964; 2013). This makes the most sense to understand the lives of people who love and care for those with an addiction, it gives the researcher a glimpse in their own words to their lives. It is based more in lived experiences rather than a thematic analysis which qualifies and organises data (Smith, 2019). Using IPA allows the participant to explain in their own words their experiences and to be heard by the researcher.

Sampling

Participants for this study should be currently caring for someone with an addiction. These participants would have to be willing to keep a written record of their thoughts, in the form of a diary or journal. They would have to be willing to share this with the researcher and if necessary, be willing to speak about the contents of the journal with the researcher in the format of a semi-structured interview. These participants would be chosen once they have discussed with the researcher the situation they are in, as well as if they are healthy and mentally prepared to discuss and write down how they are feeling in detail, and what their life is like in detail. This project will have to be a longitudinal study and participants would have to currently be in the situation. To find these participants, the researcher would have to reach out to shelters, social services, as well as support groups to invite people who fit the criteria of living and caring for a loved one suffering from addiction to participate in this project. There would have to be a clear arrangement with the interviewer over the contents of the diary and be clear about the anonymity of their writing (Woll, 2013). To be able to use the contents of a diary, it would have to be kept consistently over the period of the study, and they would have to be comfortable sharing their thoughts. The only resources needed for this project would be the diaries that the participants will be using to record their thoughts.

This could be a positive way to study the participants because it allows them to write their thoughts first and then let researchers read it, it could make them more comfortable expressing their thoughts. There can be issues with using a diary, especially if the diary had been kept before the study, it would not be monitored and lack the structure necessary to find compelling information (Woll, 2013). It should be noted that it is likely that the contents of the diary would drop off over time, most of the information that could be used in the analysis would come from earlier stages of the diary due to the “first day’s effect” (Woll, 2013). However, diaries can reduce bias from the researcher as well as limit the invasiveness of the study (Morell-Scott, 2018). The diary can be used to find patterns of behaviour that will emerge as themes from the project. The researcher will know that they have enough participants when they analyse the data and common themes and experiences begin to emerge. The possible number of participants for this study would be around 4-6, being able to compare the possible patterns and themes from these diaries will support the aim of the study. With only a few diaries, there is hope that comparable themes will begin to emerge.

Analysing the Data

To start, the researcher would have to take the contents of the dairy, find the commonalities in behaviours and beliefs that emerge: how were they feeling, what was their daily experience like? (Morell-Scott, 2018). And begin to hopefully find patterns across the diaries. These patterns will then become themes which the researcher discusses towards the end of the project. This can be a very long process, as the diaries will have been kept over a long period of time, there will be quite a lot of data to go through. The researcher should take the time to read through and find commonalities in behaviour before identifying them as themes. These themes should emerge from the readings of the diaries from the selected participants and if necessary, the interviews with the participants (Smith, 2008). A semi-structured interview would only occur if the contents of the diary could not be understood and there is a belief that important information could be overlooked. To properly analyse the data, a comparison would be done following the diaries and finding commonalities that will then emerge as themes.

Quality and Rigour

Because this project would rely heavily on the openness of the participants, sensitivity to context will be really important. By showing sensitivity to the context of the situation for the participants it would show the quality and rigour of the experiment (Yardley, 2000). To do this, it requires the research to create a clear understanding with the participants about what the project is about, alerting them beforehand of what can come from the project and preparing them as to what is to be expected of them. The participants need to know that if it becomes too much for them, they are able to stop participating in the project at any time and counselling will be made available to them. This also relates to transparency and coherence. To have clarity in the project on both the participants and the researcher’s end will lead to more clear data and better analysis can be done. Commitment and rigour would be shown in the continued keeping of the diary following the guidelines laid out before the project and agreed upon by the participants and the researcher (Yardley, 2000). Consistent dialogue with the researcher checking in on the effect that the diary is having on the participants also contributes to rigour and commitment.

Ethics

There are some ethical considerations to be aware of when looking to do this project. The main ethical concern would be the possible invasiveness of the study and the negative mental effect this could have on the participants. The reason that researchers would be looking at diaries is to mitigate this potentially negative effect. The thought is that by avoiding a face to face discussion that this would lessen the invasiveness (Morell-Scott, 2018). It could also affect their relationships with the people that they care for with an addiction.  Another ethical issue to consider would be the effect of keeping the diary and using it as the data since the diary would be started and kept over the course of the experiment would the participants be able to have the diary back? Would they want the diary back? The agreement with the researcher would have to include what would happen to the diary and they would have to consent to whatever is decided before the start of the project (Woll, 2013). The main ethical concern would be to minimise the effect of what writing the diary could have on the beliefs and thoughts of the participant (Yardley, 2000). This would include getting informed consent from the participants about the matter of the study as discussed, what the diary will consist of, making sure the participants know that they can withdraw from the project at any time, and providing a full debrief at the end with the offer of counselling for the participants and possible treatment options for the loved one.

Reflexivity

This topic is necessary because there are thousands of people who spend the majority of their time loving and caring for someone with a disability, this is most often significant others, but can be children or parents. The emotional toll this takes on them is not well understood or often talked about. To be able to shed some light on the experiences of loved ones caring for people with an addiction, it could help those who are going through the same things but feel alone. Over the years I have seen people have to care for people they love that have an addiction, I have seen how it changes them. Their lives stop being about them, their sole focus is following a partner through the ups and downs of addiction. I would like for them to be able to share their experiences and hopefully, this project would be able to show them that they can. This project would hopefully use the data to show how there are many common themes in the experiences of those caring for a loved one suffering from addiction.

Dissemination of Themes and Outcomes

The data from this project could be disseminated to clinics and shelters where loved ones could be living. It could be an example of what people are going through that they could possibly relate to, and maybe help them realise they are in a similar situation, hopefully women, men, and children will be able to see that they are not alone. There are others in similar situations and that it is possible to survive and get help if they feel they need it. Possible dissemination could aid in future research about how they have changed and how being able to identify their feelings could have helped in the future. The use of IPA allows for the participants own words to form the themes that emerge, it would allow anyone reading the project to see the true effect of living with and caring for someone suffering from addiction (Smith, 2019). The dissemination can also help people reading possibly realise that they are in a similar position that they were not aware of before. There are many positive possibilities that can come from the dissemination of the data and emergent themes from this project.

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