Nursing: Disease Influenza - Essay Example

Influenza Introduction: This paper looks at the communicable disease influenza and nursing research. Influenza was chosen due to the prevalence of the numerous influenza viruses that have circulated globally over the last few decades and the presence of community health nurses on the frontlines of dealing with the diseases. Some of the influenza viruses that emerged were the following: H5N1/97 virus from Hong Kong which was transmitted from poultry stock to humans; and, the H1N1/2009 virus, also from Hong Kong. The difference between the two viruses, of particular note to this paper, is that the H5N1/97 virus did not become a pandemic because of the “…sound human and animal disease and virus surveillance systems…” (Shortridge, 2003, 1416) that Hong Kong had established based on previous experience of similar diseases. The H1N1/2009 virus, on the other hand, in conjunction with globalization and more frequent travel by individuals, had numerous opportunities to spread and circulate across borders. Today’s community health nurse is, therefore, faced with the prospect of attending to patients who have been exposed to a disease contracted half a world away. A particular example of this is the SARS (SCoV) virus that initially started in the Far East and then spread to Toronto, Canada and other travel hub points across North America. Of note is the fact that the H5N1/97 virus and SARS were both from the same region of the world that is regarded as an epicentre of influenza viruses (Shortridge, 2003, 1417). Influenza & Its Demographic of Interest: The earliest records of influenza go as far back as the third century B.C., as noted by Hippocrates and Livy (Kuszewski & Brydak, 2000, 188). Kuszewski & Brydak advise, at the time of writing, that of the last 12 pandemics, 11 started in China, supporting Shortride’s comments regarding China being an epicentre of the virus (Kuszewski & Brydak, 2000, 188). It was only in 1891, however, that the “germ of influenza naemed Bacillus influenzae…” (Kuszewski & Brydak, 2000, 188) was discovered. The actual influenza virus was discovered in 1933 and the first vaccine developed in 1936 (Kuszewski & Brydak, 2000, 188). The virus is part of the Orthomyxoviridae family, with two genera (Kuszewski & Brydak, 2000, 188). Influenza A and B viruses are found in one genera, and within the other, the influenza C virus. Within the type A virus are many subtypes distinguished by surface glycoproteins, i.e., haemagglutinin and neuraminidase (there are 15 types of these) and neuraminidase (there are nine types of these) (Kuszewski & Brydak, 2000, 188). WHO uses these to distinguish between types and subtypes when describing the disease (Kuszewski & Brydak, 2000, 188). If there is a variant, the letter v is added after the identified influenza, e.g., H1N1v, which would represent a H1N1 varient. The disease attacks the respiratory system, is spread by inhaling droplets and these droplets are spread when an infected,contagious person sneezes and/or contaminated hands and/or surfaces are touched and then the virus gains entry into the body. The disease has a 1-2 day incubation period and symptoms displayed can include the following: “… malaise, myalgia … fever lasting a few days and respiratory symptoms of varied intensity” (Kuszewski & Brydak, 2000, 188). Some of the complications that can develop from contracting the disease are myocardial infections or pheumonia (Kuszewski & Brydak, 2000, 189). Individuals with low inmmune systems, the young and the old, are particularly susceptible to the disease. Epidemiologically, an influenza outbreak occurs when there are higher than normal levels of infected persons, a low rate of mortality and very few complications. In a pandemic situation, the death rate is quite high and there are numerous complications and, sometimes, depending on the severity of the pandemic, there are short and long-term effects on an economy (Kuszewski & Brydak, 2000, 189). Determinants of Health & Influenza: The Centres for Disease Control define the social determinants of health as “…the circumstances in which people are born, grow up, live, work, and age, as well as the systems put in place to deal with illness…” (CDC, 2014). The CDC further notes that the above circumstances are strongly influenced by “…economics, social policies, and politics…” (CDC, 2014). In other words, disease does not occur in isolation, but is influenced by the manner in which individuals live. In the instance of influenza, when the lens of the social determinants of health is applied, a number of variables must be taken into consideration. Is the individual patient born into a community where fiscal resources allow parents to adequately feed, clothe and provide for the individual? Does the individual have enough of the right foods to eat? Is housing adequate? Can the individual afford to take sick days from work when sick, or is the individual obliged to work, while sick and infectious, thereby spreading the disease to others? Dean, Williams, & Fenton (2013) note that policy makers are now considering a wider approach to addressing health issues, that is, comprehensively looking at “…health inequalities, and accelerating health impact” (Dean, Williams, & Fenton, 2013, 1). In other words, health inequities can cause an increase or accelerating of health impacts on a given population. An individual who is living in poor housing, has inadequate nutrition, a low paying job and who has clothing inadequate to the prevailing weather conditions, is fundamentally unable to meet optimal conditions for remaining healthy, particularly when there is an influenza outbreak. The community health nurse is more likely to encounter such patients that fit this particular demographic. The Epidemiologic Triangle & Influenza: The classic epidemiologic triangle is defined as “a unique interaction between the human host, the infectious agent, the environment in which the host’s exposure to the agent occurs, and the vector that brokers this exposure” (Huerta & Leventhal, 2002, 498). If there are any changes in the apices of this triangle, the disease characteristics will change. Huerta & Leventhal note that examples of when changes in these apices resulted in outbreaks or pandemics, were the 1918, 1957 and 1968 influenza pendemics (Huerta & Leventhal, 2002, 498). The influenza virus (the agent) changed in each of these instances and resulted in a pandemic. Isolation of an infected person can, in itself, change the apice of such a triangle because the host of the infection is seperated from the environment and, therefore, this reduces the ability of the agent to transmit itself to a new host. Role of the Community Health Nurse & Influenza: The community health nurse is on the frontline between the community and healthcare. In terms of the influenza virus, the community health nurse can be among the first to detect that an individual has the symptoms of the virus. As well, when there is an outbreak or threat of an outbreak, the nurse is in the community assisting with administering vaccinations and providing public health data to sentinel data collection points for further study and analysis. The nurse can also better read the community and provide information to healthcare administration regarding uptake of vaccinations or advise if there is an issue with vaccination administration. A National Agency/Organization & Influenza: The Centers for Disease Control (CDC), headquartered in Atlanta, Georgia, is a national agency dedicated to the surveillance, monitoring, and directing of US national public health policy and direction. In the instance of influenza, the CDC has ongoing sentinel and surveillance mechanisms that allow the organization to be on the forefront of (i) identifying the circumstances that would create the opportunity for the influenza virus to impact public health; (ii) monitoring sentinel healthcare facilities and/or reporting mechanisms; (iii) providing the scientific and technical advice to advise government health policy; (iv) developing operational vaccination strategies in the event of an outbreak; (v) providing guidance documents for frontline healthcare professionals in the event of an outbreak; (vi) monitoring the activities of public health laboratories before, during and after an outbreak; and, (vii) debriefing after an outbreak in order to examine successes and areas for improvement in the event of a future outbreak. Community health nurses work with the CDC in order to ensure that community health is optimized and, in the event of an influenza outbreak, nurses assist in the administration of appropriate healthcare to infected communities. Bibliography CDC. (2014). Social Determinants of Health. Retrieved from CDC: http://www.cdc.gov/socialdeterminants/ Dean, H., Williams, K., & Fenton, K. (2013). From Theory to Action: Applying Social Determinants of Health to Public Health Practice. Public Health Reports, Sup. 3, Vol. 128, pp. 1-4. Huerta, M., & Leventhal, A. (2002). The epidemiologic pyraid of bioterrorism. IMAJ, Vol. 4, 498-502. Kuszewski, K., & Brydak, L. (2000). The eopdemiology and history of influenza. Biomed & Pharmacother, Vol. 54, 188-195. Shortridge, K. (2003). Severe Acute Respiratory Syndrome and Influenza. American Journal of Respiratory and Critical Care Medicine, Vol. 168, No. 12, 1416-1420. Read More