The Development of Islamic-Based Nursing Support Model to Enhance TB Treatment Completion in Drug Users after Release from a Male Prison in Indonesia

Abstract

Post-release TB completion in prisoners with drug users and TB is a big issue due to difficulties in life after release from the prison. This study aimed to know participants' perceptions about existing situation and expectation of post-release TB treatment completion of prisoners with drug abuse and nurse's roles in supporting this and to develop an Islamic-based nursing support model for successful TB treatment completion in drug users after release from a male prison in Indonesia. Participatory action research is used by involving ten prisoners with TB, a physician, two correctional nurses, a NGO person, two associate prisoners in TB program, an Islamic leader, an associate prisoner in Islamic education program, and two family members. The study was conducted in a prison and in the community. Data were collected in three cycles based on the Kemmis and McTaggart method using various methods including interviews, dialogues, focus group discussions, and observations. The data were gathered through several guidelines in performing the data collection methods. The researcher applied the Miles and Huberman's qualitative data analysis framework consisting of data reduction, data display and conclusion drawing/verification. The researcher employed several strategies in enhancing credibility, confirmability, transferability, and dependability of the study. The model was developed through the stages of reconnaissance, planning, enacting and observing, reflecting, and replanning. The emerged themes in the reconnaissance phase were categorized in two groups including situations and expectation of post-release TB care based on perspectives of providers and patients. The situations from providers' views were: (1) losing contact with patients at the point of release due to unpredictable date of release; (2) rarely receiving reports back from the health center due to failure in the patient follow-up; (3) lack of employing any provider guidelines to facilitate TB completion; (4) perceiving post-release TB care is not the prison authority; (5) prison officer uniform obscures nurse's identity; and (6) separation of TB care and Islamic services. The situations based on patients' perceptions were: (1) feeling being isolated by others; (2) perception of getting TB due to prison life and no need for medication after release; and (3) fear to meet people after release. The participants' expectations included: (1) expecting providers to supervise the medications in the pre- and post- release period; and (2) desire to recover from TB and looking forward to healthy living after release. The model development consisted of three cycles including: (1) building nurse-prisoner trust using Islamic reflection and completing the existing pre- and post-release TB care procedures; (2) inviting patients to Allah's path; and (3) engaging related parties. The building nurse-prisoner trust using Islamic reflection consisted of two activities which are re-orientating Islamic values to emerge an awareness of being a nurse and identifying the gap of Muslim nurses' attitudes and behaviors. The themes of completing the existing pre- and post-release TB care procedures involves clarifying job description of TB care providers, identifying release date and post-release information, and modifying wrong perception about TB and its treatment. Activities to invite patients to Allah's path consisted of stimulating the patients with the issue of discontinuation TB consumption and motivating patients to return to Allah's path. The last support was engaging related parties including: (1) involving family to confirm post-release information before prisoners' release and to provide support to patients in the post-release period; (2) collaborating with some divisions in the prison; and (3) directly communicating with the referral services in the community. The outcomes of the model were categorized in two groups at the individual and system levels. The transformation in individual level include the return of a nurse's identity, Islamic belief using in life, increase patient's knowledge about TB and its treatment, and family supports for TB client. The changes at the system level involve the professional relationship between nurses and prisoners, the clear TB nurse's job description in the prison, the health education method modification, the valid post-release information, two-way communication between providers in the prison with the referral services, and integrated Islamic-based TB care. Finally, the major outcome is the increase of post-release TB treatment completion rates.