Nurse-Led Model of Care That Helps a Community Heal: Curbside Immunizations With Assistance in Social Determinants.

The COVID-19 pandemic has overwhelmed communities. Physical, emotional, and financial struggles have heightened, especially with our vulnerable populations. People have been afraid to return to their provider's office. For children, there has been an interruption of well-visits and immunizations. As the nation saw a decline in immunization uptake, a pilot nurse-led program was designed to increase vaccinations and address the social determinant needs during a global pandemic. The purpose of this article is to describe the planning and implementation of a curbside immunization event. The Logic model was used as a framework to ensure an efficient and replicable process. Initial observations showed an overall increase in immunization uptake and 97% of participants current with recommended vaccinations. Most parents (93%) would attend again and recommend it to others. They also felt that infection control precautions helped make the care delivered safe and efficient. Social determinants of health were assessed and addressed. This method of vaccine delivery is a viable model going into the future. Others may replicate this model, and it may also serve as a platform regarding flu or COVID-19 vaccine distribution.

Factors Associated With Infant Pain Severity Undergoing Immunization Injections.

PURPOSE: Factors influencing infants' behavioral and vocal (cry) response to painful stimuli are explored to improve pain management plans for infants undergoing immunizations. DESIGN AND METHODS: An observational study design was used. Pain responses of 60 to 75 days-old infants (44% male vs 56% female) undergoing two-month immunization injections were videotaped and coded using the Modified Behavioral Pain Scale (MBPS), and duration of total crying time during injection was recorded. The influences of five factors (gender, caregiver attendance, previous experience of nociception (circumcision), mode of delivery), and weight (birth and current) were examined at baseline, during and post-immunization. RESULTS: Higher birth weight was the most significant factor that reduced pain responses during (p = 0.001) and post-immunization (p = 0.03). A higher birth weight reduced full lung crying (p = 0.04), which reflects crying during injection as compared to total crying time. Vaginal delivery had a significant effect on behavioral pain responses of infants only post-immunization (p = 0.006). Parent's presence in the immunization room significantly reduced total crying time (p = 0.03). Uncircumcised male infants had a significant reduction in behavioral pain responses during immunization (p = 0.01) compared to circumcised infants. CONCLUSIONS: The literature well supports the acknowledgement of early pain experience and its psychological consequences. Knowing and controlling for each of mentioned factors early in life during every painful procedure could improve coping mechanisms of infants for any painful procedures later in life. PRACTICE IMPLICATIONS: Control of certain factors during early life experiences can modify pain of immunization.

The effect of sucrose as pain relief/comfort during immunisation of 15-month-old children in health care centres: a randomised controlled trial.

AIMS AND OBJECTIVES: To investigate the effect of 30% sucrose compared with a placebo (water) as pain relief and comfort during immunisation of 15-month-old children in health care centres. BACKGROUND: Children experience different levels of pain and distress during immunisation. Sweet solutions function as pain relief during immunisation for infants up to one year of age. However, there are few studies of older children. DESIGN: An experimental design in which the participants (15-month-old infants) were randomly assigned to an intervention group that received a 30% sugar solution or a control group that received a placebo (water). METHODS: The study was performed at three health care centres in a large Norwegian municipality. The parents of all 15-month-old infants who were recommended for vaccination (for measles, mumps and rubella) between 5 September 2013 and 31 March 2014 were invited to have their infant participate. Duration of crying was the outcome measure. RESULTS: A total of 114 children were included (59 in the intervention group, 55 in the control group). The intervention group infants' crying was shorter (18 seconds mean) compared with the control group infants (33 seconds mean). The difference in crying duration between the groups was both statistically and clinically significant. CONCLUSION: This trial revealed that 30% sucrose orally has a calming and pain-relieving effect on 15-month-old infants during immunisation. RELEVANCE TO CLINICAL PRACTICE: Public health nurses should use a 30% sucrose solution for pain relief during immunisation of 15-month-old infants.

Workarounds and obstacles: unexpected source of innovation.

Nurse leaders are aware that nurses are finding ways to adapt health information technology to patient care activities. Previous literature has presented nurses' response to technology obstacles as a work-around, characterized as a negative behavior. Using narrative inquiry, this article examines 9 direct care nurses' interactions on a medical/surgical/telemetry unit. Specifically, nurses' encounters with technology obstacles will be addressed from a complexity science perspective. Four support staff including the clinical nurse manager, pharmacist, quality nurse, and project manager who is also a nurse were interviewed as part of data collection. Complexity science provides nurse leaders' insight into nurses' behavior where outcomes emerge from tensions in the environment through multidirectional and self-organizing interactions. Innovation was found when nurses responded to health information technology obstacles with self-organizing interactions, sensitivity to initial conditions, and multidirectionality. Their actions were also influenced by many sets of rules. Nurses self-organized with coworkers to find better ways to deliver care to patients when using technology. Opportunities exist for nurse leaders to facilitate interactions among nurses and other members of the organization to realize better use of health information technology that improves the patient experience.

Pain management strategies used during early childhood immunisation in Victoria.

AIM: The study aims to identify pain management practices used during scheduled childhood immunisation. METHODS: A survey of members of the Australian Nurses Federation (Victorian Branch) Immunisation Nurses Special Interest Group. Questions included frequency of use of pain reduction strategies during immunisations for infants, toddlers and children, injection techniques and existence of an articulated pain management policy. RESULTS: The survey was emailed to 274 Immunisation Nurses Special Interest Group members with registered email addresses, and 125 (46%) completed the survey. Nineteen respondents (15.2%) stated their main place of employment had a pain management policy during immunisations and 20 (16.0%) respondents were not sure. Distraction strategies were frequently used during immunisation for all age groups, with 95 (76.0%) replying that distraction was used often or always. Breastfeeding during immunisation for infants younger than 6 months was used occasionally (n = 54, 44.6%), often (n = 11, 9.1%) or never (n = 55, 45.5%) and was used even less frequently for infants aged 6-12 months. Sucrose or other sweet solutions were almost never used for infants prior to, or during, immunisation. As a reward, lollies were frequently given to children after immunisations. Topical anaesthetics were almost never used in any age groups. Over half the respondents used a rapid injection technique; 55 (44.7%) used a slow technique and four respondents aspirated the needle before injections. CONCLUSIONS: Many distraction strategies were used during and following immunisation but sweet solutions, breastfeeding or topical anaesthetics were rarely used. Use of these strategies where feasible, should be facilitated in diverse settings where immunisations take place.

Professional educational interventions designed to improve knowledge and uptake of immunisation.

The Healthy Child e-Learning Programme is a modular, educational intervention to support professionals to deliver the Healthy Child Programme (HCP). A group of clinical academics was convened to design an evaluation of the HCP e-Learning Programme. This article presents the findings of the literature review to identify a method of evaluating an educational intervention designed for professionals that improves knowledge. The discussion highlights the complexities of selecting an evaluation method that could be used or adapted for evaluating the HCP e-Learning Programme. The immunisation module was selected for evaluation, offering a number of measurable outcomes, including a secondary outcome measure of any increase in immunisation uptake in the evaluation population. Very few published papers were found evaluating educational interventions that were related to our search criteria, none of these papers evaluated the transfer of learning from the intervention against practice improvement outcomes or evaluated stakeholder perspectives. Evaluating an educational intervention with the aim of attributing improvements in practice solely to that intervention is complex and resulted in the task group mapping all the factors that occurred in the literature that may influence immunisation uptake to construct a conceptual framework to inform our evaluation design.

Influencing factors in MMR immunisation decision making.

Immunisation decision making is not a straightforward process for parents. Many factors influence parental decision making on whether they immunise their child with the measles, mumps and rubella (MMR) vaccine. The feasibility study described in this article provides insight into influencing factors associated with decisions regarding the immunisation of children by parents. The study findings suggest that the practice nurse is a credible source of information for parents seeking informed decision making. At a time when the incidence of measles and mumps is rising in the UK, the provision of appropriate information by the practice nurse has the potential to increase uptake of the MMR vaccine.

Call to ARMS: recent measles outbreak reminds us of the importance of immunizations.

As health advisories go, the one this past summer released by the Public Health Agency of Canada went by largely unnoticed. Issued in July, the advisory alerted Canadians to the identification of nearly 30 cases of measles across six different provinces-including Alberta. Most of those cases were travel related, and involved travelers bringing measles back with them to Canada. A few small news articles followed, but by August most people had forgotten all about it. Except for experts and epidemiologists, who recognize that outbreaks like these should remind everyone that measles is not only poised for a resurgence, but already gaining headway in some parts of the world. And that's exactly why RNs and NPs should be encouraging more people to take vaccinations seriously.

Update on immunizations commonly used in the NICU.

With few exceptions, it is currently recommended that all premature infants should receive routine childhood vaccines at the same chronologic age as term infants. Thus, neonatal nurses need to stay current on the recommendations for immunizations commonly used in the NICU setting. It is important for nurses to provide information that is reliable and verifiable with scientific evidence to the parents.

Travel immunization update for older adults.

Older Americans are among the most widely traveled group in our society. Recent trends point to more international travel, more travel to Third World countries, and more travel by older adults with significant health problems. Regardless of the reason for travel, older adults need to plan for healthy travel. Primary care providers need to inquire at routine visits if patients have plans for international travel. If travel to other countries or regions is being considered, patients must be advised of the importance of early travel preparation. To begin with, older adults should be up to date on all routine immunizations. Those planning on international travel may need additional required and/or recommended immunizations, depending on the individual's health status, travel itinerary, length of stay, and health risks associated with destination sites. Primary care providers should be knowledgeable about travel medicine resources in the community to make referrals for travelers requiring additional immunizations and health information.

The impact of adult behaviors and vocalizations on infant distress during immunizations.

OBJECTIVE: The Child-Adult Medical Procedure Interaction Scale-Infant Version (CAMPIS-IV) was used to examine the influence of adult and infant behaviors on infant distress following injections. METHODS: In this naturalistic observation study, videotaped interactions of 49 infants, parents, and nurses were coded using the CAMPIS-IV. A series of three lag sequential analyses were used to examine the immediate and delayed effects of each of the CAMPIS-IV criterion behaviors, as well as the effects of the onset of each behavior, on infant distress. RESULTS: Strong support was found for beneficial effects of the infants playing with an object and sucking, and for adults' belly-to-belly contact and nonprocedural talk to infant. Some benefit was found for bouncing, patting, and rocking the infant. Apologizing, empathizing, and reassuring the infant received no support, with some indication of detrimental effects. CONCLUSIONS: The CAMPIS-IV was useful for identifying modifiable risk and protective factors for infants undergoing injections.

Travel health. Part 2: advising travellers visiting friends and relatives abroad.

International travel has become more accessible and affordable, and travel, particularly to tropical and malaria regions, has increased by up to 8% annually. This change in travel has surprisingly not resulted in an increase in imported diseases. Surveillance reports of hepatitis A and enteric fever have not increased and a significant and sustained fall in malaria over the decade has been described. Nurses in primary care are the predominant providers of pre-travel health services and they have an important and influential role in preventing travel-associated illness. This is the second article in a 3-part series on the spectrum of health issues associated with travel. Part one discussed pre-travel health advice, including risk assessment and educating travellers. This article explores the highest risk group of traveller, those visiting friends and relatives (VFRs). The article highlights the specific disease risks for VFRs and how these may be influenced by their health beliefs. The article explores ways in which nurses can optimize the travel health consultation to ensure that the specific needs ofVFRs are met and that they receive accurate and achievable advice.

Improving herpes zoster vaccine rates: The impact of a targeted educational program.

BACKGROUND AND PURPOSE: Despite demonstrated efficacy, the utilization of herpes zoster vaccine (HZV), recommended by the Centers for Disease Control (CDC) for all immunocompetent adults aged above 60 years, is low (31%). The aim of this study was to identify nurse practitioner (NP) barriers to HZV administration and then to use these results to develop and evaluate the outcomes of an educational program. METHODS: This study used a two-phase design. In Phase I, barriers that obstruct the provision of HZV were identified and NPs were surveyed to determine current HZV practice. The second phase used a quasiexperimental pretest-posttest design to evaluate the impact of the constructed program. CONCLUSIONS: In Phase I, NYS Primary Care NPs with practice years ranging from 1 to 24, who reported working in practice sites that ranged from 1 to 20 providers, possessed limited knowledge of the vaccine, especially, the financial aspects of the vaccination such as up-front cost (46%), cost to patients (39%), and reimbursement (29%), resulting in fewer provider recommendations. In Phase II, a paired-samples t test revealed a statistically significant difference between pretest scores (mean = 3.4, SD = 1.2) and posttest scores (mean = 4.7, SD = 1.3) on the knowledge survey, t (37) = -7.1, p < .0, demonstrating NPs' improved understanding of HZV. IMPLICATIONS FOR PRACTICE: Nurse practitioners will increase compliance with the CDC recommendations for HZV administration.

Family practice/Primary health care nurses in Nova Scotia.

The authors describe a study that was designed to explore the current role of family practice/primary health care (FP/PHC) nurses in Nova Scotia. A survey was created and mailed to FP/PHC nurses. Forty-one returned surveys met the criteria of the study. Twenty-two of these nurses were contacted for a followup telephone interview. The findings confirm that FP/PHC nurses working in N.S. are key members of the collaborative health-care team and, although they are often underutilized, they perform key functions such as triage, health education and immunization. Most FP/PHC nurses are underpaid and often work with little or no job security. FP/PHC nurses indicated that they are isolated in their practice and could benefit from networking and educational opportunities with their peers. They are frustrated that they cannot bill the provincial medical insurance plan for basic nursing services. The study results indicate a need to better define scope of practice and highlight the need for leadership and support for the role of FP/PHC nurses in N.S.

Organização do processo de trabalho através de conhecimento, atitudes e práticas para administração segura de vacinas em crianças: uma revisão de escopo / Organización del proceso de trabajo a través de conocimientos, actitudes y prácticas para la administración segura de vacunas en niños: una revisión de alcance / Organization of the work process through knowledge, attitudes, and practices for safe administration of vaccines in children: a scoping review

RESUMO Objetivo: mapear a organização do processo de trabalho através de conhecimento, atitudes e práticas para administração segura de vacinas em crianças. Método: realizou-se uma revisão de literatura com o método Scoping Review, de acordo com as recomendações do guia internacional PRISMA-ScR, e o método do Joanna Briggs Institute Reviewers Manual. A busca eletrônica dos estudos foi realizada nas bases de dados PubMed, CINAHL, Web of Science, Scopus, COCHRANE, LILACS e PsycINFO e na literatura cinzenta, entre os anos 2000 e 2021. Foram incluídos artigos, revisões, teses, dissertações e manuais disponibilizados na íntegra que estivessem em consonância com o objetivo deste estudo, tendo sido contemplando os idiomas inglês, português, italiano, espanhol e francês. Foram excluídos da revisão estudos não gratuitos pela plataforma CAFe, duplicados, que não tivessem relação com a temática pesquisada e não tivessem sua metodologia bem definida. Resultados: a revisão englobou 19 estudos publicados. O Brasil foi o país com maior número de estudos. Os principais achados propiciaram a construção das categorias conceituais. As sete primeiras se referem às principais características dos estudos incluídos nesta revisão de escopo; as outras três categorias objetivaram responder à questão norteadora e foram compostas por indicadores presentes na organização do processo de trabalho antes, durante e após a administração segura de uma vacina na criança. Conclusão: conclui-se que os objetivos desta pesquisa foram alcançados mediante mapeamento da organização do processo de trabalho através de conhecimento, atitudes e práticas para administração segura de vacinas em crianças. Como limitação deste estudo, evidencia-se a escassez de pesquisas que norteiam os cuidados pós-vacinação e sugere-se que novas pesquisas sejam realizadas.

RESUMEN Objetivo: mapear la organización del proceso de trabajo a través de los conocimientos, actitudes y prácticas para la administración segura de vacunas en niños. Método: se realizó una revisión de la literatura mediante el método Scoping Review, según las recomendaciones de la guía internacional PRISMA-ScR y el método Joanna Briggs Institute Reviewers Manual. La búsqueda electrónica de estudios se realizó en las bases de datos PubMed, CINAHL, Web of Science, Scopus, COCHRANE, LILACS y PsycINFO y en la literatura gris entre los años 2000 y 2021. Se incluyeron artículos, revisiones, tesis, disertaciones y manuales disponibles en su totalidad que estuvieran en línea con el objetivo de este estudio, en inglés, portugués, italiano, español y francés. Se excluyeron de la revisión los estudios no gratuitos a través de la plataforma CAFe, los duplicados, los que no estaban relacionados con el tema investigado y los que no tenían bien definida su metodología. Resultados: la revisión incluyó 19 estudios publicados. Brasil fue el país con el mayor número de estudios. Los principales resultados propiciaron la construcción de las categorías concebidas, las siete primeras se refieren a las principales características de los estudios incluidos en esta revisión de alcance, las otras tres categorías tienen como objetivo responder a la pregunta orientadora y se componen de indicadores presentes en la organización del proceso de trabajo antes, durante y después de la administración segura de una vacuna en el niño. Conclusión: se concluye que se lograron los objetivos de esta investigación al mapear la organización del proceso de trabajo a través de los conocimientos, actitudes y prácticas para la administración segura de las vacunas en los niños, se evidencia como limitación de este estudio la escasez de investigaciones que orienten la atención post-vacunación y se sugiere la realización de nuevas investigaciones.

ABSTRACT Objective to map the organization of the work process through knowledge, attitudes, and practices for the safe administration of vaccines in children. Method: a literature review was carried out using the Scoping Review method, in accordance with the recommendations of the international PRISMA-ScR guide, and the method of the Joanna Briggs Institute Reviewers Manual. The electronic search of the studies was carried out in the databases PubMed, CINAHL, Web of Science, Scopus, COCHRANE, LILACS and PsycINFO and in the gray literature, between the years 2000 and 2021. Articles, reviews, theses, dissertations, and manuals available were included. in full that were in line with the objective of this study, having been contemplating the English, Portuguese, Italian, Spanish and French languages. Studies that were not free of charge through the CAFe platform, duplicated, unrelated to the researched theme and that did not have a well-defined methodology were excluded from the review. Results: the review included 19 published studies. Brazil was the country with the highest number of studies. The main findings led to the construction of conceptual categories. The first seven refer to the main characteristics of the studies included in this scope review; the other three categories aimed to answer the guiding question and were composed of indicators present in the organization of the work process before, during and after the safe administration of a vaccine to the child. Conclusion: it is concluded that the objectives of this research were achieved by mapping the organization of the work process through knowledge, attitudes, and practices for the safe administration of vaccines in children. As a limitation of this study, there is a lack of research that guides post-vaccination care, and it is suggested that further research be carried out.