Effectiveness of a vaccination education module for college freshmen.

Objective: To evaluate the effectiveness of a vaccination education module to improve vaccine expectations and behaviors among college freshmen. Participants: The participants were 177 college freshmen at one private Utah university. Participants were eligible for this study if admitted as new freshmen during the 2019-2020 school year. Methods: The study was a cross-sectional pre- and post-education evaluation assessing vaccine expectations and behaviors using Likert-type and open-ended questions. Results: After completing the vaccination education module, participants' vaccine expectations and behavioral intentions improved. Participants reported they were more likely to be up-to-date on personal vaccines and more likely to expect other students to be up-to-date on their vaccinations. Participants were more likely to ask other students to vaccinate and were also more likely to ask their family members to be vaccinated. Conclusions: This online vaccination education module effectively improved participants' vaccine expectations and behavioral intentions.

Barriers to the Use of Pain Prevention Techniques During Immunization.

INTRODUCTION: The purpose of this project was to identify barriers to the use of pain prevention techniques during immunization. METHOD: A national, voluntary survey was distributed to members of the National Association of Pediatric Nurse Practitioners in June 2019. RESULTS: The survey gathered information about the type of practitioner (pediatric nurse practitioner, family nurse practitioner, nurse, etc.), practice location (inpatient, primary care, specialty care, etc.), and patient population served and also included information regarding geographic location, socioeconomic status, insurance coverage, and immunization status as well as current practice information. Respondents identified the following barriers: time (22.4%), availability (17.5%), lack of knowledge (17%), staff support (14.1%), cost (12.1%), lack of resources (7.4%), safety concerns (4.7%), environmental factor (3.4%), and other (1.4%). DISCUSSION: The lack of pain prevention techniques is primarily because of availability, lack of knowledge and staff support, and cost. Proposed means to address these barriers include the development of a toolkit.

Empowering nurse practitioners to make health policy CHANGE: Steps to successful passage of legislation in Utah.

ABSTRACT: Nurse practitioners have the skills needed to make meaningful policy change to improve health care. In 2017, the authors championed a bill, House Bill 308 Substitution 2 (HB 308 Sub 2), which passed in the Utah Legislature. This health policy article details the process of successful passage of HB 308 Sub 2 and guides advanced practice registered nurses (APRNs) in enacting legislation. The steps detailed to enact legislation are based on Longest's policy framework (2006). The acronym CHANGE was developed and stands for collecting data, hinge, associations, negotiate, gather, and expect to be the expert. Intricacies of lawmaking are also explained including timing of legislation, the three readings, and lobbying. The CHANGE acronym outlines the following: Collecting data to legitimize the problem and proposed solution. The Hinge refers to the specifics of the proposed solution. Associations involve garnering support from key stakeholders early and often in the legislative process. Negotiate refers to finding a bill sponsor that is trustworthy, negotiates well, and has political capital. Gather public support is a critical step to increase legislatures' constituent communication requesting support for the bill. Expect to be the expert refers to understanding arguments for and against the bill and crafting power statements. Passing of HB 308 Sub 2, through the work of APRNs, provides a step-by-step guide to successful passing of legislation. This guide will empower APRNs across the nation with the knowledge to enact and pass policies to improve health care in our nation.

Adult Vaccination Rates in the Mentally Ill Population: An Outpatient Improvement Project.

Background: Adults who suffer with severe and persistent mental illness (SPMI) rarely access medical care to receive preventive vaccines. Aims: To increase the rate of vaccines among the SPMI population in an outpatient community mental health center (CMHC). Methods: A review of the literature identified a gap between the general population and SPMI clients in receiving preventive vaccinations. An initial mixed-method convenience survey of SPMI clients (n = 392) provided information on current vaccination status, demographics, beliefs, and interest in receiving vaccines. A vaccination program was developed to address identified barriers and increase vaccination rates. Postintervention data were collected through a mixed-method convenience survey of SPMI clients (n = 60) who participated in immunizations clinics to evaluate client satisfaction. A partnership between the health department and CMHC was developed to deliver vaccines in a nontraditional site. Vaccines administered included annual influenza; hepatitis A; hepatitis B; herpes zoster; measles, mumps, and rubella; pneumococcal; and tetanus, diphtheria, and pertussis (Tdap). Results: More than 1,000 vaccines were administered in the first 8 months, with a significant increase in vaccination rates over baseline for individual vaccines ranging from 18.75% to 83%. Postintervention survey results found a 95% satisfaction rate. Conclusions: Implementation of a vaccination program in a nontraditional site that facilitates access for SPMI clients can promote an overwhelming increase in the vaccination rates for this underserved population. Results suggest that the integration of mental health and CMHC services can have a profound positive effect on SPMI population health.

A Whooping Cough Education Module for WIC Clients in Utah.

BACKGROUND: Clients in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) are required to complete education modules quarterly to maintain eligibility. The purposes of this project were to: (1) create a whooping cough vaccination education module for WIC clients; (2) evaluate baseline perceptions of WIC clients on the whooping cough vaccine and disease; and (3) evaluate whooping cough knowledge following completion of the module. PROBLEM: A decline in vaccination rates among infants and children using WIC services was reported by a local WIC program director who requested whooping cough vaccination education materials. This quality improvement project included development of a whooping cough education module and evaluation of learning. METHODS: Learning was evaluated using a pre- and posttest design. Client feedback was solicited via open-ended questions. Quantitative analysis was performed on visual analog-type questions with paired t-tests and a Cohen's d. Content analysis was conducted on open-ended items. INTERVENTIONS: The module was designed by a team of vaccination experts and included general definitions, signs and symptoms during the three stages of disease, recommendations to prevent whooping cough, and vaccination recommendations. Learning of users of the module was then evaluated. RESULTS: After using the module, clients indicated they were significantly more likely to vaccinate themselves and their child against whooping cough, and to recommend the vaccination to their family members. The greatest concern of participants about whooping cough was how it affected infants. Participants reported they learned new information on disease seriousness, recognition of symptoms, and treatment options but still requested additional information on the whooping cough disease and vaccine. CONCLUSIONS: A whooping cough education module is an effective strategy to improve whooping cough knowledge and promote the whooping cough vaccine.

Global Immunizations: Health Promotion and Disease Prevention Worldwide.

BACKGROUND: Immunizations are one of the most important health interventions of the 20th century, yet people in many areas of the world do not receive adequate immunizations. Approximately 3 million people worldwide die every year from vaccine-preventable diseases; about half of these deaths are young children and infants. Global travel is more common; diseases that were once localized now can be found in communities around the world. PROBLEM: Multiple barriers to immunizations have been identified. Healthcare access, cost, and perceptions of safety and trust in healthcare are factors that have depressed global immunization rates. INTERVENTIONS: Several global organizations have focused on addressing these barriers as part of their efforts to increase immunization rates. The Bill and Melinda Gates Foundation, The World Health Organization, and the United Nations Children's Emergency Fund each have a part of their organization that is concentrated on immunizations. CLINICAL IMPLICATIONS: Maternal child nurses worldwide can assist in increasing immunization rates. Nurses can participate in outreach programs to ease the burden of patients and families in accessing immunizations. Nurses can work with local and global organizations to make immunizations more affordable. Nurses can improve trust and knowledge about immunizations in their local communities. Nurses are a powerful influence in the struggle to increase immunization rates, which is a vital aspect of global health promotion and disease prevention.

Vaccination policies of Utah family practice clinics.

BACKGROUND AND PURPOSE: The purpose of this study was to collect information regarding healthcare worker (HCW) vaccination policies in Utah family practice clinics. METHODS: The study was conducted in Utah family practice clinics in the most densely populated counties in the state and was a cross-sectional descriptive design. Data were collected from 91 family practice clinic managers. Descriptive statistics were performed, as well as a content analysis for open-ended items. CONCLUSIONS: HCWs are employed in environments where infectious diseases can be easily spread from person to person, thus, vaccinations can be instrumental in protecting the health of HCWs and patients alike. In Utah, 56.8% of family practice clinics had either no vaccination policy for HCWs or had a policy with no consequences for noncompliance. Utah family practice clinics need to implement changes to create and maintain HCW vaccination policies. IMPLICATIONS FOR PRACTICE: Nurse practitioners can be leaders and change agents by working with their county and state health departments to create state-wide policies that mirror the position statements from the American Nurses Association and the American Association of Nurse Practitioners.

Nursing Student Experiences Regarding Safe Use of Electronic Health Records: A Pilot Study of the Safety and Assurance Factors for EHR Resilience Guides.

Previous research has linked improper electronic health record configuration and use with adverse patient events. In response to this problem, the US Office of the National Coordinator for Health Information Technology developed the Safety and Assurance Factors for EHR Resilience guides to evaluate electronic health records for optimal use and safety features. During the course of their education, nursing students are exposed to a variety of clinical practice settings and electronic health records. This descriptive study evaluated 108 undergraduate and 51 graduate nursing students' ratings of electronic health record features and safe practices, as well as what they learned from utilizing the computerized provider order entry and clinician communication Safety and Assurance Factors for EHR Resilience guide checklists. More than 80% of the undergraduate and 70% of the graduate students reported that they experienced user problems with electronic health records in the past. More than 50% of the students felt that electronic health records contribute to adverse patient outcomes. Students reported that many of the features assessed were not fully implemented in their electronic health record. These findings highlight areas where electronic health records can be improved to optimize patient safety. The majority of students reported that utilizing the Safety and Assurance Factors for EHR Resilience guides increased their understanding of electronic health record features.

Immunization Status of NICU Graduates at a Tertiary Care Children's Hospital.

BACKGROUND: Approximately 500,000 infants are born prematurely each year in the United States. Immunization of infants in a neonatal intensive care unit (NICU) set a precedence for future immunizations. PURPOSES: The objectives of this study were to determine the current rates of immunization and identify variables associated with immunizations of NICU graduates who were aged 60 days or older at time of discharge. METHODS: This descriptive pilot study utilized retrospective paper medical record review in one tertiary children's hospital. The relationships between immunization status and study variables were examined using t tests and logistic regression. RESULTS: Of 43 infants discharged at least 60 days of age or older from the NICU, 74.4% were fully immunized in accordance with American Academy of Pediatrics (AAP) recommendations. Significant predictors were age at discharge for immunization and steroid use for nonimmunization. IMPLICATIONS FOR PRACTICE: Immunization needs to be a priority in order to give NICU infants every advantage regarding their future health status. Nurses need to implement hospital policies ensuring immunizations of NICU graduates. IMPLICATIONS FOR RESEARCH: Future studies should focus on samples from diverse hospitals and levels of NICUs. Qualitative studies exploring and describing parent and provider knowledge of current AAP guidelines will strengthen our understanding of potential barriers to immunization.

Evaluation of Employee Vaccination Policies in Outpatient Oncology Clinics: A Pilot Study.

BACKGROUND: All major hospital facilities in the state of Utah have employee vaccination policies. However, the presence of healthcare worker vaccination policies in outpatient oncology clinics was unknown. OBJECTIVES: The objectives of this article are to identify oncology outpatient employee vaccination policies in Utah and to identify what consequences, if any, are present for unvaccinated employees. METHODS: This was a cross-sectional, descriptive study design in which clinic managers from outpatient oncology clinics were asked, via questionnaire, to describe the clinic's employee vaccination policy and the consequences for refusing the policy. FINDINGS: Most vaccination policies applied to employees primarily assigned to work in the direct patient care area. Most commonly, influenza and hepatitis B vaccines were required as part of the vaccination policy. Most managers offered free vaccinations to employees, but most managers also allowed employees to refuse to follow the vaccination policy for medical, religious, or personal reasons.

Promoting Adult Pertussis Vaccination in the Workplace.

Vaccines are an important disease prevention strategy among individuals of all age groups. Despite the success of vaccinations in preventing communicable diseases, adults, in particular, often have sub-optimal vaccination rates. Consequently, some vaccine-preventable diseases, such as pertussis, are still on the rise in the United States despite the availability of the Tdap vaccine. As most adults can be found in the workplace, occupational and environmental health nurses are in a unique position to encourage employers to promote adequate Tdap vaccination among their employees. As specific resources regarding Tdap vaccination are lacking, the Pertussis Prevention Toolkit was developed to help occupational health nurses promote Tdap vaccination in the workplace.

Evaluation of Vaccination Policies Among Utah Pediatric Clinic Employees.

INTRODUCTION: Pediatric health care settings are high-risk environments for spreading communicable and vaccine-preventable diseases from health care workers to susceptible patients. METHOD: All managers of pediatric clinics operating in the state of Utah were included. Participants were invited to complete a two-page questionnaire regarding their clinic vaccination policies. RESULTS: Half (n = 23) of Utah pediatric outpatient clinic managers recommend employee vaccinations, although employee refusal was allowed without consequence. Of all adult vaccines, influenza was most often included by managers as part of the employee vaccination policy. Some managers required unvaccinated employees to wear masks in the event of illness, but many had no additional requirements for unvaccinated and ill employees. DISCUSSION: Vaccination of health care workers is an effective approach to reduce disease transmission. Mandatory vaccination policies can significantly improve vaccination rates among health care workers.

Addressing Parental Vaccination Questions in the School Setting: An Integrative Literature Review.

School nurses work in a unique environment with key opportunities to address parental concerns and questions regarding their child's health. A common concern for parents during school enrollment is childhood vaccination safety and efficacy. As public health leaders, school nurses are well respected among parents, therefore school nurses are in a prime position to educate parents and promote childhood vaccinations while also dispelling common vaccination myths. The purpose of this integrative literature review is to synthesize evidence-based answers to common parental questions regarding childhood vaccinations.

Perception of safety, importance, and effectiveness of vaccinations among urban school employees in Utah.

PURPOSE: School employees are in direct contact with children in confined areas, a setting in which communicable infection can quickly spread. Therefore, it is important for school employees to be fully vaccinated. The purpose of this study is to ascertain the current vaccination status and perceptions of school employees in an urban school district. DATA SOURCES: The study employed a nonexperimental mixed-method design. School employee participants (N = 1400) completed a questionnaire to evaluate vaccination status, availability of vaccination records, and vaccination awareness. Participants were randomly selected from 85 schools within one urban school district. CONCLUSIONS: Two common perceptions about vaccines emerged from the questionnaire: (a) vaccines are only for children and (b) vaccinations received during childhood are still effective. School employees are unaware of their own vaccination status and the recommended vaccination schedule for adults. Additionally, accessibility to immunization records for adults is frequently inadequate. IMPLICATIONS FOR PRACTICE: Healthcare providers (HCPs), including nurse practitioners (NPs), are the first line of defense to ensure adults are adequately vaccinated. When vaccinations are tracked and recommended by HCPs, vaccination uptake is improved. NPs who discuss recommended vaccinations with adult patients are instrumental in improving vaccination rates among school employees.

Vaccination perceptions of school employees in a rural school district.

BACKGROUND: There continues to be a need for increases in adult vaccination rates, especially among those working in environments which may easily become communicable disease outbreak centers, such as school employees in the school environment. The purpose of this study was to evaluate why rural Utah school employees were non-compliant with the influenza and measles, mumps, and rubella (MMR) vaccines, as well as to identify their views on mandatory vaccination policies. METHODS: A questionnaire was distributed to all school employees in a rural Utah school district. Data analysis included frequencies and measures of central tendency and dispersion for quantitative items and theme identification for qualitative items. RESULTS: Only 51% of school employees were adequately vaccinated for influenza. Reasons for noncompliance with the influenza vaccine included inconvenience, lack of perceived need, and questionable vaccine efficacy. There were 39.3% school employees who had not received an MMR during adulthood, which was commonly attributed to lack of knowledge regarding the need for this vaccine. Almost half (45.7%) of school employees believed a mandatory vaccination policy should be instituted, although 24.2% of school employees were opposed to mandatory adult vaccination policies. Reasons for opposing vaccination mandates included violation of personal choice, lack of perceived vaccination safety and efficacy, lack of perceived need for adult vaccines, and vaccine cost. CONCLUSIONS: Suboptimal vaccination rates of school employees may negatively affect the health and well-being of individuals in the school environment. School employees report a variety of beliefs regarding the influenza and MMR vaccines. While over half of school employees support mandatory vaccination policies for adults working in the school environment, those opposing such a policy report concerns regarding violation of personal choice. Public health officials and school administrators should coordinate efforts to increase vaccination rates among adults in the school environment.

Parent Involvement in End-of-Life Care and Decision Making in the Newborn Intensive Care Unit: An Integrative Review.

Survival rates for very preterm and critically ill infants are increasing, raising complex ethical issues for health-care providers and parents who face the challenge of making end-of-life decisions for newborns. The purpose of this integrative literature review was to evaluate parental involvement in end-of-life care and decision making for their infant in the newborn intensive care unit. Findings revealed that establishing good relationships and clear communication between health-care providers and parents builds trust and eases stress placed on parents making decisions about the care of their infant. Palliative care programs provide support for parents and facilitate their decision making. Parents can be educated about how to communicate with health-care providers. Educating nurses on how to provide end-of-life care may also help improve support for parents during this difficult time. Additional research is recommended to examine parents' needs during and after end-of-life care decisions for their newborn.