Issues up close

The nation’s immunization effort is getting its own booster shot as ANA’s educational campaign—Bringing Immunity to Every Community—continues to expand. At the center of the campaign is the website www.anaimmunize.org, which provides a wealth of information for nurses on all things vaccine-related.

Launched in April, Bringing Immunity to Every Community is a 2-year cooperative agreement with the Centers for Disease Control and Prevention (CDC) that aims to increase the knowledge and competency of the nation’s 3.1 million – 3.6 million registered nurses (RNs) regarding immunization; encourage nurses to be vaccinated; and position nurses as leading advocates for immunization among healthcare professionals, patients, and the public.

The ongoing need for sound, easily accessible information on vaccines, from their efficacy to their safety, is clear. In California alone, health officials recently reported that the number of cases of pertussis (whooping cough) doubled in the first quarter of 2010 and led to the death of four infants. Studies have shown that half the infants who develop pertussis are infected by their parents, according to the California Department
of Public Health (CDPH). Among other strategies, CDPH officials are urging parents and caregivers to get vaccinated against this preventable disease before or at the birth of their child.

Meanwhile, the CDC’s preliminary survey findings presented at a recent pediatricians’ conference showed that nearly 40% of parents were either postponing or refusing to vaccinate their children against childhood diseases for a host of reasons, including a belief in the persistent myth that vaccines are linked to autism. (Scientific research has disproved this connection.)

Looking at healthcare workers themselves, generally only two of five roll up their sleeves in any given year to get a seasonal influenza vaccination, according to the National Foundation for Infectious Diseases.

“Nurses have a critical role in educating and vaccinating the public against preventable diseases,” says Katie Brewer, MSN, RN, senior policy analyst with ANA’s Department of Policy and Practice and its representative on the federal Advisory Committee on Immunization Practices. “And they have an obligation as professionals and as part of their own communities to get vaccinated so they don’t contribute to the spread of illnesses, such as influenza.”

Communicating benefits and risks

South Dakota Nurses Association member Tom Stenvig, PhD, MPH, RN, CNAA-BC, has been involved in immunization activities for more than 30 years and currently serves on the steering committee of the National Network for Immunization Information and advisory board of the Immunization Action Coalition. “The development of vaccines to prevent illness is one of the top successes of modern medicine,” says Stenvig, who has served on ANA’s Congress on Nursing Practice and Economics.

Brewer agrees. Many people are unaware of or have forgotten what conditions were like in this country before childhood immunizations were available. Rubella outbreaks caused numerous miscarriages, birth defects, and infant deaths; communities closed public pools to prevent the spread of polio. “When you look at the rates of childhood diseases after vaccines are introduced, they plummet,” she says. “For example, the introduction of the Hib [Haemophilus influenzae type b] vaccine led to the annual number of bacterial meningitis cases dropping from somewhere around 20,000 to the single digits.”

Still, fears about vaccine safety persist among the public—and even healthcare workers. Some fears are steeped in history, particularly among minority populations, and are termed the “Tuskegee effect,” according to Stenvig. Fears also can arise from pop culture (“celeb­rity effect”) and can be just as difficult to counter.

Then there are fears associated with the inherent risks of any vaccine, which can be addressed through effective communication. “Most people do listen to and trust their physicians and nurses,” Stenvig says.

But they still need accurate information. “They need to understand the reason for the vaccine and common side effects, such as soreness at the injection site,” says Catherine Ruhl, MS, CNM, director of women’s health programs at the ANA organizational affiliate, the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN). “Some patients may want to drill a little deeper and ask ‘What am I really putting in my body?’ Nurses need to have that information, feel confident delivering it, and be able to explain, in the big picture, the benefits of vaccination.” For example, nurses need to know the benefits of herd immunity so they can explain to patients that when they vaccinate their child, they also are protecting their family and their community, Ruhl says.

In addition to having accurate, up-to-date information, nurses must be skilled at risk communication to accurately address vaccine risks and side effects. Risk communication is in no way meant to disregard fears expressed by parents, patients, and nurses about potential adverse events for vaccines, Brewer says.

“But the way we listen to our patients and choose our words is important,” Stenvig says. “We don’t want to alarm them when we talk about risks. We want to put risks in context, by saying, for example, ‘This is a safe vaccine, but in very rare cases, this can happen.’”

Even the way a vaccine’s benefits are described matters, according to Ruhl, who was involved in AWHONN’s awareness campaign for the human papillomavirus (HPV) vaccine. “Parents may think their daughters do not need the HPV vaccine if they think of it as only protecting them from a sexually transmitted disease,” Ruhl says. “But the vaccine also prevents abnormal changes in the cervix that can lead to cervical cancer, and the treatment for these abnormal cells can increase a woman’s chances of having preterm labor and birth.” (For more information on AWHONN’s educational efforts in promoting the HPV vaccine and H1N1 vaccination for pregnant women, go to http://www.awhonn.org/.)

The need for education and risk communication also is key when trying to influence other nurses, according to Washington State Nurses Association member and pediatric intensive care nurse Kathy Ormsby, RN. “I was amazed at how skeptical some nurses were about the H1N1 vaccine,” Ormsby says. Some were concerned because it was being manufactured so quickly or were worried about the amount of mercury in the vaccine. Others just said they never got the (seasonal) flu shot and never became sick, so why should they get the H1N1 vaccine?

“What I saw was a big knowledge deficit based on a lot of myths. That fueled my search to find out what nurses needed to know about the vaccine, its side effects, and the consequences of not getting it. I also was taking care of patients with H1N1, and I saw how far worse the disease was than the potential risks from the vaccine. These children were really sick, and some will have long-term effects.”

With facts in hand, Ormsby was able to talk with her colleagues about the risks and benefits of the vaccine. For example, she put the risk of mercury used in the preservative in context. “I explained that the amount of mercury used is so minute,” Ormsby says. “If they ate a tuna sandwich, they’d be getting more mercury than the amount in the vaccine.”

Heading on the campaign trail

Looking back on her research efforts, Ormsby reports it was difficult finding information on the vaccine that was tailored for bedside nurses. “Either it was written for the lay person or it was really scientific—talking about the molecular structure of the vaccine,” she says.

So when she was asked to become a member of an advisory group to help develop content for ANA’s immunization campaign website, Ormsby jumped right in to share her experiences and insights. Along with Ruhl, who lent her expertise on immunizations for women, Ormsby believes the ANA website is like one-stop shopping for nurses. It has a variety of information on vaccine schedules and recommendations, patient education tools, journal articles, immunizations for nurses, and information specific to nurses’ roles and settings. “Because nurses work in so many settings, they can look at the website and determine what speaks to them for their practice,” Ruhl says.

Nurses also can subscribe to the e-newsletter ANA ImmuNews on the website and receive e-mail notification of the latest immunization-related news, online additions, changes, and events. An ongoing section reports on vaccine-preventable outbreaks and deaths to keep nurses aware of what’s happening on that front. And Brewer is encouraging nurses to take an online survey aimed at helping ANA assess additional immunization needs among nurses and gather feedback about the website.

Finally, Brewer recently attended a CDC conference where she met with nurses and other staff from public health departments around the country. “They were really glad ANA is carrying this public health message,” Brewer says. “It also was clear that when it comes to improving immunization rates, nurses need to be driving that train.”

Susan Trossman is the senior reporter in ANA’s communications department.

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