Nursing practice and work environment

A mother spent 3 agonizing days in the hospital with her 10-month-old son. Too young for the measles vaccine, he had contracted measles from an unvaccinated child in a pediatrician’s waiting room. With his fever spiking to 106° F (41° C), his mother feared she would lose her son. Thankfully, he made a full re­covery, and at age 12 months received the measles, mumps, rubella (MMR) vaccine. “This way, he won’t suffer from mumps or rubella or spread them to anyone else,” said the grateful mother.

Should we be worried about the diseases we thought were eradicated? Based on events like the one above, reported by the Centers for Disease Control and Prevention (CDC), the answer, unfortunately, is yes. Most adults, including healthcare providers, have not observed the diseases we fight so hard to prevent—and that is a good thing. Here are the facts:

  • Before the MMR vaccine was licensed in the United States in 1963, an estimated 3 to 4 million people were infected with measles each year.
  • The United States reported 206,000 cases of diphtheria in 1921, resulting in more than 15,000 deaths. Since the diphtheria vaccine was introduced in the 1920s, the number of cases has dropped dramatically and no cases of diphtheria were reported between 2004 and 2008.
  • From the 1930 to 1950s, the iron lung was the only way many Americans (especially children) could breathe when poliovirus paralyzed their throat and chest. The Salk vaccine was considered effective in 1955, and polio was no longer a threat.
  • According to the CDC, the current outbreak of measles in the United States is caused by “failure to vaccinate.”
    So what does this mean for registered nurses (RNs)? RNs are in prime positions to provide the latest education and prevention methods to families with questions related to vaccines. Here’s how:
  • Trust the science. Information regarding the success of immunizations is well-documented. RNs should be knowledgeable about the latest information from literature regarding vaccines. When explaining the value of vaccines to families, use evidence-based studies to reassure patients that vaccines are the safest method to prevent disease. (See ANA resources at http://anaimmunize.org.)
  • Keep communication open. Patients who have reservations about vaccines may not “get it” during the first educational encounter with the nurse. Provide education just the same. It is important not to give up on them, to continue to communicate with them, and to provide follow-up as necessary.
  • Lead by example. As stated in Provision 5 of the ANA Code of Ethics for Nurses with Interpretive Statements, RNs “have a duty to take the same care for their own health and safety” as their patients by being fully vaccinated.

So are vaccine-preventable diseases a thing of the past? Absolutely not! It is, however, the responsibility of all healthcare professionals to ensure that patients are safe and healthy, and this can be done only if the collective immunity of the nation remains high. We do not want to repeat history.

Selected references

Centers for Disease Control and Prevention. 106 degrees: A true story. In Vaccines and Immunizations. Page last reviewed and updated August 22, 2012. www.cdc.gov/vaccines/vpd-vac/measles/unprotected-story.htm

Centers for Disease Control and Prevention. Measles history. Page last reviewed and updated November 3, 2014. www.cdc.gov/measles/about/history.html

College of Physicians of Philadelphia. (n.d.). History of diphtheria. In The history of vaccines. www.historyofvaccines.org/content/timelines/diphtheria

Salmon D. Understanding increasing rates of vaccine hesitancy and what we can do about it. In Johns Hopkins Bloomberg School of Public Health; Measles symposium webcast. February 9, 2015. www.jhsph.edu/events/2015/measles-symposium

Seward JF. Measles in 2015: Situational update. In Johns Hopkins Bloomberg School of Public Health; Measles symposium webcast. February 9, 2015. www.jhsph.edu/events/2015/measles-symposium

Ruth Francis is the program specialist in the Nursing Practice and Work Environment Department at ANA.

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