1. Immunizations By: Lauren Kasperlik, Cory Tepatti, Megan MacDermaid, Kaytlyn Jordan

2. Objectives: ●Identify safety and quality in vaccinations throughout one’s lifespan. ●Explain evidence-based practice on vaccinations from a nursing point of view. ●Explain vaccinations from another discipline. ●Explain the relationship between the research of vaccinations to Jean Watson’s theory and the Instructional Theory. ●Explain a concept map on the impact and safety and quality of vaccinations. ●Explain the clinical implications of vaccinations.

3. Outcomes: ●Increase awareness of vaccinations and how it affects the population. ●Demonstrate ethical awareness from a nurses point of view. ●Educate the population on the myths of vaccinations.

4. Introduction Based on evidence-based research, we promote immunizations throughout lifespan development and create awareness in nursing practice.

5. Facts ●All major health organizations currently recommend that infants and children be vaccinated against 14 communicable disease. ○by age 6, children will have received 29 vaccinations ●In the United States, most states have enacted laws that require proof of certain vaccinations before allowing them to attend daycare or school. ○All 50 states issue medical exemptions ○48 states (excluding Mississippi and West Virginia) permit religious exemptions. ●There is a federal program called Vaccines for Children which provides free vaccinations to children without health insurance. ● The United States has one of the best safety programs in the world. Scientist are constantly monitoring and studying vaccines before they are licensed to the public.

6. PICO Question ●Patient/population: Children (2 months and older) and parents, individuals who oppose immunizations. ●Intervention of Interest: Educate the patient about immunizations and the effects. ●Comparison on interest: Compared to children who have not been vaccinated or adults who chose to forgo vaccinations. ●Outcome of Interest: Prevent diseases and illness in the future.

7. Pros ●Illnesses such as Diphtheria, Rubella, and Whooping Cough which once killed thousands of infants annually are now prevented by vaccinations. ●Studies from John Hopkins University School of Public Health and Centers for Disease Control have proven that mercury based preservatives in vaccinations do not cause autism ●According to The American Academy of Pediatrics, most childhood vaccinations are 90-99% effective in preventing disease. ●Immunizing individual children also helps to protect the health of the community, especially those who cannot be immunized. This includes: o children less than a year old o medical reasoning such as leukemia o those that cannot make an adequate response to vaccinations

8. Cons ●People argue that children’s immune systems can deal with infections naturally ●Side effects of vaccinations such as seizures, paralysis, and death are not worth the risks of safeguarding against diseases. ●Vaccines may cause autism, ADHD, and multiple sclerosis.

9. Vaccination Safety ●Years of testing are required by the FDA before a vaccine can be licensed. o This can take up to 10 years or longer ●Vaccinations are continuously monitored for safety and efficacy. ●Any problems with a vaccine prompts further investigation with the FDA and the CDC. ●If researchers find a vaccine may be causing possible side effect’s appropriate actions will be taken. This includes: o changing of vaccine labels or packaging o distributing safety alerts o revoking the vaccines license o inspecting manufacturers facilities and records

10. Vaccination Safety Continued ●AFIX is a quality improvement program to raise immunization coverage levels, reduce missed opportunities to vaccinate and improve standards of practice at the provider level. o Assessment of the healthcare provider’s vaccination coverage levels and immunization practices o Feedback of results to the provider along with recommended quality improvement strategies to improve process, immunization practices, and coverage levels. o Incentives to recognize and reward improved performance o Exchange of information with providers to follow up on their progress towards quality improvement in immunization services and improvement in coverage levels.

11. Nursing Research First Study: Improving Immunization Rates at 18 Months of Age: Implications for Individual Practices. ●Location: South Carolina ●9 facilities were included, but only 6 facilities chose to participate. ●Number of doses & vaccine types. ●Results from the 6 practices.

12. Nursing Research Second Study: Nurse Practitioner's Role in Providing Evidence-Based Research on Childhood Vaccines ●What is a healthcare providers role in providing information on vaccinations? ●Polio Vaccine became available in 1959 and no cases have occurred in the United States for 20 years. ●Healthcare providers face ethical dilemma with vaccines. ●The CDC and schools have guidelines for vaccinations. ●Reasons parents forgo vaccinations: side effects, religious beliefs, and the fear of developing autism.

13. Nursing Research Continued ●Autism debate first began in 1998. ●Evidence shows little association between vaccines and autism. ●Over the years there has been an increase of mothers who believe the MMR vaccine is safe. ●Patients look to healthcare providers for guidance to vaccinate their children. ●Vaccinations will always be controversial topic.

14. Other Discipline: Social Work Child Immunization Status Among a Sample of Adolescent Mother: Comparing the Validity of Measurement Strategies. ●Our Family Services: Tucson, Arizona ●Teen pregnancy: Postpartum ●Social programs ●Immunization records ●Two self-report strategies ●Study ●Results

15. Nursing Theory: Jean Watson 1979 Theory of caring: Nursing is concerned with promoting and restoring health, preventing illness, and caring for the sick. Jean Watson’s Theory: ●Individualized care ●Limitations of theories in community health nursing ●Caring consists of carative factors that result in the satisfaction of certain human needs ●Effective caring promotes health and individual or family growth ●Caring responses accept person not only as he or she is now but as what he or she may become

16. Nursing Theory cont. & Clinical Implications ●A caring environment is one that offers the development of potential while allowing the person to choose the best action for himself or herself at a given point in time ●Caring is more “ healthogenic” than is curing. A science of caring is complementary to the science of curing ●The practice of caring is central to nursing ●Helping-trust relationship ●Teaching-learning ●To be a Nurse is to Care Whether or not immunizations are given, it is our job to care for and provide for each patient and circumstance individually and with the same respect

17. Theories of Moral Development-Lawrence Kohlberg ●Postconventional Level ●“Involves moral judgement that is rational and internalized into one’s standards or values” ●Healthcare providers and parents are faced with moral dilemmas regarding vaccinations. ●Providers need to respect the patient’s decision and not be forceful. ●The nurse must have moral judgement and ethics with controversial topics such as vaccines.

18. Impact on Safety and Quality

19. Summary of Research Findings ●Healthcare facilities need to implicate vaccination education. ●Providers need to provide evidence-based research to their patients when looking for advice about vaccinations. ●Vaccinations need to be more readily available to the uninsured and single income families. ●Different beliefs about vaccinations exist especially in the home school population.

20. Questions

21. Conclusion ●Evidence-based research is essential to providing information and influencing safety and quality regarding vaccinations. ●Access to vaccines need to be more readily available to the public. ●Healthcare providers need to actively participate in their patients decision regarding vaccinations. ●A role of a nurse is to provide care and be a patient advocate for health promotion.

22. Reference Page ●AAP immunization best practices making flu vaccine accessible. (2013). American Academy of Pediatrics. Retrieved April 21, 2014. ●AFIX (Assessment, Feedback, Incentives, and Exchange). (2014, March 11). Centers for Disease Control and Prevention. Retrieved April 21, 2014, from http://www.cdc.gov/vaccines/programs/afix/index.html http://www.cdc.gov/vaccines/programs/afix/index.html ●Ayesha Khan. (June 13, 2013). Vaccines. Retrieved from http://bionews- tx.com/news/2013/06/13/ut-yale-flu-vaccines-aimed-at-younger-populations-could-break-annual- transmission-cycle/http://bionews- tx.com/news/2013/06/13/ut-yale-flu-vaccines-aimed-at-younger-populations-could-break-annual- transmission-cycle/ ●Bay Health. Keep Your Baby Save Through Immunizations. Retrieved from http://www.bayhealth.org/BayhealthContentPage.aspx?nd=1149&news=625 http://www.bayhealth.org/BayhealthContentPage.aspx?nd=1149&news=625 ●McElligott, J. T., Roberts, J. R., O’Brien, E. S., Freeland, K. D., Kolasa, M. S., Stevenson, J., & Darden, P. M. (2011). Improving immunizations rates at 18 months of age: Implications for individual practices. Public Health Reports, 126, 33-38. Retrieved from http://www.jstor.org/stable/41639283 http://www.jstor.org/stable/41639283

23. Reference Page Continued ●Phillips, C., Cota-Robles, S., Knight, M., Francis, J., Phillips, E., & Mazerbo, L. (2011). Child immunization status among a sample of adolescent mothers: Comparing the validity of measurement strategies, Journal of Famliy Social Work, 14, 326-328. DOI:10.1080/10522158.2011.584303 ●San Mateo County Health System. (2012). Immunization Programs. Retrieved from http://www.smchealth.org/immunizations http://www.smchealth.org/immunizations ●Staullbaumer, Tonya. (March 2012). Nurse practitioner’s role in providing evidence-based research on childhood vaccines. The Kansas Nurse, 87. Retrieved April 16, 2014. ●Taylor, C. R., Lillis, C., LeMone, P., Lynn, P. (2011). Fundamentals of Nursing: The Art and Science of Nursing Care. (7th ed., pg. 369). Philadelphia, PA: Lippincott Williams & Wilkins. ●Thorpe, Elizabeth. (February 1, 2012). Homeschooling parents’ practices and beliefs about childhood immunizations. Vaccine, 30,6 pg 1149-1153. http://dx.doi.org/10.1016/j.vaccine.2011.12.019 http://dx.doi.org/10.1016/j.vaccine.2011.12.019

24. Reference Page Continued ●Vaccines. (2013, November 18). ProConorg Headlines. Retrieved April 21, 2014, from http://vaccines.procon.org/ http://vaccines.procon.org/ ●Vaccine Safety. (2011, February 8). Centers for Disease Control and Prevention. Retrieved April 21, 2014, from http://www.cdc.gov/vaccinesafety/Vaccines/Common_questions.html6+http://www.cdc.gov/vaccinesafety/Vaccines/Common_questions.html6+