TranslatingEvidence into Practice
ThePICOT Question and Significance to Nursing Practice
Thelow rate of children vaccination in communities is a great challengefor nurses since most patients and their families are reluctant toreceive some recommendable vaccines. Vaccination of childrengenerally reduces hospitalization and improves efficiency of careproviders. Additionally, morbidity and mortality rates reduce aswell. This fact led to the following PICOT question: Whatare the adverse effects in infants who receive vaccinations? Thisstudy lends itself to the salient role played by nurses in ensuringadherence to vaccination schedules for children. It aims to translateand apply recommendable strategies that will increase vaccinationuptake in children to reduce cases of hospitalized morbidity andmortality.
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Vaccinationof children has been is the backbone of immunization programs but afew parents still resist having their children vaccinated. Polit andBeck (2016) observed that it is important to assure parents thatvaccines are safe. Nursing practice is at the fore font of ensuringthat immunization services are readily accessible, integrated intodaily health care provisions, and potential barriers identified andeliminated through the evidence-based nursing research and practice(Polit and Beck, 2016). Additionally, Briss et al., (2010) found thatthe essential nursing practice supported by evidence will be ensuringadherence to vaccination. Most of the policy makers will selecttailored vaccine schedules basing on immunogenicity and burden ofdisease. Reduction in adherence to vaccination schedule might resultfrom views about vaccineside effects, the fear of autism, moral and or religious grounds,objection to the many injections, lack of information, and lack ofaccess due to cost.
Therecommendations provided in the national guideline are not adequateto explain the variations in vaccinations. Comorbidity wasattributable for the variations in immunization schedules and somecases were a result of patient characteristic’s and were notaligned with the evidence based practice(Briss et al., 2010).Studies relating to barrier to adherence to vaccination guidelinesfound that most nurses could not alter vaccination initiated by theCenterfor Disease Control (Cairns et al., 2012).Sometimes even nurses more often than not disagree with theadvantages put forward for the vaccinations basing on the uniquenessof the populations across the globe in terms of the risks associatedwith some diseases. With more parents considering themselves liberaland refuse vaccines citing parental choice and freedom, the problemof ensuring adherence to vaccination is complex for nurses.
Theevidence based vaccine schedules offer a safe way of reducing theburden of infectious diseases by sparing children from morbidity ofvaccine preventable diseases. Indeed, immunization at childhood levelis recommendable since the antigens offer the backbone of preventionof deadly childhood diseases (Cairnset al., 2012).Most of the preventable diseases are a threat in the initial years ofthe child development and might result to risk of exposure to thediseases, disability from the disease as well as mortality andmorbidity with delayed vaccinations. Also, failing to follow thevaccine schedule even in cases where the threats relating to thedisease are minimal will lead to cases where the risk of morbidityand disability is unacceptable.
Disseminatingthe uptake of the findings of the study could include training nursesto learn about engaging culturally diverse populations invaccinations, provision of monetary incentives to nurses forcommunity engagement and engagement of opinion leaders andcelebrities to influence patterns of vaccinations across differentcultures. Also, public health officials should educate patients andtheir families about vaccine schedules hoping that they will seeksuch vaccines in future consultations with nurses. The mostappropriate course of action will be to select, tailor and implementvaccine programs in the local health care facilities.
Toimplement the strategy at my workplace, passive education includingwritten guidelines and conferences will be useful. This will go handin hand with active engagement such as outreach visits to incorporatethe interventions into practice. The hospital should enhance itsknowledge management practice to provide opportunities for sharingand discussing challenges relating to vaccination schedules andincorporating the interventions into day to day activities. This willbe done through open forums and development of work based website oronline wikis for self-study. Additionally, patient-directedintervention will help to source data on vaccination patterns acrossdifferent ethnic groupings. For instance, consultation questionnairesshould be designed to include vaccination status of the patients andtheir families.
Itis anticipated that various forces will resist patients possibly dueto lack of sufficient knowledge about the adverse effects that comewith infectious diseases resulting from related vaccines, healthofficials due to high costs and nurses due to inadequate capitaland human resources. Health officials are all aware of the possibleimpacts of failures to get vaccinated. To communicate effectively, Iwill provide to the hospital management team the statistics on thevaccination trends to back up the need to improve on the currentpractices. Form this point, I will advise on holding staff briefsabout the need to evaluate the current practices and to incorporatemost recent evidence based practices to reduce resistance. Duringthese forums, I will communicate the desired changes to collogueputting in consideration their input.
Problemsrelating to vaccine uptake come from the patients and their families,health care providers, health officials and policies. Diversity ofthe population was identified as a pertinent issue when it comes tovaccine uptake. Most of the populations refuse to take vaccinesbasing on the fact that they have no first-hand experience with someof the illnesses. For instance, the last case of polio in the UnitedStates was ten years ago. Also, some vaccines available in the US aredifferent from those in other country and immigrants getting newbornsmight be unwilling to adhere to new schedules in the subsequentbirths. Parents decline to vaccinate their children for fear ofinfections, moral grounds and stress on the part of the child andthey have the freedom to choose what is best suited for theirchildren.
Nursingpractice supports ensuring adherence to treatments and vaccines.Intervention for adherence to vaccination and translation intopractice should be tailored to the local setting and requiresengagement with the community. The methods of implementing vaccineschedules are varied despite the evidence-based interventions sincethe methods of tailoring vary across studies. Evidence based practiceis limited to some extent because it is not decisive on the mostappropriate vaccination schedules to use but it shades light ongeneral protocols for adherence. For this reason, it is important totailor the evidence to reflect the needs of the populations andnursing staff.
Briss,P. A., Rodewald, L. E., Hinman, A. R., Shefer, A. M., Strikas, R. A.,Bernier, R. R., … & Task Force on Community PreventiveServices. (2010). Reviews of evidence regarding interventions toimprove vaccination coverage in children, adolescents, and adults. Americanjournal of preventive medicine,18(1), 97-140.Cairns,G., MacDonald, L., Angus, K., Walker, L., Cairns-Haylor, T., &Bowdler, T. (2012). Systematic literature review of the evidence foreffective national immunisation schedule promotional communications.EuropeanCentre for Disease Prevention and Control (ECDC).Maglione,M. A., Das, L., Raaen, L., Smith, A., Chari, R., Newberry, S., … &Gidengil, C. (2014). Safety of vaccines used for routineimmunization of US children: a systematic review. Pediatrics,134(2),325-337.Polit,D. F., & Beck, C. T. (2016). Nursingresearch: Generating and assessing evidence for nursing practice.Philadelphia,PA: Wolters Kluwer. Ventola,C. L. (2016). Immunization in the United States: Recommendations,Barriers, and Measures to Improve Compliance: Part 1: ChildhoodVaccinations. Pharmacyand Therapeutics, 41(7),426.