Factors affecting influenza vaccination rates in older people admitted to hospital with acute medical problems

Influenza is a major problem both in the community and hospital and elderly people who are at particular risk should be included in vaccination programmes. In August 1998 the Chief Medical Officer for England extended the current influenza immunization policy to include all those aged 75 years or over. However, prior to this date only those patients with co-existing cardiac or respiratory diseases at increased risk of influenza were vaccinated routinely. In order to determine whether such patients had been immunized, we approached all patients admitted to Care of the Elderly wards during an 8-week period in January and February. The study additionally identified factors that may have influenced patients' participation in this immunization programme. Six hundred and forty-nine patients on Care of the Elderly wards with acute medical illness were questioned with regard to vaccination against influenza during the previous year. Of the 649 patients 279 were suitable for entry into the study. Of these 39% had been vaccinated against influenza. When considering the 171 who were not vaccinated, 25% (44 patients) had actually been offered and declined vaccination, in 46% of these cases due to previous side-effects, or fear of anticipated side-effects. In those unvaccinated three-quarters considered that the influenza vaccine was not efficacious. Unfortunately, patients with co-existing cardiac, respiratory or endocrine diseases were no more likely to have been vaccinated than were those without these diseases. Many older patients admitted with acute medical problems had not been vaccinated against influenza and the reasons for this included not being offered vaccination, a belief that influenza vaccination was not efficacious and concerns about possible side-effects. The role of community doctors and nurses in facilitating the vaccination of such an at-risk group is evident and should be incorporated into resource planning.     

Support among healthcare workers for the new mandatory seasonal influenza vaccination policy and its effects on vaccination coverage

IntroductionFinland was the first European country to introduce a nation-wide mandatory seasonal influenza vaccination policy for healthcare workers (HCWs) by mandating that administrators of health care institutions only employ vaccinated HCWs. In this study, we examine the effects of the new policy and the view of HCWs on the new policy.MethodsA cross-sectional observational study was conducted in Kuopio University Hospital among HCWs working in close patient contact. The statistics on vaccination coverage were obtained from the hospital’s own databases, where employees were asked to self-report their suitability for work. An anonymous survey was sent to HCWs in 2015–2016 (n = 987) and 2018–2019 (n = 821).ResultsVaccination coverage increased from 59.5 to 99.6%, according to the hospital’s own records. Among the survey respondents, the seasonal influenza vaccination coverage of HCWs increased from 68.2 to 95.4%. 83.8% of doctors and 49.4% of nurses supported the new policy. 12.7% of doctors and 41.5% of nurses found the new mandate coercive or that it restricted their self-determination.ConclusionsOur study confirms the positive effects of mandating the administrators of health care institutions to only employ vaccinated HCWs. The majority (57.9%) of all HCWs supported the new policy, with doctors being more compliant than nurses.

Key messages

• Finland became the first European country to mandate influenza vaccination for HCWs by mandating that administrators of health care institutions only employ vaccinated HCWs.
• After the new act, the vaccination coverage of HCWs increased close to 100%.
• Most of the HCWs supported the new act and did not find it coercive.

     

Attitudes and practices regarding influenza vaccination among emergency department personnel

In the United States, infections related to influenza result in a huge burden to the health care system and emergency departments (EDs). Influenza vaccinations are a safe, cost-effective means to prevent morbidity and mortality. We sought to understand the factors that contribute to the professional and personal influenza vaccination practices of health care workers in the ED setting by assessing their knowledge, attitudes, and practices with regards to the influenza vaccine. A cross-sectional study of all full-time ED staff (nurses, emergency medicine residents, and emergency medicine faculty) at an urban academic medical center in Boston treating > 90,000 ED patients annually, was performed. We examined knowledge, attitudes, and practices regarding personal influenza vaccination and support of an ED-based influenza vaccination program using an anonymous, self-administered questionnaire. Of 130 ED staff, 126 individuals completed the survey (97% response rate). Overall, 69% of respondents reported that they were very or extremely likely to be vaccinated before the coming influenza season. Residents (94%) and attending physicians (82%) were significantly more likely than nurses (42%) to be vaccinated (p < 0.001). Respondents likely to be vaccinated this year were more likely to support a vaccination program for ED patients (80% vs. 55% of those not vaccinated,p < 0.001). Providing regular education on the efficacy of preventive vaccination therapy and dispelling misconceptions regarding adverse effects may reduce barriers to vaccination programs. An educational initiative may result in acceptance of influenza vaccination by ED providers themselves, which could result in increased support for an influenza vaccination program for ED patients.     

Factors influencing the decision to comply with nurse recommendations to take or avoid influenza vaccination

Influenza is a major cause of morbidity and mortality. Although vaccination is an efficient means of prevention, low rates of vaccination are reported periodically. The study aimed to examine factors affecting acceptance of nurses' recommendations to take or avoid influenza vaccination. Study design was quasi‐experimental with a 2 × 2 between subjects design: two variables were manipulated and two were not. The research variables were expertise (of nurses and respondents), type of recommendation (to vaccinate or not) and respondents' a‐priori intention to vaccinate. Data were collected from 374 respondents. The study was scenario based, differing in nurse expertise and type of recommendation. After each scenario, the respondents were requested to indicate their a‐priori intention to vaccinate and to complete questionnaires on epistemic authority (EA) attributed to the nurse, and of self‐epistemic authority (SEA). There is a general tendency to avoid vaccination. Intention to vaccinate correlated positively with nurse recommendations, respondent a‐priori intention and nurse expertise. A significant three‐way interaction between respondents' SEA, nurse recommendations and nurse expertise was found. The nurse's recommendation has the strongest effect when the nurse is an expert and the respondent perceives him/herself as having high self‐EA. The results highlight the importance of patients' sense of knowledge for assuring their co‐operation and compliance with medical recommendations.     

Prevalence and correlates of influenza vaccination among non-institutionalized elderly people: An exploratory cross-sectional survey

Background

Worldwide pandemics of influenza virus caused extensive morbidity and mortality around the world and influenza vaccination is the most effective method for preventing influenza virus infection and its potentially severe complications. A large proportion of the Hong Kong elderly population has not undergone influenza vaccination. An exploration of the correlates will provide significant information to help identify ways of improving vaccination uptake among Chinese elderly people.

Objectives

To explore the prevalence and correlates of influenza vaccination Hong Kong Chinese elderly people aged 65 or above. To investigate any differences in attitudes toward influenza vaccination among Hong Kong elderly people with different levels of cognitive and physical functioning.

Design

An exploratory cross-sectional survey with two objective assessments was employed. Settings: Fifteen elderly centers in Hong Kong Special Administrative Region. Participants: A total of 816 Hong Kong Chinese elderly participants were recruited.

Methods

Face-to-face interviews were adopted to explore the demographic characteristics, perceptions, health status, knowledge, and resources of, and the influence of disease outbreaks on, influenza vaccination. Two objective validated instruments, the Chinese Mini-Mental State Examination (CMMSE) and the Barthel Index-Modified Chinese Version (MCBI) were used to assess the cognitive status and physical functioning of the participants.

Results

Approximately two in three individuals (62.4%) had undergone influenza vaccination. Lower cognitive and physical functioning scores were found among the non-vaccinated participants. Multivariate logistic regression analyzes revealed the significant correlates associated with influenza vaccination to be consideration of vaccination in the subsequent years (aOR = 7.877; p < 0.001); consideration of vaccination if all people aged 65 or above were eligible to receive free vaccination (aOR = 3.024; p = 0.002); the belief that there is a need to receive influenza vaccination following the Severe Acute Respiratory Syndrome (SARS) and avian influenza (aOR = 2.413; p = 0.001); receiving advice from nursing staff of elderly centers (aOR = 7.161; p < 0.001); the medical staff of elderly centers (aOR = 3.771; p < 0.001) or family members or friends (aOR = 3.023; p = 0.001).

Conclusions

The prevalence of elderly Chinese people undergoing influenza vaccination remains suboptimal. The government can promote vaccination by educating the public about the advantages, by publicizing locations where vaccinations are available, and having nursing, other medical staff, family and friends encourage elderly people to be vaccinated. A high vaccination coverage rate must be ensured to achieve international goals.     

Cancer nurses narrating after conversations with cancer outpatients: how do nurses’ roles and patients’ perspectives appear in the nurses’ narratives?

Aim: The aim of this study was to contribute to knowledge of nursing practice in the cancer care field by exploring cancer nurses’ perceptions of conversations with cancer outpatients. Background: Current practice at cancer outpatient clinics in Norway is that nurses have planned conversations with patients and relatives as a follow‐up after patient–physician conversations about assessment and medical treatment. Little is known about nurses’ experiences of conversations in the ambulatory context. This study reports the experiences of initial patient–nurse consultations. Data were collected in 2006–2007. Design: A qualitative phenomenological hermeneutic study was performed. A purposive sample of 12 cancer nurses was selected for qualitative interviews where nurses were narrating about conversation experiences. Significance and meaning of conversation experiences were analysed within a hermeneutic perspective, inspired by Ricoeur. Anonymity and voluntary participation procedures were followed. Ethical approval for the study was obtained from the Regional Committee for Medical Research Ethics of the region. Findings: There were plots of nurses experiencing conversations as hard work, routine work or artistry. The nurses’ conceptualizations of their roles as an information provider, or patient‐centred caring role were rooted in rules of the nursing community or in humanistic caring ethics. Differences of nurses’ perceptions and experiences of conversations are explained by different attitudes and role appreciations. Conclusion: Cancer nurses’ role appreciation and meaning horizons are guiding their perceptions of patient–nurse communication. Feeling free to act in interplay with patients’ voices, the patients’ perspectives become foreground. There is an educational challenge here in terms of developing methods to help nurses to discover how their mental work and meaning horizons guide conversational practice.