A few weeks ago a friend with a new grandchild whispered to me, "What am I going to do? My daughter doesn't want to get the baby vaccinated!" My dismay must have been evident as I spoke gently to her, "Oh Linda, I'm so sorry. What have you tried so far to convince her?" She went on to list her various tactics, everything from infomercial-style science to cajoling to arguing to demanding. Nothing was working. The baby had passed the time for its 2-month shots. The mother had even changed providers in order to find one that agreed to see her child without vaccinations.
What do we do as nurses? What is the best way to convince reluctant parents of the benefits of vaccination for all children? How do you talk to someone who is completely against vaccination and who believes the false news stories condemning their use?
Our tendency is to want to assign blame for the situation we find ourselves in as a society. How did we get where we are? What caused this sudden shift in vaccination usage? The causes would involve a long exploration of lots of studies and literature, but ultimately, parents have given birth to children in a time of deep distrust of the established way of doing things. That coupled with sensationalized stories of supposed harm from vaccinations may have led to drop in the numbers of children being vaccinated and to dangerous outbreaks of diseases like measles-once a rarity, now distressingly more common. Another factor pointed out by researchers is the fact that these childhood diseases, once common and dreaded passages of childhood, are now so uncommon that many parents have never witnessed the true misery they can inflict on a child and the potential sequelae. In their efforts to protect their child from harm, they mistakenly think that they are doing the best thing by not vaccinating.
The CDC does an impressive job with their easily accessible information on vaccination (Facts for Parents: For Parents of Infants and Young Children (birth through 6 years old) | CDC). Listing the 14 diseases that vaccines prevent before age 2, the CDC goes on to provide all the science and detail that parents might be interested in regarding those once common scourges: Chickenpox (Varicella), Diphtheria, Flu (Influenza), Hepatitis A, Hepatitis B, Hib, Measles, Mumps, Polio, Pneumococcal, Rotavirus, Rubella, Tetorifice, Whooping Cough (Pertussis).
So what's a nurse to do to counter this tsunami of non-compliance? How can we help our patients/parents understand the risks and benefits of vaccinations in a comprehensive way that promotes health for all children?
Stay respectful
Shaming and blaming are not great tools in our teaching toolkit. We have to acknowledge that just about every parent out there only wants what is ultimately best for their child. When we are less than professional we break the tenuous bridges of communication and miss out on an opportunity to offer that particular parent the benefit of our knowledge and expertise.
Listen with compassion to the parents' reasoning and motivation
Having open-ended conversations that allow for questions and answers has a chance of producing the desired outcome. When we listen, we build trust. When we build trust, we maximize the opportunity for success in being able to have our instruction received in a positive manner. This is easier to do when we remember that one of the contributing factors to the drop in level of inoculation may be the distrust between young parents and the established medical community.
Learn a few facts that can make an impression
One that I used several times this past flu season was the fact that children who were vaccinated for influenza got less sick than children who were not vaccinated and of those children who died, 74% had not had the vaccine (Influenza Vaccine Effectiveness Against Pediatric Deaths: 21-214 | Articles | Pediatrics). The number of statistics and the complexity of their interpretation can make our arguments seem like so much white noise to parents who are already overwhelmed. If we keep our advice on topic, our information to the point, it is possible that we will avoid turning the parents' attention setting to "off" before we get started. Sometimes it seems like we can be our own worst enemies as we try to cover every possible scenario, every single number, every potential complication-all in an effort to be complete. Is it possible that this is one of those times when less is actually more?
Lay down the law
After California laid down laws making it tougher for parents to get exemptions, vaccination rates rose among incoming school-age children (Vaccination rate jumps in California after tougher inoculation law). As professional nurses, we can all speak to our state officials and our representatives about the need for stricter vaccination standards.
Make it clear
Zach Horne, a graduate student in psychology at the University of Illinois at Urbana-Champaign researched the link between information and change in behavior related to vaccinations: "What's going on with anti-vaccination parents, we think, is because they haven't seen kids with measles and mumps, those consequences aren't that real to them." (There's a surprisingly simple way to convince vaccine skeptics to reconsider - The Washington Post) Is it possible that because parents had never seen the devastating effects of the "Big 14" listed above, they were less likely to inoculate? Horne and others emphasize that more work needs to be done. Meanwhile, could it help to show some pictures? It is unclear but may be helpful.
As nurses, we are ambassadors for accurate scientific information. As we help spread the good news that vaccinations really do help kids, may we do it with kindness, respect and also thoroughness. My friend's grandchild remains unvaccinated, but the conversation continues and has really only just begun.
