How Nurses Can Help Improve Vaxx Rates

[jeastridge, BSN, RN]

Facts vs. Myths

Myth - Herd Immunity

The office nurse addressed the mom after reviewing her chart, “So it looks like it is time for Christopher's shots.” She listed what was due and then the mom countered that she did not want the vaccinations. The nurse began to explore further, “So why would you say that?” The mom was well-read and listed off her concerns regarding the safety of immunizations. The nurse presented information about the specific concerns that mother put forth. The mother countered with the concept of “herd immunity” and how her child was unlikely to get sick because so many other children were vaccinated. The nurse patiently went on to explain the recent outbreaks of common childhood diseases and the seriousness of some of these illnesses.

Myth - Getting sick builds the immune system

The final argument the mom submitted was that “getting sick builds their immune system.” The nurse responded from something she had read in a nursing journal, “Yes, but you wouldn’t break a child’s leg just because you think it will grow back stronger.” She said it with humor and the mother laughed as the nurse exited the room to gather more information and let the physician know about the mother’s concerns.

Fact - Responsibility for Public Health

When he came in, he talked with her more about “herd immunity” and the responsibility we all have to protect everyone’s health; the risks to her child were extremely small. With recent outbreaks on the rise, her child would be more at risk than ever.

Unfortunately, this exchange is real and although the details are changed somewhat, this is an actual patient interaction. All too often physicians and nurses are spending valuable care time trying to educate parents and counter rumors, unfounded and false information, and myths about vaccinations.

Studies show that patients trust doctors and nurses above other sources of information. In fact, "73% of people worldwide would trust a doctor or nurse more than any other source of health advice, including family, friends, religious leaders or famous people.” (https://wellcome.ac.uk/reports/wellcome-global-monitor/2018).

Why do vaccination myths proliferate?

Why do myths and misinformation seem to proliferate at a rapid rate in our time? Why do people seem to be more inclined to believe hyperbole and “personal testimony” over the factual studies evinced in medical journals?

Here are some possible explanations to think about regarding fringe news becomes mainstream:

• The internet may make “fast food” learning the norm. With a headline-grabbing statement, unscrupulous players can manipulate public opinion to serve their own purposes.
• The average person doesn’t have the energy to distinguish between true and false. In more modern news, we are subject to input that requires less critical thinking and leans instead toward emotional responses with split-second judgments. Studies have found that older adults (ages 60+) are much more susceptible to believing untruths without question.
• There is a general distrust of government, studies and science as people are bombarded with conflicting information and a plethora of sources.
• The prevalence of misinformation is so high that some colleges are offering actual courses in identifying “***.” In one syllabus the professors state: “Our aim in this course is to teach you how to think critically about the data and models that constitute evidence in the social and natural sciences.” (http://www.openculture.com/2017/01/calling-***.html)

How can parents validate sources of vaccination information?

In their recent publication, “Making PIES out of PEACH,” a number of nurses with advanced degrees who are with the Vaccine Task Force list some of the problems with the anti-VAXX movement and their publications and information. The list of issues includes: outdated information, biased sources, discredited sources, selective information, false information, and irresponsible actions. In Engaging in Medical Education with Sensitivity (EMES), the authors conclude: “EMES recommends that healthcare providers listen to and respect concerned parents.”

For parents, they offer a number of recommendations including caution about sources of information, offering practical suggestions about how to check sources and how to read studies. They suggest, for example, that parents stick to “.edu” or “.org” sites and be cautious about “.com” addresses online. Some other highlights include checking dates on studies, reading about the authors, noting the disclosure section and checking to see if the study was repeated.

The CDC and the American Academy of Pediatrics both publish thoughtful and thorough vaccination information, attempting to answer every question put out there by concerned parents. While the anti-vaxx movement has grown and continues to produce erroneous information at a rapid pace, the trust parents place in nurses and doctors remains high.

What can nurses do?

As professionals, we must become well-informed and be prepared to answer incorrect statements with facts based on valid studies. We must not give into anger or to passivity in our responses. We must continue to be educated, to understand statistics and studies, to be able to discern what is factual and what is not. It is our job to help keep children and the larger population healthy by using every means at our disposal to spread the most accurate studies available.

I recently was helping out my daughter and took my granddaughter to visit her pediatrician’s office for her shots. The nurse administered her vaccinations flawlessly and provided the necessary paperwork. After the visit, the nurse again showed great finesse charming my little one with a sticker and silly faces. As I left, I thought about the great influence nurses have in an office setting and beyond, making the most of the few minutes of contact they have with the child, parents or extended family. We can, and must, continue to use our influence to promote information that leads to genuine health improvements for all.

[Luchador, CNA, EMT-B]

Great article.

[vintagemother, BSN, CNA, LVN, RN]

Indeed, it is very helpful for us, as nurses to explore pts reasons for not vaccinating to then help explain the benefits of vaccinations.

[JKL33]

4 hours ago, jeastridge said:

The nurse responded from something she had read in a nursing journal, “Yes, but you wouldn’t break a child’s leg just because you think it will grow back stronger.”

I would strongly advise against this tactic. Approaches involving argumentum ad absurdum are quite likely to make people feel insulted, and why wouldn't they feel that way? You have equated the concern with something nearly everyone can easily judge as being ridiculous.

We can do better than that.

???

[Jory, MSN, APRN, CNM]

The first part of the problem is nurses perpetuating vaccination myths. You can't control what someone does in their personal life, but you can control what they do in their professional life. Nurses that perpetuate vaccination myths should be swiftly disciplined.

This includes other treatments, such as Vitamin K after birth and erythromycin.

Problem number two is pediatricians and even neonatologists that cater to it.

Delayed vaccination schedules, in the absence of a medical condition that would warrant such a move, places an infant/child at risk and it is a schedule that is not evidence-based nor built on years of research. Anytime a vaccination is delayed, your child is unprotected.

I have heard, "My pediatrician said I could do a delayed schedule, he said there was nothing wrong with it"...yup, because your pediatrician is trying to keep you as a patient and is putting financial gain ahead of patient care.

I do believe in patient choice....but you still give the correct information, "Yes, you can do the delayed vaccination schedule, but it is against medical advice. We will administer the vaccines when you are comfortable or on an alternative schedule, but you need to sign this form where you acknowledge that an alternative schedule is not the current recommendation and will not optimally protect your child."

[jeastridge, BSN, RN]

On 7/31/2019 at 7:07 PM, JKL33 said:

I would strongly advise against this tactic. Approaches involving argumentum ad absurdum are quite likely to make people feel insulted, and why wouldn't they feel that way? You have equated the concern with something nearly everyone can easily judge as being ridiculous.

We can do better than that.

???

Agreed. Not recommended as a response. Joy

[jeastridge, BSN, RN]

54 minutes ago, Jory said:

The first part of the problem is nurses perpetuating vaccination myths. You can't control what someone does in their personal life, but you can control what they do in their professional life. Nurses that perpetuate vaccination myths should be swiftly disciplined.

This includes other treatments, such as Vitamin K after birth and erythromycin.

Problem number two is pediatricians and even neonatologists that cater to it.

Delayed vaccination schedules, in the absence of a medical condition that would warrant such a move, places an infant/child at risk and it is a schedule that is not evidence-based nor built on years of research. Anytime a vaccination is delayed, your child is unprotected.

I have heard, "My pediatrician said I could do a delayed schedule, he said there was nothing wrong with it"...yup, because your pediatrician is trying to keep you as a patient and is putting financial gain ahead of patient care.

I do believe in patient choice....but you still give the correct information, "Yes, you can do the delayed vaccination schedule, but it is against medical advice. We will administer the vaccines when you are comfortable or on an alternative schedule, but you need to sign this form where you acknowledge that an alternative schedule is not the current recommendation and will not optimally protect your child."

Thank you for your thoughtful response. You offer some concrete suggestions that have potential for making a difference. Joy