One Nurse’s Approach to Discussing the COVID-19 Vaccine

How Do We Have the Difficult Conversation with the Greatest Chance of Success?

Over a year and a half later, we are still in this pandemic looking for a light at the end of the tunnel. As people and even healthcare workers continue to refuse the COVID vaccine, how can we approach this discussion? What techniques can we use to try to improve vaccination rates? Here is an approach I have found to be most effective.

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How Do We Have the Difficult Conversation with the Greatest Chance of Success?

I am a pediatric pulmonary nurse coordinator and remain per diem as a bedside NICU nurse. I made the decision to get vaccinated a couple of months after it became available at my hospital. As the vaccine was brand new, I put a lot of thought and research into it before making my decision. Ultimately, based on the facts I found and the science, I decided the benefits outweighed the risks. While I felt I would be okay if I were to get COVID, as I am relatively young and very healthy, we have all seen exceptions to this. However, I moreso felt a responsibility to those at higher risk in my personal life and my professional life—Most of all my vulnerable patients.

I believe this reasoning was the driving force for a lot of healthcare workers to get vaccinated—more than just any fear of contracting COVID themselves. I think this is why we all get so emotional when it comes to still discussing the vaccine and the pandemic. In fact, just about a month ago after a particularly hard week, I could not wait to get home. It had been a week filled with parents arguing against the vaccine for their children. A week filled with ordering COVID tests for children who might end up hospitalized if they were to turn out positive. A week of writing school letters for patients to ensure accommodations that would keep them safe. A week of parents demanding letters from our section stating their child should be exempt from wearing a mask to school. A week of explaining to parents why we could not write that letter because their child would be safest with a mask.

Not Making A Difference

Due to these taxing conversations, it was no surprise how upset I became when I was driving home on my hour-long commute behind a bumper sticker that read, “Unmask our kids.” I tried to ignore it but it kept catching my eye until it eventually overwhelmed me and brought me to tears. Tears we have all cried during this pandemic, even if in different roles and different levels of care for our communities. Tears from being burnt out and unheard. Tears from being unappreciated. Tears from feeling like we are trying so hard, but not making enough of a difference.

So where do we go from here, over a year and a half into this new way of life? When our co-workers and friends are refusing vaccinations, what can we do? They are people with the same basic training as us, but somehow do not view the science and statistics the same way. I have spent a lot of time contemplating this. In my opinion, it comes down to Roger’s diffusion of innovation theory.

It Takes Time For Ideas To Gain A Following

If you are not familiar, Roger’s diffusion of innovation theory essentially explains how it takes time for ideas or products to gain a following. The adoption of this idea or product happens throughout five stages or groups. First, we have the innovators, who make up just 2.5% of the population and seek out new ideas such as this vaccine. Next, we have the early adopters, 13.5%, who embrace change. After that, the early majority, 34%, who usually need to see some evidence of this idea or product and its success, but still adopt it before others. Then we have the late majority, 34%, who are skeptical, but once tried by the majority they will adopt the change. Finally, we have the laggards, the last 16%, who are very conservative to change, but may eventually give in to the majority because of things like pressure or fear.

In terms of nursing, I usually consider myself the early adopter. I love to keep up on the latest research and changes. I get excited when I see a new study and think, “I want to implement that in my practice or on my unit!” However, when it came to the vaccine, I was more of the early majority. Since statistically, my personal risk was low, I thought it might be better for me to wait for more people to get vaccinated and see if any side effects appeared. However, as my coworkers began to get vaccinated and the momentum grew, I decided not to wait any longer. As stated before, I weighed my risk and benefits and from the statistics I had seen initially, I decided it was better to go for it.

However, I think what makes me an excellent confidante for talking to coworkers as well as patients and their families about the COVID vaccine is that initial hesitancy I felt. We as healthcare workers know to assess risks versus benefits of everything. We also know that so many medications or products can come with side effects, however minimal. We have often seen first hand these very things, even after much research and FDA approval, get pulled off the market due to side effects that are not seen until much later. This is why we have a duty to do our due diligence, as I believe I did mine prior to deciding the vaccine was the best choice for me. This is also why I see the importance of discussing such controversial matters.

Thus that is how I start these hard conversations. I do not dwell on politics. I do not attack people’s opinions. I do not insult people. I keep my emotions in check. I try to meet people where they are and understand what they are seeing. Now, albeit some people cannot be reasoned with, but in my opinion, those people only make up a fraction of the “laggard group.” So to have these conversations, I revert back to the basic building blocks of our careers—including therapeutic communication and being non-judgmental. This approach can give us the added bonus of not being as emotionally invested and thus help prevent additional burnout by these conversations.

Use Psychology and Research

In combination with these techniques, I try to use psychology and research to help make my case successful. For instance, when you listen and agree with the other person, you make them feel understood. This is as easy as, “If I were you, I would feel the same way if that was the information I had.” Not immediately disagreeing with people opens up a better line of communication and makes them more likely to also listen to your point of view. Personally, I actually do feel many who are hesitant do have valid concerns based on the knowledge they have. Additionally, we do not have to get defensive off the bat and we can ask to share our point of view as well. We can admit to certain shortcomings of the vaccine, such as how those who get vaccinated can still get COVID. We can then use this as an opportunity to explain why the vaccine is still beneficial, such as lessening symptoms. Trying to have an honest conversation where both parties are heard can truly have a profound impact in my experiences.

Beyond that, a study looking at the adoption of evidence-based practice (EBP) using Roger’s diffusion of innovation theory found that adoption is influenced by individual motivation, attitude, knowledge, work experience, and the perception of EBP attributes. Interestingly, attitude was found to have the greatest effect on adoption of a change. The article suggests that changes should thus be promoted through, “use of cognitive principles that can change people’s attitudes in positive ways”1. I like to think this is similar to the approach I use based on therapeutic communication and psychology as described above.

Take A Step Back

Sometimes the best thing we can do whether we are at the bedside with one patient, speaking with a coworker, or trying to sway a group opinion, is just take a step back. Take a step back to breathe and listen. Give people space to express themselves and establish rapport. Remember that decisions take time and people all reach decisions differently, as we often see day to day in our field. While we feel the urge to get as many people vaccinated as quickly as possible in hopes that it will help rid our communities of COVID, we need to remember that we cannot simply force things onto people and expect them to happen. In a world where the past year and a half has been so complicated, we may need to simplify our approach to get the best results. We also may need to understand that while doing this work, based on the theory of diffusion, it may still take time. However, we need to keep having the difficult conversations until we begin to reach of late majority and laggards. There really is a light at the end of the tunnel, but unfortunately, adoption of change takes time and the COVID vaccine is no exception to this theory. However, by focusing on how we approach implementation, we can perhaps shorten this timeline.

References

1Evaluating the adoption of evidence-based practice using Rogers’s diffusion of innovation theory: a model testing study

Natalia Dabrowska, MSN-CNL, RN - Pediatric Pulmonary Nurse Coordinator at Yale New Haven Children's Hospital. Nurse and Safety Coach at Connecticut Children's Medical Center at UConn Health in the Neonatal Intensive Care Unit.

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Guest219794

2,453 Posts

Thoughtful and well written.
Thank you.

 

 

CFitzRN, ADN

385 Posts

Specializes in L&D; GI; Fam Med; Home H; Case mgmt. Has 15 years experience.

The basic premise of this article is condescension. "We are right, they are wrong, so how do we make them do what we want?"  And this is what I find with the gene-therapy pushing crowd. They won't consider any of the evidence that the gene therapy injection may NOT be what's best, or listen to the statistics indicating that some populations with the highest injection rates are acquiring more infections now. We "laggers" are educated and trained. We can think critically and make decisions for ourselves. We, too, consider the science and the research. How about you trust that we have valid reasons for our hesitancy and not treat us like children who need to be convinced to your side of the argument?  

Guest219794

2,453 Posts

32 minutes ago, CFitzRN said:

We, too, consider the science and the research.

No.  You don't.  Not really.  

32 minutes ago, CFitzRN said:

How about you trust that we have valid reasons for our hesitancy and not treat us like children

Guest219794

2,453 Posts

34 minutes ago, CFitzRN said:

We "laggers" are educated and trained. We can think critically and make decisions for ourselves

 

37 minutes ago, CFitzRN said:

gene therapy injection

Your choice of words there does a pretty good job establishing your credibility.

Maybe explain a little more about the training you have, and the research you did that brought you to a different conclusion from the experts in the subject.  By experts, I mean the overwhelming majority of critical docs, virologists, folks like that.

Have you noticed the relationship between advance education and training and accepting vaccinations?  Any thoughts on why you haven't seen that article about all the doctors leaving the profession because of vaccine requirements?

 

CFitzRN, ADN

385 Posts

Specializes in L&D; GI; Fam Med; Home H; Case mgmt. Has 15 years experience.
10 minutes ago, hherrn said:

No.  You don't.  Not really.  

Oh look, more condescension. Imagine my shock.  

macawake, MSN

2,141 Posts

Has 15 years experience.
54 minutes ago, CFitzRN said:

And this is what I find with the gene-therapy pushing crowd. They won't consider any of the evidence that the gene therapy injection may NOT be what's best, or listen to the statistics indicating that some populations with the highest injection rates are acquiring more infections now.

 

The ”gene therapy crowd”?

mRNA vaccines are NOT gene therapy. 

The vaccines never enter the nucleus where DNA resides. It does not and cannot interact with or change the DNA. Therefore it is not gene therapy. 
 

And the vaccines work. I’m sure that you know that unvaccinated individuals are dying from Covid infections at a much higher rate than vaccinated individuals? The following indicates that unvaccinated people have been dying at an eleven times higher rate than vaccinated folks, since the Delta variant became the dominant variant in the US.


https://www.bmj.com/content/374/bmj.n2282
 

54 minutes ago, CFitzRN said:

We "laggers" are educated and trained. We can think critically and make decisions for ourselves. We, too, consider the science and the research. How about you trust that we have valid reasons for our hesitancy and not treat us like children who need to be convinced to your side of the argument?  

No, you haven’t demonstrated that you are capable of critical thinking if you think that it’s correct to call mRNA vaccines, gene therapy. I’m sure that you’ll think I’m being rude, but I’m just stating the truth. 
 


https://www.genomicseducation.hee.nhs.uk/blog/why-mrna-vaccines-arent-gene-therapies/

Gary Mendoza

84 Posts

Specializes in Emergency Department.
1 hour ago, macawake said:

 

The ”gene therapy crowd”?

mRNA vaccines are NOT gene therapy. 

The vaccines never enter the nucleus where DNA resides. It does not and cannot interact with or change the DNA. Therefore it is not gene therapy. 
 

And the vaccines work. I’m sure that you know that unvaccinated individuals are dying from Covid infections at a much higher rate than vaccinated individuals? The following indicates that unvaccinated people have been dying at an eleven times higher rate than vaccinated folks, since the Delta variant became the dominant variant in the US.


https://www.bmj.com/content/374/bmj.n2282
 

No, you haven’t demonstrated that you are capable of critical thinking if you think that it’s correct to call mRNA vaccines, gene therapy. I’m sure that you’ll think I’m being rude, but I’m just stating the truth. 
 


https://www.genomicseducation.hee.nhs.uk/blog/why-mrna-vaccines-arent-gene-therapies/

mRNA is absolutely gene therapy, unless you're saying the NIH doesn't know what they're talking about. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4817894/

How about respecting peoples freedom of choice instead of trying to use mandates, trickery and psychology to manipulate them and make them comply.

maji2002

40 Posts

3 hours ago, CFitzRN said:

The basic premise of this article is condescension. "We are right, they are wrong, so how do we make them do what we want?"  And this is what I find with the gene-therapy pushing crowd. They won't consider any of the evidence that the gene therapy injection may NOT be what's best, or listen to the statistics indicating that some populations with the highest injection rates are acquiring more infections now. We "laggers" are educated and trained. We can think critically and make decisions for ourselves. We, too, consider the science and the research. How about you trust that we have valid reasons for our hesitancy and not treat us like children who need to be convinced to your side of the argument?  

Calling it "gene therapy" totally negates your argument that you have thought critically , are educated and considered the science.  You indeed have not.

toomuchbaloney

9,777 Posts

Specializes in NICU, PICU, Transport, L&D, Hospice. Has 44 years experience.
3 hours ago, CFitzRN said:

Oh look, more condescension. Imagine my shock.  

You haven't provided any evidence that you are following the science and evidence.  Your remarks suggest otherwise. Imagine our shock that yet another antivaxx stance is unsupported by science but quickly assumes the posture of victim.  This time the member is a victim of "condescension" rather than bullying. 

Shrugs

macawake, MSN

2,141 Posts

Has 15 years experience.
2 hours ago, Gary Mendoza said:

mRNA is absolutely gene therapy, unless you're saying the NIH doesn't know what they're talking about. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4817894/

How about respecting peoples freedom of choice instead of trying to use mandates, trickery and psychology to manipulate them and make them comply.

I’ve read your link. Can you explain in your own words what part of it you think proves that the Covid vaccines are gene therapy? I’m guessing that it’s the title and that you haven’t even read the rest of the article. Do you interpret that article as the NIH specifically confirming that the vaccines should be classed as gene therapies? The article does not make that claim. Do you understand the details of the article? The reason I say that is because I’ve seen that particular article referenced before by people who either don’t understand how the vaccines work or who are deliberately attempting to spread disinformation about the vaccines.
 

By the way, would you like to explain what your understanding of what a gene is? And how you think the vaccines do anything to a person’s genes? (you know, the therapy part in ”gene therapy”…)
 

mRNA is genetic material so I guess it would be fair to call the mRNA vaccines ”genetic-based”. However, that’s not the same thing as gene therapy.

Gene therapy involves making a deliberate change to a person’s DNA in order to treat or cure a disease or disorder. 
 

I feel I need to repeat this one more time. The mRNA in the vaccines DO NOT and CAN NOT enter a cell’s nucleus. That’s where you find the DNA. That means that the vaccines can’t interact or change a person’s DNA. 

I’ve seen this false allegation about the vaccines being gene therapy so many times online. It is always said by people who are either trying to defend their own choice to not get vaccinated, but more often it is said to try to fearmonger about the vaccines.

 

Here are two links that explain what gene therapy really is:


https://www.fda.gov/vaccines-blood-biologics/cellular-gene-therapy-products/what-gene-therapy
 


https://www.mayoclinic.org/tests-procedures/gene-therapy/about/pac-20384619
 

 

Guest219794

2,453 Posts

What would be great is if at least some of this thread was about the OP.  The OP is not about mandates.  There are threads about mandates, and that would be a great place to complain about mandates.

If you want to debate the science, maybe start a thread, establish your credentials, and explain why your interpretation of the science is different from most scientists.

This is about education.  Her job is to educate people using the best information available, and that is what she is doing.

Her approach is based on respect, and she cites her sources for her methods.