Addressing Vaccine Hesitancy: A Nursing Perspective.

PURPOSE: Vaccination is one of the most successful and cost-effective health promotion interventions, preventing millions of deaths per year. Vaccine hesitancy (VH) received renewed attention in the United States when over 30 million Americans were undecided or had barriers to receiving the COVID-19 vaccine. The purpose is to examine the literature regarding vaccine hesitancy, its history and legal aspects. DESIGN: An interprofessional team of a lawyer and two nurses reviewed the literature to synthesize the history of vaccine hesitancy and documented effective strategies to address disinformation, misinformation, and other barriers to vaccine uptake. METHODS: The authors conducted a thorough review of the literature regarding vaccine hesitancy, including legal aspects. FINDINGS: There is a scarcity of available literature regarding effective strategies, especially from the nursing perspective. Much of the literature on vaccine hesitancy dates back to the 1970's, offering few strategies to address this issue. Nursing implications and strategies to address vaccine hesitancy from a nursing perspective are provided, including an innovative example of preparing nursing students to address vaccine hesitancy through participation in a high-fidelity simulation. CONCLUSIONS: Vaccination uptake is impacted by misinformation and disinformation. Vaccine hesitancy is impacting the uptake of other routine immunizations putting Americans at risk. Regardless of vaccination policies, health care professionals must be prepared to communicate with people who have a wide range of VH. Strategies such as providing accurate information, addressing patient concerns, and reducing barriers to access decrease VH.

Vaccine Hesitancy: Developing Competency in Nursing Students Through Simulation.

BACKGROUND: Many Americans are undecided about or have barriers to receiving vaccines. Complacency, confidence, convenience, misinformation, and disinformation impact vaccine hesitancy (VH). PROBLEM: During the COVID-19 pandemic, rates for flu and routine childhood vaccinations declined globally. As vaccination rates decline, the risk of disease outbreaks increases. Nursing students need to be prepared to address VH in the clinical setting. APPROACH: Four simulation experiences were developed to build confidence and competency in the provision of vaccinations and addressing VH. Nursing students practiced communication skills critical to motivational interviewing, health education, health promotion, and goal setting. OUTCOME: There were statistically significant increases in student confidence and perceived competence in vaccine administration and addressing VH through motivational interviewing. CONCLUSIONS: High-fidelity simulation combined with a virtual simulation was effective in developing confidence among nursing students. Students demonstrated skill in addressing VH and motivational interviewing.

Toward user-centered assistive technologies for aging in place with cognitive impairment: a survey.

PURPOSE: To reduce the burden of Alzheimer's disease, the use of assistive technologies for patients and their informal caregivers is considered essential. However, these technologies are made as "one size fits all" instead of being tailored to accommodate people with varying degrees of cognitive impairment and those with diverse races/ethnicities. Thus, the aim of this survey was to determine whether the types of assistance needed most, and the technology used by those with cognitive impairment differed by race (White/non-Hispanics, Black or African Americans, and Hispanic/Latinos or Puerto Ricans) and severity of dementia (mild, moderate, severe). RESEARCH DESIGN AND METHODS: One hundred and eighty informal caregivers of people with different levels of severity of cognitive impairment and several different races/ethnicities filled out an online survey regarding assistance needed and technologies used. RESULTS: The results show that racial minorities considered the needs for assistance with Basic Activities of Daily Living as more important compared to White/non-Hispanics with mild dementia. Furthermore, Hispanic/Latinos or Puerto Ricans and White/non-Hispanics with severe dementia were shown to use technology that is designed to help with Instrumental Activities of Daily Living more than those with moderate dementia. Lastly, during COVID-19, devices to assist with walking, preparing meals and personal hygiene have been used significantly more by White/non-Hispanics with severe dementia compared to Hispanic/Latinos or Puerto Ricans. CONCLUSION: The results point to the need to design for those with severe dementia, regardless of race, and should focus on addressing needs related to both Instrumental and Basic Activities of Daily Living.

Developers of assistive technology should consider designing technology that can accommodate all severity levels of cognitive impairment.More research is needed to determine the usability of assistive technology that is designed for those with cognitive impairments.

Teaching Social Determinants of Health Through an Unfolding Case Study.

BACKGROUND: The impact of social determinants of health (SDOH) was developed to educate nursing students through the use of an unfolding case study. PROBLEM: SDOH and population health are critical components of prelicensure nursing education. Unfolding case studies are a strategy to develop critical thinking and teach SDOH to nursing students. APPROACH: A model was used to develop the case study including a community assessment, which follows a male veteran and family through life events. Implementation of the unfolding case study took place over 3 consecutive semesters in a community health nursing course. OUTCOMES: This educational activity achieved standardized examination scores, which are intended to assess student preparedness for the National Council Licensure Examination (NCLEX), above the national averages. Student participation was above 90%. CONCLUSION: Unfolding case studies can present realistic scenarios that are useful to teach critical thinking. As the Next Generation NCLEX moves to scenario-based testing, unfolding case studies are a teaching strategy to prepare students.

Disability Attitudes of Nursing Students: A Curriculum Intervention.

ABSTRACT: People with disabilities (PWD) have reported that health care workers' negative attitudes are among the most significant barriers to accessing health care services. PWD constitute one quarter of the population, yet the curriculum for PWD is inconsistent. This study describes a curriculum intervention allowing student interaction with a panel of PWD to change nursing student attitudes. Surveys were administered before and after the intervention. Our pilot study did not reveal a significant change in attitudes, which suggests that more exposure to PWD and education may be needed.

Appraisal of disability attitudes and curriculum of nursing students: a literature review.

Worldwide, more than one billion people live with a disability (World Health Organization. (2011). World report on disability. Retrieved from https://www.who.int/disabilities/world_report/2011/report/en/). People with a disability (PWD) have unmet needs with the delivery of health care, secondary to nursing student's negative attitudes, knowledge, and skill deficits. This integrative literature review evaluated nursing student's education and attitudes towards PWD. Deficient education, attitudes, knowledge, and skills are addressed. Combined search terms utilized included: healthcare students; healthcare education; nursing students; clinical experience; clinical rotation; attitude of health care students; and exposure to PWD. Thirty articles were analyzed with common themes identified. Educational methods that produced improved attitudes, knowledge and skills included standardized patients with disabilities; phenomenological approaches; curriculum enhancement; empathy exercises and clinical experiences (Anderson, E. S., Ford, J., & Thorpe, L. (2011). Learning to listen: Improving students' communication with disabled people. Medical Teacher, 33(1), 44-52. doi: 10.3109/0142159X.2010.498491; Castro, S. S., Rowe, M., Andrade, L. F., & Cyrino, E. G. (2018). Developing competencies among health professions students related to the care of people with disabilities: A pilot study. Interface: Comunicacao, Saude, Educacao, 22(65), 551-563. doi: 10.1590/1807-57622016.0684; Hensel, D., Malinowski, C., & Watts, P. A. (2015). Implementing a pediatric camp clinical for pre-licensure education. Nursing Education Perspectives, 36(1), 60-61. doi: 10.5480/12-871.1; Levett-Jones, T., Lapkin, S., Govind, N., Pich, J., Hoffman, K., Jeong, S. Y., . . . Everson, N. (2017). Measuring the impact of a 'point of view' disability simulation on nursing students' empathy using the comprehensive state empathy scale. Nurse Education Today, 59, 75-81. doi: 10.1016/j.nedt.2017.09.007; Smith, P., Ooms, A., & Marks-Maran, D. (2016). Active involvement of learning disabilities service users in the development and delivery of a teaching session to pre-registration nurses: Students' perspectives. Nurse Education in Practice, 16(1), 111-118. doi: 10.1016/j.nepr.2015.09.010). Nursing schools must incorporate disability education to fully realize its impact and eliminate barriers to transform care.