ABSTRACT
Human papillomavirus (HPV) infection, the most common sexually transmitted disease in the US, is a preventable cause of cancer. HPV vaccination has the potential to prevent 90% of HPV-related cancer cases but is underutilized, especially among American Indian/Alaska Native (AI/AN) adolescents. The objectives of this study were to (1) describe trends and identify predictors of HPV vaccination initiation and completion in Michigan's AI and Non-Hispanic White children age 9 through 18 years and (2) to identify barriers to HPV vaccination and promotion methods at the tribal, state, and local levels in Michigan. Data from Michigan's immunization information system from 2006 to 2015 were used for analysis. Additionally, semi-structured interviews were conducted with public health professionals across the state to identify barriers to and promoters of HPV vaccination. Predictors for vaccine initiation included being female, AI/AN, and living in high poverty zip code. Predictors of vaccine completion were female gender and younger age at vaccine initiation. Barriers to vaccination included misinformation and weak or inconsistent provider recommendations. Strategies used by health professionals to promote HPV vaccination included immunization summaries, vaccine information statements, the Vaccines for Children (VFC) program, and provider training. Findings suggested the need for education of parents to demystify HPV vaccine benefits and risks and provider training for more consistent recommendations.
Subject(s)
Health Promotion/methods , Immunization Programs/organization & administration , Indians, North American , Papillomavirus Infections/prevention & control , Papillomavirus Vaccines , Patient Acceptance of Health Care , Adolescent , Child , Female , Health Personnel , Humans , Interviews as Topic , Male , Michigan , Minority Groups , Papillomavirus Infections/ethnology , Poverty , Vaccination , Vaccination Coverage , White PeopleABSTRACT
RATIONALE: Caring for patients at the end of life is emotionally taxing and may contribute to burnout. Nevertheless, little is known about the factors associated with emotional distress in intensive care unit (ICU) nurses. OBJECTIVES: To identify patient and family factors associated with nurses' emotional distress in caring for dying patients in the ICU. METHODS: One hundred nurses who cared for 200 deceased ICU patients at two large academic medical centers in the Northeast United States were interviewed about patients' psychological and physical symptoms, their reactions to those patient experiences (e.g., emotional distress), and perceived factors contributing to their emotional distress. Logistic regression analyses modeled nurses' emotional distress as a function of patient symptoms and care. RESULTS: Patients' overall quality of death (odds ratio [OR], 3.08; 95% confidence interval [CI], 1.31-7.25), suffering (OR, 2.34; CI, 1.03-5.29), and loss of dignity (OR, 2.95; CI, 1.19-7.29) were significantly associated with nurse emotional distress. Some 40.5% (79 of 195) of nurses identified families' fears of patient death, and 34.4% (67 of 195) identified families' unrealistic expectations as contributing to their own emotional distress. CONCLUSIONS: Patients' emotional distress, physical distress, and perceived quality of death are associated with nurse emotional distress. Unrealistic family expectations for the patient may be a source of nurse emotional distress. Improving patients' quality of death, including enhancing their dignity, reducing their suffering, and promoting acceptance of an impending death among family members may improve the emotional health of nurses.
