Evaluation of a team-based quality improvement initiative for influenza vaccination in an underserved population.

BACKGROUND: Influenza vaccine is the most effective way to prevent influenza. However, low vaccination rates continue especially in underserved populations. OBJECTIVES: To increase influenza vaccinations in an underserved population and to evaluate the impact of influenza vaccinations compared to previous year influenza vaccinations. PRACTICE DESCRIPTION: Federally-Qualified Health care Center for the Homeless, Richmond, Virginia PRACTICE INNOVATION: Team-based quality improvement initiative led by a pharmacist champion. EVALUATION METHODS: Before and after evaluation of the quality improvement initiative was conducted by comparing the total number of vaccines administered to those administered the previous year. RESULTS: Influenza vaccinations increased by 42% over the prior influenza vaccination season (1269 vs. 895), respectively. From a population perspective, 31% of patients received an influenza vaccine in 2019-20 and 48% in 2020-21. During the 2019-20 influenza vaccine season, the majority of patients vaccinated were female 56% versus 50.9% in 2020-21. The average age increased from 2019-20 to 2020-21, 37.62 years of age versus 42.71 years of age, respectively. CONCLUSION: A team-based quality improvement initiative was successful in improving our influenza vaccination program for adults and has served as a foundation for the delivery of other vaccines. Lessons learned were used to implement a COVID-19 vaccine program.

The Whanaungatanga Model of Care.

The 1988 Royal Commission on Social Policy recommended that the Treaty of Waitangi ('the Treaty'), be "enshrined" within social policy. Subsequently health care organisations have integrated the Treaty principles as defined by the Royal Commission (1988)--partnership, protection and participation--into the philosophies underpinning their services. Through the Treaty partnership at Tauranga Hospital a unique secondary health service evolved, one that is delivered by Maori for Maori. The Kaupapa nursing service at Te Puna Hauora implements an indigenous health model, the Whanaungatanga Model of Care, to guide nursing practice. This paper describes the Kaupapa Service and the model it uses. It also explores the benefits and challenges associated with implementing such a model.

Caring as an imperative for nursing education.

Caring is a universal need that is an important component in the delivery of nursing care. Nurse educators face the challenge of teaching the value of caring as a necessary part of nursing. Watson's theoretical framework, which focuses on interpersonal and transpersonal processes in human care, presents an effective model in understanding the concept of caring (1). Krathwohl, Bloom, and Masia's model of affective domain provides a taxonomy of affective competencies that guides the process of value development (2). Both models enhance our understanding of caring and provide the theoretical foundation for integrating caring into nursing education. This article describes an associate degree program's effort to thread the concept of caring across its curriculum. It includes an overview of the steps used for integrating caring in individual clinical courses and emphasizes teaching/learning and assessment strategies used in the educational process.

An outbreak of travel-associated Legionnaires disease and Pontiac fever: the need for enhanced surveillance of travel-associated legionellosis in the United States.

Travel-associated outbreaks of legionnaires disease (LD) and combined outbreaks of LD and Pontiac fever (PF) are rarely identified. During one travel-associated combined outbreak at a hotel, a cohort study of potentially exposed persons and an environmental investigation were performed. Two LD and 22 PF cases were identified. Legionella pneumophila serogroup 6 (Lp6) isolates from the index patient and the hotel whirlpool spa were found to be identical by amplified fragment-length polymorphism typing. Disease occurred in 10 of 26 guests who were exposed to the spa versus 2 of 29 guests who were exposed only to the pool area (38% vs. 7%; P=.005). Immunoglobulin M (IgM) antibody to the outbreak Lp6 strain was more common among persons with PF (4 of 9) than among non-ill persons (2 of 32) (44% vs. 6%; P=.02). Spa exposure correlated with disease (P=.001) and IgM seropositivity (P=.007). New laboratory techniques facilitate outbreak investigation; to expedite outbreak interruption and measure the impact of travel-associated legionellosis, surveillance must be improved.