A Simulation Experience for Preparing Nurses to Address Refusal of Childhood Vaccines.

BACKGROUND: Parents' refusal of childhood immunizations presents a challenge to the provision of care to children. Nurses should be prepared for having difficult conversations with vaccine-refusing families and for contributing to discussions with their colleagues regarding whether to continue to provide care to these families. METHOD: A novel high-fidelity ethics simulation experience was developed and implemented in the pediatrics course of a baccalaureate nursing program. The simulation experience involved a clinical scenario in which nurses encountered and addressed parental vaccine refusal and discussed options for addressing refusal with their physician colleagues. RESULTS: Three themes emerged from analysis of the students' evaluations of the simulation experience. Students reported feeling better prepared for addressing vaccine hesitancy, having greater awareness of their own biases toward vaccine-refusing families, and becoming newly acquainted with their potential role in enforcing practices' dismissal policies for vaccine-refusing families. CONCLUSION: Nurse educators should consider incorporating ethics simulation experiences into existing ethics instruction and clinical training. [J Nurs Educ. 2020;59(4):222-226.].

Nurses' Perspectives on the Dismissal of Vaccine-Refusing Families From Pediatric and Family Care Practices.

PURPOSE: Dismissal of families who refuse mandated childhood vaccines from pediatric practices has become more common among US pediatricians over the past 2 decades. While nurses (registered nurses [RNs] and advanced practice registered nurses [APRNs]) often are the first health-care professional to encounter parents' vaccine hesitancy and serve as a primary source of information, there are no published data on nurses' perspectives on dismissal as a response to vaccine refusal. This study examined nurses' perspectives on dismissal of vaccine-refusing families from primary care practices. DESIGN: Cross-sectional survey administered electronically from February to September 2018. Data analysis was conducted from November 2018 to March 2019. SETTING: Data were collected electronically from a national sample of nurses. SUBJECTS: A convenience sample of 488 primary care nurses (74% APRNs) was recruited and enrolled in the study through collaboration with 4 professional nursing associations. MEASURE AND ANALYSIS: A cross-sectional survey was conducted from February to September 2018. We explored correlates of nurses' (n = 488) attitudes toward dismissal by modeling attitude scores as a function of practice and respondent characteristics. We also modeled odds of encountering vaccine refusal and odds of reporting dismissal of a vaccine-refusing family in the last 12 months, each as a function of respondents' practice characteristics. RESULTS: Eighty-four percent of respondents encountered vaccine refusal in the previous 12 months, and 22% reported that their practice had dismissed a vaccine-refusing family within the previous 12 months. Twenty-eight percent agreed/strongly agreed that they would dismiss or support a decision to dismiss families who refuse all vaccines, and 12% supported dismissal of families for refusal of some but not all vaccines. Thirty-nine percent of respondents disagreed/strongly disagreed with dismissing families who refuse all vaccines, and 50% disagreed/strongly disagreed with dismissal for refusal of some but not all. CONCLUSION: Almost all nurses working in primary care encounter vaccine refusal, and most consider all Centers for Disease Control and Prevention-recommended childhood vaccines to be important to public health. There is significant polarization of nurses' attitudes toward the appropriateness of dismissal as a response to vaccine refusal. We recommend the development of professional nursing guidelines for responding to vaccine refusal. However, because there are no data on the community health impact of dismissal policies, we recommend further research on outcomes of dismissal policies to inform such guidelines.

Perspectives of public health nurses on the ethics of mandated vaccine education.

BACKGROUND: Since 2015, Michigan has required parents who request nonmedical exemptions (NMEs) from school or daycare immunization mandates to receive education from local public health staff (usually nurses). This is unlike most other US states that have implemented mandatory immunization counseling, which require physicians to document immunization education, or which provide online instruction. PURPOSE: To attend to the activity and dispositions of the public health staff who provide "waiver education". METHOD: This study reports results of focus group interviews with 39 of Michigan's vaccine waiver educators (37 nurses), conducted during 2016 and 2017, and analyzed in 2018. FINDINGS: Four themes emerged from analysis of the transcripts of these interviews: Participants had (1) complex and nuanced observations and evaluations of parents' judgments and feelings about vaccines and vaccine education; (2) sympathetic attitudes about alternative vaccine schedules; (3) critical and supportive evaluations of institutional policies and the background political context of immunization education; and (4) consistent commitments to respect parents, affirm their values, and protect their rights. DISCUSSION: These results show that public health nurses are sensitive to the burdens mandatory immunization education places on families, the motivations for parents' requests for nonmedical exemptions, and the values implicated by personal immunization decisions and government immunization policies. In light of the unique training, experiences, and public reputation of nurses, there is good reason for additional investigation into the roles that nurses can play in immunization education and in vaccine mandate policies, more generally.

Nurses' Voices Matter in Decisions About Dismissing Vaccine-Refusing Families.

APRNs and RNs have a stake in these policies-and an invaluable perspective to contribute.

Genomic Contraindications for Heart Transplantation.

Genome sequencing raises new ethical challenges. Decoding the genome produces new forms of diagnostic and prognostic information; however, the information is often difficult to interpret. The connection between most genetic variants and their phenotypic manifestations is not understood. This scenario is particularly true for disorders that are not associated with an autosomal genetic variant. The analytic uncertainty is compounded by moral uncertainty about how, exactly, the results of genomic testing should influence clinical decisions. In this Ethics Rounds, we present a case in which genomic findings seemed to play a role in deciding whether a patient was to be listed as a transplant candidate. We then asked experts in bioethics and cardiology to discuss the implications of such decisions.

Geographic variations in electronic cigarette advertisements on Twitter in the United States.

OBJECTIVES: Studies have identified a proliferation of e-cigarette advertisements on Twitter. We investigate whether the prevalence of e-cigarette related advertising is associated with state tobacco regulations after taking socio-economic characteristics into account. METHODS: We collected e-cigarette related tweets from July 23 to October 14, 2015 (n = 757,167) on Twitter. State regulations and smoking prevalence were provided by the Campaign for Tobacco-Free Kids program. The socio-economic data were provided by the American Community Survey. RESULTS: The number of commercial tweets was 319,041/day with a high potential reach (830,495,700/day). The prevalence of commercial tweets varied significantly by US state. The higher prevalence of e-cigarette advertising was associated with states with better tobacco control impact (r = 0.54, p < 0.0001) and lower youth smoking prevalence (r = -0.39, p = 0.005). In the multivariate analysis, state tobacco control impact is significantly associated with the prevalence of commercial tweets (ß = 0.03 ± 0.01, p = 0.02). CONCLUSIONS: Policies at both the federal and state levels are needed to regulate the content of commercial tweets and mitigate the negative effect of social media advertisements.

Whole-Genome Sequencing and Disability in the NICU: Exploring Practical and Ethical Challenges.

Clinical whole-genome sequencing (WGS) promises to deliver faster diagnoses and lead to better management of care in the NICU. However,several disability rights advocates have expressed concern that clinical use of genetic technologies may reinforce and perpetuate stigmatization of and discrimination against disabled persons in medical and social contexts. There is growing need, then, for clinicians and bioethicists to consider how the clinical use of WGS in the newborn period might exacerbate such harms to persons with disabilities. This article explores ways to extend these concerns to clinical WGS in neonatal care. By considering these perspectives during the early phases of expanded use of WGS in the NICU, this article encourages clinicians and bioethicists to continue to reflect on ways to attend to the concerns of disability rights advocates, foster trust and cooperation between the medical and disability communities, and forestall some of the social harms clinical WGS might cause to persons with disabilities and their families.