According to the Centers for Disease Control and Prevention (and many other reputable health organizations around the world), vaccines are safe and effective for preventing disease at the individual and population levels. So why, given this straightforward, scientifically proven and cost-effective medical intervention are so many children in the United States going unvaccinated and why has that trend been increasing since 2001? The recent eruption of measles in New York City is but one troubling example of the toll the decision to not vaccinate can take. How, many health care workers and public health planners are asking, can childhood vaccination rates be increased?
Second-year doctor of nursing practice (DNP) student Shelby Pope believes the answer to the second question resides in education – specifically, by sharing evidence-based data with parents so they can make informed decisions.
“Two essential components of modern nursing are communication and patient education,” Pope observed. “Time and again, these have been shown to be central to safe and effective care.” For her family nurse practitioner (FNP) practice-improvement project, Pope – who served in the United States Army as a chaplain’s assistant before becoming a nurse – intends to use these tools to help increase childhood vaccination rates.
“I have always been pretty passionate about vaccines, even before I decided to go the advanced practice route,” Pope commented. “Vaccines are one of the greatest gifts of modern medicine.”
At the heart of Pope’s project is the recognition that various “social determinants” play a significant role in vaccination rates. Researchers, she points out, have shown that children from households below the federal poverty line have lower combine seven-vaccine series coverage (62.8%) compared with children living at or above the poverty line (73.8%). Another influential factor is health insurance. Uninsured families have the lowest vaccination rates (48.5%); those with private insurance have the highest (76%).
In addition to working full time with St. John Clinic Urgent Care in Tulsa, Pope is currently laying the groundwork for her investigation. She intends to set it in a primary care office that has a high ratio of uninsured pediatric patients or in a health department that serves the local community, ideally in or near her present home community of Skiatook. “In either case,” she noted, “it will be important for the quality of my study’s findings and potential impact to ensure diversity in practice types, practice settings and patient populations.”
Once Pope has identified and secured a location, the next step will be an initial chart review documenting the ratio of vaccine-compliant patients. “Then, once I have completed the education component, I will conduct a second chart review to compare pre- and post-intervention rates. This comparison will enable me to gauge my project’s effectiveness and identify areas for improvement.”
Pope proposes taking a “multimodal educational approach.” This will consist of verbal education for health providers that’s based on the latest research. In addition, Pope is planning for parents to employ visual education using electronic media and written education using printed handouts.
For the electronic media portion, Pope has chosen a free app called Vaccines on the Go: What You Should Know, which was developed at Children’s Hospital of Philadelphia (CHOP). Some of the information contained in this app are vaccines and the diseases they prevent, safety concerns associated with vaccines and recommended immunization schedules broken out by age group.
“I recognize,” Pope said, “that not everyone will have a computer, smartphone or other mobile devices in order to access this app. Therefore, I’m building into my project the ability for parents to have the option of touring the app on a tablet at the health care office prior to their appointment time.”
In addition to using digital technology, Pope will provide printed handouts from CHOP’s Vaccine Education Center. She will also give written instructions on how to find accurate medical information in the internet.
“Childhood vaccination rates have decreased over the past several years, and research is needed to find out why,” said Dr. Sandi Mellor, APRN, FNP-BD, who is an FNP professor with TU’s School of Nursing. “Vaccination programs have clearly reduced the disease burden in communities. Barriers to getting children vaccinated must be overcome through positive discussions of the benefits of vaccinating and an honest review of medical evidence. I believe that Shelby is on the right track with her approach.
“My own experience as a nurse practitioner has shown me that meeting patients and their families where and how they are comfortable receiving information – for example, through handheld digital technology, as Shelby is proposing – is vital to communicating scientific evidence and persuading people to make positive behavioral changes.”
Investing in our communities
While Pope’s project is driven by science, that is not her only motivation. Her research also is infused with a profound ethical orientation toward what she regards as her professional duty.
“If more people aren’t willing to get out into their community, change just isn’t going to happen. You can only talk so much and expect things to happen. And they just don’t. That’s why it’s important for nurse practitioners to invest in their communities and track ‘which of my patients are really struggling?’ and ‘why are they struggling?’ and ‘what do these people have in common?’ and ‘how can I address those issues?’”
Now in her second year in TU’s DNP program, Pope transferred here from an online DNP program. Two of the major reasons for her decision were the emphasis at TU on in-class learning and the university’s commitment to arranging career-relevant clinical placements for every student, something that is very challenging for nurse practitioner students. If you are interested in taking your nursing career to the next level, find out more about our ACEN-certified DNP program.