Evidence Of Nursing For Varicella Infection In Children: A Case-Control Study

The Study Conducted by Glanz et al. (2010)

Describe about the Evidence of Nursing for Varidella Infection in Childrens.

In this article, Glanz et al. (2010), describe a research study that aimed to review the attributable risk associated with varicella infection in those children whose parents refused the varicella immunizations. The authors used a case-control study in order to identify whether varicella infected children were more probable to have obtained parents refusal against varicella immunization than a like group of children who did not develop this infection. The authors gathered information regarding the potential cases of the infection by the use of KPCO automated databases and the case status by reviewing the medical records of potential cases. The data was collected with the use of a logistic regression model on the unmatched data, sex, controlling for age and the extent of KPCO enrollment.

The whole experiment was conducted in “Kaiser Permanente of Colorado (KPCO) health plan” between the years 1998 and 2008. The experiment was conducted on children between the age 12 months to 8 years old and all the children were of the members of the health plan. The total number of case diagnosed with vericella was 133 and number of controls taken were 493.  The authors made certain special considerations regarding the research in ethical manner. While conducting the research it was important to get informed consent of the participants so that the research could have been understood clearly. The ethical issue that should have been a matter of concern was that parent’s believe regarding the immunization and the actual approach to reduce the complications could have clashed with each other (Glanz et al., 2010).

The study conducted had clinical implications and it was observed that universal immunization against this infection had notably reduced the rates of hospitalization and mortality in children. The research thus highlights the fact that nursing intervention if implemented and contribution of nursing leadership can impact positively on the reduction of mortality rate in children. With regards to the study conducted, it has been observed that children of vaccine refusing parents are prone to the risk of varicella illness nine times more than normal children. According to Glanz et al. (2010), the data obtained revealed that five percent vericilla infected children were immunization refused. According to the authors this study was able to reduce the biases that exist due to o misclassification of exposure and outcome by validating both varicella vaccination status and varicella case status with a detailed medical record review.

Study Findings and Clinical Implications

The strength of the study is that the statistics of parental refusal has helped to realize the risks associated in a broad population and affect of immunization on morbidity and mortality. The key limitations of the study was that the whole population was selected from a specific health care plan that is KPCO and the diagnostic bias associated with the varicella in children can be associated with risk. Moreover, there was not sufficient statistical data to evaluate the link the vaccine refusal and infection by year 1998 to 2008. In the future this study can be used to recognize the risk associated with varicella infection and instant treatment can be devised to cure the infected children (Glanz et al. 2010).

In this article, the authors focused on reviewing the evidence that there is an elevation of immunization uptake with mandates (Lee & Robinson, 2016). The data were extracted and created qualitatively since the study was designed with regards to heterogeneity. In this study the authors used systematic protocol based on the “Preferred Reporting Items for Systematic Reviews and Met-Analyses (PRISMA) statement. The aim of this study was to evaluate the effect of immunization mandates on long-term or short-term uptake of schedule immunization in children. The inclusion criteria was compared immunization rates with a specific population prior and subsequent to the new immunization mandate of a pre-present mandate. On the contrary, resource limited setup studies were excluded from the study.

In this study, a total of twenty one studies were used out of which eleven before and after studies were selected. Data was collected and summarized in standard form with data was reviewed by both the authors. Data collected involved study design, age range, country, publication year, immunization and intervention. The data were synthesized qualitatively. The data arch identified 15,522 articles in total, out of which 42 complete articles were reviewed. Then out of these 42 articles 21 articles were involved in the studies (Lee & Robinson, 2016).

According to the author, evidences revealed in terms of short-term introduction of mandates or improved mandates are linked to higher immunization level. Moreover, mandates that existed from long-term reflected higher up-to-date status of immunization. The main focus of the introduction of mandates is to reduce the incidence of diseases. For example, in Hull, the rate of incidence of measles is more than that of Ottawa after the introduction of the mandates at the school level six years back. Moreover, two studies revealed the fact that the mandates of immunization are uniformly efficient. Thus, the authors conclude the fact that improved enforcement and introduction of immunization mandates in school entry or middle school has elevated the uptake of vaccine in a pool in which the mandate relates to both long-term and short-term application. However, the authors while conducting the study has advice to be caution before administration of the vaccine mandates (Lee & Robinson, 2016).

The main strength of this article is that this is the only systematic review based n immunization mandates. However, here are several limitations of this article. First of all, the non-English studies were excluded. Secondly, the methodology prohibited comparing studies. Thirdly, majority of the studies were conducted in demographic, cultural and political climates in US are different from other industrial countries. Fourthly, all the studies were unable to manage for perplexing factors like the media coverage, vaccine preventable diseases, modification in the insurance coverage, and mandates on the vaccination rates. Lastly, the reports obtained from the parents regarding immunizations might be inaccurate. Thus, the study reveals the fact that mandate immunization can increase the rate of prevalence of a disease with regards to long-term or short-term affect (Lee & Robinson, 2016).

This study focuses on the effectiveness of proper information in meeting the needs of the parents. The main aim of the study is to understand the need of the parents in regards to child immunization in order to optimize data shared to the parents by the rural health professional Miller et al. (2008), in this article the authors used a descriptive qualitative study type by conducting semi-structured interviews of the legal aged mothers who are responsible for taking decisions about immunization their children in the previous year. Identification of vaccine used throughout the year has been an effective intervention which has assisted in the reduction of morbidity and mortality in the childhood.

The public health nurses employed in the “Rural South Area of Calgary Health Region” proceeded with the recruitment of parents in order to complete the study. The inclusions of the study were legal age, experience of making decision regarding immunization of their infants in the past year, the infant should be two or less than two years and resident of rural area. A total of thirty nine parents volunteered to participate but two of them did not match the criteria and so they were excluded from the study. In this article the authors reported that the data collection method was semi-structured interviews. According to Miller et al. (2008), the data collected was based on the questions constructed specifically for the interview and the questions involved four areas of interest. The four areas are whether the data contributed were according to their decision or not, type of information or contents needed by the parents, the types of sources of data considered to be trusted and helpful and parents suggestion on the amount of information that can be given to them effectively. Ata were analyzed using the qualitative content analysis method. After the data were collected these information was documented, coded and compared with the existing categories.

Study Findings and Implications

The ethical clearance was given by “Community Research Ethics Board of Alberta (CREBA), Canada based on the tools used and the study design. The results of the study conducted were categorized into five classifications and they are complete immunization at the recommended age, immunized at an older age, selective immunization, and undecided and not immunized. The study revealed that there are factors that influence mother’s decision, concern of the mother in making decision, perception of good information, need of information by the mother and recommendations to the health professionals. Through the study conducted it has been confirmed that proper information regarding the immunization has influenced the decision making process of the parents. Moreover, the results obtained from the studies revealed information that would help to improve the health practice (Miller et al. 2008).

The main strength of the study was that the information gathered through the interview would help in the future to realize the importance of data provision to the parents in order to motivate their decision making regarding infant immunization. The limitation of the study was a small human resource utilized for conducting the study. Secondly, the study only motivated the mother’s to participate and the geographical location were limited to rural area Miller et al., 2008).

Evidences based on the reports of the experts, immunization the practice of immunization varies. Such practices are expected to produce potential outcomes for the health care professionals and their clients. However, there are several barriers that have been observed in order to achieve the ideal vaccination practice. According to the three articles, lack of information, knowledge, mandates and importance of immunization can increase the risk of any severe disease. Nursing practice if implemented in this arena can create a major difference to the public health. In regards to the vaccination practice, the nurses should act as a guide in incorporating the importance vaccine in the community. The three articles have same viewpoint regarding the immunization mandate. All the three articles states that immunization can reduce the morbidity and mortality rate of a community and therefore the awareness of vaccination should be developed among people through nursing intervention (Glanz et al. 2010).

The first article deals with the refusal to the varicella virus by the parents causing the children prone to the varicella infection and this leads to the elevated child mortality. The study therefore, indicated that if the number of vaccine refusing parents continues to get elevated across the globe, it can be realized that the incidence of this disease related to immunization refusal will also increase withy time. According to high immunization rate would be able to prevent the spread of the infection in the community. Therefore, it is the duty of the nurses to develop certain interventions such as community based education that can help to motivate the parents to realize the significance of immunization as a preventive method (Lee & Robinson 2016).

In regards to the second article, mandates in terms of immunization can help to improve the rate of vaccination in children especially in the school children. Parents are generally not aware of this indirect benefit of immunization. Therefore, it is important to recognize the immunization practice that exists in the local community nurses who have the ability to vaccinate the school based children Lee & Robinson (2016). The nursing practice in the school level children where vaccination is a mandate can motivate the other individuals of the community to avail the immunization. Moreover, the responsibility of the nurses towards immunization can create awareness in the community and among other health professionals

According to Lee & Robinson (2016), there is importance of providing proper information to the parents in order to make them realize the importance of vaccination or provoke them to avail immunization for their children. The study impacts the nursing practice by stating that local nurses can provide support to the parents by inculcating their process of decision making related to child information. It was the help of the nursing practice that aided in observing the reluctance of certain parents regarding immunization. Therefore, it can be concluded that the nursing role can be highly effective in implementing and improving the safety, education, information and vaccination of the children in the community. With the help of the nurses the rate of immunization can increase in the society thereby decreasing the various risk factors associated with the diseases (Glanz et al. 2010).

References:

Glanz, J. M., McClure, D. L., Magid, D. J., Daley, M. F., France, E. K., & Hambidge, S. J. (2010). Parental refusal of varicella vaccination and the associated risk of varicella infection in children. Archives of pediatrics & adolescent medicine, 164(1), 66-70.

Lee, C., & Robinson, J. L. (2016). Systematic review of the effect of immunization mandates on uptake of routine childhood immunizations.Journal of Infection, 72(6), 659-666.

Miller, N. K., Verhoef, M., & Cardwell, K. (2008). Rural parents’ perspectives about information on child immunization. Rural Remote Health, 8(2), 863.