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Monday, May 29, 2017

Nursing opinion and vaccinations

TED talk: 

Nurses need to reclaim their roots in public health.

Why I changed my mind on vaccinations! by Dani Stringer

By RNL Editors | 05/11/2017- from Sigma Theta news

For pediatric nurse practitioner Dani Stringer, presenting a TED talk was a dream come true.

Dani Stringer, MSN, CPNP, PMHS, always wanted to give a TEDx talk but was still shocked, and felt immensely humbled, when Grand Canyon University asked her to present her views on vaccination.

“In addition to explaining why I left vaccine-hesitancy behind and now advocate for immunizations, I explored the critical need for people to depolarize the vaccine debate by communicating with kindness," Stringer says. 

“This is a topic that has been very personal for me for several years. Both with KidNurse [her website] and in practice, I've seen that parents have a dire need to better understand vaccines.

By now, you’ve undoubtedly seen the mass media coverage about the measles outbreak in the United States. With nearly 200 measles cases confirmed just in the first few months of 2015 and rapidly continuing to spread throughout the country, epidemiologists and public health experts predict these outbreaks are not going away. In fact, at this rate, we are expected to surpass the number of cases seen in 2014.
That is incredibly substantial when you consider that the number of measles cases in 2014 marked a 20-year high. Did you catch that? Twenty-year high. America hasn’t seen this many cases of the measles for decades.

Now that Disneyland, that iconic symbol of childhood paradise and happiness, has been tainted by vaccine-preventable infectious disease, a firestorm of controversy has erupted. Everything from national news stories to your Facebook newsfeed has likely been inundated with measles information, opinions, and, all too often, overly passionate arguments.

National decline of herd immunity

As a pediatric nurse practitioner and author of the blog KidNurse.org, I have been following and even breaking news on the measles outbreak. When a local Arizona pediatrician shared his thoughts in a letter after his immune-compromised daughter with leukemia and his infant son were exposed to measles by a simple visit to urgent care, I published it in my blog. 

At the time, millions saw the story, and I had to work around the clock just to keep my site from crashing. Measles outbreaks have become the quintessential example of why vaccines are so important in combatting—and reversing—our national decline of herd immunity. The world is watching and waiting, and I have been watching and waiting as well.

As one who daily takes care of young children in an Arizona outpatient clinic, I held my breath as I read the notification from our county department of health stating that measles had been confirmed in Arizona. 

As a matter of fact, with the massive outbreak in California, I knew it was only a matter of time to hear about infections in Arizona, but it was disheartening, nonetheless. And it hit way too close to home when I received a fax message that one of my patients, too young to be vaccinated, had been exposed to the measles. Because the infant’s older brother has cystic fibrosis, it was especially concerning.

I immediately called the child’s mom and described the extremely contagious nature of measles and the typical quarantine process, explaining why she would have to cancel her child’s birthday party and keep him inside the house for 21 days. As frustrating as it is for any parent to receive that news, what’s worse is constantly waiting for the other shoe to drop and thinking that every runny nose may develop into a life-threatening disease. That’s information no healthcare provider wants to give a parent.

The next day at work, I couldn’t help but feel gloomy when I posted signs, as instructed by the public health department, on the door of our clinic, warning parents of the outbreak and providing quarantine precautions. It reminded me of what I had read about steps taken by the federal government back in the 1920s, when quarantine notices were nailed on the doors of infected homes. Were we really going through this again?

Where I’m coming from

As knowledgeable about vaccines as I now consider myself to be, I wasn't always that way. When I was younger, I was swept up into vaccine skepticism as well, and that experience gives me a different perspective on the vaccine debate than most healthcare providers have.

It’s true; I used to be part of the anti-vaccination movement. As a child, I received every vaccine recommended. But, as time progressed and my parents had more children, they were misled by the rising doubt about the harm versus benefits of vaccines, and confusion set in. By the time my third and fourth siblings were born in the 1990s, they received very few vaccinations. Why would my highly educated parents make such a decision? Well, in part, because of the decline in infectious diseases.

The glory of vaccine efficacy in dramatically reducing—if not eliminating entirely—global, deadly diseases has fallen prey to its own success. Like my mom and dad, many parents are no longer intensely motivated to vaccinate children the way our grandparents were. It’s simply human nature. Nothing illustrates this better than a Gallup poll taken back in May 1954, in the midst of the national polio crisis when thousands of children became paralyzed from that horrible disease. The poll found that more Americans knew about the field trial of Jonas Salk’s polio vaccine than knew the full name of Dwight David Eisenhower, the U.S. president at the time. Viewed against the background of the current and very vocal anti-vaccine movement, this survey is especially astonishing.

In the words of Paul A. Offit, MD, a leading infectious disease physician and vaccine advocate, “Once you’ve scared them, it’s hard to un-scare them.” When parents become afraid, whether from facts or myths, it’s difficult to fully leave that fear behind. However, fearing vaccines more than deadly diseases is incredibly misguided.

My journey

As knowledgeable about vaccines as I now consider myself to be, I wasn’t always that way. … It’s true; I used to be part of the anti-vaccination movement.

Because of the anti-vaccine views I had been exposed to as a child, I had to go on a journey to understand this for myself. In becoming a nurse, I studied and explored the science and research behind vaccines, and later, working in the trenches further opened my eyes. When you hear the gasping of a 1-month-old fighting pertussis and witness a desperate mother crying by the child’s bedside, you never forget it. When you work with a child who has lost his arms and legs from meningitis, you always remember. When you hospitalize a limp toddler for severe dehydration from rotavirus, you learn. When you hear that a newborn died in your county shortly after birth because her mom just had a case of varicella, you mourn. But most of all, when you work with little children suffering—and sometimes dying—from terrible diseases that are preventable, you change. I changed.

I believe vaccines are safe, effective, and absolutely the best defense we—individuals and communities—have against infectious diseases. As a pediatric nurse practitioner, I’ve vaccinated thousands of children, and I spend time each day educating parents about the importance of vaccines. Vaccinations are crucial for public health.

My parents were not alone in their anti-vaccine beliefs. Many parents and caregivers are still making the decision not to vaccinate. As nurses, we must address the importance of immunizations in our daily practice. My participation in the vaccine debate has taught me several important lessons.

Nurse voices vital to public health

First and foremost, when nurses speak, people listen. 

Pediatric Nurse Practioner

Year after year, the public ranks nurses as the most trusted professionals. Many nurses freely advocate for the health of their patients but sometimes fail to advocate effectively on health issues to the public. When I started writing about children’s health on my blog, I thought my mom and a few friends would read it—if I was lucky. To my extreme surprise, more than 2 million people have visited Kid Nurse since I started writing the blog. People are desperate for health information from experienced, trustworthy healthcare professionals, and nurses need to fill that gap.

Secondly, when it comes to discussing vaccinations, nurses must figuratively take off their white coats. We need to communicate with care and personal understanding to make ourselves as approachable as possible. The debate about immunization is emotionally driven and fueled by fear. As nurses, we need to use our empathy skills to understand where people are coming from before presenting the science and research that supports vaccines. To get to the heart of the matter, we need to first ask people about their fears and concerns.

Finally, I fully believe it’s time for nurses to reclaim our roots in public health. 

Vaccinations, nursing, and public health are inseparable. 

Public health in America would never have been established the way it is today without the devotion and dedication of public health nurses. Lillian Wald transformed New York City in 1893 with the creation of the Henry Street Nurses’ Settlementorganization. By 1933, this public health organization served more than 100,000 people who, otherwise, would not have had access to healthcare.

Nurses have the same opportunity today, and advocating for vaccines is a foundational aspect of this mission. As daunting as the vaccine debate and the measles outbreak may be, nurses play a critical, irreplaceable role. It’s time to find our voices and join the conversation.

Dani Stringer, MSN, CPNP, PMHS, is a pediatric nurse practitioner in Arizona. When she isn’t seeing lots of little patients in the office, she spends her time blogging at www.kidnurse.org with the goal of bringing public awareness to children’s health.
Editor's note: Dani Stringer passed her pediatric nurse practitioner certification exam in January 2011 at the age of 18. At that time, she was the youngest nurse practitioner in the United States. 

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