Methods of Current Practice: Qualitative Analysis of Intervention Strategies Utilized by Vaccine Waiver Educators in Michigan

By enacting administrative rule 325.176 (12), Michigan added a vaccine education component as a precondition to granting vaccine waivers to vaccine-hesitant parents wishing to file a nonmedical vaccine exemption for their school-aged child. The purpose of the study was to identify best practices for reaching vaccine-hesitant parents during face-to-face vaccine education sessions conducted by vaccine waiver educators in Michigan. This study utilized qualitative descriptive content analysis of semi-structured phone interviews with vaccine waiver educators from local health departments (LHDs) in Michigan. Participants were vaccine waiver educators who were employed by a local health department in Michigan and had conducted at least 30 vaccine waiver education sessions. Strategies, resources, and techniques identified by educators as beneficial included using and providing information from a variety of sources, compiling their own educational materials, creating a positive experience, holding personalized sessions, and streamlining exemption and vaccination sessions. However, unexpected themes that emerged from the interviews revealed that vaccine waiver educators need additional training in discussing vaccine ingredients with parents, handling religious vaccine exemption requests, and assessing the role of schools. Implementing successful vaccine education interventions targeting vaccine-hesitancy is crucial to public health. Charging LHDs with overseeing vaccine education via a face-to-face discussion is a novel intervention strategy, the effective implementation of which may inform vaccine education intervention nationwide and may even be translated into international contexts and prove useful to current COVID-19 vaccination efforts.

More Than a Story: My Life Came Back to Life

PURPOSE

Social models of aphasia rehabilitation emphasize the importance of supporting identity renegotiation, which can be accomplished in part through personal narrative construction. The purpose of this study was to examine the experiences of persons who had engaged in a project to coconstruct personal narratives about life with aphasia.

METHOD

Qualitative interviews were conducted with 3 participants with aphasia who completed a 4-week personal narrative coconstruction project, which included preadministration and postadministration of the Communication Confidence Rating Scale for Aphasia (Cherney & Babbitt, 2011). Results were analyzed using interpretative phenomenological analysis.

RESULTS

Three themes were revealed: (a) More than a story: It changed my life validated the idea that the narrative coconstruction process supported a positive view of identity; (b) A positive experience captured the participants' enjoyment in coconstructing and sharing their story; (c) Hope engendered by the coconstruction experience empowered participants with new levels of confidence not only in their communication skills but also in themselves.

CONCLUSIONS

This study provided insight into the experience of coconstructing personal narratives using a structured protocol. Participants experienced the project as a positive, meaningful opportunity to actively contemplate their life and look forward. The study has implications for clinicians considering support of identity renegotiation in aphasia rehabilitation.

The Knowledge-about-Older-Patients - Quiz (KOP-Q) for nurses: Cross-cultural validation between the Netherlands and United States of America

BACKGROUND

The Knowledge about Older Patients-Quiz (KOP-Q) is designed as a unidimensional scale measuring knowledge of hospital nurses about older patients. Furthermore, the KOP-Q measures a second unidimensional construct, certainty of hospital nurses about their knowledge. The KOP-Q is developed and validated in the Netherlands. Whether the KOP-Q can be used in other countries is unknown given the cultural and language differences.

OBJECTIVES

Investigate the level of measurement invariance of the KOP-Q between the Netherlands and United States of America (USA).

DESIGN

A multicenter international cross-sectional design.

SETTINGS

Four general hospitals in the Netherlands and four general hospitals in the USA.

PARTICIPANTS

Nurses from the Netherlands (n=201) and the USA (n=130) were invited to participate by email from the ward manager, distributing flyers and present messages on the online hospital communication boards. Questions of the KOP-Q were completed online.

METHOD

The level of measurement invariance (configural, metric or scalar invariance) across countries was tested by running increasingly constrained structural equation models, and testing whether these models fitted the data.

RESULTS

Both the knowledge and certainty construct of the KOP-Q proved unidimensional in the Netherlands and USA sample. Test results of the measurement invariance across the Netherlands and USA indicated a stable, partial scalar invariance (15 items full scalar invariance) for the knowledge items and full scalar invariance for the certainty items.

CONCLUSIONS

The KOP-Q shows to function uniformly across both language groups and can therefore be used to assess nurses' knowledge and their certainty about this knowledge which can be important for educational and/or quality improvement programs in the USA. Furthermore, the KOP-Q is suitable to make comparisons between the Netherlands and the USA using latent variable models. Before the KOP-Q can be used in other countries, cross-cultural tests should again be performed.

Nurse middle managers contributions to patient-centred care: A 'managerial work' analysis

Nurse middle managers are in an ideal position to facilitate patient-centred care. However, their contribution is underexposed in literature due to difficulties to articulate this in practice. This paper explores how nurse middle managers contribute to patient-centred care in hospitals. A combination of time-use analysis and ethnographic work was used to disclose their contribution to patient-centred care at a micro level. Sixteen nurse managers were shadowed for over 560 hours in four hospitals. Some nurse middle managers seldom contribute to patient-centred care. Others are involved in direct patient care, but this does not result in patient-centred practices. At one hospital, the nurse middle managers did contribute to patient-centred care. Here balancing between "organizing work" and "caring work" is seen as a precondition for their patient-centeredness. Other important themes are feedback mechanisms; place matters; with whom to talk and how to frame the issues at stake; and behavioral style. Both "hands-on" and "heads-on" caring work of nurse middle managers enhances their patient-centeredness. This study is the first of its kind to obtain insight in the often difficult to articulate "doings" of nurse middle managers with regard to patient-centred care through combining time-use analysis with ethnographic work.

Association Between Attitude Toward Death and Completion of Advance Directives

Advance directives provide health-care instruction for incapacitated individuals and authorize who may make health-care decisions for that individual. Identified factors do not explain all variance related to advance directive completion. This study was an analysis of an association between advance directive completion and death attitudes. Surveys that included the Death Attitude Profile—Revised were completed anonymously. Comparisons of means, chi-square, and logistic regression tests were conducted. Among individuals who did not consider themselves religious, the mean death avoidance attitude scores differed significantly among those with advance directives (mean = 1.93) and those without (mean = 4.05) as did the mean approach acceptance attitude scores of those with advance directives (mean = 5.73) and those without (mean = 3.71). Among individuals who do consider themselves religious, the mean escape acceptance attitude scores differed significantly among those with advance directives (mean = 5.11) and those without (mean = 4.15). The complicated relationships among religiosity, advance directives, and death attitudes warrant further study.

Coverage and representation of condoms in conjunction with HIV/AIDS in the Kenyan Daily Nation Newspaper from 1989-2003: a qualitative content analysis to inform health promotion

HIV/AIDS has been a pressing problem in the East African country of Kenya for over 20 years. Promotion of condom use is one prevention strategy embraced in global health prevention of HIV, but use remains relatively low in Kenya. In order to better understand the socio-historic context of discourses about condoms in Kenya, this study explored how condoms were covered and represented in the Kenyan Daily Nation newspaper from 1989-2003. Qualitative content analysis was conducted for 91 items from the Daily Nation including articles, letters to the editor, columns, opinion and editorial pieces, advertisements, and cartoons. These items were systematically examined for the manner and content of manifest and latent references to condoms. Researchers found four major themes, "controversy and confusion," "we need to do more: condoms might help," "not for Kenyans or from Kenyans," and "stigmatized associations." Findings provide needed insight into the socio-cultural context surrounding condoms in Kenya that is often lacking within health promotion and HIV prevention programs.

Clerical frames for nursing practice: missionary nurses at Rehoboth

This paper presents a discourse analysis of publications of the Christian Reformed Church regarding its Rehoboth Mission near Gallup, New Mexico, among the Navajo. All issues of The Banner, Acts of Synod of the Christian Reformed Church, the Rehoboth Hospital Bulletin, and the Annual Report of the Rehoboth Mission from 1880 to the present were reviewed for references to health-care at Rehoboth from 1903 to 1943. Four religiously framed discourses were identified: discourses justifying provision of health-care at the mission, discourses of the Navajos as immature and potentially dangerous, needing to be civilized, discourses of cleanliness, and discourses of calling. This paper adds to a growing body of knowledge about religious frames within which nurses have practiced in North America.

Voices from the pipeline: high school completion among rural Latinos

Although significant strides have been made in increasing the numbers and proportions of minorities in nursing, at 2.0% of the RN population (MinorityNurse.com, 2001), Latinos continue to lag far behind other minorities (Buerhaus & Auerback, 1999). As the fastest growing minority group in the United States--an increase from 9% of the population in 1990 to 11.9% in 2000 and projections of 14.6% by 2001 and 17% by 2020 (U.S. Census, 2001)--Latinos' under-representation in all fields of health care is expected to continue unless concerted efforts are taken to recruit and educate more students. This paper presents an analysis of narratives of high school completion as articulated by Latino adolescents in group interviews. Narrative inquiry of the focus group data found three major categories of supports and challenges: peers, family, and schools. The paper concludes with a discussion of how these findings can be used to develop community based interventions to increase high school completion and thus increase the pool of applicants for nursing and other health careers.

Nursing, social contexts, and ideologies in the early United States birth control movement

Using historical discourse analysis, this study provides a thematic analysis of writings of nursing and birth control as found in The Birth Control Review from 1917 to 1927. The author contrasts this publication with the official journal of the American Nurses Association, the American Journal of Nursing from the same years to explore nursing voices and silences in early birth control stories. In dialogue with social contexts, nursing endeavors and inactivity have played important yet conflicting roles in the birth control movement in the United States. Nursing writings from the early twentieth century reflect eugenic beliefs, national fears of immigrants, and ambivalence about women's roles in society and the home. Nurses simultaneously empowered women to choose when to become pregnant and reinforced nativist and paternalistic views of the poor.

Medical staff consolidation issues and concerns

In the past decade there have been increases in health care consolidations. While the literature on hospital mergers is abundant, there is little on mergers of medical staffs. In this study, we interviewed senior administrators in 22 midwestern medical institutions that had consolidated between 1987 and 1990. Our study is an exploration of topics of concern that administrators have encountered during processes of medical staff consolidation. Administrators stated that the medical staff was most concerned about relationships with nursing and support staff, "turf" issues, and a sense of loss. They recommended that increased attention be paid to specific local issues and that there be active involvement and communication between medical staff and administrators at all phases of the consolidation process.