Dr. Janelle Macintosh - Academia.edu (original) (raw)
Papers by Dr. Janelle Macintosh
Nursing Education Perspectives, 2021
Results: Immediate improvements in knowledge for Fijian faculty and students were manifested by a... more Results: Immediate improvements in knowledge for Fijian faculty and students were manifested by a significant increase in the number of correct responses in 13 of the 18 questions on the posttest. Two questions showed only minimal increases due to a majority of participants choosing the correct answer on the pretest. One question revealed no change, and one revealed a decrease in the number of correct answers on the posttest. Conclusion: HBB is an effective program for limited-resource countries for increasing immediate provider knowledge and skills in neonatal resuscitation. Implementing HBB in an academic setting may help ensure educators are up to date on current guidelines. Educational settings provide ideal locations for future nurses to learn and practice evidence-based neonatal resuscitation skills.
American Journal of Critical Care
Background Critical care nurses routinely care for dying patients. Research on obstacles in provi... more Background Critical care nurses routinely care for dying patients. Research on obstacles in providing end-of-life care has been conducted for more than 20 years, but change in such obstacles over time has not been examined. Objective To determine whether the magnitude scores of obstacles and helpful behaviors regarding end-of-life care have changed over time. Methods In this cross-sectional survey study, questionnaires were sent to 2000 randomly selected members of the American Association of Critical-Care Nurses. Obstacle and helpful behavior items were analyzed using mean magnitude scores. Current data were compared with data gathered in 1999. Results Of the 2000 questionnaires mailed, 509 usable responses were received. Six obstacle magnitude scores increased significantly over time, of which 4 were related to family issues (not accepting the poor prognosis, intrafamily fighting, overriding the patient’s end-of-life wishes, and not understanding the meaning of the term lifesaving...
Dimensions of Critical Care Nursing
Background: Critical care nurses (CCNs) frequently provide end-of-life (EOL) care for critically ... more Background: Critical care nurses (CCNs) frequently provide end-of-life (EOL) care for critically ill patients. Critical care nurses may face many obstacles while trying to provide quality EOL care. Some research focusing on obstacles CCNs face while trying to provide quality EOL care has been published; however, research focusing on family behavior obstacles is limited. Research focusing on family behavior as an EOL care obstacle may provide additional insight and improvement in care. Objectives: We wanted to gather firsthand experiences of CCNs regarding working with families of dying patients. We then wanted to determine the predominant obstacle themes noted when CCNs share these rich experiences in EOL care. Methods: A random geographically dispersed sample of 2000 members of the American Association of Critical-Care Nurses was surveyed. Responses from a qualitative question on the questionnaire were analyzed. Results: Sixty-seven EOL obstacle experiences surrounding issues with families' behavior were analyzed for this study. Experiences were categorized into 8 themes. Top 3 common obstacle experiences included families in denial, families going against patient wishes and advanced directives, and families directing care that negatively impacted patients. Conclusions: In overcoming EOL obstacles, it may be beneficial to have proactive family meetings to align treatment goals and to involve palliative care earlier in the ICU stay.
Journal of Emergency Nursing
The current state of scientific knowledge on emergency nurses' perceptions of the impact of ED de... more The current state of scientific knowledge on emergency nurses' perceptions of the impact of ED designs on end-of-life care for dying patients and their families indicates many obstacles still exist such as limited space, poor department design, and the lack of privacy for patients. The main finding of this research is the need for improved areas for family presence during resuscitation, areas for improved body stowage, and the need for more resuscitation rooms. Key implications for emergency nursing practice from this research are empowering emergency nurses to become directly involved in ED layout and design modifications specifically to improve space, work flow, and privacy needs at the end of life.
Psycho-Oncology
Human papillomavirus (HPV) infects millions of men and women annually and is a substantial contri... more Human papillomavirus (HPV) infects millions of men and women annually and is a substantial contributing factor in many cancers including oral, penile, anal, and cervical. Vaccination can reduce risk but adherence nationwide and, particularly in highly religious states, is suboptimal. Religious principles of abstinence before marriage and total fidelity following marriage may create a belief of protection through adherence to religious guidelines. However, while one partner may remain monogamous, one cannot be assured of their partner's behavior both before and after marriage. These misconceptions may create a barrier to religious youth's adherence to vaccine recommendations.
The Journal for Nurse Practitioners
Nurse practitioners are on the front lines providing parental education regarding vaccines. Some ... more Nurse practitioners are on the front lines providing parental education regarding vaccines. Some reasons for vaccine hesitancy include the potential common mild problems of vaccine administration, such as pain and/or elevated temperature. According to research, prophylactic administration of an antipyretic/analgesic medication, such as acetaminophen, reduces common mild problems related to vaccines when administered before or at the time of vaccination. Additionally, the evidence that prophylactic administration of antipyretic/analgesic medication decreases antibody response to vaccinations is insufficient at this time. However, this research has led to some confusion on best practice guidelines. This review of the literature resulted in recommendations that nurse practitioners should reassure parents that an antipyretic/analgesic medication will not reduce the immune response and can be administered to prevent or reduce common mild problems of vaccinations, which may then reduce vaccine hesitancy among parents.
Dimensions of Critical Care Nursing
Background: Critical-care nurses (CCN) provide end-of life (EOL) care on a daily basis as one in ... more Background: Critical-care nurses (CCN) provide end-of life (EOL) care on a daily basis as one in five patients dies while in Intensive Care Units (ICU). CCNs overcome many obstacles to perform quality EOL care for dying patients. Objectives: The purposes of this study were to collect CCNs' current suggestions for improving EOL care and determine if EOL care obstacles have changed by comparing results to data gathered in 1998. Methods: A 72-item questionnaire regarding EOL care perceptions was mailed to a national, geographically dispersed, random sample of 2,000 members of the American Association of Critical-Care Nurses. Nurses were asked for suggestions to improve EOL care. Results: Of the 509 returned questionnaires, 322 (63.3%) had 385 written suggestions for improving EOL care. Major themes identified were ensuring characteristics of a good death, improving physician communication with patients and families, adjusting nurse/patient ratios to 1:1, recognizing and avoiding futile care, increasing EOL education, physicians who are present and "on the same page," not allowing families to override patients' wishes, and the need for more support staff. When compared to data gathered 17 years previously, major themes remained the same, but in a few cases, changed in order and possible causation. Conclusion: Critical-care nurses' suggestions were similar to those recommendations from 17 years ago. Although the order of importance changed minimally, the number of similar themes indicated obstacles to providing EOL care to dying ICU patients continue to exist over time.
Advances in Neonatal Care
Background: The objectives of this study were to determine the current rates of immunization and ... more Background: The objectives of this study were to determine the current rates of immunization and identify variables associated with immunizations of NICU graduates who were 60 days of age or older at time of discharge. Methods: This is a descriptive pilot study utilizing retrospective paper chart review. The relationships between immunization status and study variables were examined using logistic regression. Results: Of 43 infants discharged at least 60 days of age or older from the NICU, 74.4% were up to date for immunizations in accordance with AAP recommendations. Additional variables were not significant. Conclusion: Immunization needs to be a priority in order to give NICU infants every advantage regarding their future health status.
Journal of Vaccines & Vaccination
Background: Children are required by law to receive vaccinations to enter school. States and terr... more Background: Children are required by law to receive vaccinations to enter school. States and territories offer exemptions for parents who refuse to vaccinate their children. Types of exemptions vary by state or territory, as does the exemption filing process. The purpose of this research was to identify the various education-related processes implemented by states and territories which allow parents to exempt children from vaccinations. Methods: A questionnaire was distributed to immunization program managers in the 50 United States, District of Columbia, the United States Indian Health Service, and eight United States territories. Managers reported vaccination requirements for their jurisdiction (collectively referred to as "state"). Education-related questions identified which states required parents to: 1) read and sign a vaccination risk/benefit statement prior to exemption; 2) complete mandatory vaccine education before obtaining vaccination exemption; 3) complete education within a certain time period before school admission. Additionally, states were asked how parental vaccine education was regulated. Results: A parent-signed risk/benefit statement was required by 25 states for religious exemptions, 12 states for personal exemptions, 10 states for medical exemptions, and 1 state for temporary medical exemptions. Thirteen states required mandatory parental vaccine education prior to obtaining an exemption. For states that mandated parental vaccine education prior to exemption, the education was most commonly regulated by statute, verses administrative rule or school policy. Conclusions: Vaccine education requirements and the process for providing this education to parents seeking immunization exemptions vary greatly between the states. More research is needed to fully understand the impact of the education requirement on exemption rates. Familiarity with and effectiveness of various state vaccine education requirements may aid policymakers who are considering enacting mandatory vaccine education in their state.
Journal of emergency nursing: JEN : official publication of the Emergency Department Nurses Association, 2017
Many patient visits to emergency departments result in the patient dying or being pronounced dead... more Many patient visits to emergency departments result in the patient dying or being pronounced dead on arrival. The numbers of deaths in emergency departments are likely to increase as a significant portion of the U.S. population ages. Consequently, emergency nurses face many obstacles to providing quality end-of-life (EOL) care when death occurs. The purpose of this study was to identify suggestions that emergency nurses have to improve EOL care, specifically in rural emergency departments. A 57-item questionnaire was sent to 53 rural hospitals in 4 states in the Intermountain West, plus Alaska. One item asked nurses to identify the one aspect of EOL care they would change for dying patients in rural emergency departments. Each qualitative response was individually reviewed by a research team and then coded into a theme. Four major themes and three minor themes were identified. The major themes were providing greater privacy during EOL care for patients and family members, increasing...
Clinical Journal of Oncology Nursing, 2016
Background: All major hospital facilities in the state of Utah have employee vaccination policies... more Background: All major hospital facilities in the state of Utah have employee vaccination policies. However, the presence of healthcare worker vaccination policies in outpatient oncology clinics was unknown. Objectives: The objectives of this article are to identify oncology outpatient employee vaccination policies in Utah and to identify what consequences, if any, are present for unvaccinated employees. Methods: This was a cross-sectional, descriptive study design in which clinic managers from outpatient oncology clinics were asked, via questionnaire, to describe the clinic's employee vaccination policy and the consequences for refusing the policy. Findings: Most vaccination policies applied to employees primarily assigned to work in the direct patient care area. Most commonly, influenza and hepatitis B vaccines were required as part of the vaccination policy. Most managers offered free vaccinations to employees, but most managers also allowed employees to refuse to follow the vaccination policy for medical, religious, or personal reasons.
The Journal for Nurse Practitioners, 2016
The purpose of this study was to explore public school employee perceptions regarding vaccination... more The purpose of this study was to explore public school employee perceptions regarding vaccinations. Employees from 1 urban school district in Utah responded to the School Employees' Perception of Immunizations Questionnaire. Lack of perceived efficacy was the most common explanation for lack of seasonal influenza vaccine. Being unsure of need was the most common reason participants were unvaccinated for measles, mumps, and rubella. The most common reason for rejecting a mandatory vaccine policy was a perceived violation of personal freedoms. Nurse practitioners can positively influence the health of public school employees by ensuring they are properly vaccinated.
Workplace health & safety, 2016
Vaccines are an important disease prevention strategy among individuals of all age groups. Despit... more Vaccines are an important disease prevention strategy among individuals of all age groups. Despite the success of vaccinations in preventing communicable diseases, adults, in particular, often have sub-optimal vaccination rates. Consequently, some vaccine-preventable diseases, such as pertussis, are still on the rise in the United States despite the availability of the Tdap vaccine. As most adults can be found in the workplace, occupational and environmental health nurses are in a unique position to encourage employers to promote adequate Tdap vaccination among their employees. As specific resources regarding Tdap vaccination are lacking, the Pertussis Prevention Toolkit was developed to help occupational health nurses promote Tdap vaccination in the workplace.
Journal of the American Association of Nurse Practitioners, Jan 26, 2016
The purpose of this study was to collect information regarding healthcare worker (HCW) vaccinatio... more The purpose of this study was to collect information regarding healthcare worker (HCW) vaccination policies in Utah family practice clinics. The study was conducted in Utah family practice clinics in the most densely populated counties in the state and was a cross-sectional descriptive design. Data were collected from 91 family practice clinic managers. Descriptive statistics were performed, as well as a content analysis for open-ended items. HCWs are employed in environments where infectious diseases can be easily spread from person to person, thus, vaccinations can be instrumental in protecting the health of HCWs and patients alike. In Utah, 56.8% of family practice clinics had either no vaccination policy for HCWs or had a policy with no consequences for noncompliance. Utah family practice clinics need to implement changes to create and maintain HCW vaccination policies. Nurse practitioners can be leaders and change agents by working with their county and state health departments...
Using a systematic approach students critically analyze and synthesize the research studies to de... more Using a systematic approach students critically analyze and synthesize the research studies to determine the strength of the evidence regarding the clinical problem. Based on the findings, recommendations are made for clinical practice. The papers are published in professional journals and presented at professional meetings.
Journal of Emergency Nursing, 2015
Introduction: Rural emergency nurses face unique obstacles to providing quality end-of-life (EOL)... more Introduction: Rural emergency nurses face unique obstacles to providing quality end-of-life (EOL) care. Stories provided by emergency nurses embody their most difficult EOL care obstacles. Methods: A questionnaire was sent to 53 rural hospitals. Respondents were asked to share stories that epitomized the obstacles faced while providing EOL care in the rural emergency setting. Results: The lack of an ideal death (nurse personally knows the patient, issues with family members, and unknown patient wishes) was the top obstacle. Other reported obstacles were insufficient ED staff and power struggles between nurses and physicians. Discussion: Rural emergency nurses often provide EOL care to friends and family members, while their urban counterparts are likely to transfer care to nurses with no relation to the dying patient. Not only does caring for patients that the nurse knows or is related to cause great distress to rural emergency nurses, this unfortunately common situation may also prevent patients from receiving the highest quality of EOL care. Conclusion: Emergency nurses often face obstacles that hinder their ability to provide high quality EOL care to patients. These obstacles are compounded by a unique set of challenges faced by nurses working in rural emergency departments. Stories from rural emergency nurses revealed that being unable to provide optimal care at the EOL, having difficulties with family members, or not knowing the patient's wishes for EOL care were the most common obstacles. Additional obstacles included stories about the impact of low or unavailable staff and feeling powerless in some EOL situations.
Journal of Pediatric Health Care
Pediatric health care settings are high-risk environments for spreading communicable and vaccine-... more Pediatric health care settings are high-risk environments for spreading communicable and vaccine-preventable diseases from health care workers to susceptible patients. All managers of pediatric clinics operating in the state of Utah were included. Participants were invited to complete a two-page questionnaire regarding their clinic vaccination policies. Half (n = 23) of Utah pediatric outpatient clinic managers recommend employee vaccinations, although employee refusal was allowed without consequence. Of all adult vaccines, influenza was most often included by managers as part of the employee vaccination policy. Some managers required unvaccinated employees to wear masks in the event of illness, but many had no additional requirements for unvaccinated and ill employees. Vaccination of health care workers is an effective approach to reduce disease transmission. Mandatory vaccination policies can significantly improve vaccination rates among health care workers. Copyright © 2015 Natio...
Journal of the American Association of Nurse Practitioners, 2015
Purpose: School employees are in direct contact with children in confined areas, a setting in whi... more Purpose: School employees are in direct contact with children in confined areas, a setting in which communicable infection can quickly spread. Therefore, it is important for school employees to be fully vaccinated. The purpose of this study is to ascertain the current vaccination status and perceptions of school employees in an urban school district. Data Sources: The study employed a nonexperimental mixed-method design. School employee participants (N = 1,400) completed a questionnaire to evaluate vaccination status, availability of vaccination records, and vaccination awareness. Participants were randomly selected from 85 schools within one urban school district. Conclusions: Two common perceptions about vaccines emerged from the questionnaire: 1) vaccines are only for children and 2) vaccinations received during childhood are still effective. School employees are unaware of their own vaccination status and the recommended vaccination schedule for adults. Additionally, accessibility to immunization records for adults are frequently inadequate. Implications for Practice: Healthcare providers (HCP), including nurse practitioners, are the first line of defense to ensure adults are adequately vaccinated. When vaccinations are tracked and recommended by HCPs vaccination uptake is improved. Nurse practitioners who discuss recommended vaccinations with adult patients are instrumental in improving vaccination rates among school employees.
The Journal of School Nursing, 2013
As key members of the school environment, it is important for school employees to be vaccinated. ... more As key members of the school environment, it is important for school employees to be vaccinated. Employees are in direct contact with children in close quarters for long periods of time and such an environment can easily serve as an outbreak center for vaccine-preventable communicable diseases such as measles. Despite the fact that most school employees believe vaccines are safe and effective and many school employees report they are up-to-date with their vaccines, a closer examination reveals discrepancy between belief and behavior. This research study evaluates the vaccination status, awareness, and perceptions of school employees located in a large rural school district in Utah. As a vaccine advocate, the school nurse can be influential in providing adult vaccination education for school employees, thus increasing awareness of the importance of adult vaccines and knowing one’s vaccination status. Additionally, school nurses might need to meet with school district policy makers to...
The Journal of School Nursing, 2013
Schools are where vaccine-preventable diseases can spread. Vaccination of school children has bee... more Schools are where vaccine-preventable diseases can spread. Vaccination of school children has been studied; however, data are lacking on the vaccination status, perceptions, and barriers to vaccination for school employees. We surveyed school employees’ vaccination perceptions, awareness of current vaccination status, and potential barriers to vaccinations. Adult vaccination knowledge is lacking in the school employee population. School employees were unaware of their vaccination status for diseases such as measles and pertussis. Most subjects believed vaccinations were safe and effective, although they believed vaccinations were more important for children than adults. Many believed vaccine mandates should exist for school employees. Knowledge gaps regarding adult vaccines can be positively influenced by school nurses. Gaps may be especially important to bridge regarding adults working in the school setting, an environment ideal for the spreading of communicable diseases.
Nursing Education Perspectives, 2021
Results: Immediate improvements in knowledge for Fijian faculty and students were manifested by a... more Results: Immediate improvements in knowledge for Fijian faculty and students were manifested by a significant increase in the number of correct responses in 13 of the 18 questions on the posttest. Two questions showed only minimal increases due to a majority of participants choosing the correct answer on the pretest. One question revealed no change, and one revealed a decrease in the number of correct answers on the posttest. Conclusion: HBB is an effective program for limited-resource countries for increasing immediate provider knowledge and skills in neonatal resuscitation. Implementing HBB in an academic setting may help ensure educators are up to date on current guidelines. Educational settings provide ideal locations for future nurses to learn and practice evidence-based neonatal resuscitation skills.
American Journal of Critical Care
Background Critical care nurses routinely care for dying patients. Research on obstacles in provi... more Background Critical care nurses routinely care for dying patients. Research on obstacles in providing end-of-life care has been conducted for more than 20 years, but change in such obstacles over time has not been examined. Objective To determine whether the magnitude scores of obstacles and helpful behaviors regarding end-of-life care have changed over time. Methods In this cross-sectional survey study, questionnaires were sent to 2000 randomly selected members of the American Association of Critical-Care Nurses. Obstacle and helpful behavior items were analyzed using mean magnitude scores. Current data were compared with data gathered in 1999. Results Of the 2000 questionnaires mailed, 509 usable responses were received. Six obstacle magnitude scores increased significantly over time, of which 4 were related to family issues (not accepting the poor prognosis, intrafamily fighting, overriding the patient’s end-of-life wishes, and not understanding the meaning of the term lifesaving...
Dimensions of Critical Care Nursing
Background: Critical care nurses (CCNs) frequently provide end-of-life (EOL) care for critically ... more Background: Critical care nurses (CCNs) frequently provide end-of-life (EOL) care for critically ill patients. Critical care nurses may face many obstacles while trying to provide quality EOL care. Some research focusing on obstacles CCNs face while trying to provide quality EOL care has been published; however, research focusing on family behavior obstacles is limited. Research focusing on family behavior as an EOL care obstacle may provide additional insight and improvement in care. Objectives: We wanted to gather firsthand experiences of CCNs regarding working with families of dying patients. We then wanted to determine the predominant obstacle themes noted when CCNs share these rich experiences in EOL care. Methods: A random geographically dispersed sample of 2000 members of the American Association of Critical-Care Nurses was surveyed. Responses from a qualitative question on the questionnaire were analyzed. Results: Sixty-seven EOL obstacle experiences surrounding issues with families' behavior were analyzed for this study. Experiences were categorized into 8 themes. Top 3 common obstacle experiences included families in denial, families going against patient wishes and advanced directives, and families directing care that negatively impacted patients. Conclusions: In overcoming EOL obstacles, it may be beneficial to have proactive family meetings to align treatment goals and to involve palliative care earlier in the ICU stay.
Journal of Emergency Nursing
The current state of scientific knowledge on emergency nurses' perceptions of the impact of ED de... more The current state of scientific knowledge on emergency nurses' perceptions of the impact of ED designs on end-of-life care for dying patients and their families indicates many obstacles still exist such as limited space, poor department design, and the lack of privacy for patients. The main finding of this research is the need for improved areas for family presence during resuscitation, areas for improved body stowage, and the need for more resuscitation rooms. Key implications for emergency nursing practice from this research are empowering emergency nurses to become directly involved in ED layout and design modifications specifically to improve space, work flow, and privacy needs at the end of life.
Psycho-Oncology
Human papillomavirus (HPV) infects millions of men and women annually and is a substantial contri... more Human papillomavirus (HPV) infects millions of men and women annually and is a substantial contributing factor in many cancers including oral, penile, anal, and cervical. Vaccination can reduce risk but adherence nationwide and, particularly in highly religious states, is suboptimal. Religious principles of abstinence before marriage and total fidelity following marriage may create a belief of protection through adherence to religious guidelines. However, while one partner may remain monogamous, one cannot be assured of their partner's behavior both before and after marriage. These misconceptions may create a barrier to religious youth's adherence to vaccine recommendations.
The Journal for Nurse Practitioners
Nurse practitioners are on the front lines providing parental education regarding vaccines. Some ... more Nurse practitioners are on the front lines providing parental education regarding vaccines. Some reasons for vaccine hesitancy include the potential common mild problems of vaccine administration, such as pain and/or elevated temperature. According to research, prophylactic administration of an antipyretic/analgesic medication, such as acetaminophen, reduces common mild problems related to vaccines when administered before or at the time of vaccination. Additionally, the evidence that prophylactic administration of antipyretic/analgesic medication decreases antibody response to vaccinations is insufficient at this time. However, this research has led to some confusion on best practice guidelines. This review of the literature resulted in recommendations that nurse practitioners should reassure parents that an antipyretic/analgesic medication will not reduce the immune response and can be administered to prevent or reduce common mild problems of vaccinations, which may then reduce vaccine hesitancy among parents.
Dimensions of Critical Care Nursing
Background: Critical-care nurses (CCN) provide end-of life (EOL) care on a daily basis as one in ... more Background: Critical-care nurses (CCN) provide end-of life (EOL) care on a daily basis as one in five patients dies while in Intensive Care Units (ICU). CCNs overcome many obstacles to perform quality EOL care for dying patients. Objectives: The purposes of this study were to collect CCNs' current suggestions for improving EOL care and determine if EOL care obstacles have changed by comparing results to data gathered in 1998. Methods: A 72-item questionnaire regarding EOL care perceptions was mailed to a national, geographically dispersed, random sample of 2,000 members of the American Association of Critical-Care Nurses. Nurses were asked for suggestions to improve EOL care. Results: Of the 509 returned questionnaires, 322 (63.3%) had 385 written suggestions for improving EOL care. Major themes identified were ensuring characteristics of a good death, improving physician communication with patients and families, adjusting nurse/patient ratios to 1:1, recognizing and avoiding futile care, increasing EOL education, physicians who are present and "on the same page," not allowing families to override patients' wishes, and the need for more support staff. When compared to data gathered 17 years previously, major themes remained the same, but in a few cases, changed in order and possible causation. Conclusion: Critical-care nurses' suggestions were similar to those recommendations from 17 years ago. Although the order of importance changed minimally, the number of similar themes indicated obstacles to providing EOL care to dying ICU patients continue to exist over time.
Advances in Neonatal Care
Background: The objectives of this study were to determine the current rates of immunization and ... more Background: The objectives of this study were to determine the current rates of immunization and identify variables associated with immunizations of NICU graduates who were 60 days of age or older at time of discharge. Methods: This is a descriptive pilot study utilizing retrospective paper chart review. The relationships between immunization status and study variables were examined using logistic regression. Results: Of 43 infants discharged at least 60 days of age or older from the NICU, 74.4% were up to date for immunizations in accordance with AAP recommendations. Additional variables were not significant. Conclusion: Immunization needs to be a priority in order to give NICU infants every advantage regarding their future health status.
Journal of Vaccines & Vaccination
Background: Children are required by law to receive vaccinations to enter school. States and terr... more Background: Children are required by law to receive vaccinations to enter school. States and territories offer exemptions for parents who refuse to vaccinate their children. Types of exemptions vary by state or territory, as does the exemption filing process. The purpose of this research was to identify the various education-related processes implemented by states and territories which allow parents to exempt children from vaccinations. Methods: A questionnaire was distributed to immunization program managers in the 50 United States, District of Columbia, the United States Indian Health Service, and eight United States territories. Managers reported vaccination requirements for their jurisdiction (collectively referred to as "state"). Education-related questions identified which states required parents to: 1) read and sign a vaccination risk/benefit statement prior to exemption; 2) complete mandatory vaccine education before obtaining vaccination exemption; 3) complete education within a certain time period before school admission. Additionally, states were asked how parental vaccine education was regulated. Results: A parent-signed risk/benefit statement was required by 25 states for religious exemptions, 12 states for personal exemptions, 10 states for medical exemptions, and 1 state for temporary medical exemptions. Thirteen states required mandatory parental vaccine education prior to obtaining an exemption. For states that mandated parental vaccine education prior to exemption, the education was most commonly regulated by statute, verses administrative rule or school policy. Conclusions: Vaccine education requirements and the process for providing this education to parents seeking immunization exemptions vary greatly between the states. More research is needed to fully understand the impact of the education requirement on exemption rates. Familiarity with and effectiveness of various state vaccine education requirements may aid policymakers who are considering enacting mandatory vaccine education in their state.
Journal of emergency nursing: JEN : official publication of the Emergency Department Nurses Association, 2017
Many patient visits to emergency departments result in the patient dying or being pronounced dead... more Many patient visits to emergency departments result in the patient dying or being pronounced dead on arrival. The numbers of deaths in emergency departments are likely to increase as a significant portion of the U.S. population ages. Consequently, emergency nurses face many obstacles to providing quality end-of-life (EOL) care when death occurs. The purpose of this study was to identify suggestions that emergency nurses have to improve EOL care, specifically in rural emergency departments. A 57-item questionnaire was sent to 53 rural hospitals in 4 states in the Intermountain West, plus Alaska. One item asked nurses to identify the one aspect of EOL care they would change for dying patients in rural emergency departments. Each qualitative response was individually reviewed by a research team and then coded into a theme. Four major themes and three minor themes were identified. The major themes were providing greater privacy during EOL care for patients and family members, increasing...
Clinical Journal of Oncology Nursing, 2016
Background: All major hospital facilities in the state of Utah have employee vaccination policies... more Background: All major hospital facilities in the state of Utah have employee vaccination policies. However, the presence of healthcare worker vaccination policies in outpatient oncology clinics was unknown. Objectives: The objectives of this article are to identify oncology outpatient employee vaccination policies in Utah and to identify what consequences, if any, are present for unvaccinated employees. Methods: This was a cross-sectional, descriptive study design in which clinic managers from outpatient oncology clinics were asked, via questionnaire, to describe the clinic's employee vaccination policy and the consequences for refusing the policy. Findings: Most vaccination policies applied to employees primarily assigned to work in the direct patient care area. Most commonly, influenza and hepatitis B vaccines were required as part of the vaccination policy. Most managers offered free vaccinations to employees, but most managers also allowed employees to refuse to follow the vaccination policy for medical, religious, or personal reasons.
The Journal for Nurse Practitioners, 2016
The purpose of this study was to explore public school employee perceptions regarding vaccination... more The purpose of this study was to explore public school employee perceptions regarding vaccinations. Employees from 1 urban school district in Utah responded to the School Employees' Perception of Immunizations Questionnaire. Lack of perceived efficacy was the most common explanation for lack of seasonal influenza vaccine. Being unsure of need was the most common reason participants were unvaccinated for measles, mumps, and rubella. The most common reason for rejecting a mandatory vaccine policy was a perceived violation of personal freedoms. Nurse practitioners can positively influence the health of public school employees by ensuring they are properly vaccinated.
Workplace health & safety, 2016
Vaccines are an important disease prevention strategy among individuals of all age groups. Despit... more Vaccines are an important disease prevention strategy among individuals of all age groups. Despite the success of vaccinations in preventing communicable diseases, adults, in particular, often have sub-optimal vaccination rates. Consequently, some vaccine-preventable diseases, such as pertussis, are still on the rise in the United States despite the availability of the Tdap vaccine. As most adults can be found in the workplace, occupational and environmental health nurses are in a unique position to encourage employers to promote adequate Tdap vaccination among their employees. As specific resources regarding Tdap vaccination are lacking, the Pertussis Prevention Toolkit was developed to help occupational health nurses promote Tdap vaccination in the workplace.
Journal of the American Association of Nurse Practitioners, Jan 26, 2016
The purpose of this study was to collect information regarding healthcare worker (HCW) vaccinatio... more The purpose of this study was to collect information regarding healthcare worker (HCW) vaccination policies in Utah family practice clinics. The study was conducted in Utah family practice clinics in the most densely populated counties in the state and was a cross-sectional descriptive design. Data were collected from 91 family practice clinic managers. Descriptive statistics were performed, as well as a content analysis for open-ended items. HCWs are employed in environments where infectious diseases can be easily spread from person to person, thus, vaccinations can be instrumental in protecting the health of HCWs and patients alike. In Utah, 56.8% of family practice clinics had either no vaccination policy for HCWs or had a policy with no consequences for noncompliance. Utah family practice clinics need to implement changes to create and maintain HCW vaccination policies. Nurse practitioners can be leaders and change agents by working with their county and state health departments...
Using a systematic approach students critically analyze and synthesize the research studies to de... more Using a systematic approach students critically analyze and synthesize the research studies to determine the strength of the evidence regarding the clinical problem. Based on the findings, recommendations are made for clinical practice. The papers are published in professional journals and presented at professional meetings.
Journal of Emergency Nursing, 2015
Introduction: Rural emergency nurses face unique obstacles to providing quality end-of-life (EOL)... more Introduction: Rural emergency nurses face unique obstacles to providing quality end-of-life (EOL) care. Stories provided by emergency nurses embody their most difficult EOL care obstacles. Methods: A questionnaire was sent to 53 rural hospitals. Respondents were asked to share stories that epitomized the obstacles faced while providing EOL care in the rural emergency setting. Results: The lack of an ideal death (nurse personally knows the patient, issues with family members, and unknown patient wishes) was the top obstacle. Other reported obstacles were insufficient ED staff and power struggles between nurses and physicians. Discussion: Rural emergency nurses often provide EOL care to friends and family members, while their urban counterparts are likely to transfer care to nurses with no relation to the dying patient. Not only does caring for patients that the nurse knows or is related to cause great distress to rural emergency nurses, this unfortunately common situation may also prevent patients from receiving the highest quality of EOL care. Conclusion: Emergency nurses often face obstacles that hinder their ability to provide high quality EOL care to patients. These obstacles are compounded by a unique set of challenges faced by nurses working in rural emergency departments. Stories from rural emergency nurses revealed that being unable to provide optimal care at the EOL, having difficulties with family members, or not knowing the patient's wishes for EOL care were the most common obstacles. Additional obstacles included stories about the impact of low or unavailable staff and feeling powerless in some EOL situations.
Journal of Pediatric Health Care
Pediatric health care settings are high-risk environments for spreading communicable and vaccine-... more Pediatric health care settings are high-risk environments for spreading communicable and vaccine-preventable diseases from health care workers to susceptible patients. All managers of pediatric clinics operating in the state of Utah were included. Participants were invited to complete a two-page questionnaire regarding their clinic vaccination policies. Half (n = 23) of Utah pediatric outpatient clinic managers recommend employee vaccinations, although employee refusal was allowed without consequence. Of all adult vaccines, influenza was most often included by managers as part of the employee vaccination policy. Some managers required unvaccinated employees to wear masks in the event of illness, but many had no additional requirements for unvaccinated and ill employees. Vaccination of health care workers is an effective approach to reduce disease transmission. Mandatory vaccination policies can significantly improve vaccination rates among health care workers. Copyright © 2015 Natio...
Journal of the American Association of Nurse Practitioners, 2015
Purpose: School employees are in direct contact with children in confined areas, a setting in whi... more Purpose: School employees are in direct contact with children in confined areas, a setting in which communicable infection can quickly spread. Therefore, it is important for school employees to be fully vaccinated. The purpose of this study is to ascertain the current vaccination status and perceptions of school employees in an urban school district. Data Sources: The study employed a nonexperimental mixed-method design. School employee participants (N = 1,400) completed a questionnaire to evaluate vaccination status, availability of vaccination records, and vaccination awareness. Participants were randomly selected from 85 schools within one urban school district. Conclusions: Two common perceptions about vaccines emerged from the questionnaire: 1) vaccines are only for children and 2) vaccinations received during childhood are still effective. School employees are unaware of their own vaccination status and the recommended vaccination schedule for adults. Additionally, accessibility to immunization records for adults are frequently inadequate. Implications for Practice: Healthcare providers (HCP), including nurse practitioners, are the first line of defense to ensure adults are adequately vaccinated. When vaccinations are tracked and recommended by HCPs vaccination uptake is improved. Nurse practitioners who discuss recommended vaccinations with adult patients are instrumental in improving vaccination rates among school employees.
The Journal of School Nursing, 2013
As key members of the school environment, it is important for school employees to be vaccinated. ... more As key members of the school environment, it is important for school employees to be vaccinated. Employees are in direct contact with children in close quarters for long periods of time and such an environment can easily serve as an outbreak center for vaccine-preventable communicable diseases such as measles. Despite the fact that most school employees believe vaccines are safe and effective and many school employees report they are up-to-date with their vaccines, a closer examination reveals discrepancy between belief and behavior. This research study evaluates the vaccination status, awareness, and perceptions of school employees located in a large rural school district in Utah. As a vaccine advocate, the school nurse can be influential in providing adult vaccination education for school employees, thus increasing awareness of the importance of adult vaccines and knowing one’s vaccination status. Additionally, school nurses might need to meet with school district policy makers to...
The Journal of School Nursing, 2013
Schools are where vaccine-preventable diseases can spread. Vaccination of school children has bee... more Schools are where vaccine-preventable diseases can spread. Vaccination of school children has been studied; however, data are lacking on the vaccination status, perceptions, and barriers to vaccination for school employees. We surveyed school employees’ vaccination perceptions, awareness of current vaccination status, and potential barriers to vaccinations. Adult vaccination knowledge is lacking in the school employee population. School employees were unaware of their vaccination status for diseases such as measles and pertussis. Most subjects believed vaccinations were safe and effective, although they believed vaccinations were more important for children than adults. Many believed vaccine mandates should exist for school employees. Knowledge gaps regarding adult vaccines can be positively influenced by school nurses. Gaps may be especially important to bridge regarding adults working in the school setting, an environment ideal for the spreading of communicable diseases.