Influenza Vaccinations for Prevention of Children Hospitalizations

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Table of Contents

Introduction
Outcome
Nursing Theory
Conclusion
References

Introduction

Vaccinations against influenza are one of the methods that healthcare providers may use to preventively address complications, particularly in vulnerable groups. The phenomenon of interest (POI) in this research is the effectiveness of influenza vaccinations against hospitalization in school-aged children, which can be studied through the advanced nursing practice (APN) framework. APN direct professionals to focus on providing nursing services through provider-patient interaction and possess a defined yet constantly growing scope in addition to the competencies acquired through appropriate education (Brown, 1998). It is distinct for combining the flexibility and adaptability to continuously arising new knowledge, both practice-based and scholarly. Hence, POI is explored through the lens of the nursing metaparadigm and several nursing theories, such as Orem’s self-care deficit theory, the theory of bureaucratic choices, and complexity theory. Ultimately, this paper explores what factors govern the effectiveness of vaccination administration in school-aged pediatric populations, its relationship with hospitalization rates, and the research on the matter.

Outcome

Nursing Metaparadigm

The nursing metaparadigm originated as an amalgam of several central nursing concepts. Regardless of its iterations, the original four facets remain: person, environment, health, and nursing (Fawcett, 1984). In addition, there are three recurrent themes: governing processes of well-being and sickness, human behavior patterns concerning their environment in daily and extreme situations, and the processes of instilling positive health changes (Fawcett, 1984). The facets of the POI are analyzed through the four concepts above.

Person

The first aspect of the metaparadigm revolves around the concept of a person. More specifically, it concerns people receiving care – in other words, the patients and their socio-economic characteristics (Fawcett, 1984). In the case of influenza vaccine research, the target patient group is school-aged children since they represent the group with the highest risks of infection and spreading of the disease (Kalligeros et al., 2020). This concept of the metaparadigm assists with focusing scholarly research on a specific group, creating potentially more targeted and precise recommendations.

Environment

The second facet of the nursing metaparadigm is related to the environment in which care is provided to the patient. It can be physical, societal, or other, but it ultimately affects the operations and decision-making around a person’s health (Fawcett, 1984). For instance, vaccinations against influenza reduced any hospitalization risk by 53%, but the number varies depending on the age, season, location, and virus variant (Olson et al., 2022, p. 7). The changing environment affects the breadth of research that needs to be conducted and the effectiveness of implemented solutions and may even affect patient compliance.

Health

A third concept that the nursing metaparadigm revolves around is health. The care provided to the patient by the provider addresses specific health problems with the expectation of obtaining a particular state of well-being (Fawcett, 1984). With the chosen POI, the health issues concerning practitioners are the adverse health effects or complications of influenza, such as acute respiratory infections that result in children being admitted to the intensive care unit (Olson et al., 2022). According to Olson et al. (2022), influenza may have severe, life-threatening health implications. These consequences may be reduced if nursing professionals take appropriate preventive measures.

Nursing

Lastly, although sometimes considered tautological, the last concept in the metaparadigm is nursing itself. The process entails the provision of diagnosis and appropriate treatment, whether preventive or responsive, for the health problems (actual or potential) (Fawcett, 1984). For this POI, scholarly research confirming that influenza vaccines reduce the risk of severe disease and subsequent hospitalizations should be conducted before annual vaccination recommendations. Indeed, scholars from the US, Japan, Hong Kong, and Israel confirm that the vaccines are effective in reducing influenza-induced hospitalizations (Chua et al., 2021; Chung et al., 2020; Feldstein et al., 2021; Kalligeros et al., 2020; Segaloff et al., 2019; Shibata et al., 2018). Consistent with the concept requirements, such research can then become the basis for enforcing the recommendations for annual vaccinations in schools (Segaloff et al., 2019). Therefore, the concept of nursing encompasses the research and administration of vaccines.

Nursing Theory

Grand Nursing Theory

The selected grand nursing theory is Orem’s self-care deficit nursing theory. This theory views one’s freedom and agency – capacity to participate in deliberate action – as an underlying premise of self-care. According to Orem et al. (2001), for the patient’s behavior to be considered self-care, it must serve the purpose of fulfilling a self-care requisite or deficit. In other words, patients exercise self-care and care for others when they identify a life-sustaining or function-regulating need and make inputs to meet it. However, if patients fall short of resources, skills, or knowledge, they may not be able to perform self-care. Thus, this concept presupposes the role of nurses as actors who help patients overcome limitations – not only as care providers but also as educators (Orem et al., 2001). To fulfill this task, nurses should possess antecedent knowledge to perform actions appropriate for the cause. Then, they can educate their patients regarding available health options, such as different vaccines and the potential consequences of not getting vaccinated.

Middle Range Theory

The interplay between the concepts of ‘person,’ ‘environment,’ and ‘health’ of the nursing metaparadigm gives rise to one of its themes. One is the theory of bureaucratic choices, which effectively incorporates the environment into an individual’s health choices and healthcare provision. It examines what happens with the fundamental concept of nursing care when viewed through the prism of political, economic, legal, technological, educational, and physical factors (Ray, 1989, 2018). In its essence, the theory of bureaucratic caring assesses the healthcare system’s corporate organizational culture and explores how caring and bureaucracy may coexist productively. Viewing the POI through its prism allows for considering pediatric health, vaccine management, and hospitalization as administrative processes that exist within and are governed by a bureaucratic environment.

The political and economic factors of the theory refer, among others, to the pressure healthcare professionals experience from external sources: for instance, governmental agencies, union activists, or insurance companies (Ray, 1989). These parties may influence the scope and the depth of the research conducted by applying financial and diplomatic pressure on healthcare institutions. As Greer et al. (2018) contend, public health is fundamentally political, and the politicization of healthcare matters dramatically influences the research discourse and the interventions based on the research results. This observation is evidenced by the fact that very few nations have comprehensive vaccination programs, which may be explained by the sustained opinion on the low reliability of the vaccine. For instance, only 38-62% of American children are vaccinated against influenza (Olson et al., 2022, p. 1). Therefore, the current public discussions around vaccine effectiveness may fundamentally affect the POI.

Another aspect of caring that these middle-range theory covers are education. Ray (1989, 2018) contends that communicating and teaching patients, their families, communities, and working organizations about the methods to improve well-being allows for predicting and improving health outcomes. Like Orem’s theory, it emphasizes the role of nurses as public educators and consultants within the healthcare system. According to Olson et al. (2022), improving public understanding of vaccines’ value in protecting against life-threatening influenza is simultaneously urgent and vital. Given that the research on the POI concerns school-aged children, the role of school nurses may be critical as they may educate children and their families on the topic of vaccination.

The Relationship between the Self-Care Deficit and The Bureaucratic Care Theory

A significant overlap may be observed around the person-health interface. Nursing professionals are characterized, among others, by their ability to employ human capacities for healing and well-being (Orem et al., 2001; Smith & Liehr, 2018). However, this ability does not exist in a vacuum – it is externally governed and regulated by the environment, which may impose limitations or support the abilities of both providers and patients to achieve well-being. Patients’ ability to engage in self-care – to protect themselves or their families from influenza and potential hospitalizations – may be limited by the lack of knowledge. If the bureaucratic system is supportive of well-developed educational systems, healthcare providers have a better capacity to reach out and raise awareness.

Complexity Theory

As described above, the interplay between various factors and system requirements around healthcare is becoming increasingly more complex. As Plsek and Greenhalgh (2001) postulate, the modern healthcare system is complex, dynamic, and adaptive: “a collection of individual agents with freedom to act in ways that are not always totally predictable, and whose actions are interconnected so that one agent’s actions changes the context for other agents” (p. 625). Complexity science thus studies the patterns that emerge from these interconnected, unpredictable interactions. Vaccine effectiveness research is inherently complex and adaptive, focusing on the environmental aspect. One of the sources of complexity in the effectiveness of influenza vaccines lies in natural, unpredictable factors, such as closely matched strains that circulate in the population at a given moment (Chen et al., 2020). According to Olson et al., an influenza shot causes a 47% reduction in severe disease against viruses of a different variant and 78% against viruses of the same variant as the vaccine (Olson et al., 2022, p. 6). Additionally, there are previously discussed ‘bureaucratic’ factors (internalized rules and key actors), such as politics, education, or personal factors.

A complex adaptive system (CAS) in the POI is, therefore, the system built around the responsiveness to the influenza virus. According to the CAS principles, these systems do not have rigid boundaries as they rely on interdisciplinary collaboration and co-evolve with others. Further, they are embedded within larger systems (such as pediatric healthcare), and they have unpredictable elements (viruses) (Olsson et al., 2020). Lastly, they function in a larger adaptation pattern: accurately predicting and identifying seasonal strains, developing appropriate annual measures, and distributing vaccine formulation recommendations (Chen et al., 2020). Overall, it can be confidently stated that the process of understanding and improving influenza vaccine effectiveness functions as a CAS.

Conclusion

In conclusion, the effectiveness of influenza vaccinations against hospitalization in school-aged children is a complex topic governed by several processes. While vaccines reduce hospitalization rates across the board, their effectiveness varies depending on the seasonal virus composition, introducing the impact on the environment. Moreover, the bureaucratic choices theory highlights other aspects of the environment, such as politics and the economy. The nursing metaparadigm helps identify the patient population and the actions required to prove the effectiveness of the vaccinations and introduce them as annual measures. The process of developing and administering vaccinations is directed by patients’ willingness to avoid severe health consequences and hospitalization and providers’ desire to help patients achieve this goal. Further, both grand nursing and middle-range theories highlight the role of nurses as educators about the benefits of influenza vaccines in the efforts to decrease hospitalizations.

References

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