Immunization –Health Beliefs | Assessment 1

Assessment 1 (2000 words)
Instructions:
 Please read the background information below. When you have read the background
information, you can proceed to the questions on the Assessment Template. These
questions relate to the background information.
 You will need to apply the knowledge that you have gained from Topics 1-4 to complete
these questions.
 The marks allocated to each question are stated next to the question.
 The word count is stated next to each question. Note that when the word count says
‘equivalent’ it means that you do not need to have that exact number of words to
answer the question – just provide as much detail as required to answer the question.
 You are advised to frequently refer to the Assessment Feedback Sheet to guide you on
what characteristics of a response constitute an F2, F1, P2, P1, C, D, and HD grade.
 As with all academic work, if you refer to the work of others to support your responses,
you must reference this information using the UniSA Harvard Reference System. You do
not need to reference the articles listed in the Tables in Question 5 but if any other
sources are used, these should be referenced.
Background: Immunisation – Health beliefs
*Nursing students: You are working as a registered nurse in a GP Practice and one of your
roles is to promote immunisation for children (this may be the MMR or other recommended
immunisations). You have had a few parents refuse vaccinations for their children and this
concerns you as you believe that this may leave the child and communities vulnerable to
outbreaks of serious diseases.
*Midwifery students: You are working as a midwife in an antenatal clinic. One of your roles
is to promote vaccination against pertussis (whooping cough) for pregnant women. You
have had a few pregnant women decline vaccination. This concerns you as you know that if
the pregnant woman is immune to pertussis that passive immunity is passed to her unborn
baby to protect them against pertussis when they are newborn until they can be immunised
themselves
You do not think that parents/pregnant women would deliberately expose their
children/baby/themselves to the risk of serious disease unless they were guided by a belief
that immunisation was not safe. You are vaguely aware via media reports that there is an
anti-vaccine movement, and you want a quick overview of what it is all about. As most of us
would do, you consult Google, and you find the following information. Read the information
below:
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The History of Vaccines: History of the anti-vaccination movement
The College of Physicians of Philadelphia (2017)
https://www.historyofvaccines.org/content/articles/history-anti-
vaccination-movements
As you want to have an informed discussion with the parents/pregnant women you are
working with, you decide to examine the available research. You are aware that both
qualitative and quantitative evidence inform evidence based practice, so you may chose
either approach (or both). For instance, you may investigate the evidence around the safety
of vaccination or you may explore why parents/pregnant women are concerned about
immunisation.
*Please do not include this page of background information when you submit the
assessment template to learnonline.
Assessment 1 Template
*Equivalent means that your responses may not equate exactly to the number of words that
you have written. As the format for this assessment is a template an approximate word
count is given that reflects the work required to complete the template. Suggested word
counts may be given in the template to guide you in how much detail is required in your
response. The template word count is not included in your word count. The template itself
(without the background) equates to approximately 900 words. You will note an elevated
similarity percentage when this is submitted via TurnItIn because of the template. Your
lecturers/tutors are aware of this.
Questions 1-4 (25 marks – 500 word equivalent)
Question 1a. From the background information provided above relating to immunisation, develop a
researchable question. Type the question below:
Does MMR vaccination improve the immunisation process of children under age of 14 compared to
non-vaccination or placebo process?
Question 1b: Identify the elements of (words relating to) PICO or PICo in the research question that
you have formulated (delete irrelevant table)
P Children under age of 14
I MMR vaccination
C Non-vaccination or placebo
O Immunisation development
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OR
P
I
Co
Question 2a. What type of research methodology do you think should be used to answer the
research question that you have formulated?
☐Quantitative
☐Qualitative
☒Mixed methods
Question 2b. Justify why this methodology was chosen to answer the question (Approx 75 words -
reference/s used to support your response should be written below your answer and are not included
in the word count).
Mixed method is effective in this case as the quantitative approach would be focused on the
experiment based study of the effectiveness of both the studies and the statistical comparison of
data can determine the effective process. On the other hand, the qualitative interview of the
experts of immunization will also effectively help in the understanding of the process that can
increase the knowledge about the immunity increase of children effectively (Morse 2016). Hence,
this methodology is useful in this study.
Question 3a. List 3 places/sources of information that can be used to obtain reliable evidence to
answer the research question that you have formulated:
1. NCBI
2. CINAHL
3. PubMed
Question 3b. Using one of the resources listed above, provide the details of a specific
resource/publication that is an example of best available evidence to assist you in answering your
research question. Complete the table below:
Provide the full reference/title for the
resource/publication
La Torre, G., Saulle, R., Unim, B., Meggiolaro, A.,
Barbato, A., Mannocci, A. and Spadea, A., 2017. The
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effectiveness of measles-mumps-rubella (MMR)
vaccination in the prevention of pediatric
hospitalizations for targeted and untargeted infections:
a retrospective cohort study. Human vaccines &
immunotherapeutics, 13(8), pp.1879-1883.
Provide the URL https://dx.doi.org/10.1080%2F21645515.2017.1330733
Question 3c. Explain why the information source chosen is an example of best available evidence for
answering the research question that you have formulated. Refer to the Levels of Evidence and
Hierarchy of Evidence tables in Topic 2 (Approx 75 words - reference/s used to support your response
should be written below your answer and are not included in the word count).
The evidence chosen for answering the reaerach question is a cohort study of the hospital
vaccination cases and the non-vaccinated patients. The sampling method and the study design is a
randomised control trial and also focused on the statistical analysis of the effectiveness of the
vaccination process. It effectively focused on the description of the study and also providing the
appropriate knowledge about the effectiveness of the vaccination process over the non-
vaccination. Hence, as per the hierarchy of evidence this resorce can be marked as level 1
evidence as well as a recent work (Del Fabbro et al. 2019). Thus, the resource has been chosen.
Question 4a: List three key words that will assist in finding suitable literature in a library database to
answer the research question that you have formulated. For each of the search terms, suggest an
alternate word for which the Boolean function “or” could be used and truncations and wildcards.
Keyword Search term/s for
Boolean ‘or’ ‘and’
‘not’
Truncation/s Wildcards
1 Vaccination and immunisation * .
2 Non-vaccination effective or ineffective * .
3 Immunisation and non- * .
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vaccination
Question 4b: What actions could be taken to extend or limit the number of articles found or
improve the quality/relevance of the articles found in the search? (Approx 75 words - reference/s
used to support your response should be written below your answer and are not included in the word
count).
Inclusion and exclusion criteria should be set for limiting and improving quality of the articles. The
inclusion criteria should focus on the language and topic relavence of the articles (Dong and Xie
2018). Moreover, it also needs to be focused on the articles which are within 5 years range. The
Inclusion criteria should also focus on the quality of the article and the full text access of the
article as well. On the other hand, the exclusion of the articles should be done by limiting the year
of the article publishing within 5 years and also full text unavailability.
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Question 5 (25 marks - 500 word equivalent)
Complete the template below by providing the requested information relating to some of the specific components of the research articles listed. IBNU
students only need to complete the two articles that are for ‘IBNU students only’ and IMBW students only need to complete the two articles that are for
‘IBMW students only’.
Table 1.
IBNU students only:
IBMW students only:
Li‐Kim‐Moy, J.P., Yin, J.K., Heron, L., Leask, J., Lambert, S.B., Nissen, M., Sloots, T. and Booy, R., 2017. Influenza vaccine
efficacy in young children attending childcare: A randomised controlled trial. Journal of paediatrics and child health, 53(1), pp.47-54.
https://doi.org/10.1111/jpc.13313
McMillan, M., Clarke, M., Parrella, A., Fell, D.B., Amirthalingam, G. and Marshall, H.S., 2017. Safety of tetanus, diphtheria, and
pertussis vaccination during pregnancy. Obstetrics & Gynecology, 129(3), pp.560-573.
https://insights.ovid.com/crossref?an=00006250-201703000-00025
Type of study (e.g.: meta-
analysis, systematic review,
cohort, RCT, ethnography,
phenomenology, etc)
The study is a randomised control trial.
Issue/Topic (what was being
studied)
The topic is, Influ-enza vaccine efficacy in young children attending childcare.
Purpose/aims of the study
(why was the study being
undertaken?)
Aim of this study is to examine the, trivalent influ-enza vaccine (TIV) efficacy and safety in young children attending childcare
Inclusion/exclusion criteria Inclusion criteria was 6 to <48 months old children at the time of first dose of vaccine.
Exclusion criteria were: clinically significant chronic illness or immunosuppression, history of allergy to egg, or any of the vaccine
component,children had seasonal TIV or HAV in present season or previous season and any child recommended with influenza
vaccination or the child with contraindication as per the Australian Immunisation Handbook 9th Edition.
Search strategy/data Data collected from the PIVOT 2011 which indicates the information about the clinical outcomes of vaccination along with the
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collection (how was the study
set up and implemented;
what intervention was used)
economic and psychosocial impacts after ILI inboth study arms, similar to methodology for PIVOT 2010.
Results (main findings) 67 children have been allocated to both the groups that is TIV and control groups. The result showed that 1.8 per cent and 13.4
per cent influenza cases among the children from TIV and control group respectively. Thus, the efficacy of the vaccine was found
to be 87 per cent for the influenza safety development among children.
Conclusion/recommendations Influenza vaccine found to be effective for the influenza immunisation development among children aged 24 to <48 months.
However, the participant rate is low thus, the caution should be maintained.
Table 2.
IBNU students only
IBMW students only:
Enkel, S.L., Attwell, K., Snelling, T.L. and Christian, H.E., 2018. ‘Hesitant compliers’: Qualitative analysis of concerned fully-
vaccinating parents. Vaccine, 36(44), pp.6459-6463. https://doi.org/10.1016/j.vaccine.2017.09.088
O'Shea, A., Cleary, B., McEntee, E., Barrett, T., O'Carroll, A., Drew, R. and O'Reilly, F., 2018. To vaccinate or not to vaccinate?
Women’s perception of vaccination in pregnancy: a qualitative study. BJGP open, 2(2), p.bjgpopen18X101457.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6184095/
Type of study (e.g.: meta-
analysis, systematic review,
cohort, RCT, ethnography,
phenomenology, etc)
There is a qualitative in depth interview has been used in this study.
Issue/Topic (what was being
studied)
The topic is, Hasitation among the parents about vaccinating their children ahs been analysed in the study that is the causes and
the adherence to the conventional factors.
Purpose/aims of the study
(why was the study being
undertaken?)
Understanding the vaccination hesitancy and the behavioural aspects of the parents regarding the vaccination of their children.
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Population (how many
participants, age, gender,
disease, etc)
10 eligible participants have been interviewed in the study with single child under the age of 5.
Materials/Method
(how was the study set up)
Purposive recruitment was conducted through the non-governmental organisation Playgroups WA. Facebook page,
monthlynewsletter, and directly invited 97 playgroup coordinators to dis-seminate recruitment information. The parents were
interviewed with open ended questionnaire and the interview process recorded and the data has been analysed thematically
using Nvivo 10 and the inductive inquiry method.
Data analysis The data analysed with the consideration of thematic anlysis using Nvivo 10 and the inductive inquiry method.
Results (main findings) The data showed that the parents are concerned about the MMR vaccine and the seasonal influenza vaccine related side effects.
They also showed concerns based on the non-vaccinationa and isolated themselves from non-vaccinated parents and children. On
the other hand, the previous cases of severe injury of one child from seasonal influenza and also the death of a child from
whooping cough in the community impacted over the behaviour of the parents regarding the vaccination.
Conclusion/recommendations The concern due to the previous side effects of the vaccination process impacted over the behaviour of the parents and also
developed fear regarding the vaccination process. Hence, the strategies of vaccination found with no use properly over the
community people. Thus, further research on this context is recommended by the authors of the study.
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Question 6 – (45 marks – 1000 words)
Discuss the reasons why the studies above would or would not be helpful in enabling a nurse/midwife to have an informed discussion with parents/a
pregnant woman about immunisation for their children/themselves. Comment on the relative value of the studies to the argument. Identify any further
information that may be useful in an informed discussion with parents/a pregnant woman about immunisation for their children/ themselves.
(Reference/s used to support your response should be written below your answer and are not included in the word count).
It can be stated that the process of the immunisation is required with higher priority for the children. Especially the children aged under 5 the
immunisation process is very much crucial. Hence, it can be stated that the nurses and th midwives are the primary care personnel who are responsible to
inform people about the importance and the requirement of the process for their children. It can be stated that the pregnant women and the mothers of
infants are to be mostly provided with the knowledge about the process of the immunisation and the impact of the process on their children. Based on the
views of Li‐Kim‐Moy et al. (2017), it can be found that the process of the immunisation through the vaccination process developed the immunity of the
children against those specific diseases. However, the authors also stated that the process can have negative impacts over the health of the childrena s well.
The vaccination is the process which has been developed by Dr. Jenner in early 1800 and the process was effective in that time period against the small pox
epidemic. However, the process had showed different side effects as well. Thus, the modernisation of the medical science effectively improved the process of
the vaccination and reduced the risks of the vaccination process. This has been seen that the vaccinated children have the induced immunity system in
comparison of the children without the vaccination process (Burke, Schwartz and Breda 2019). However, the seasonal vaccination should be completed with
the consideration of the doctor or physician prescribed dosage. Thus, the nurses and the midwives are to develop the knowleddge among the women
population regarding the importance of the vaccination process with consideration of the positive impact of the process on the children health. However, the
education should be provided with the examples to the women for better acceptance and also the practical evidence based process following. However, it can
be seen that the many studies already evidenced that the process of the vaccination and the side effects of the vaccination impacted over the thought
processes of people. Enkel et al. (2017), highlighted that the vaccination process and the side effects of the vaccination process affected the behaviour of the
parents of the children regarding the vaccination. It has been seen that the previous negative examples of the vaccination process found to be affecting the
mental status of people that impacts over the belief of people. The factor of the concern is present among people and also they were found with precautions
against the people not vaccinating their children. However, the fear of the side effects of the vaccine related negative consecuences held them back to accept
the vaccination process It can be stated that the vaccination process and the impact of the vaccination process is related to the children health. Thus, it can
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be marked as one of the most delicate factor fot the people with children especially for the mothers and the pregnant women. Thus, the nurses and the
midwives should implement the effective communicationa and the empowering strategies to reduce the fear and let the parents accept the process. It can
only be stated that the process of the vaccination should be considered with higher priority as the presenty situation of the world found with different viral and
infectious diseases. Thus, the people should consider the vaccination process for the immunity induction of the children in this situation. The immunity of the
children is not complete or rather vulnerable to the present scenario thus, the effective vaccination would be effective in the safety development among the
children. Thus, it can also be stated that the process of the knowledge development and also the improvement of the immunity would be obtained through the
process of the vaccination among the children. Thus, the nusres and the midwives should develop awareness programs and provide knowledge to the people
about the vaccination (Williams 2019). On the other hand, the strategies of positive communication and also patient prioritusation should be implemented for
the awareness build up among the people. However, the long lasting belieafs of people and also the negative impact of the previous cases of the vaccination
can be found as the most impacting factors over the belief of people or the parents. Thus, the nusres should consider this as one of the most delicate process
and also evaluate the negative factors over the positive factors as the belief of people impacted by the negative impacts of the process of vaccination. In this
context, it can also be stated that bthe government and the nurses or the health care professionals should work in a collaboration to improve the situation. On
the other hand, the prospect of the vaccination process should be shown to the people with all the positive aspects of the process. Thus, the health care
policy development regarding the vaccination process and also providing the assurance of the positivity would also be effective in the process of the
acceptance of the parents and the women population regarding the vaccination process. It can be stated that if the safety of the children can be highlighted by
the nurses to the women then the acceptance of the process can be achieved easily (Navin, Kozak and Deem 2020). However, the education should be
provided with the examples to the women for better acceptance and also the practical evidence based process following. However, it can be seen that the
many studies already evidenced that the process of the vaccination and the side effects of the vaccination impacted over the thought processes of people.
The immunity of the children is not complete or rather vulnerable to the present scenario thus, the effective vaccination would be effective in the safety
development among the children. Thus, it can also be stated that the process of the knowledge development and also the improvement of the immunity would
be obtained through the process of the vaccination among the children. It has been seen that the previous negative examples of the vaccination process
found to be affecting the mental status of people that impacts over the belief of people. The factor of the concern is present among people and also they were
found with precautions against the people not vaccinating their children. However, the fear of the side effects of the vaccine related negative consecuences
held them back to accept the vaccination process It can be stated that the vaccination process and the impact of the vaccination process is related to the
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children health. Thus, the process of the education to the mother and the parenst should be considering the emotional aspects of the child safety and the
future context of children (Palmieri, Spoltore and Lee 2017).
*5 marks will be given for writing, presentation and correct use of Harvard UniSA referencing for all responses in the template as per the assessment
feedback sheet.
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References
Burke, K., Schwartz, S. and Breda, K., 2019, October. Don't hesitate, vaccinate! An influenza vaccine education program. In Nursing forum (Vol. 54, No. 4, pp.
553-556).
Del Fabbro, G., Bzovsky, S., Thoma, A. and Sprague, S., 2019. Hierarchy of Evidence in Surgical Research. In Evidence-Based Surgery (pp. 37-49). Springer,
Cham.
Dong, X. and Xie, J., 2018. Analyzing Inclusion Criteria of 7000 Cochrane Systematic Reviews.
Enkel, S.L., Attwell, K., Snelling, T.L. and Christian, H.E., 2018. ‘Hesitant compliers’: Qualitative analysis of concerned fully-vaccinating
parents. Vaccine, 36(44), pp.6459-6463.
Li Kim Moy, J.P., Yin, J.K., Heron, L., Leask, J., Lambert, S.B., Nissen, M., Sloots, T. and Booy, R., 2017. Influenza vaccine efficacy in young children attending‐ ‐
childcare: A randomised controlled trial. Journal of paediatrics and child health, 53(1), pp.47-54.
Morse, J.M., 2016. Mixed method design: Principles and procedures (Vol. 4). Routledge.
Navin, M.C., Kozak, A.T. and Deem, M.J., 2020. Perspectives of public health nurses on the ethics of mandated vaccine education. Nursing Outlook, 68(1),
pp.62-72.
Palmieri, P.A., Spoltore, T.L. and Lee, O., 2017. An Evidence-Based Educational Strategy to Improve Influenza Vaccination Rates Among Hospital Nurses.
Williams, L., 2019. Role of the Pediatric Nurse Practitioner in Enhancing Vaccination Rates. AACN advanced critical care, 30(3), pp.278-281.
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