Anti-Vaxxers: Singular in Focus, Varied in Argument

Anti-Vaxxers: Singular in Focus, Varied in Argument

Four distinct types of anti-vaccination content seen in Facebook posts

Anti-vaccination messages on Facebook could be divided into four distinct themes: trust, alternative, safety, and conspiracy, according to researchers who analyzed comments posted in response to a pediatrics clinic’s pro-vaccination video.

A small sampling of these messages on Facebook found that “anti-vaxxers” had qualitatively different types of arguments that cater to a wide variety of audiences, reported Brian Primack, MD, of the University of Pittsburgh School of Medicine, and colleagues.

However, the one commonality was that all were distrustful of physicians and the medical community, the authors wrote in Vaccine.

The World Health Organization (WHO) lists “vaccine hesitancy” as one of its 10 threats to global health in 2019, and indeed, Primack and colleagues cited the “considerable rise in the rate of nonmedical exemptions from school immunization requirements” in the U.S.

They noted that while prior research has focused on either anti-vaccination content on Twitter, comments in response to celebrity posts, and Facebook groups, the characteristics of individuals posting anti-vaccination content on Facebook has not been thoroughly examined.

“We want to understand vaccine-hesitant parents in order to give clinicians the opportunity to optimally and respectfully communicate with them about the importance of immunization,” Primack said in a statement. “If we dismiss anybody who has an opposing view, we’re giving up an opportunity to understand them and come to a common ground.”

Primack and colleagues examined the profiles of 197 individuals who posted anti-vaccination comments on a Pittsburgh pediatrics practice’s Facebook page in response to a video promoting the vaccine against HPV. These were among “thousands” posted over a period of 8 days considered anti-vaccination, “which we defined as being either (1) threatening (e.g., ‘you’ll burn in hell for killing babies’) and/or (2) extremist (e.g., ‘you have been brainwashed’),” the group explained.

Among the 197 randomly chosen for analysis (“in order to feasibly conduct in-depth quantitative assessment”), they found a large majority of these commenters were women, and almost 80% were parents. About 30% reported an occupation and a little under a quarter reported a post-secondary education. Of the 55 individuals whose political affiliation could be determined, 56% identified as supporters of Donald Trump, while 11% identified as supporters of Bernie Sanders.

There were 116 individuals who had at least one public anti-vaccination post from 2015-2017, with posts about “educational material,” or claims that doctors are uneducated and parents need to educate themselves were the most popular (73%), followed by “media, censorship, and ‘cover up'” or the suggestion that pharmaceutical manufacturers, government, and physicians deliberately fail to disclose adverse vaccine reactions (71%) and “vaccines cause idiopathic illness,” claiming kids who are not vaccinated get less illness (69%).

The four overarching themes were more specifically:

  • Trust: emphasizing suspicion about the scientific community, concerns about personal liberty
  • Alternatives: focusing on chemicals in vaccines, use of homeopathic remedies over vaccination
  • Safety: perceived risks and concerns about vaccination being immoral
  • Conspiracy: that government “hides” information that anti-vaccination groups believe to be facts

Co-author Beth Hoffman, BSc, also of the University of Pittsburgh, said that these groups “caution against a blanket approach to public health messages that encourage vaccination.”

“Telling someone in the ‘trust’ subgroup that vaccines don’t cause autism may alienate them because that isn’t their concern to begin with. Instead, it may be more effective to find common ground and deliver tailored messages related to trust and the perception [that] mandatory vaccination threatens their ability to make decisions for their child,” she said in a statement.

Limitations to the data include that these only reflect commenters who responded to a single pro-vaccination video, and do not necessarily reflect “broader discussions of anti-vaccination issues on Facebook.” Demographic data was self-reported, and could not be authenticated, they noted.

The authors disclosed no conflicts of interest.

This story was originally posted on MedPage Today.

UNLV to Develop Continuing Education Nursing Programs Through State Grant

UNLV to Develop Continuing Education Nursing Programs Through State Grant

The Nevada Governor’s Office of Economic Development (GOED) has rewarded the University of Nevada Las Vegas School of Nursing with a $900,000 grant. UNLV will put the grant toward expanding new advanced training opportunities and continuing education for nurses.

UNLV received the grant to develop nursing certificates designed to meet specific needs around the state, such as teaching, specialty care, and clinical research.

“We are excited to be able to expand the skills and competencies of Nevada nurses as clinical research nurses, genetics counselors, and clinical preceptors,” Angela Amar, professor and dean of the UNLV School of Nursing, shared with the UNLV News Center. “This funding allows us the opportunity to advance the health of Nevada citizens by increasing the capabilities of our nurses.”

The grant support, which originated from the GOED’s Workforce Innovations for a New Nevada program, is a continuation of UNLV’s plans in recent years to work on solving the state’s continually evolving medical needs. The UNLV School of Nursing has seen an admission increase of 50 percent since fall 2017 for BSN candidates. The school also has one of the top-ranked online master’s degree programs, and is also home to the Clinical Simulation Center of Las Vegas (CSCLV). The CSCLV, a technologically advanced educational facility, provides nursing and medical students opportunities to practice their skills through various simulations.

“At the UNLV School of Nursing, we educate nurses to provide the highest quality care for the citizens of Nevada,” Amar said. “The developing Las Vegas medical district and UNLV medical school make it important that nursing grows also. The increase in enrollment furthers our ability to meet the health care needs of our diverse population. With a critical need for highly trained nurses across our region and state, expanding our BSN class sizes will increase the number of graduates who can meet this demand.”

The planned certificate programs, which include Certified Nursing Assistant Instructors, Clinical Research Administrators, and Health Information Technology and Data Analytics, were developed in partnership with several health care organizations across the state, such as University Medical Center of Southern Nevada, and Comprehensive Cancer Centers of Nevada. These partners will help with job placement for all certification program participants.

The Valley Health System, University Medical Center of Southern Nevada, Comprehensive Cancer Centers of Nevada, and the Kenny Guinn Center for Policy Priorities. Health care employer partners, along with projected industry growth, will ensure successful placement of participants following their completion of the various programs, to ensure these nurses provide the best possible care to Nevada patients.

For more information about UNLV’s School of Nursing, click here.

Addiction and Nursing: How the Epidemic Affects Nurses

Addiction and Nursing: How the Epidemic Affects Nurses

When my buddy Jason first got into his nursing program, I was excited for him. Nursing is an honorable profession, one that is constantly in demand and provides certain stability that other career paths may not.

His first few semesters were rough, understandably. The competitiveness of his nursing program, the long clinical hours, and the constant full exertion required eventually took its toll on him.

By the time he became a nurse, I hardly saw him at all. He began to ignore our invitations to go out with friends and to get defensive whenever we gave him a hard time about it.

When we finally did see him, he was always on edge, flighty, and nervous. Many of our friends began to question his mental health but I knew what had happened.

Jason was struggling with addiction.

All of the signs and symptoms were there, as were the growing pressures that led him to an addiction.

It didn’t take long for my friend to seek help and eventually sober up. He was committed to his role as a nurse and even more committed to providing the healthcare that he promised to provide once he received his license.

But with my work in addiction recovery, it became apparent to me that this was a real epidemic both in the general population and among nurses. If you’re not sure whether or not you or someone you know is struggling with addiction, then read through for symptoms of addiction and withdrawal to find out.

I’ll also outline some ways to provide support so that the nurse in your life can get back to the job they love so much without the dangerous effects of an addiction.

Substance Abuse in the Medical Profession Versus General Population

Surprisingly, dependence on alcohol and drugs for nurses isn’t too far off from that of the general population. While some may assume that nurses would stay away from an addiction, about 10 percent of nurses struggle with an addiction of some sort.

Considering that there are about four million nurses in the US alone, roughly four times the amount of physicians we have, it’s a staggering number of medical professionals who are in the throes of addiction.

As the shortage of nurses continues to rise, so does the job stress and lack of resources to support them.

Nurses have been tasked with roles that are traditionally performed by physicians and are expected to work long hours in constantly rotating shifts, making the work environment for nurses especially challenging.

Plus, they have easy access to virtually any prescription pill on the market.

But because they work with medications so regularly, many of them have intellectualized use and abuse to the point of failing to recognize when they themselves are addicted.

Symptoms of Opiate Addiction and Withdrawal

There are several different things to look for, though signs and symptoms can generally be broken down into two categories: signs of intoxication and signs of withdrawal.

Signs of opiate intoxication generally include:

  • Feelings of euphoria
  • Pinpoint pupils
  • Sweating
  • Nausea or vomiting
  • Poor memory and concentration

If any of these signs appear when they were previously absent, then it’s possible that this person is battling an addiction.

Signs of opiate withdrawal include:

  • More vomiting and nausea
  • Diarrhea
  • Muscles aches and pains
  • Intense anxiety and/or panic attacks
  • More sweating
  • Extreme irritability

While some of these symptoms can be present due to lack of sleep and stressful situations, they tend to be a bit more extreme in those experiencing withdrawal.

Another thing to watch out for that is super specific to nurses is whether or not this person is offering to cover more shifts than usual. While most people would try to get out of work, an addict in the medical field might ask for more work opportunities so that they have more access to their drug of choice.

In either case, whether intoxicated or experiencing withdrawals, an untreated chemical dependence such as this can impair judgment, slow a person’s reaction time significantly, and increase life-threatening errors that may harm a patient.

How to Support Someone With Addiction

Nurses have had to work exceptionally hard to get to where they’re at professionally. Understandably, many nurses have a touch of perfectionism. Though this makes them excellent students and even better nurses, it can sometimes make the recovery process a little challenging.

Perfectionism in addiction recovery is actually a pretty common issue, according to (Detoxes) . And though perfectionism is generally a helpful trait, it can get in the way of recovery.

Rather than expecting perfection out of your friend or colleague, try a few supportive approaches, instead. Consider that nurses addicted to drugs have unique cases where a recovery program may prevent them from continuing to work as a nurse, at least during their recovery period. Also consider that there might be a lot of shame surrounding the addiction, or that the person may not recognize the addiction at first.

Approach the topic gently and explore all options for a full and safe recovery.

For full support and guidance, the Substance Abuse and Mental Health Services Administration (SAMHSA) has put together a handful of resources to help you navigate the recovery process.

My buddy Jason was fortunate to be able to heal from his addiction and I hope for the same for all nurses struggling with addiction. The first step to ensuring this is to recognize that the risk exists right in your own station.

The author, an addiction recovery advocate, requested anonymity for publication of this piece. Names have also been changed for anonymity.

VA Nurse Executive and Veteran Encourages VA Nurses to Pursue All Opportunities to Serve Veterans

VA Nurse Executive and Veteran Encourages VA Nurses to Pursue All Opportunities to Serve Veterans

VA Nurse Executive David E. Murray is a nurse leader at the William S. Middleton Memorial Veterans Hospital in Madison, Wisconsin

For more than 28 years, David E. Murray, MSN, RN, APN, NE-BC, has worked at the U.S. Department of Veterans Affairs (VA), most recently as Associate Director Patient Care Services/Nurse Executive at the William S. Middleton Memorial Veterans Hospital in Madison, Wisconsin, a position he’s held for three years. Murray, a retired lieutenant colonel, is a combat Veteran of Operation Enduring Freedom/Operation Iraqi Freedom.

Murray provides nurse leadership in collaboration with other disciplines to improve Veterans’ care at the Wisconsin hospital. In this installment of our #ChooseVALeadership Careers and as VA prepares to attend the American Organization of Nurse Executives annual meeting in April (find us at booth 132), Murray explains his role as nurse leader and why he chose a VA career.

What is your primary job at VA?

I provide executive leadership and complex managerial and administrative tasks that impact critical healthcare issues and the activities that influence the organizational mission, healthcare and policy. My leadership has helped develop a professional practice environment that fosters excellence in nursing services, evidence-based practice, staff recruitment and retention, nursing research and scholarly inquiry, and customer satisfaction.

Describe your specialties and how you apply these skills in the care you provide to Veterans.

As a Nurse Executive, I help guide policy, mentor my Service Chiefs and Managers, and work with the executive team to make the Madison VA the best place to work and the best place for Veterans to receive care.

What was appealing about a career at VA?

I was already serving in the Wisconsin Army National Guard as a medic and a career as a nurse caring for Veterans seemed like a logical fit. Before I finished nursing school, I had a final clinical at the Madison VA and was hired before I had graduated.

What is the most rewarding part of your job?

That becomes a twofold answer. I am honored to lead a Nursing Service that provides exemplary care to our Veterans, which is clear from the positive comments we receive in the Director’s office and from the Veterans we meet when we do unit rounding. The other rewarding part is watching our nursing staff grow from novice to expert and embrace shared decision making as they become part of our facility-based nursing practice council.

How has VA helped you grow in your career?

I’ve received numerous opportunities to grow throughout my career with VA, including preceptor (instructor) opportunities as a new graduate, leadership courses at the local level and Veterans Integrated Service Network-wide leadership training. As I delved into my new role as Nurse Executive, the VA Office of Nursing Services paired me with a mentor from a similarly sized facility and established monthly mentoring calls. Within the first year, I received the Veterans Health Administration’s (VHA) New Executive Training (NExT) orientation with peers from across VA. VA’s annual Nurse Executive Conference is partnered with the annual Chief of Staff Conference, where we receive timely information from subject matter experts from VHA and VA Central Office. (Learn more about leadership opportunities for VA nurses in the brochure PDF.)

What are a few key benefits of working at VA?

Working for VA provides a plethora of benefits that only increase in value as the years go by. Nursing receives up to five weeks of annual leave starting on day one, along with 13 sick days and 10 federal holidays. You can also participate in the Thrift Savings Plan — the government’s 401(k) — where VA will match up to the first 5 percent of contributions. This is paired with a pension plan that, once vested in five years, will help you plan for retirement. VA nursing careers also have unique ladders for promotions and salary increases not often seen in other healthcare organizations.

What do you find most surprising about working at VA?

In my current role I often spend some upfront time with the new nursing hires. Although many admit they worried about coming to work for VA, once they started orientation, spent time with the Veterans and truly understood our mission, they fell in love with their new role.

What story do you most often tell people about your work?

Since 2004, we have been a Magnet facility, which is an American Nurses Credentialing Center designation indicating that our facility is committed to excellence in healthcare and support for our nurses. Even as we work on our second redesignation, our work is never done, and we do not claim to be a perfect facility. We always seek ways to support VA nurses as they lead evidence-based practice projects and make improvements that lead to great Veteran and staff experiences.

What would you tell other nurse leaders interested in choosing a career at VA?

The mission of VA is noble and, once you start working with Veterans, this is a career that becomes endearing. Veterans are so thankful for the care they receive, and they partner with you to improve their overall healthcare experience.

What else would you like us to know about your work?

The opportunities are endless for nurses coming to VA — I have had six distinctly different roles throughout my career at the Madison VA, each with its own unique challenges and rewards. I tell staff to always be prepared for whatever the next opportunity may be. Even if they are not thinking of changing roles, I still encourage VA nurses to take the courses, get the next level of education and be prepared for opportunities as they arise.

This story was originally posted on VAntage Point.

10 Questions: Therese S. Richmond, PhD, CRNP

10 Questions: Therese S. Richmond, PhD, CRNP

Therese S. Richmond, PhD, FAAN, CRNP, associate dean for research and innovation at the University of Pennsylvania School of Nursing, views nursing as “an exquisite opportunity” to help people when they are at their most vulnerable. There is nothing better than being a nurse, she told MedPage Today, explaining that even during her hardest days she reminds herself to “take a deep breath and be thankful for the honor of being a nurse.”

Richmond received her Masters in Nursing Science from Catholic University of America in the early 1980s, followed by a PhD from the University of Pennsylvania a decade later. Since then, she has spent much of her career using nursing science to prevent injury and violence and improve outcomes, particularly in patients from vulnerable urban populations worldwide.

Richmond was recently elected to the National Academy of Medicine and is also a member of the Federal Advisory Committee to the Secretary for National Health Promotion and Disease Prevention Objectives for 2030.

In this installment of “10 Questions,” Richmond discusses the complexity of the U.S. healthcare system and what she sees as its most pressing issues.

1. What’s the biggest barrier to practicing nursing today?

The complexity of healthcare systems and the rapid movement of patients through acute hospitalization poses a significant challenge. Nurses need to get to know patients and families quickly, predict what their needs will be upon discharge, and prepare patients and families to provide complex care in the home.

As an injury researcher, I have found that psychological consequences surface after injury for a substantial subset of injured patients. Yet the symptoms of psychological reactions to injury do not surface until after discharge. We need to prepare patients to recognize symptoms of disorders such as post-traumatic stress disorder and depression, so that patients and families recognize and attend to symptoms when they arise and know when and how to ask for help.

Nurses need to overcome the barriers erected by increasingly shortened hospital stays and help people know where to go to seek help — which is not easy in complex systems.

2. What’s the most important healthcare issue that nobody is talking about?

We continue to compartmentalize physical and psychological health. Today, we have systems that do not recognize the intersection of psychological and physical health. I am not speaking here about people with chronic serious mental health disorders (e.g., schizophrenia). Instead, I am talking about people who experience an acute illness (e.g., myocardial infarction) or injury (e.g., assaulted with a weapon).

A certain proportion of people with illness or injury will have symptoms of a psychological disorder emerge. While we are effective at treating the MI or the injury, we tend to be blind to the psychological responses — and even when we see these responses — in taking action. This problem is exacerbated by the fact that we predominately focus on a single episode of care. We do not fully take into account previous life experiences and exposures that can directly impact outcomes.

Think about what we know about adverse childhood experiences (ACEs) and the profound impact ACEs have on morbidity and premature mortality. Even though we know this, we don’t typically address previous trauma exposures and consider how that will affect recovery or the emergence of psychological symptoms.

3. What changes, if any, will the Trump administration impose on medical practice?

I am currently a special government employee since I sit on the Federal Advisory Committee to the Secretary of DHHS for Health Promotion and Disease Prevention and thus not in a position to answer this question.

4. What country do you think has a better healthcare system than the United States?

My previous response applies to this question as well, and thus I am not in a position to respond.

5. What is the most important piece of advice for students or providers just starting out today?

Maintain your passion and always remember the reason you entered nursing. Never forget the patient should be at the center of all we do.

6. Have you ever been afraid of a patient?

I have never been afraid of a patient. For the decades I worked in trauma and neurological critical care, there have been times that I have been in situations where behaviors are problematic. I always remind myself that if patients are acting out there is usually a physiologic, psychologic, or medication-related reason and I try to intellectually solve the puzzle of what is driving the behavior. I have found this approach is a useful strategy to address both the needs of the patient and to control any anxiety I may feel about a situation that seems to be spiraling out of control.

7. What is the most memorable research published since you became a healthcare provider and why?

I think in terms of a body of research — not just one study. As an injury and violence researcher, I think the most important is the body of research that has reduced death by motor vehicle crashes. We have learned a tremendous amount through research about cars (e.g., better, safer designs), behavior (e.g., driving while distracted, use of child safety seats, the importance of motorcycle helmets), and environment (e.g., highway design, pedestrian crossings).

As a result, we have been able to decrease death by motor vehicle a significant amount. The CDC counts this reduction in death from motor vehicle crashes as one of the top ten public health successes of the 20th century. This concerted effort required access to data, rigorous design of research studies, and a regulatory body able to institute new policies and standards based on solid science.

I am hopeful that in the future we can build a comparable body of research to reduce death by gun.

8. Do you have a favorite medical-themed book, movie, or TV show?

Can’t think of anything.

9. If you weren’t doing your current work, what do you think you would be doing today?

There is nothing better than being a nurse. Throughout the decades, I have had so many diverse opportunities to impact the lives of people and communities through my practice, my research, and my teaching. If I were not at Penn doing what I love best, I would see myself in a low-resource community trying to improve the health and well-being of those with the highest need. We have such disparities between those who have and those who have-not — it is highly disturbing. I would like to find a way to bring that into a more equal balance, which in the long-run will improve the health of all.

10. What is the biggest difference between your expectations of nursing practice when you graduated from nursing school and the reality?

There is a tremendous difference in what I expected and reality. I expected to provide high quality, knowledgeable, and skilled care to sick people. What I experienced is that at its core, nursing provides me an exquisite opportunity to touch people’s lives at a time that they are at their most vulnerable. This is a privilege afforded to me as a nurse that few others experience. During my hardest days, I take a deep breath and remember to be thankful for the honor of being a nurse.

This story was originally posted on MedPage Today.

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