The anti-vaccination (“anti-vaxx”) movement is a global phenomenon that has received a great deal of press, but how much do we really know about it? How do educated adults come to turn against medicines that have been saving literally millions of lives since the early days of smallpox inoculations?
One partial explanation is offered by health policy reporter Stuart Lyman. In a February column for STAT, he writes, “The [pharmaceutical] industry has been engaging in bad behavior for several decades, and these self-inflicted wounds have turned much of the public against it…” After reciting a horrifying litany of pharma-company scandals the public has witnessed, he concludes, “All of this has contributed to the prominent anti-pharma themes voiced by the anti-vaxx crowd.”
Anti-Vaxx is No Longer In Its Infancy
But “the anti-vaxx crowd” shows no signs of giving up their crusade anytime soon. From their original focus on parents of autistic children, they have proceeded to target orthodox Jewish communities and recently bereaved parents. Perhaps the most influential US group behind anti-vaccine campaigns is ICAN (Informed Consent Action Network). According to the Washington Post, ICAN, founded by former daytime television producer Del Bigtree, is largely funded by New York city philanthropists Bernard and Lisa Seltz, who have contributed $3 million since joining in 2012.
Lisa Seltz now serves as ICAN president, and continues to fund the organization’s message that the government and “Big Pharma” are colluding in a massive coverup regarding the hidden dangers of vaccines. Robert F. Kennedy, Jr, a nephew of the late president, runs Children’s Health Defense, his own anti-vaxx organization, and another flush-with-cash group, The National Vaccine Information Center, is run by Barbara Loe Fisher (who claims her son’s learning disabilities were the result of a 1980 DPT shot that was followed by “convulsion, collapse and brain inflammation within hours”).
Some Quick Tips from NSO’s Georgia Reiner
Considering that these wealthy and powerful organizations are finding fertile ground in today’s conspiracy-minded culture, DailyNurse interviewed Georgia Reiner, a risk specialist for Nurses Service Organization (NSO), to request a few tips for nurses who find themselves confronted by this strange controversy.
DailyNurse: What are the
actual dangers posed by the anti-vaxx movement?
GR: It is important to state up front that the vast majority of people do vaccinate. However, the anti-vaccination movement has gained a lot of attention and helped foment outbreaks of largely preventable diseases that can be deadly. The anti-vaxx movement spreads misinformation and conspiracy theories online on social media, and by word-of-mouth in tight-knit, culturally isolated communities.
Anti-vaxx propagandists have helped to create pockets of unvaccinated people, which have contributed to public health issues like the measles outbreak seen recently in Orthodox Jewish communities in New York and New Jersey. These outbreaks of highly contagious diseases such as measles put vulnerable people, including newborn babies and people who have weakened immune systems, at great risk.
Outbreaks also distract
and divert resources from other important public health issues, and cost state
and local governments millions of dollars to contain. However, nurses are in an
ideal position to counter this messaging.
DN: What are nurses doing
to counter the anti-vaccination movement?
GR: Nurses are a trusted
source of credible information and can have tremendous influence over the
decision to vaccinate. This is true even for parents who are vaccine-hesitant.
Working on healthcare’s front lines, nurses can help inform families about
vaccinations and the role they play in keeping their children healthy and
stopping the spread of disease. Nurses can also learn about questions parents
may ask about vaccines, and how to effectively address common concerns.
DN: How can nurses cope
with anti-vaxx parents?
GR: First, nurses should
assume that parents will vaccinate. Research has shown that when healthcare
providers use presumptive language, significantly more parents accept vaccines
for their child. Then, if parents are still hesitant or express concerns,
nurses should work with the treating practitioner to convey the importance of
Nurses should listen to
parents’ concerns, work to understand why they are questioning the science, and
respond respectfully. Provide parents with information about vaccines and
vaccine-preventable diseases, both verbally and in writing. Document parents’ questions
If parents still decline to vaccinate, the parents should sign a Refusal to Vaccinate form. Parents should sign a new form each time a vaccine is refused so there is a record in the child’s medical file. To minimize potential legal exposure, nurses should document all discussions, actions taken, and educational material provided.
For further information, visit the American Academy of Pediatrics site document “Countering Vaccine Hesitancy.”
Helping patients to navigate what comes after a difficult diagnosis is a necessary part of our profession. In my many years working with patients facing progressive diseases, like chronic obstructive pulmonary disease (COPD), I have found that they often have questions, namely:
do I do now?
That’s where we, as
nurses and other health care providers, can offer answers. COPD is not
currently curable; however, there is still hope for these patients. Lifestyle
changes and medical advancements make it possible for patients to improve their
ability to breathe and overall quality of life. The objective of treatment is
to slow the progression of the disease and assist with managing its symptoms. As
patients with COPD come to terms with their disease, here’s what I would
recommend to guide them through the next steps of their journey, from diagnosis
With Them to Create a Plan
After giving a
diagnosis of COPD, educating patients on the disease and working with them on a
personalized plan to start addressing their symptoms is an important first
step. In fact, there are many lifestyle changes that patients can make every
day to not only accommodate their new medical needs but also to help improve
lung function. Committing to a diet of anti-inflammatory foods — like fatty
fish or dark leafy greens — participating in regular low-impact physical
activities and other techniques can help to reduce inflammation in the lungs
that can exacerbate symptoms.
Them Take the Steps to Quit Smoking
Smoking can cause
significant damage in the lungs which only increases over time. One of the best
things that patients can do if they’ve been diagnosed with chronic lung disease
is to quit smoking if they currently smoke. It’s important to arm them with information
and tools they need to successfully do so — whether it’s helping them to
identify smoking triggers, create an exercise and diet regimen or connect to
support groups or other resources. For example, at Lung Health Institute, we
offer our patients access to programs like American Lung Association’s Freedom
From Smoking® Plus, a flexible online smoking
cessation program that can be completed in six weeks.
Have an Honest
Conversation About What Treatment Is Right for Them
patient is different, and treatments will vary for each patient with COPD — depending
on the severity of the disease and other factors, including age, fitness level or
medical history. That’s why it’s critical to create an environment where patients
are comfortable being completely honest about how they’re feeling both
physically and mentally. That will ensure that we can provide them with the
best course of action when it comes to their treatment.
Melissa Rubio, Ph.D., APRN, is a nurse practitioner and principal investigator for research at the Lung Health Institute, based at its Dallas clinic. Rubio also currently serves as a visiting professor at DeVry University’s Chamberlain College of Nursing in Downers Grove, Illinois. Prior to joining Lung Health Institute, Rubio worked at Pleasant Ridge Internal Medicine in Arlington, Texas, as a family nurse practitioner. Rubio holds a doctorate in philosophy from the University of Wisconsin-Milwaukee College of Nursing. She also earned a bachelor’s degree in nursing from the same school. She is a board-certified family nurse practitioner and a certified principal investigator. Rubio is also a member of the North Texas Nurse Practitioners and the Southern Nursing Research Society.
Nursing, as defined by the World Health Organization, encompasses care for people of all ages, families, groups, and communities, sick or well and in all types of settings. Nursing includes health promotion, illness prevention, and care of the ill. Regardless of your nursing role, or type of patient population you care for, health literacy is an essential competence necessary to effectively communicate and truly provide person-centered care. Health literacy is a precursor to health and considered a social determinant of health due to its influence upon health outcomes. It also includes engaging and empowering patients to access services and act upon health information to make informed decisions.
Early definitions of health literacy primarily focused on the skills or deficits of individuals when obtaining, processing, or understanding basic health information and services. The term has continued to evolve to reflect the complex, dynamic, multidimensional context-related components of health literacy. And while nurses have such a vital role in the promotion of health literacy, there is often a lack of understanding that health literacy is much more than the reading level of patient education material.
Nurses have a vital role in partnering with the 88% of the U.S. population that are not having their health care needs met. Nurses can make a difference beginning today!
Begin by checking out the 5 basic health literacy strategies every nurse should know.
1. Promote a shame-free environment.
Health literacy is the foundation to a successful nurse-patient interaction and necessary to promote patient safety. Writing all patient forms in plain language, providing assistance with paperwork, offering free interpretation services, and involving members of your community when designing materials or programs will assist with promoting a shame-free environment.
2. Use a health literacy universal precautions approach.
Always assume that everyone might experience difficulty understanding health information or navigating the complex health care environment. Even a well educated patient can have difficulty understanding the medical information provided.
3. Speak in plain language.
Plain language or “living room language” is beneficial for everyone! Using “everyday” words rather than medical jargon will allow you to meet your patients where they are and help clearly explain more involved concepts.
4. Confirm understanding with Teach-Back.
Respectfully ask patients to explain a concept or direction back to you. This helps ensure you were clear in all patient communications. It also gives you the opportunity to clarify any misunderstanding if needed. Teach-Back is not mimicking what you said—patients should use their own words to explain understanding.
5. Ask open-ended questions.
For example, “What are your questions?”, “What questions do you still have?, or possibly, “We just reviewed a lot of information. What parts would you like me to go over with you again?” Each of these examples can help encourage questions rather than “do you have any questions?, which often results in a quick response of “no”.
Learn more about health literacy and health literacy strategies in this award winning book, Health Literacy in Nursing: Providing Person-Centered Care. For additional resources or to request health literacy services, contact Health Literacy Partners.