Planned Community Change Group Project Janice Schmuckal, Sofia Warren, Michol Popp, Heather Nowak Ferris State University NURS 340

Outline Introduction Problem Statement Community Assessment Interventions Evaluation Conclusion References

Introduction People in the United States continue to contract diseases that are vaccine preventable, infectious disease remains a major cause of illness, disease and even death (Department of Health and Human Services (DHHS), 2011). Although there have been great strides made in immunization compliance, there is still a great need to improve the follow through of the immunization schedule to ensure the health of our nation’s children. “Despite progress, approximately 42,000 adults and 300 children in the United States die each year from vaccine-preventable diseases” (DHHS).

Problem Statement Risk of communicable vaccine preventable diseases among adolescents in Kent County related to non-compliance and knowledge deficits according to the recommended CDC immunization schedule as evidenced by comparison of Kent County and national statistics.

Causative Factors Lack of health insurance Knowledge deficits Parental resistance to vaccinations Under vaccination

Community Assessment There are about six million new cases of genital HPV in the United States each year (CDC MMWR, 2011). HPV prevalence was 24.5% among females 14-19 (CDC MMWR, 2011). Adolescent girls receiving all three doses of the HPV vaccine was 32% (CDC MMWR, 2011).

Community Assessment cont’d In Kent County pertussis has gone from 1.4 per 100,000 cases to 3.5 per 100,000 cases in the years 2000-2004 (KCHD, 2005). Pertussis is the only vaccine-preventable disease on the rise in the United States, with increasing incidents in adolescents and adults related to weaning immunity (Brooks & Clover, 2006, p. 604).

Community Assessment cont’d In Michigan, this increase was first observed in 2008, with 315 cases of pertussis that was reported. The rise is continuing and in 2009, there were 902 reported cases and in 2010, there were 1564 cases of pertussis reported (Michigan Department of Community Health (MDCH), 2011).

Community Assessment cont’d “As reported in the 2003 to 2004 National Health and Nutrition Examination Survey, at least one in four adolescents had as least one of the most common STIs – namely, genital wart-associated human papillomavirus (HPV) (18.3%)” (Harkness & DeMarco, 2012, p. 442).

“Pertussis is the only vaccine-preventable disease on the rise in the US and it is severely underreported. CDC estimates that, at best, one-third of cases are believed to be reported to the CDC; other estimates place the reported cases at 1 in 10 to 1 in 20 of the true incidence” (Brooks & Clover, 2006, p. 604).

Pertussis Infection Rate (all ages), 2000-2004 Source: Kent County Data: KCHD Monthly Notifiable Disease Report MI Data: Michigan Department of Community Health US Data: Summary of Notifiable Diseases, Center’s for Disease Control

Community Nursing Interventions Examples of primary prevention of communicable disease among adolescents include: Immunization Health education Sanitation (hand washing, safe food, safe water) Regular exams Legislation

Community Nursing Intervention Obtain current immunization records. Education to the adolescent population on immunization requirements including boosters. Education to the parent of the adolescent population. Information regarding access to immunization clinics and applications for free immunizations.

The school nurse provides a critical link between the child the family and the education and healthcare systems. One of the screening requirements of a school nurse is immunization review” (Harkness & DeMarco, 2012, p.453).

Roles of School Nurse Direct care to students Leadership for health services Screening and referral for health conditions Assessment of acute illness Promotes a healthy school environment Health promotion Leadership role in health policies and programs Liaison between personnel, family, healthcare professional and the community Education Hygiene Immunizations Safety Signs of communicable disease

Education: Education to adolescent can be provided in a number of ways including: Informational handouts Internet Television Educational sessions

Educational Session Educational sessions will be geared toward middle and high school adolescents The facility used will be large, such as a school gym or auditorium. These sessions can be during school hours to ensure a large audience attendance.

Education: Education to the parent has proven to be beneficial: According to one study, parents that received a vaccine information pamphlet (VIP) were twice as likely to want to obtain immunizations for their children. (Clayton & Miller, 1994, p.370)

Access to Community Resources in Kent County, MI

Evaluations The evaluation of the community nurse’s educational session aimed at high school adolescents will be best obtained through the use of a survey.

Evaluations The questionnaire may also include questions on attitudes, on values that may underlie attitudes on the issue, message statements pro and con, demographic and lifestyle questions, and questions on policies and behavior. (Belden, et al., 2004)

Evaluations Surveys are a valuable tool. The results of surveys can provide the information needed to show the effectiveness of the nursing intervention: Has the audience digested the information? Has it influenced their thoughts on the issue of vaccination? Was it a positive or negative response from the surveyed individuals, and why? Has the intervention motivated actions? (Belden, et al., 2004)

Conclusion Immunizations of our youth ensure the prevention of communicable disease. With the recent statistics we fall short of the goals. Education of our adolescents and their parents play a large role in compliance and empowers the adolescent to be responsible for their own health. By providing information and resources for immunization we are closing the gap on non-compliance.

Conclusion Immunization will always be an ongoing process as there are new citizens born every minute. Breaking the barriers and empowering people with knowledge is the goal of the community health nurse. Nursing can evaluate the educational process by using a survey as a tool to analyze the feedback to ensure success.

References Beldon, Russonello, Stewart, (2004). Using Survey Research to Evaluate Communications Campaigns. Retrieved from http://www.brspoll.com/commentary/Using%20Survey%20Research.pdf Brooks, D. A., & Clover, R. (2006, December). Pertussis Infection in the United States: Role for Vaccination of Adolescents and Adults . Journal of the American Board of Family Medicine , 19(6), 603-611. doi:10.3122/jabfm.19.6.603 Centers for Disease Control and Prevention. (2005, December 23). Morbidity and Mortality Weekly Report, 54(50), 1283-1286. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5450a3.htm Centers for Disease Control and Prevention. (2011, September 16). Morbidity and Mortality Weekly Report, 60(36);1254-1267. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6036md.htm?s_cid=mm6036md_w Clayton, E., Hickson, G., & Miller, C. (1994). Parent’s responses to vaccine information pamphlets. Pediatrics, 93, 369-372. Retrieved from http://pediatrics.aappublications.org.libcat.ferris.edu/content/93/3/369.long Dorell, C., Yankey, D., & Strasser, S. (2011, August 19). Parent-Reported Reasons for Nonreceipt of Recommended Adolescent Vaccinations, National Immunization Survery--Teen, 2009. Clinical Pediatrics, 1-9. doi:10.1177/0009922811415104 Freed, G., Clark, S., & Cowen, A. (2000, October). State-level perspectives on immunization policies, practices, and program financing in the 1990s. American Journal of Preventative Medicine, 19(3), 32-44. doi:10.1016/S0749-3797(00)00219-1 Harkness, G. A., DeMarco, R. F. (2012). Community and Public Health Nursing Practice: Evidence for Practice. Wolters Kluwer/Lippincott, Williams & Wilkins: Philadelphia Health Promotion Model. (2011, April 15). Retrieved November 10, 2011, from http://nursingplanet.com/health_promotion_model.html

References Heart of West Michigan United Way. (2011). 2-1-1. Retrieved November 10, 2011, from http://www.hwmuw.org/index.php?pr=211 Merck & Co., Inc. (2011). Gardasil. Retrieved November 2, 2011, from http://www.gardasil.com/ Michigan Care Improvement Registry. (2011). Retrieved October 27, 2011, from http://www.mcir.org/immunratesbycounty.html Michigan Department of Community Health. (2011). Pertussis in Michigan. Retrieved November 1, 2011 from www.michigan.gov/mdch/0,1607,7-132-2945­_5104_5281-240419--,0 Public Health Clinic Services. (2011). Retrieved November 14, 2011, from http://www.accesskent.com/Health/HealthDepartment/health_clinics.m U.S. Department of Health and Human Services. (2011). Immunizations and Infectious Diseases. Retrieved November 1, 2011, from http://www.healthypeople.gov/2020/topicsobjectives2020/overview.asp x?topicid=23