B740 : Nursing Theory : Assessment Answers

This assessment aims to empower you with the confidence to deliver patient education tools and communication skills through the application of the knowledge gained in Themes 1 and 2.

Instructions:

Design a poster to promote immunisation coverage rates. In your submission, provide the following:

1. An image of the poster you have designed.

2. An evidence-based script based on the poster, that you would use to promote immunisation coverage rates. The script must also be relevant to your professional scope of practice 

3. All projects are to be supported by a referenced reflective paper using Rolfe’s reflective model (Maximum 1000 words). The reflective paper should:

Identify the target audience and where the poster will be displayed
Refer to the three questions posed by Rolfe’s model being ‘what’, a description of the project including poster design and delivery method for script and, So ‘what’, an analysis of the project including expected outcomes for people in your practice and ‘what’ next, what you have learned and the implications for future practice.
Guide on Poster presentation

A poster is a visual combination of bold design, colour, and message intended to catch and hold the attention of the passer-by long enough to implant or reinforce a significant idea in his/her mind (Wittich & Schuller cited in McCann, Sramac & Rudy 1994, p. 45).

A well designed poster addresses the following points:

identifies author and date of preparation
is clutter free, concise and in plain English with space between sections and headings
is readable because it has:
appropriate typeface:

serif typefaces are recommended for bodies of text e.g. times new roman, palatino.

sans serif typefaces are recommended for titles and headings e.g. arial, verdana, helvetica.

– typeface of a size that is readable from a distance

– important points at eye level

– lists that are formatted using bullet points

– headings or captions for pictures, tables and graphs

is visually dynamic

Answer:

Image of the poster:

 

Evidence based script of the poster:

Vaccine preventable diseases (VPD) are the major cause of mortality and morbidity and contribute to burden for the health care system worldwide. Despite the implementation of vaccination programs in developed countries, about 1.5 million children are dying everywhere from VPD (Odone et al. 2015). This is seen mainly because of inadequate vaccination coverage in various countries like Indonesia, UK, Austria and others. Sub-optimal vaccination coverage is seen because of several barriers or obstacles to immunization coverage in different population. Poor attitude towards vaccination and lack of knowledge regarding the benefits of vaccine are one of the reasons for poor acceptance among some parents. In addition, the accessibility to vaccination services, inconvenient timing and less satisfaction with immunization is also the is also the reason to avoid vaccination. The poster recognizes the issues and gives an insight into the role of education and patient reminder intervention to boost immunization coverage rates in people residing in rural and remote areas.

The poster emphasizes on applying an evidence based intervention of patient reminder and patient recall systems and parent education to improve vaccination coverage rate. Patient education has been chosen as one of the strategy to improve vaccination rate as communication with parents can improve vaccination uptake and address all concerns that prevents parent from going for vaccination (Salmon et al. 2015). This is supported by research evidence as a research by Awadh et al. (2014) explained that vaccine hesitancy can be eliminated by means of parent’s education. Parent’s decision of not vaccinating can is influence by reports of adverse vaccine reactions and presence of conflicting information about vaccines on the internet. From this issue, it can be said that lack of knowledge about vaccines among parents contributes to low vaccination coverage. Awadh et al. (2014) aimed to address negative attitudes among parents by means of an educational seminar to improve knowledge related to childhood vaccination. The education materials for the seminars covered topics like importance of immunization, types of immunization, benefits of immunization and side effects and contraindications of different vaccines. The main expectation of delivering the intervention was to increase immunization rate by better knowledge about immunization among parents. The study proved effectiveness of educational intervention to improve vaccination rate. This strategy can be combined with other intervention to address barriers in vaccination uptake.

The poster also gives an overview about combining educational intervention with client reminder and recall system to improve coverage. The main advantage of the reminder system is that it is the most cost-effective way to increase vaccination coverage for all sections of the population. It is a powerful way to remind families whose children are due for immunization (reminder) or those who are behind the immunization date (recall). Another advantage of this intervention is that patient reminders can be delivered in various formats such as phone calls, mails, text message or patient portals with the use of EHR (Electronic Health Record) system (Jacobson Vann et al. 2018). The review of evidence related to the effectiveness of interventions that apply new media to improve vaccination uptake shows that patient-held web-based portals, computerised reminders and text messages are effective in improving immunization coverage rates. The evidence shows benefits of new media in improving immunization coverage rate (Odone et al. 2015). Another study examining the effects of an EHR alert for HPV (Human papillovurus initiation) proved that using EHR improved the number of women completing vaccine in a timely manner (Ruffin et al. 2015).   It is planned to use the content of the poster as a trigger to encourage public to participate in educational session and get idea about reminder system to improve uptake of vaccinations in their child too.

Reflective paper related to poster:

The reflective paper provides a reflection on the process of making the poster to improve vaccination uptake rate and critically reflect on the delivery method, expected outcomes and implications for future practice by making the poster. The rational for poster design and delivery method can give an idea regarding ways to reach target audience and improve their attitude towards vaccination uptake. The reflective paper is guided by the Rolfe’s model of reflection which is based on ‘what’, ‘so what’ and ‘what next question?’. It provides a good framework for reflection on any activity based on the three questions and it supports a person to understand the purpose of an activity, effectiveness of the activity and its implication for future practice (Rolfe, Jasper and Freshwater, 2011). This paper uses steps from the Rolfe’s model of reflection to show the effectiveness of the poster in improving parent’s attitude towards vaccination.

What?

As part of the patient education project, I was given the task of developing a poster to promote immunisation coverage rates. Before thinking about the design and content of the poster, my first strategy is to identify the target audience for the poster. As the main intention of the poster is to increase participation in immunization programs and reduce vaccine hesitancy among parents, the target audience for the posters are parents living in rural and remote areas. Vaccine hesitancy is defined as the delay in vaccination and parents living in rural areas have been targeted because of poor education and reduced access to reliable source of information among them. According to Oku et al. (2017), the main source of information for vaccination among rural parents includes radio, home visits by health workers and town announcements. Another limitation or disadvantage resulting in poor attitude towards vaccination among rural parents is that they do not receive in-depth information related to vaccines compared to urban counterparts. Long waiting times and clinic environment is also a barrier to vaccination uptake for them. Hence, parents living in rural areas have been chosen as the target audience for the poster to address misconceptions related to vaccine and direct them to ideal source to obtain information about vaccine and vaccine uptake in a timely manner.

After deciding on the target audience, my aim is to develop an innovative design for the poster and plan appropriate delivery method for script. Although I cannot give in-depth information relation to importance of vaccination for target audience, however the aim was to design a poster that attracts attention of the audience from its title only and write a content that provokes interest in audience to know about vaccination and contact ideal source to maintain their child’s immunization status in a timely manner. The design of the poster is attractive with many figures and bullet checklist to influence the audience. As the poster is designed for rural audience, the language is kept simple yet informative. Many sentences have been given in first speech so as to give a real feeling to the audience and provoke an interest to change their views regarding vaccination. Another strategy for the success of the poster is to plan appropriate delivery method for the poster. The plan is to install the poster in local areas and health clinics and also distribute the poster at homes so that everyone gets the poster and its content on time.

So what?

The poster has been designed to give the message to the audience that their perceptions or views about vaccine is not always correct and they should look towards reliable source to get all information related to vaccine and vaccination schedule. It is also intended to make them aware about innovative resources to get reminders regarding vaccination schedule. The first message is aimed towards behavioural change and the second message intends to support parents to address barrier in obtaining immunization for their children. The poster encourages audience to take part in educational session first and then contact relevant agencies to get vaccine reminders. Hence, after the dissemination of the poster, it is expected that positive response will be received from rural parents regarding taking part in the education program.

Getting large number of request for participation in the program will have implications for other staffs in the clinical setting. For example, nursing leaders or other experienced health staffs will have to prepare an informative presentation with reliable data to address the misconceptions related to vaccines among parents and plan the content in such a way that parent’s attitude towards vaccination uptake is changes. New media sources like case study based videos or live videos of parents suffering after avoiding vaccination for their child can be included in educational session so as to change attitude towards vaccination and enhance interest in vaccination among parents (Grant et al. 2015). The education session should be made a two way process to identify barriers to vaccination uptake in target audience and take adequate steps to ensure equity of access to immunisation services for all Australians irrespective or financial or geographical barriers. This action is in accordance with the National Immunisation Strategy of Australia (National Health and Medical Research Council 2014). Funding issues also needs to be taken into consideration to improve immunization service delivery and reduce parent’s confusion regarding seeking immunization services.

What next?

After engaging in the task of developing a poster to educated parents regarding the benefits of vaccination, I have learned a lot about communication process to influence attitude or behaviours of people. By planning the design and content of the program, I have gained rich knowledge regarding the challenges and issues faced by rural audience in accessing vaccination. This knowledge has helped me to plan patient education material considering the context and knowledge of audience. By engaging in the process of designing poster, I have learnt about the process needed to provoke behavioural change in an individual. In future, I aim to acquire more knowledge regarding several learning theories so as effectively use important concepts from the theories to empower people to modify their thoughts and adapt new behaviour. Learning theories act as a good source of guidance to plan and develop classroom content and training schedule for target audience (Aliakbari et al. 2015).

Reference:

Aliakbari, F., Parvin, N., Heidari, M. and Haghani, F., 2015. Learning theories application in nursing education. Journal of education and health promotion, 4.

Awadh, A.I., Hassali, M.A., Al-Lela, O.Q., Bux, S.H., Elkalmi, R.M. and Hadi, H., 2014. Does an educational intervention improve parents’ knowledge about immunization? Experience from Malaysia. BMC pediatrics, 14(1), p.254.

Grant, L., Hausman, B.L., Cashion, M., Lucchesi, N., Patel, K. and Roberts, J., 2015. Vaccination persuasion online: a qualitative study of two provaccine and two vaccine-skeptical websites. Journal of medical Internet research, 17(5).

Jacobson Vann, J.C., Jacobson, R.M., Coyne?Beasley, T., Asafu?Adjei, J.K. and Szilagyi, P.G., 2018. Patient reminder and recall interventions to improve immunization rates. The Cochrane Library.

National Health and Medical Research Council 2014. National Immunisation Strategy. Retrieved from: https://www.nhmrc.gov.au/guidelines-publications/cd7

Odone, A., Ferrari, A., Spagnoli, F., Visciarelli, S., Shefer, A., Pasquarella, C. and Signorelli, C., 2015. Effectiveness of interventions that apply new media to improve vaccine uptake and vaccine coverage: a systematic review. Human vaccines & immunotherapeutics, 11(1), pp.72-82.

Odone, A., Ferrari, A., Spagnoli, F., Visciarelli, S., Shefer, A., Pasquarella, C. and Signorelli, C., 2015. Effectiveness of interventions that apply new media to improve vaccine uptake and vaccine coverage: a systematic review. Human vaccines & immunotherapeutics, 11(1), pp.72-82.

Oku, A., Oyo-Ita, A., Glenton, C., Fretheim, A., Ames, H., Muloliwa, A., Kaufman, J., Hill, S., Cliff, J., Cartier, Y. and Owoaje, E., 2017. Perceptions and experiences of childhood vaccination communication strategies among caregivers and health workers in Nigeria: A qualitative study. PloS one, 12(11), p.e0186733.

Rolfe, G., Jasper, M. and Freshwater, D., 2011. Critical reflection in practice: Generating knowledge for care. Palgrave Macmillan.

Ruffin, M.T., Plegue, M.A., Rockwell, P.G., Young, A.P., Patel, D.A. and Yeazel, M.W., 2015. Impact of an electronic health record (EHR) reminder on human papillomavirus (HPV) vaccine initiation and timely completion. The Journal of the American Board of Family Medicine, 28(3), pp.324-333.

Salmon, D.A., Dudley, M.Z., Glanz, J.M. and Omer, S.B., 2015. Vaccine hesitancy: causes, consequences, and a call to action. American journal of preventive medicine, 49(6), pp.S391-S398.

Smith, L.E., Amlôt, R., Weinman, J., Yiend, J. and Rubin, G.J., 2017. A systematic review of factors affecting vaccine uptake in young children. Vaccine.