C159 Policy, Politics, and Global Health.docx - Running head C159 POLICY POLITICS AND GLOBAL HEALTH C159 Policy Politics and Global Health Western

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Unformatted text preview: Running head: C159 POLICY, POLITICS, AND GLOBAL HEALTH C159 Policy, Politics, and Global Health Western Governors University 2 C159 POLICY, POLITICS, AND GLOBAL HEALTH C159 Policy, Politics, and Global Health Public Policy Issue According to the California Department of Public Health, [CDPH], (2018) during a fourweek period, 36 people died from Influenza illness, with 21.1% of influenza swabs testing positive for the presence of the virus. As nurses, we took a vow to protect and advocate for our patients. By requiring mandatory flu vaccination in the state of California, we can ensure we are helping to prevent the spread of the virus to our patients. Issue Selection Every year when flu vaccination is brought up during daily shift huddles, it is met with groans and the proud statement “I am never getting the flu shot! I always get the flu after getting it!” In reality, influenza is a deadly virus that kills across the lifespan and causes huge financial implications for the patients and healthcare institutions that treat them. According to the Centers for Disease Control and Prevention [CDC], 2018,) flu vaccination prevented 85,000 flu-related hospitalizations during 2016-2017 and decreased pediatric flu-related pediatric intensive care unit (PICU) admissions by 74%. With these statistics provided by the CDC, it is clear that flu vaccination decreases the overall morbidity, mortality, and cost associated with influenza illness. In California, it is county specific as to mandatory flu vaccination occurs; with the current literature, (demonstrating the overall benefit of flu vaccination) California should adopt a mandatory flu vaccination policy for healthcare providers, to protect not only themselves, but also the patients they serve. Issue Relevance 3 C159 POLICY, POLITICS, AND GLOBAL HEALTH As previously stated, each year numerous people are affected by influenza-related illness. During the flu season, hospitals are inundated with emergency department visits and subsequent hospitalizations due to flu complications. The public is often unaware of the importance of vaccination and is often misinformed about flu vaccination facts. Nyhan & Reifler, (2015) conducted a survey of 1000 volunteer participants with informed consent provided to each participant. The volunteers were randomly assigned to one of three different condition groups, with each group asked if they intended to receive a flu vaccination that year. Prior to administering additional information, participants were asked to rate on a five-point scale from “not all concerned” to “extremely concerned” about their concerns about the side effects of the flu vaccine (Nyhan & Reifler, 2015). The first group received information dispelling the myth that the flu vaccine causes a person to contract the flu. The second group received information about the risks associated with contracting influenza, and the third group received no additional information (Nyhan & Reifler, 2015). Additional information collected included age range, sex, and level of education (Nyhan & Reifler, 2015). The results of the study revealed that four in 10 Americans believe that the flu vaccine can cause influenza illness, but fewer people believe that the vaccine is “not very safe” (12%) or “not safe at all” (4%) (Nyhan & Reifler, 2015) (prior to corrective information). The results also demonstrated that corrective information dispelling the myth of flu vaccination causing flu illness increases the likelihood of patients agreeing to be vaccinated (Nyhan & Reifler, 2015). Increasing the rates of people agreeing to be vaccinated annually with decrease subsequent illness associated with contracting the influenza virus. As demonstrated by (Nyhan & Reifler, 2015), increasing vaccination rates is partially dependent upon dispelling vaccination myths and educating the general public. 4 C159 POLICY, POLITICS, AND GLOBAL HEALTH According to Galloway, (2015), the influenza virus is extremely contagious, and is spread through large and small aerosolized droplets, hand to mouth contact, and can even be spread by mild or asymptomatic individuals. Common symptoms of the influenza virus include a sudden onset of fever, chills, myalgias, vomiting, and diarrhea (Galloway, 2015). It is estimated that if 30% of children were vaccinated, it would decrease the rate of influenza-related death by 2,000 and have 11,000 fewer hospitalizations (Galloway, 2015). As demonstrated by the above articles, mandatory vaccinations of healthcare providers is a public issue due to the common misconceptions associated with vaccination (leading to decreased vaccination rates among the general public) and ability to prevent death and hospitalizations by vaccination. By providing education about influenza vaccination and providing statistics about hospitalizations and deaths related to the virus, we can increase awareness and possibly increase the rate of vaccination within the general population. Financial Impact While implementing a policy to require mandatory influenza vaccination for staff would incur an initial cost, the predicted savings for a healthcare institution (e.g., hospitalizations for influenza-related illness and sick days from staff) far outweigh the initial proposed cost of vaccination. According to the CDC, (2018), the cost for Afluria Quadrivalent vaccine is $12.13 per one dose syringe and $11.35 per 10 dose vial respectively. Using a moderately-sized emergency department, as an example, with 350 staff members, the total cost to vaccinate this one department would be $4,245.50 using the single dose syringe price quoted above (Centers for Disease Control and Prevention [CDC], 2018). Other factors to be considered would be the costs of using staff to administer the vaccine, but a cost-effective way would be to have the nursing staff administer the vaccines to each other, physicians, and departmental ancillary staff 5 C159 POLICY, POLITICS, AND GLOBAL HEALTH while on shift, incurring no additional staffing costs to the department. On the opposite side of the spectrum, examining the costs associated with contracting influenza is staggering; per the CDC, (2018) adults vaccinated against influenza had a 40% reduction in influenza-related hospitalizations than their unvaccinated counterparts and saw lower rates of cardiac-related events (Centers of Disease Control and Prevention [CDC], 2018). Given the relatively low costs to vaccinate and the overall reduction of hospitalizations, mandatory flu vaccination is a win for everyone involved. Personal Values From a personal perspective, I feel very strongly for mandating flu vaccines for healthcare providers during flu season. Every day we provide care to patients who may be immunocompromised and cannot fight off the influenza virus; as nurses, we took an oath to provide care and advocate for our patients, how would it feel to know you inadvertently killed your patient because you refused to get the flu vaccine? I hope that mandating flu vaccines for every staff member will prevent one unnecessary death from occurring. Ethical Principle The ethical principle associated with mandatory flu vaccination is nonmaleficence, which is defined as avoiding harm or hurt (America(American Nurses Association [ANA], n.d.) This ethical principle applies to the idea of mandatory influenza vaccination because it seeks to avoid doing harm to our patients by preventing of virus transmission. By requiring vaccination, we can help prevent transferring the virus from a healthcare provider to a vulnerable patient through vaccination, this will bring about avoidance of harm (nonmaleficence). Decision Maker 6 C159 POLICY, POLITICS, AND GLOBAL HEALTH My decision maker for the top-down approach will be Senator Jerry Hill of district 13. He is my local California senator. Explanation Mandatory influenza vaccination for healthcare staff (including nurses) providing direct patient care is important because it will significantly reduce the morbidity and mortality associated with this highly infectious virus. As demonstrated by (Nyhan & Reifler, 2015) there are common misconceptions associated with receiving the influenza vaccination, including that the vaccine causes the flu and that the vaccine has unsafe side effects. (Nyhan & Reifler, 2015) Conducted a survey in which education was provided about the influenza illness, vaccine side effects, and dispelling vaccination risks showed an increase in understanding amongst the general population. By providing the same education to healthcare providers and requiring vaccination, we stand to protect our vulnerable patients. Galloway, (2015) states that the influenza virus can cause upper respiratory illness, including fever, chills, myalgias, nausea, and vomiting. The virus can be spread through droplets and hand-to-mouth contact (Galloway, 2015). Vaccinating only 30% of children would reduce the number of influenza-related deaths by 2,000 and 11,000 hospitalizations respectively (Galloway, 2015). Galloway, (2015) demonstrates that influenza causes unpleasant symptoms and is easily spread from person to person. Galloway, (2015) demonstrates that vaccinating even a small percentage of the population will result in a significant reduction in the number of deaths and hospitalizations. Both Nyhan & Reifler, (2015) and Galloway, (2015) show that through vaccination education and actual vaccination we can reduce the morbidity and mortality associated with influenza. Senator Hill is the decision maker for this proposal of mandatory vaccination due to his involvement in politics and government on a state level and his proximity to my geographic location. Examining his webpage for local 7 C159 POLICY, POLITICS, AND GLOBAL HEALTH district 13, he is apparent he is in support on improving healthcare. He has championed multiple healthcare bills including safe antibiotic stewardship and improving safe prescribing of medications by physicians (California State Senate Majority Caucus [CSSMC], 2018). Challenges With any change in the status quo, there will be challenges faced. Many of the potential challenges may come from the healthcare workers themselves. According to (Pless, McLennan, Nicca, Shaw, & Elger, 2017) nurses had a variety of challenges against getting vaccinated. The researched conducted was semi-structured interviews with 18 nurses with various years of experience of types of nursing backgrounds. Pless et al., (2017) were able to conclude that the reasons nurses chose not to vaccinate fell into the broad categories of it would weaken their strong mind and body, it interfered with their ability to make decisions about their health, and forcing vaccination creates an untrustworthy environment, which restricts their autonomy. Other potential challenges include the increased costs of mandatory vaccination (see costs breakdown briefly discussed above), and the belief that getting the flu vaccine causes influenza illness (see the discussion above). Options Should Senator Hill read my proposal, he has multiple options as to what to do with my proposal for mandatory influenza vaccination. The first option would be to accept my proposal outright and lobby to require all healthcare workers with direct patient contact to be vaccinated. (there is a legislative process behind this, that is beyond the scope of this nursing course). This option would (in my opinion) be the best option, as we would increase the number of California residents vaccinated, decrease the risk of influenza transmission to our patients, and decrease subsequent deaths and hospitalizations. The second option for Senator Hill would be to amend or 8 C159 POLICY, POLITICS, AND GLOBAL HEALTH change my proposal, possibly giving alternatives to vaccination, such as wearing a mask during flu season. This option is probably a little more amenable to the general public, as no one is forced to be vaccinated, however, it would raise concerns about the true impact it would have on flu transmission (e.g., is that employee who declined vaccination going to wear a mask all shift?). The third option would be to do nothing and outright reject my idea for mandatory vaccination within California. This option would allow for the status quo to continue and would probably be the easiest option for Senator Hill, but without change, there cannot be any improvement in our current rates of transmission of the influenza virus. Course of Action As mentioned above, potentially passing a bill for vaccination will be met with challenges. Some of the challenges identified include the feeling of loss of autonomy and facing an untrustworthy environment due to being forced to vaccinate as well as the proposed cost associated with vaccination. To combat the fears brought on with loss of autonomy and an untrustworthy environment, meetings could be held explaining the rationale behind mandatory vaccination as well as statistics about the overall decrease in harm towards our patients. As a whole, healthcare providers are very well educated and logical; presenting them with statistics, providing education about the vaccine, and answering individual questions should alleviate the feeling of “being forced” and losing the ability to choose to vaccinate. The person presenting at these meetings would need to be knowledgeable in infectious diseases, such as a public health physician or nurse in order to present the information factually and be able to answer questions correctly. To address costs, again providing the workforce and healthcare institutions with the facts about how much each individual vaccine costs versus the potential for savings should paint a clear picture as to why vaccination is necessary. 9 C159 POLICY, POLITICS, AND GLOBAL HEALTH Success of the Policy Brief The first measure of success would be to have Senator Hill endorse mandatory influenza vaccination for healthcare workers. Additional successes would be an endorsement by major influencers within medicine and the community. These endorsers may be the local nurses union, parent groups, and hospital administration. The final success would be to have the proposed bill to go through the California legislative process and signed in as a California law. Long-term success could be measured over time with data collection. Data to be collected would track the number of healthcare providers immunized and the reduction of influenza-related hospital visits and hospitalizations. Achievable goals within the first couple of years with this law could be an immunization rate greater than 80% and a reduction of visits and hospitalizations by 20%. Over time, there could be room for increased growth, as in a greater number of immunized healthcare providers, or the possibility of expanding the include other members of the community, such as teachers or first responders. Bottom-Up Approach Collaborating Organization The organization I would choose to collaborate with would be the California Nurses Association (CNA). This is the nurses’ union that largely represents nurses in California. Summary of Expressed Interest CNA is a nurses’ union that largely represents nurses in California. CNA has over 100,000 members with growth over the last 15 years of nearly 400% (California Nurses Association [CNA], 2018) CNA believes in patient advocacy and providing Medicare for all American Citizens (California Nurses Association [CNA], 2018). The biggest accomplishment of CNA thus far including implementation of the nurse to patient ratios as California law 10 C159 POLICY, POLITICS, AND GLOBAL HEALTH (California Nurses Association [CNA], 2018). Based off of the mission of CNA to be patient advocate’s and being a large influence in a nurse’s career, I believe that my goal of protecting the patient’s through vaccination is in line with CAN’s beliefs. CBPR Principles The Community-Based Participatory Research (CBPR) are principles that are evidencebased and help communities successfully create public policies (WK Kellogg Foundation Community Health Scholars Program [WKKFCHSP], 2013). The three principles that I identify with for my proposal are principles two, three, and five. Principle two identifies that we need to build upon the strengths and resources within the community. Principle three promotes equal collaboration among members throughout the phases of implementation. Principle six recommends focusing goals balancing research with a policy change that will address the needs of the community. Approach and Collaboration My first point of contact for CNA would be my immediate union representative within my department. Derek Derksen. I have known Derek for many years, so our first meeting would be over a cup of coffee. During the meeting, I would ask him about who specifically handles the backing of potential legislative policies, and I would discuss my general aims (e.g., reducing illness through vaccination). Additionally, I would share my goal of gaining support for mandatory healthcare vaccination in hopes of bill sponsorship. Recruitment of volunteers could be on multiple levels; on a local level, I would ask my fellow nurses to support my causes by they themselves being vaccinated and asking others to be vaccinated. On a broader scope, I would ask for support through social media posts, emails to other CNA members, and potentially writing an article in the monthly CNA newsletter. Group meetings could occur on a biweekly or 11 C159 POLICY, POLITICS, AND GLOBAL HEALTH monthly basis depending on factors such as support, other members work schedules and rallying to make an idea become law. Goal Alignment As mentioned above, the mission statement of CNA is patient advocacy and providing medical care for all American citizens (California Nurses Association [CNA], 2018). CNA has extensive experience is lobbying for changes in state law from the patient-to-nurse California state law to the Healthcare Care Violence Prevention Act, which requires healthcare employers to provide a “comprehensive workplace violence prevention plan.” (H.R. Res. H.R. 5223, 2018). With this extensive experience in lobbying and my personal goal that aligns with their mission statement, CNA seems to be an ideal fit for making a small idea become state law. Action steps In order to successfully rally support from stakeholders, multiple subcommittees would need to be formed in order to divide the work and reach the greatest number of people. The subcommittees would be divided into the following: Healthcare Provider group, Influenza Virus group, Marketing group, and Legislature group. The “virus” group would be tasked with gathering statistical data regarding the rate of virus transmission among the general public and from the healthcare provider to patient, the morbidity and mortality rates, and the effects of an influenza pandemic. The Healthcare Provider group would research vaccination rates amongst healthcare providers, barriers that prevent healthcare workers from getting vaccinated, and look into the CDC’s recommendation regarding vaccination for special groups (e.g., egg allergies, pregnancy, absolute contraindications for vaccination). The Legislative group would be tasked with examining other states which have passed mandatory influenza vaccination laws and determining the best approach for passing a bill (e.g., top down or bottom up approach). Finally, 12 C159 POLICY, POLITICS, AND GLOBAL HEALTH the Marketing group would be in charge of rallying additional support through the use of buttons, “I protect my patients against the flu, do you?” social media campaigns, and print materials. While the subcommittees are important, as demonstrated by Nyhan & Reifler, (2015) misinformation and subsequent education is key to successfully getting people to vaccinate. Education could take multiple forms including short huddles at the beginning and ending of shifts, educational module through Healthstream (or similar platform), and buttons w...
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