Listening, building trust and providing evidence-based resources are just some of the ways that nurse practitioners, or NPs, can play an impactful role in addressing vaccine hesitancy and combatting misinformation.
Jean Wilson, a nurse practitioner and assistant professor, teaching stream, in the University of Toronto's Lawrence Bloomberg Faculty of Nursing, says that with measles cases on the rise, addressing vaccine hesitancy can be a powerful way for health care providers, including nurse practitioners, to support those managing an outbreak situation.
"NPs are really well positioned to understand the current environment of misinformation and how to respond to it," Wilson says. "They have trusting relationships with patients and the public, and they are able to take the time to provide evidence-based resources and information without pressure and judgement - especially when parents are making decisions about vaccines."
The measles vaccine is offered as part of the routine immunization schedule for children, with the first dose at 12 months of age and a second dose between ages four and six. Two doses provide nearly 100 per cent protection for life against the disease, but in a post-pandemic world, rates of immunization have fallen, a result of both missed appointments, and a rise in misinformation.
"Vaccine hesitancy is not specific to measles," says Wilson. "There can be a lack of confidence in vaccine safety, efficacy, the health system and policy officials, as well as, I think, a lack of awareness among many people of the risk of serious complications and death that many of these diseases pose."
Writer Rebecca Biason spoke with Wilson about some of the most common ways nurse practitioners are helping patients make decisions about vaccines and how U of T's master of nursing, nurse practitioner program is preparing future nurse practitioners to provide accurate information and support to those managing outbreaks.
How can nurse practitioners support patients who are making decisions about vaccines?
Listening to a patient's concerns is first and foremost the way to start any conversation about vaccines.
NPs look to create a respectful and empathetic dialogue with patients that is evidence-based and supports their decision-making. With parents, we understand that they want to do what is best for their children, they want to protect and be responsible for their children's health and NPs want to help them do that. By providing information without pressure and judgement - even if the person goes away and thinks about it - creates an environment of safety and positivity that helps facilitate people coming back to ask more questions or change their minds and get vaccinated.
NPs have a very collaborative relationship with public health who are often managing outbreak situations. NPs are able to support local public health units by encouraging people to get vaccinated during an outbreak because we are so embedded within the community. NPs are strategically located in multiple health settings, including hospitals, primary health clinics, shelters and other community organizations, allowing us to diagnose and identify individuals who potentially have an infectious disease like measles, and support those who are at risk and require vaccination.
How are nurse practitioners trained to address vaccine hesitancy?
Students in U of T's master of nursing, nurse practitioner program take several modules in their first semester on vaccines and infectious disease including organisms, vaccine types, safety, efficacy, schedules and what to expect in the face of outbreak situations. During an outbreak, we will also offer additional sessions for students that cover emerging guidelines from the National Advisory Committee on Immunization (NACI) on post-exposure prophylaxis protocols - how to treat someone who has already been exposed to the infectious disease. This ensures they are up to date in their practicum settings.
Common concerns that contribute to vaccine hesitancy often include questions about safety and efficacy, so our students are given ample knowledge about routine and seasonal vaccines, including dosing, side effects and why someone might not be eligible for certain vaccines.
This knowledge base sets them up well to deal with questions, particularly from parents. They are also able to explain the reasons for giving a vaccine more clearly by providing information about the organism the vaccine is protecting against, how it might present if their child got infected and complications that could arise.
We also provide students with a global health perspective in our courses, covering the impact of communicable diseases that we know do not respect borders or boundaries. We focus not only on issues of vaccine hesitancy around the world, but also address challenges to access to vaccines for some low and middle-income countries.
What other factors might contribute to vaccine hesitancy?
In addition to misinformation, fear of pain or needles are often drivers of vaccine hesitancy. NPs are taught different strategies to mitigate pain when giving a vaccine such as comfort holds and distraction techniques, the use of numbing patches and we also might suggest breastfeeding for infants or sugar water.
Many populations are hesitant to be vaccinated because of historical or systemic racism that they have experienced. In our role as NPs, we take that into consideration as part of our approach in really seeking to create a trust-based and culturally respectful environment when explaining the benefits of vaccination and keeping communities healthy.
