Challenged by Immunization Compliance? Five Steps for Nurses in Urban High Schools With Multilingual Students

Abstract

Immunization compliance can require time and resources not readily available to school nurses in urban schools. Furthermore, immunizations can be perceived as lower priority at the high school level. But communicable disease outbreaks, such as the one experienced across the United States with measles, highlight the important role of school nurses in compliance activities. Using a five-step process, a school nurse was able to update one urban high school’s database to more accurately reflect student measles vaccination compliance. An initial immunization database query indicated that 12% of approximately 2,000 enrolled students lacked even one measles-containing vaccine. A search through the state immunization registry and individual student educational folders revealed that 65% of these students actually had at least one measles vaccination. Remedies under consideration by the district in addressing this discrepancy are described. The remaining students (4% of total enrollment) required the additional steps of notification and intensive follow-up with students and their families. Within 2 months, fewer than 1% of students lacked a record of measles vaccination. The five steps presented can be adapted to achieve compliance with all required vaccines.

The Role of the School Nurse in the United States, United Kingdom, and Italy During the COVID-19 Pandemic: A Scoping Review

“…During and after the pandemic, school nurses were thought to be ideally placed to initiate the immunization and education process for students and school staff (Moss, 2021; NASN Position Statement: School-Located Vaccination, 2022; Park et al, 2021), conducting school viral testing (Moss, 2021), working with community partners to achieve high immunization coverage of school children, surveying school spaces intended to accommodate vaccinations (NASN Position Statement: School-Located Vaccination, 2022), theoretical knowledge related to COVID-19, for example, differences between influenza and COVID-19 in the school context, as indicated by Tucker and colleagues (2022). School vaccination during COVID-19 has been perceived as an opportunity to increase access to and equity in vaccines (Behrmann et al, 2022); the school nurse can identify those who have not received vaccines or have missed some doses (Boyer-Chu, 2020). The COVID-19 pandemic has resulted in a significant increase in the rate of student visits to school nurses for mental health and anxiety, suggesting that the pediatric population is at risk of increased adverse mental health impacts related to the pandemic and underlining the key role that the nurse has in identifying young people in need of assistance (Banzon et al, 2023).…”

In Their Own Words: Resources Needed by School Nurses to Facilitate Student Immunization Compliance

“…However, phone calls and letters emerged as the most common mechanisms. Several studies and case reports described using similar communication methods and reaching parents with reasonable success 15,16 . Swallow and Roberts 17 described a school‐based compliance intervention using direct‐mailed letters to parents.…”

“…For the latter, nurses described a combination of written and verbal communication methods, primarily calling on resources that were already available to them, such as ESL teachers and translation services. A study by Boyer‐Chu 16 described several different strategies for reaching this population and highlights the importance of developing translated materials for immunization education and compliance. Engaging students in the immunization compliance conversation was a tactic utilized by several nurses, and similarly supported in a study by Maurer et al 20 who describe having students develop immunization compliance reminder postcards to be mailed to their parents as they approach a school‐entry immunization milestone.…”

Addressing Vaccine Hesitancy Among Students and Families: Interventions for School Nurses

“…In addition to letters and phone calls, some school districts have begun to utilize text message reminders, which go directly to student and family cell phones (Hoke et al, 2021). In utilizing the remind/recall intervention, it is important that school nurses provide material to families that is brief and understandable in a language that is primarily spoken at home, and with clear deadlines (Boyer-Chu, 2019).…”

“…In following the nursing process, it is imperative that a school nurse first assess for vaccine compliance within the school community (Boyer-Chu, 2019). This will alert school nurses of students who do not meet local requirements, so appropriate follow-up and, if necessary, school exclusion in the presence of an outbreak may be initiated.…”