Reasons why nurses decline influenza vaccination: a qualitative study

Abstract

BackgroundTo explore reasons of non-vaccinated nursing staff for declining seasonal influenza vaccination. The annual influenza vaccination of healthcare workers reduces morbidity and mortality among vulnerable patients. Still, vaccination rates remain very low, particularly in nursing staff. While several studies have explored barriers for healthcare workers to get vaccinated, most have used a quantitative approach.MethodsData were collected by in-depth individual semi-structured interviews with 18 nurses from a range of fields, positions in organizational hierarchy, work experience and hospitals in two German-speaking cantons in Switzerland. Interviews were transcribed and analysed using conventional content analysis.ResultsThree interconnected themes explaining why nurses decline influenza vaccination were identified: Firstly, the idea of maintaining a strong and healthy body, which was a central motif for rejecting the vaccine. Secondly, the wish to maintain decisional autonomy - especially over one's body and health. Thirdly, nurses' perception of being surrounded by an untrustworthy environment, which restricts their autonomy and seemingly is in opposition to their goal of maintaining a strong and healthy body.ConclusionNurses tend to rely on conventional health beliefs rather than evidence based medicine when making their decision to decline influenza vaccination. Interventions to increase influenza vaccination should be tailored specifically for nurses. Empowering nurses by promoting decision-making skills and by strengthening their appraisal may be important factors to consider when planning future interventions to improve vaccination rates. The teaching of evidence-based decision-making should be integrated on different levels, including nurses' training curricula, their workspace and further education.

Recommendations for Mandatory Influenza Vaccinations for Health Care Personnel From AMDA's Infection Advisory Subcommittee

“…Furthermore, nurses surveyed were reported to feel that mandatory influenza vaccine protocols violate personal autonomy. 28 This perceived lack of vaccine effectiveness is backed up by CDC data. Since the 2008e2009 influenza season, when data were more rigorously collected, the effectiveness of influenza vaccines has ranged from 19% in the 2014e2015 season to 60% in the 2010e2011 season.…”

The Impact of Rhode Island's Mandatory Health Care Worker Influenza Vaccination Regulation on Influenza Incidence in Long-Term Care Facility Residents

“…An article by Pless, McLennan, Nicca, and Elger (2017) explored reasons why nurses decline influenza vaccine. Methods for this study included individual semistructured interviews with 18 nurses from a variety of settings and positions.…”

“…Maintaining autonomy was especially important and their ability to make their own choices regarding influenza vaccination. Nurses also feared that accepting influenza vaccination would open the door for more initiatives that would restrict their autonomy (Pless, McLennan, Nicca, & Elger, 2017). The last theme was lack of trust.…”

“…Some nurses disputed that the number of influenza viruses and the frequent mutation of the virus, only makes the vaccine an assumption and therefore not effective. They also did not believe the vaccine was safe due to the pace needed for annual production along with doubts regarding true motivations of those who are promoting the vaccine (Pless et al, 2017).…”

“…The authors noted in their interviews lack of awareness among nurses as to the importance of influenza vaccination to protect vulnerable patients (Pless et al, 2017).…”