Deployment of Clinical Grant to Enhance Influenza Vaccination Among Spinal-Cord Injury Outpatient Veterans

2.50
Hdl Handle:
http://hdl.handle.net/10755/622059
Category:
Full-text
Format:
Text-based Document
Type:
Presentation
Level of Evidence:
N/A
Research Approach:
N/A
Title:
Deployment of Clinical Grant to Enhance Influenza Vaccination Among Spinal-Cord Injury Outpatient Veterans
Other Titles:
Promoting Health Through Immunizations
Author(s):
Cozart, Huberta-Corazon (Bette) Thiam
Lead Author STTI Affiliation:
Beta Beta (Houston)
Author Details:
Huberta-Corazon (Bette) Thiam Cozart, PhD, RN, Professional Experience: Bette Cozart is a registered nurse, clinician, educator and researcher. I have considerable and varied bedside nursing experiences, including medical-surgical care, critical care, mental health care, pediatric care, long-term acute care, rehabilitation care and spinal cord injury care. Currently, I am the Clinical Nurse Educator in the Spinal Cord Injury (SCI) Department at Michael E. DeBakey VA Medical Center (MEDVAMC) in Houston, TX. I have con-current appointments as Instructor at Baylor College of Medicine, and Assistant Clinical Professor at Prairie View A/M University College of Nursing. In 2009, I completed my doctoral dissertation at Texas Woman’s University entitled, “Environmental Effects on Incidence of Falls in the Hospitalized Elderly”. I was the primary grant writer of the Clinical Grant sponsored by the VHA Clinical Public Health Program, Office of Public Health and Office of Health Equity, entitled; “Promotion of Influenza Vaccination in the Spinal Cord Injury Clinic”, which was subsequently awarded. Author Summary: Huberta (Bette) Cozart, PhD, RN, has over 30 years of experience, as a bedside clinician and nurse educator in the hospital and academic settings. She is the Clinical Nurse Educator in the Spinal Cord Injury Department at Michael E. DeBakey VA Medical Center. She was the primary clinical grant writer for the Public Health Clinical Grant sponsored by the VHA Office of Public Health and Office of Health Equity, which was subsequently awarded in 2015.
Abstract:

Background: A top priority of the US Veterans Health Administration (VHA) Public Health Office, Goals for 2014-15 VHA Influenza Vaccination Program was to; “promote seasonal influenza vaccination to all Veteran patients” per Center of Disease Control (CDC) recommendation that, “all persons aged 6 months and older are recommended for annual vaccination”. Latest VHA Influenza Surveillance Data Report (2014) cites heightened influenza cases in both inpatient and outpatient settings, with “nearly one-third” of veterans being tested for influenza were found to be positive. Thus, to enhance influenza vaccination amongst Spinal Cord Injury Veterans considered as vulnerable population due to the chronicity and co-morbidity of their health trauma, an inter-professional team was assembled and application for a clinical grant was submitted to the VHA Office of Public Health (OPH) and Office of Health Equity (OHE) Program (2015), entitled: "Promotion of Influenza Vaccination amongst Veterans in the Spinal Cord Injury (SCI) Out-Patient Clinic”; which was selected and subsequently awarded ($1.5 K).

DesignExploratory, prospective and purposive convenience sampling of patients presenting to the SCI Clinic for annual screening in a large VA hospital in the US southwest region. Upon official allocation of the grant to the facility, influenza vaccination commenced in September 2015 to January 2016. With the grant's tri-fold objectives, namely; 1) actual administration of influenza vaccination to SCI outpatients during annual screening; 2) Pre-and post-vaccination counseling through collaboration and partnership with inter-and intra-professional staff the local facility and the federal Office of Public Health (OPH) and Office of Health Equity (OHE); and 3) Provision of incentives, in the form of personal item (bag of socks) and gift certificates.

Methods: During FY 2015-2016 (September-January), there were 240 patients who presented to the SCI Clinic. There were two nurses assigned to the SCI Clinic, one Registered Nurse and one Licensed Vocational Nurse. There were three ways any patient might have presented to the Clinic; 1) annual screening, 2) medical/health appointments (i.e., skin condition), and 3) "walk-in" patients who would ask the Clinic clerk for influenza immunization. Either nursing staff would then offer and/or administer the influenza vaccination for the patient who would accept it. For those who accepted the influenza vaccination, the staff provided gift vouchers and bag of socks. Likewise, the staff offered both incentives to those who declined.

Results: There were 240 patients who presented to the SCI Clinic from September 2015 to January 2016. The percentage of patients who accepted and received the influenza vaccine was 68%; those who declined the influenza vaccination was 15%; and 17% was recorded as "unknown". Ages of veterans ranged from 18-90. The majority of patients who received influenza vaccinations were 61-70 years old (42%). Other age ranges were as follows: a) 51-60 (21%); b) 71-80 (15%); c) 41-50 (13%); d) 31-40 (6%); e) 81-90 (2%) and 18-30 (1%). For gender, overwhelming majority was male (96%); female (4%). Results for the level of spinal cord injury were as follows: a) paraplegia (38%); b) tetraplegia (24%); and c) unknown (not recorded) 38%.There were 11 verbatim declinations recorded by the clinic staff. Reasons verbalized, included; 1) "made me sick" (n-7); 2) "never takes shot" (n-2); 3) "does not get sick" (n-1); 4) "don't want it" (n-1). However, there were other health factors documented that influenced non-acceptance of influenza vaccination for 53 patients; which were: 1)Refusal (outright) (N- 18); 2) Fear (of vaccination) (N-5), with two subcategories namely, side-effects (n-3) and needles (n-2); 3) Contraindications (influenza vaccination) (N-3); 4) Health reasons /Allergy) (N-1); 5) Delay (N-1); 6) Not effective (N-1); 7) “Never gets” vaccination (N-1); and 8) Non-VA vaccination (N-23).

Conclusion: SCI patients are considered amongst vulnerable populations due to the chronicity and co-morbidity of their health trauma sustained from combat. Thus, influenza vaccination rates of veterans are closely monitored in the federal performance measurement system. Incentives provided to encourage patient participation in influenza vaccination were received favorably by those who received the immunizations. One patient initially declined vaccination, but was persuaded with incentive offer. Majority of patients who declined were not influenced by the incentives and may be worthwhile to explore qualitatively the personal reasons for declination.

Keywords:
clinical grant award; influenza vaccination; spinal cord injury veterans
Repository Posting Date:
24-Jul-2017
Date of Publication:
24-Jul-2017
Other Identifiers:
INRC17B04
Conference Date:
2017
Conference Name:
28th International Nursing Research Congress
Conference Host:
Sigma Theta Tau International
Conference Location:
Dublin, Ireland
Sponsors:
Veterans Health Administration
Description:
Event Theme: Influencing Global Health Through the Advancement of Nursing Scholarship; Support provided by: Public Health Clinical Grant Award from the Veterans Health Administration OPH and OHE.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryFull-texten
dc.formatText-based Documenten
dc.typePresentationen
dc.evidence.levelN/Aen
dc.research.approachN/Aen
dc.titleDeployment of Clinical Grant to Enhance Influenza Vaccination Among Spinal-Cord Injury Outpatient Veteransen_US
dc.title.alternativePromoting Health Through Immunizationsen
dc.contributor.authorCozart, Huberta-Corazon (Bette) Thiamen
dc.contributor.departmentBeta Beta (Houston)en
dc.author.detailsHuberta-Corazon (Bette) Thiam Cozart, PhD, RN, Professional Experience: Bette Cozart is a registered nurse, clinician, educator and researcher. I have considerable and varied bedside nursing experiences, including medical-surgical care, critical care, mental health care, pediatric care, long-term acute care, rehabilitation care and spinal cord injury care. Currently, I am the Clinical Nurse Educator in the Spinal Cord Injury (SCI) Department at Michael E. DeBakey VA Medical Center (MEDVAMC) in Houston, TX. I have con-current appointments as Instructor at Baylor College of Medicine, and Assistant Clinical Professor at Prairie View A/M University College of Nursing. In 2009, I completed my doctoral dissertation at Texas Woman’s University entitled, “Environmental Effects on Incidence of Falls in the Hospitalized Elderly”. I was the primary grant writer of the Clinical Grant sponsored by the VHA Clinical Public Health Program, Office of Public Health and Office of Health Equity, entitled; “Promotion of Influenza Vaccination in the Spinal Cord Injury Clinic”, which was subsequently awarded. Author Summary: Huberta (Bette) Cozart, PhD, RN, has over 30 years of experience, as a bedside clinician and nurse educator in the hospital and academic settings. She is the Clinical Nurse Educator in the Spinal Cord Injury Department at Michael E. DeBakey VA Medical Center. She was the primary clinical grant writer for the Public Health Clinical Grant sponsored by the VHA Office of Public Health and Office of Health Equity, which was subsequently awarded in 2015.en
dc.identifier.urihttp://hdl.handle.net/10755/622059-
dc.description.abstract<p><strong>Background:</strong><span> A top priority of the US Veterans Health Administration (VHA) Public Health Office, </span><em>Goals for 2014-15 VHA Influenza Vaccination Program</em><em> wa</em><span>s to; “promote seasonal influenza vaccination to all Veteran patients” per Center of Disease Control (CDC) recommendation that, “all persons aged 6 months and older are recommended for annual vaccination”. Latest VHA Influenza Surveillance Data Report (2014) cites heightened influenza cases in both inpatient and outpatient settings, with “nearly one-third” of veterans being tested for influenza were found to be positive. Thus, to enhance influenza vaccination amongst Spinal Cord Injury Veterans considered as vulnerable population due to the chronicity and co-morbidity of their health trauma, an inter-professional team was assembled and application for a clinical grant was submitted to the VHA Office of Public Health (OPH) and Office of Health Equity (OHE) Program (2015), entitled: </span><em>"<em>Promotion of Influenza Vaccination amongst Veterans in the Spinal Cord Injury (SCI) Out-Patient Clinic”; </em></em><span>which was selected and subsequently awarded ($1.5 K).</span></p> <p><strong>Design</strong><strong>: </strong>Exploratory, prospective and purposive convenience sampling of patients presenting to the SCI Clinic for annual screening in a large VA hospital in the US southwest region. Upon official allocation of the grant to the facility, influenza vaccination commenced in September 2015 to January 2016. With the grant's tri-fold objectives, namely; 1) actual administration of influenza vaccination to SCI outpatients during annual screening; 2) Pre-and post-vaccination counseling through collaboration and partnership with inter-and intra-professional staff the local facility and the federal Office of Public Health (OPH) and Office of Health Equity (OHE); and 3) Provision of incentives, in the form of personal item (bag of socks) and gift certificates.</p> <p><strong>Methods: </strong>During FY 2015-2016 (September-January), there were 240 patients who presented to the SCI Clinic. There were two nurses assigned to the SCI Clinic, one Registered Nurse and one Licensed Vocational Nurse. There were three ways any patient might have presented to the Clinic; 1) annual screening, 2) medical/health appointments (i.e., skin condition), and 3) "walk-in" patients who would ask the Clinic clerk for influenza immunization. Either nursing staff would then offer and/or administer the influenza vaccination for the patient who would accept it. For those who accepted the influenza vaccination, the staff provided gift vouchers and bag of socks. Likewise, the staff offered both incentives to those who declined.</p> <p><strong>Results</strong>: There were 240 patients who presented to the SCI Clinic from September 2015 to January 2016. The percentage of patients who accepted and received the influenza vaccine was 68%; those who declined the influenza vaccination was 15%; and 17% was recorded as "unknown". Ages of veterans ranged from 18-90. The majority of patients who received influenza vaccinations were 61-70 years old (42%). Other age ranges were as follows: a) 51-60 (21%); b) 71-80 (15%); c) 41-50 (13%); d) 31-40 (6%); e) 81-90 (2%) and 18-30 (1%). For gender, overwhelming majority was male (96%); female (4%). Results for the level of spinal cord injury were as follows: a) paraplegia (38%); b) tetraplegia (24%); and c) unknown (not recorded) 38%.There were 11 verbatim declinations recorded by the clinic staff. Reasons verbalized, included; 1) "made me sick" (n-7); 2) "never takes shot" (n-2); 3) "does not get sick" (n-1); 4) "don't want it" (n-1). However, there were other health factors documented that influenced non-acceptance of influenza vaccination for 53 patients; which were: 1)Refusal (outright) (N- 18); 2) Fear (of vaccination) (N-5), with two subcategories namely, side-effects (n-3) and needles (n-2); 3) Contraindications (influenza vaccination) (N-3); 4) Health reasons /Allergy) (N-1); 5) Delay (N-1); 6) Not effective (N-1); 7) “Never gets” vaccination (N-1); and 8) Non-VA vaccination (N-23).</p> <p><strong>Conclusion: </strong>SCI patients are considered amongst vulnerable populations due to the chronicity and co-morbidity of their health trauma sustained from combat. Thus, influenza vaccination rates of veterans are closely monitored in the federal performance measurement system. Incentives provided to encourage patient participation in influenza vaccination were received favorably by those who received the immunizations. One patient initially declined vaccination, but was persuaded with incentive offer. Majority of patients who declined were not influenced by the incentives and may be worthwhile to explore qualitatively the personal reasons for declination.</p>en
dc.subjectclinical grant awarden
dc.subjectinfluenza vaccinationen
dc.subjectspinal cord injury veteransen
dc.date.available2017-07-24T15:10:29Z-
dc.date.issued2017-07-24-
dc.date.accessioned2017-07-24T15:10:29Z-
dc.conference.date2017en
dc.conference.name28th International Nursing Research Congressen
dc.conference.hostSigma Theta Tau Internationalen
dc.conference.locationDublin, Irelanden
dc.description.sponsorshipVeterans Health Administrationen
dc.descriptionEvent Theme: Influencing Global Health Through the Advancement of Nursing Scholarshipen
dc.descriptionSupport provided by: Public Health Clinical Grant Award from the Veterans Health Administration OPH and OHE.en
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