Influenza is one of the main causes of pneumonia and during the influenza season, many at-risk individuals are at risk of developing pneumonia. Elderly individuals aged 65 and older are especially at risk of developing pneumonia due to their immune senescence, institutional quarters, and multimorbidity. Chan et al. (2013) identified that up to 90 percent of influenza-related deaths occur among people aged 65 years or older. As a result, there is a need to develop preventative measures to minimize the risk of individuals in this population acquiring influenza and pneumonia. One preventative measure that is widely available is an influenza vaccine. However, it’s efficacy among individuals in the population is actively debated due to insufficient evidence supporting its efficacy. Nevertheless, there are positive indications of its potential in reducing influenza incidences in the current literature. Therefore, this essay seeks to review the clinical problem and identify criteria and databases to be used in search of articles that will provide a basis to develop an evidence-based protocol for the vaccination of elderly individuals aged 65 and over against influenza.
Clinical Problem
PICOT Question
For elderly patients who are 65 years of age and older, how does the use of influenza vaccine versus no vaccine affect the risk of developing pneumonia during the influenza season?
Importance of the Problem to Nursing Practice
One of the common causes of pneumonia is influenza. Chan et al. (2013) identified that up to 90 percent of influenza-related deaths occur among people aged 65 years or older. According to Pop-Vicas, Rahman, Gozalo, Gravenstein, and Mor (2015), elderly adults aged 65 or older who reside in a nursing home are the major at-risk population for influenza-related mortality. The vulnerability of the population to the effects of influenza results from various factors such as their immune senescence, institutional quarters, and multimorbidity. Consequently, the high risk for influenza-related negative outcomes that face this population necessitates the need to identify suitable interventions to minimize its outcomes.
Impact of the Problem on Outcomes
During influenza season, elderly individuals who develop pneumonia are exposed to a number of health risks that contribute to poor health outcomes. The effects of pneumonia that elderly adults often have to incur include healthcare costs, significant morbidity, and mortality (Juthani-Mehta, et al., 2015). Consequently, due to the poor outcomes associated with pneumonia, there is a need to develop effective evidence-based interventions that will minimize the risks associated with the development of pneumonia as well as review factors which may contribute to nurses failing to implement evidence-based protocols.
Selection of Intervention
While vaccination is the mainstay in the prevention of influenza and is recommended for all persons ages 6 months and older in the United States, the vaccination of elderly adults ages 65 years and older is a controversial subject due to the absence of sufficient evidence supporting its effectiveness (Pop-Vicas, Rahman, Gozalo, Gravenstein, & Mor, 2015). Furthermore, the numbers of vaccinated elderly adults is significantly low due to the fears of potential adverse effects arising from the vaccination. However, various reviews have highlighted the potential of influenza vaccination to significantly reduce hospitalization and mortality among elderly populations (Chan, et al., 2013). Consequently, the lack of sufficient evidence discounting the effectiveness of influenza vaccinations coupled with the potential of its positive outcomes identified in various reviews necessitates the need to investigate the potential of this intervention for evidence-based practice (EBP).
Barriers to EBP
There are various barriers that may lead to a nurse failing to implement EBP in their daily work. Stokke, Olsen, Espehaug, and Nortvedt (2014) identified that nurses might lack the concept of whether or not EBP is time-consuming or difficult due to lack of involvement in EBP activities. Furthermore, nurses may find their daily responsibilities for advanced care and the many patients under their care to be difficult to juggle with carrying out EBP. Another barrier that Stokke, Olsen, Espehaug, and Nortvedt (2014) identified is that the absence of ongoing support to encourage the development of an EBP culture in the workplace could result in nurses overlooking the need to update themselves with the current evidence consistently.
Possible Actions against Barriers to EBP
Stokke, Olsen, Espehaug, and Nortvedt (2014) identified that there is a need to develop an EBP culture in the workplace to encourage nurses to have more belief in the efficacy of EBP. Some of the measures that can be implemented to promote the development of an EBP culture include the provision of accessible resources, education and competence building, using EBP mentors who will provide support to nurses in the implementation of EBP, and availing time to the nurses. Therefore, the creation of an EBP culture in the institution will encourage the adoption of EBP among nurses.
Stokke, Olsen, Espehaug, and Nortvedt (2014) identified potential solutions to nurses lacking the concept of implementing EBP in clinical practice. The researchers identified that departments in hospitals could train a group of selected nurses to become expert resources in EBP. Since not all nurses may not possess expert level knowledge to find, evaluate, generate, and implement research, the trained experts can engage with the staff and ensure that the entire department maintains an EBP approach. This action, therefore, ensures that the shortcomings of individual nurses in implementing EBP are countered as they will have the support they need in the process.
Inclusion Criteria
The search will include the following inclusion criteria: research with participants aged 65 or older and research where an influenza vaccine intervention was implemented.
Exclusion Criteria
The search will exclude articles which do not focus on a nursing intervention and those which do not focus on influenza vaccination as an intervention to prevent the development on pneumonia during the influenza season for elderly individuals.
Databases
The search will be conducted in CINAHL, Cochrane Library, MEDLINE, and Nursing Reference Center Plus databases using the following keywords: influenza vaccine, elderly patient, pneumonia, and influenza season.
Conclusion
Although the efficacy of influenza vaccinations among elderly individuals aged 65 and over has been a matter of ongoing debate, current research has highlighted that this intervention could yield positive outcomes in the prevention of influenza and pneumonia in this population. This essay reviewed the barriers that nurses may face in the implementation of EBP such as lack of time and ongoing support as well as potential solutions to these problems such as the creation of an EBP culture in the workplace and the creation of a team of experts at EBP in each department respectively. The search for articles to develop an EBP will be carried out in databases that provide access to nursing journals and will include internal and external criteria that ensure the articles are appropriate to the study.
References
Chan, T. C., Fan-Ngai, H. I., Ka-Hay, L. J., Chiu-Yat, W. P., Chu, L. W., & Hon-Wai, C. F. (2013). Efficacy of trivalent seasonal influenza vaccination in reducing mortality and hospitalization in Chinese nursing home older adults. Journal of the American Medical Directors Association, 14(12), 889-894. doi:10.1016/j.jamda.2013.04.004.
Juthani-Mehta, M., Van Ness, P. H., McGloin, J., Argraves, S., Chen, S., Charpentier, P., . . . Quagliarello, V. J. (2015). A cluster-randomized controlled trial of a multicomponent intervention protocol for pneumonia prevention among nursing home elders. Clinical Infectious Diseases, 60(6), 849-857. doi:10.1093/cid/ciu935.
Pop-Vicas, A., Rahman, M., Gozalo, P. L., Gravenstein, S., & Mor, V. (2015). Estimating the effect of influenza vaccination on nursing home residents’ morbidity and mortality. Journal of the American Geriatrics Society, 63(9), 1798-1804. doi:10.1111/jgs.13617.
Stokke, K., Olsen, N. R., Espehaug, B., & Nortvedt, M. W. (2014). Evidence based practice beliefs and implementation among nurses: A cross-sectional study. BMC Nursing, 31(1), 8-18. doi:10.1186/1472-6955-13-8.
