Project Methodology: Non-Vaccinated Patients

Participants

The study targets non-vaccinated patients aged 65 years and above. This study targets all non-vaccinated patients above 65 years. Their consent to involve them in the study will be sought before they can include in the project. As part of preparation for the study, historical patient data will be used to assess the rates of immunization for influenza, pneumococcal, zoster, and tetanus diphtheria. This information will be verified from patient’s history. It will also be verified by having the patients fill questionnaires.

Settings

The project was conducted in Dr. McLean’s office, a primary care practice that is located Broward County, which is one of the biggest urban counties within South Florida. The office does not have a vaccination protocol for geriatrics, and this is deemed to have contributed to the low vaccination rates.

Stakeholders identified to take part in this project include geriatric patients, APN, the director and the internal medicine medical doctor. There are two doctors, one nurse practitioner and two medical assistants in Dr. McLean’s office who will educate patients on the four recommended vaccinations, administer them to the geriatrics and collect all the relevant data pertaining to the project. Their selection in the project is based on their education and information about vaccination.

Before the project starts, I will brief the staff on the relevance, significance and step-by-step procedure that will see the project completed. I will brief the stakeholders on the privacy policy of the study, and their responsibilities towards ensuring that the participants understand what they are involving themselves in. It will be the responsibility of the team to ensure that no patient is required to get vaccinations they do not consent to, or give information they don’t want to. The team will also not be allowed to manipulate the answers the patients give in the questionnaires.

Tools

Data collected will be categorized into primary and secondary. Secondary data will be collected using the SWOT and GAP analysis, where a needs assessment test will be carried out in the parameters of organizational resources, stakeholders and organization structures (Royse, 2009). The GAP analysis aims at comparing the gap between the performances of the primary care setting in offering immunization to geriatric patients, against its potential output. In carrying out the GAP analysis, the current state of immunization among the geriatric patients will be listed down as well as its potential immunization rates (Franklin, 2006). After this, the primary care setting will come up with a comprehensive plan to fill the gap between the two components. A GAP analysis helps any organization to analyze its current performance and decide whether it is performing optimally (Franklin, 2006).

The SWOT analysis focuses on both the external and internal environment. It evaluates the strengths and weaknesses with the internal environment of the organization and the opportunities and threats in the external environment (Houser & Oman, 2011). The main aim of carrying out a SWOT analysis in any company is to help it in generating strategic options that will improve its performance (Bohm, 2009). Both the SWOT and GAP analysis help the primary care setting to know that although the patients and practitioners had knowledge on the importance of immunizations for senior citizens, this was not converted to immunization preventative care. The reason for this is that the primary care setting had not set up an office to identify patients who required recommended vaccines and administered them accordingly to improve their health.

An assessment for the current immunization rates at the primary health care setting will be conducted using 150 patients’ charts, under the supervision and direction of Dr. McLean, the medical director. The historical data for geriatric patients will be used to evaluate the immunization rates for tetanus diphtheria, zoster, pneumococcal and influenza. Immunization rates are continuous variables that are measured at baseline. Baseline measures are popularly used in most chronic conditions where researchers want to measure whether a certain treatment can reduce the intensity of the conditions (Jones, 2000). Statistical comparison in the immunization rates will be made through calculating the change in score by subtracting follow up scores from the baseline scores. The rates from the charts were then compared with the national standard set by the CDC Healthy People 2020 objectives. The assessment will be carried out to ascertain whether the immunization rates for the four recommended diseases in the care setting are below the national goals that were set up as a benchmark.

To collect primary data, non-vaccinated 65 year olds will be asked to fill the questionnaires as a tool to gather primary information. However, nurses are not allowed to influence a patient’s answer under any circumstances as instructed in the briefing meeting. The questionnaires will be used to verify the number of participants that know about vaccinations. They will also be used to verify how much information the participants have regarding vaccination. In the questionnaires, the participants will answer on their willingness to be vaccinated, need for more information and their expectations.

The front office will sign up participants as they do in their everyday operations. Their medical information for the participants will be taken and each assigned a file for more accurate follow-up in the future. The patients will then be directed to a waiting room where the medical assistant will speak to those patient that are above 65 years about vaccination. If any of the patients need more information on the subject, the nurses and the doctors will be notified. In this case, the patient will have a private session with the doctor or nurse to have his or her questions answered. After the patients have a full understanding about vaccinations, those who consent to having one will be served. The patients will then sit at the resting bay for 15 minutes to see if there are any reactions. If none, the patient will be released to leave and given the date or return.

Evaluation and Data Analysis

Data Analysis

Farr (2011) defines data analysis as “the process of inspecting, cleaning, transforming, and modeling data with the goal of highlighting useful information, suggesting conclusions, and supporting decision-making”. Data analysis comprises of diverse techniques depending with the type of data and expected outcomes. When conducting a study, data mining is an indispensable technique since it involves discovering knowledge as opposed to describing it (Ditsa, 2003). Information technology techniques available today, allows any study to convert data into useful knowledge without much difficult.

In this study, it is expected that at least 80% of the questionnaires distributed will be returned and filled correctly. Secondary data will be extremely valuable and will be collected to augment the research.Data analysis tools and software will be beneficial when sorting out data and identifying patterns. Available data analysis for this study include the online analytical processing, excel power, among many others. Answers to close-ended questions will be analyzed in percentages while others will be individually analyzed and discussed.

In this project, the Iowa- model of evidence-bases practice is used in describing the research findings. The Iowa- model is used in situations whereby clinicians identify a clinical problem through a series of questions. In most cases, triggers come from questioning a recent practice within their healthcare setting (Houser, & Oman, 2011). The triggers will focus on the problems facing the current practice using the available data and highlight the need for an improvement. In the Iowa- model, nurses usually identify relevant clinical practice problems that can be solved using the EBP process (Houser, & Oman, 2011). The staff members will then decide whether the research findings can be used to improve the patient care. In the Iowa model, finding from studies are combined with existing scientific knowledge and other scientifically sound studies that the researcher comes across during the literature review to improve and develop clinical practices (Melnyk & Fineout-Overholt, 2011)

In the Iowa model, recommendations for the clinical practice are formulated using the evidence synthesis that is collected from research findings and other existing scientific studies. The practices that have been recommended for practice, based on the evidence are then compared with the current practices, and the organization makes a decision (Lobiondo-Wood, 2013). In this project, the first practice question was whether under immunization was a clinical issue for the geriatric patients. The evidence for this question is drawn from conducting a literature search on existing data about this problem. Literature from various authors shows that indeed many geriatric patients die from diseases that could have been prevented through immunization.

The second question aims at finding out if changes in practice within the primary healthcare setting would increase the rates of immunization. The evidence from this question is gathered thorough the research findings that will show that most geriatric patients will get the recommended vaccines after the introduction of the vaccination protocol. This is attributed to the fact that the primary care givers are able to disseminate the relevant information on the importance of getting the vaccinations and urging the geriatrics to get them.

The third question aimed at finding out if implementing practice changes in the primary care setting had a positive impact on the immunization rates. Findings from the research conducted can provide evidence for this because the geriatric immunization rates in the primary health care were expected to go up after dissemination of information during clinical visiting. Also, research from previous scientific studies also shows a positive impact on immunization rates when vaccinations are offered in primary care offices when patients are attending wellness clinics. Using the research findings and other evidence-based practice, the primary health care provider can incorporate clinical practice into their everyday activities to improve the health of their patients (Hall & In Roussel, 2014).

The data collected is expected to shed more light on the number of patients that would benefit from a vaccination protocol and the magnitude of the problem. The results will also be used to identify the appropriate intervention methods. By comparing what is already available in the clinic and what the government recommends, it will be possible to design a protocol guiding immunization practices in the clinic. The results analysis will also be used to and aimed at measuring the rates of vaccinations against pneumococcal, influenza, herpes zoster and tetanus diphtheria.

Significance to Advanced Practice Nursing

It is quite clear from existing literature and research findings that under-immunization is a common problem among the older adults. Vaccinations prevent diseases that are associated with premature death and long hospital stays. Although there is a lot of knowledge on the importance of vaccination, certain practices within the primary health care prevent the organization from improving the immunization rates among the geriatrics. However, results from this study and evidence from existing literature will be used to show that it is important to establish a vaccination pool that makes it easier to disseminate information and increase the vaccination rates. In the long term, this will reduce the prevalence of preventable diseases, such as influenza among the older people, prevent premature deaths and eliminate long hospital stays associated with such illnesses.

References

Bohm, A. (2009). The SWOT analysis. Munchen: GRIN Verlag.

Ditsa, G. (2003). Information management: Support systems & Multimedia technology. Hershey: IRM Press.

Farr, R. (2011). Basic business research methods. Management Help. Retrieved from:http://managementhelp.org/research/research.htm

Franklin, M. (2006). Performance gap analysis: Human performance improvement. Alexandria,Va: ASTD Press.

Hall, H. R., & In Roussel, L. (2014). Evidence-based practice: An integrative approach to research, administration, and practice. Burlington, MA: Jones & Bartlett Learning.

Houser, J., & Oman, K. S. (2011). Evidence-based practice: An implementation guide for healthcare organizations. Sudbury, MA: Jones and Bartlett Learning.

Jones, T.M. (2000). An integrating framework for research in business and society: A step toward the elusive paradigm. The Academy of Management Review, 8(4), pp. 559-564.

Lobiondo-Wood, G. (2013). Nursing research: Methods and critical appraisal for evidence-based practice. S.l.: Elsevier Mosby.

Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.

Royse, D. D. (2009). Needs assessment. New York: Oxford University Press.

(Appendix omitted for preview. Available via download)