Reasons why nurses decline influenza vaccination: a qualitative study

doi:10.1186/s12912-017-0215-5

. 2017 Apr 28:16:20.

doi: 10.1186/s12912-017-0215-5. eCollection 2017.

Reasons why nurses decline influenza vaccination: a qualitative study

Anina Pless^#¹, Stuart R McLennan^#^{1

2}, Dunja Nicca³, David M Shaw¹, Bernice S Elger¹

Affiliations

¹ Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland.
² Institute for History, Ethics and Philosophy of Medicine, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
³ Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland.

^# Contributed equally.

PMID: 28465672
PMCID: PMC5410084
DOI: 10.1186/s12912-017-0215-5

Reasons why nurses decline influenza vaccination: a qualitative study

Anina Pless et al. BMC Nurs. 2017.

. 2017 Apr 28:16:20.

doi: 10.1186/s12912-017-0215-5. eCollection 2017.

Authors

Anina Pless^#¹, Stuart R McLennan^#^{1

2}, Dunja Nicca³, David M Shaw¹, Bernice S Elger¹

Affiliations

¹ Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland.
² Institute for History, Ethics and Philosophy of Medicine, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
³ Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland.

^# Contributed equally.

PMID: 28465672
PMCID: PMC5410084
DOI: 10.1186/s12912-017-0215-5

Abstract

Background: To 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.

Methods: Data 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.

Results: Three 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.

Conclusion: Nurses 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.

Keywords: Attitudes; Influenza; Nurses; Qualitative research; Vaccination.

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**Fig. 1**
Nurses’ reasons for declining seasonal influenza vaccination

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References

1. Hayward AC, Harling R, Wetten S, Johnson AM, Munro S, Smedley J, et al. Effectiveness of an influenza vaccine programme for care home staff to prevent death, morbidity, and health service use among residents: cluster randomised controlled trial. BMJ. 2006;333(7581):1241. doi: 10.1136/bmj.39010.581354.55. - DOI - PMC - PubMed
1. Ajenjo MC, Woeltje KF, Babcock HM, Gemeinhart N, Jones M, Fraser VJ. Influenza vaccination among healthcare workers: ten-year experience of a large healthcare organization. Infect Control Hosp Epidemiol. 2010;31(3):233–40. doi: 10.1086/650449. - DOI - PMC - PubMed
1. Mereckiene J, Cotter S, Nicoll A, Lopalco P, Noori T, Weber J, et al. Seasonal influenza immunisation in Europe. Overview of recommendations and vaccination coverage for three seasons: pre-pandemic (2008/09), pandemic (2009/10) and post-pandemic (2010/11) Euro Surveill. 2014;19(16):20780. doi: 10.2807/1560-7917.ES2014.19.16.20780. - DOI - PubMed
1. Zhang J, While AE, Norman IJ. Seasonal influenza vaccination knowledge, risk perception, health beliefs and vaccination behaviours of nurses. Epidemiol Infect. 2012;140(9):1569–77. doi: 10.1017/S0950268811002214. - DOI - PMC - PubMed
1. Christini AB, Shutt KA, Byers KE. Influenza vaccination rates and motivators among healthcare worker groups. Infect Control Hosp Epidemiol. 2007;28(2):171–7. doi: 10.1086/511796. - DOI - PubMed

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[1] Hayward AC, Harling R, Wetten S, Johnson AM, Munro S, Smedley J, et al. Effectiveness of an influenza vaccine programme for care home staff to prevent death, morbidity, and health service use among residents: cluster randomised controlled trial. BMJ. 2006;333(7581):1241. doi: 10.1136/bmj.39010.581354.55. - DOI - PMC - PubMed

[2] Hayward AC, Harling R, Wetten S, Johnson AM, Munro S, Smedley J, et al. Effectiveness of an influenza vaccine programme for care home staff to prevent death, morbidity, and health service use among residents: cluster randomised controlled trial. BMJ. 2006;333(7581):1241. doi: 10.1136/bmj.39010.581354.55. - DOI - PMC - PubMed

[3] Ajenjo MC, Woeltje KF, Babcock HM, Gemeinhart N, Jones M, Fraser VJ. Influenza vaccination among healthcare workers: ten-year experience of a large healthcare organization. Infect Control Hosp Epidemiol. 2010;31(3):233–40. doi: 10.1086/650449. - DOI - PMC - PubMed

[4] Ajenjo MC, Woeltje KF, Babcock HM, Gemeinhart N, Jones M, Fraser VJ. Influenza vaccination among healthcare workers: ten-year experience of a large healthcare organization. Infect Control Hosp Epidemiol. 2010;31(3):233–40. doi: 10.1086/650449. - DOI - PMC - PubMed

[5] Mereckiene J, Cotter S, Nicoll A, Lopalco P, Noori T, Weber J, et al. Seasonal influenza immunisation in Europe. Overview of recommendations and vaccination coverage for three seasons: pre-pandemic (2008/09), pandemic (2009/10) and post-pandemic (2010/11) Euro Surveill. 2014;19(16):20780. doi: 10.2807/1560-7917.ES2014.19.16.20780. - DOI - PubMed

[6] Mereckiene J, Cotter S, Nicoll A, Lopalco P, Noori T, Weber J, et al. Seasonal influenza immunisation in Europe. Overview of recommendations and vaccination coverage for three seasons: pre-pandemic (2008/09), pandemic (2009/10) and post-pandemic (2010/11) Euro Surveill. 2014;19(16):20780. doi: 10.2807/1560-7917.ES2014.19.16.20780. - DOI - PubMed

[7] Zhang J, While AE, Norman IJ. Seasonal influenza vaccination knowledge, risk perception, health beliefs and vaccination behaviours of nurses. Epidemiol Infect. 2012;140(9):1569–77. doi: 10.1017/S0950268811002214. - DOI - PMC - PubMed

[8] Zhang J, While AE, Norman IJ. Seasonal influenza vaccination knowledge, risk perception, health beliefs and vaccination behaviours of nurses. Epidemiol Infect. 2012;140(9):1569–77. doi: 10.1017/S0950268811002214. - DOI - PMC - PubMed

[9] Christini AB, Shutt KA, Byers KE. Influenza vaccination rates and motivators among healthcare worker groups. Infect Control Hosp Epidemiol. 2007;28(2):171–7. doi: 10.1086/511796. - DOI - PubMed

[10] Christini AB, Shutt KA, Byers KE. Influenza vaccination rates and motivators among healthcare worker groups. Infect Control Hosp Epidemiol. 2007;28(2):171–7. doi: 10.1086/511796. - DOI - PubMed

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Reasons why nurses decline influenza vaccination: a qualitative study

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Reasons why nurses decline influenza vaccination: a qualitative study

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