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Association Of Nurse Practitioners American

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Association Of Nurse Practitioners American

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The main purpose of the paper was to study the concepts of child vaccination among the parents of Singapore, and correlate the gaps that were present in the healthcare system of the country and develop vaccination management programs across the country (Luthy et al. 2015). The authors described vaccination referencing the world health organization as the process of immunizing or developing competence in an individual against a disease that is deemed infectious. This is basically carried out when a vaccine is administered. Given that there are diseases that can be controlled or avoided from the community; vaccination is therefore among the most cost-effective interventions of healthcare that can be adapted to prevent the occurrences of these diseases. The researchers conducted the study which helped them realize that to increase a country’s rates of vaccination, it is very important to fully comprehend the perceptions of the parents in reference to the vaccination of the child.
Relevance to nursing/midwifery practice

Explain how this question was relevant to nursing/midwifery practice.

The nursing and midwifery staffs play an important role to act as mediator for communication between the practitioner and the patients (Rosen et al. 2015). The practitioner provides the instruction for a treatment or care, which the nurses carry forward to achieve improved health outcome. The nurses and midwives occupationally spend more time with patients, or in this case, with the parents of infants. This provides a solid platform to develop trust with the child’s parents and help them understand the importance of vaccination.  The study will help nurses and midwives in Singapore will able to communicate with the parents and teach about the importance of vaccination from an early stage and inhibit any future diseases progression.

What were the possible risks of participating in the study?

The possible risk factor, which was evident in the paper, was the reluctance from the participants (Klabunde et al. 2013). Some of the participants pointed out that at times they would make changes in their kid’s vaccination schedule. They said they could choose to split or delay the vaccinations since they had concerns related to some effects of vaccination. These effects may be on the growth of their children, vaccine-related issues, religious beliefs as well as negative past experiences. Some had concerns with the vaccines saying it could cause fever or dangerous allergic reactions and also the possible delay in the child’s development.

Were these risks clearly identified by the authors? Yes / No
If risks were identified by the authors, how did they propose to minimise risk?

The addressed the issue or previous negative vaccination experiment, reluctance by reaching out to the parents and providing assurance that their privacy would do be jeopardized (Shiono et al. 2014).  In order to management the pain or crying and other outcomes that may not be pleasing, a number of parents used different methods to counter such incidences. During the whole vaccination process, some parents employed distraction techniques such as phones, offering sweets and cakes or even playing videos and once done some parents would breastfeed their children in order to calm them. Other parents went further ahead by rescheduling their work involvements in order to stay at home to take care of their kids.

Did the authors state that they had approval from an ethics committee to undertake the study?

       Yes / No

How did the authors obtain informed consent from participants?

The authors documented written consents from all the participants by engaging in interpersonal communication (Lewis 2015). The participants were ensured on the maintenance of privacy concerning the participation of the parents and their opinions will not be revealed.  

Did you identify and potential risks associated with the study that were not identified by the authors and if so, what were they?

The researchers failed to contemplate the situation where the parents who were not of English speaking background, would not be able to clearly understand the implications of vaccination. Additionally, the authors did not contemplate that not all participants will be ready to show enthusiasm.
Study Methodology

What the chosen methodology for this study?

The authors formulated a descriptive and qualitative method of study, which was aimed to address the concern of vaccinations.

Was this choice suitable for the given research problem/question?                                              Yes/ No
Explain your response to (b):

The authors chose this form of methodology, because this provided room for the participants to engage in interpersonal communication and improve the misconceptions of vaccination. The interviews mainly evolved on four main issues from the guide: healthcare support and needs, general experiences, vaccination decisions and concerns/difficulties.
Data Collection/Rigour

Describe how the data was collected for this study (interview, observation, etc).

The author engaged in interpersonal interview sessions with the participants after documenting the written consent and privacy policy. The interview method was semi-structured with either by personal interview sessions or telephone calls at convenient settings. The interview was audio taped for data analysis. The analysis f the data was conducted by using open coding system by the primary author until a mutual decision was made.

Did the researchers provide the participants with the opportunity to check the collected dataor research findings?

Did the researchers continue recruiting people to the study until data saturation was reached?

Yes / No

Did the study use multiple data collection methods (e.g., collect data from more than one source)?                                      

Yes / No

Explain how the points in (b), (c) and (d) contribute to the trustworthiness of the overall research findings.

The author and the group collected data from parents of the age group 27-40, irrespective of gender to minimize research bias. The research group also included people from Chinese, Malay, Indian and other ethnic identities to include representation of the common population. In order to promote rigour, the researchers employed several strategies such as making reviews on the transcripts and using own words of the participants, written reflections, investigator triangulation, audio recordings, developing an audit trail, field notes, interview transcripts and how coding, themes and subthemes were found and also the use of verbatim quotes. The above strategies were meant to basically support the findings

How many participants were included in the study?

The researchers approached 44 parents from which 16 decided not to participate and another 6 not meeting the inclusions requirements. A further 2 withdrew their participation and 1 participant went for the pilot interview which was not included in the final analysis. Therefore there was 19 audio-recorded interviews for the analysis each lasting between 10-30 minutes

What were the inclusion and exclusion criteria?

Inclusion criteria: the parent must-

Participants must have a healthy child between the age of 0-18 months who is under vaccination treatment
Participant being questioned have to be the main caregiver of the said child
Participants have to be able to read and communicate in English

Exclusion criteria: those parents who-

Participants with visual and/or hearing impairment will not be considered
Participants with cognition impairment were excluded.
Explain how the participants were recruited.

The authors attended the clinic, which virtually seemed to be accessed by multiple ethnicities in Singapore. The author devised purposive sampling to recruit the participants and the sample size determined by saturation.

Describe the setting in which the study took place (hospital, community, etc).

The author selected a vaccination clinic which was accessed by many children of the age of going for pre-schooling in Singapore.
Research Findings (outcomes)

What were the main findings of this study? (provide a dot point summary)

The main findings of the study are provided in the following bullets:

Factors that promote vaccination: mandatory promotion of vaccination programs, health care services trust, promoting child immunity, ease of access and availability and stigmas that are known about the side effects of vaccinations.
Factors that impede vaccination conformity: health risk and side effects of vaccination was a major concern among the parents. Previous trauma   due to wrong care affected their mindset; rigidity about vaccination schedules, limitations that come with accessibility and alternatives for vaccination was a major concern, misconceptions about severity of the diseases.
Parents who provided supportive roles: some parents made sure that their child were nutrition sufficient, some parents were exceptionally well at handling their child in difficult situation than others, like in times of pain management which helped in the vaccination process.
Improvement in service, information and communication: short waiting list, quick access to appointment made it easier for parents to get their child vaccinated.  Availability and accessesibility of vaccines and proper information exchange helped parents be motivated to get their children vaccines.

From the above data, the researchers were able to make the following results/findings

All those who took part in the study were married
Their ages ranged from 26-47 years
There were ten fathers and nine mothers
Ethnicities: Chinese n=11, Malay n=4, Indian n=4 and a Jewish categorised under others n=1
12 participants had only one child
The maximum number of children was 6
15 participants had attained university education.
15 participants had received education related to vaccination within a period of the last 1-18 months at different timings while 4 participants had not.
Main sources of information were from the internet and healthcare professionals.
9 boys were undergoing vaccination with ages of between 1-18 months.
Of all the participants, only 4 could not remember how many vaccinations their children had received while the rest reported that their children had received from 1-9 vaccinations from birth.
Household and monthly incomes levels were from between less than S$ 2,000 to more than S$10,000. Other specific 14 parents had a monthly income of over S$ 3,000.

Study limitations

What were the limitations of this study stated by the author/s?
The authors conducted the study in only one clinic where the participants came to get their children vaccinations (Palinkas et al. 2015)
The authors did not include non English speaking demographic which excludes a majority of the Singaporean population. This provides a gap in the communities of Singapore and the people who are challenged due to socio-economic determinants of health will be left out.
The authors excluded the parents who commenced delayed vaccination for their children.
Explain why these are study limitations.
Carrying out a research study in only one site limits the comparison of the findings and transfer of information between multiple settings (Palinkas et al. 2015).  
Leaving out those who could not communicate in English, which implicates that a majority of the population who have less education will be excluded from the programme.
Did the researchers disclose any personal ideas, experiences or knowledge (bias) that might influence the conduct and outcomes of the study?                                                                           Yes / No
Explain why personal ideas, experiences or knowledge (bias) may reduce the validity of the study

Involving the researchers own ideas and preferential bias would jeopardize the authenticity of the research methodology (Simon and Goes 2013).  The data would be focused to the preference of the researcher and the holistic approach to research outcome would not be achieved. Including people irrespective of gender, ethnic or racial background would provide conceptions from multiple backgrounds. 
Applicability to clinical practice

According to the Levels of Evidence pyramid, what level of evidence are the reported results from this paper?

The paper provides evidence under the Level VI- Evidence pyramid from a solo descriptive or qualitative research (Murad et al. 2015).

Overall, should the outcomes of this study be used to inform evidence-based practice?                  

Yes / No

Explain your rationale for your responses to questions (a) and (b).

It is important o understand the repercussion that would follow if a child is not exposed to vaccination during their growing years. The maturity of the immunity will be deprived and the child will be susceptible to various diseases, which might cause harm in the future (Goldstein MacDonald and Guirguis 2015). Nurses are required to teach the child’s parents the information and reassure them about the outcome that would be received from vaccination.
The critical analysis of the two chosen articles provided information about utilizing the practice of evidence based research. I was immunized as a kid, which helped me improve my immunity, so I was exposed to the concept of vaccination from a young age and my choice of career provided more insight into the importance of vaccination (Healy Montesinos and Middleman 2014). I had both life experience and experience gained from secondary sources on issues related to vaccination. These sources included books and from the internet. Vaccination has always been a large area of concern for all communities and most specifically to the health sector (Kuruvilla et al. 2016). I did have an idea when it comes to immunization in children as I already mentioned and these article provided information of how I can engage the patients to get their children vaccines on time. I gained the knowledge as a part of my academic curriculum and since I am assigned as a nurse in the pediatric department, I was aware of the concept of vaccination but not regarding the social stigma that comes with it (Sobo 2015). I did not have any such social or religious preferences that would direct me against this practice, my profession and my academic background cemented my thoughts about the importance of medical science on population. Having myself undergone vaccination on timely basis at an infant stage, I am not opposed of the opinion obligatory and firmly imposition of vaccination should be maintained (Grabenstein 2013). I would like to advocate my idea regarding vaccination as it helps in minimizing the chances of contracting diseases and by so doing; it increases the chances of survival for an infant. The ideas gathered from this study have further increased my support towards vaccinations. Most of my concerns have been addressed and well explained on how best to manage my fears on issues related to vaccination. The paper addressed the issue where the parents expressed their concerns about the availability and accessibility of vaccines, which is an important factor in healthcare. I would be careful to let the parents know about the alternative methods for vaccines and where they can find them. I would ensure that proper communication helps them clear their misconceptions about the safety and efficacy of vaccines. Providing proper information, like febrile conditions is normal after vaccinations in some children will also help the parents understand the process of vaccination. The paper helped me understand the importance to teach a parent’s the importance of vaccination, which I previously thought was a personal opinion. Sometimes, interventions like in article one, is important to gain better patient outcome (Ylitalo Lee and Mehta 2013). I also learned that by including the parents in the information outlet it could be made sure that their fear for negative impact of vaccination or other related misconceptions are reduced.
Boulos, M.N.K., Brewer, A.C., Karimkhani, C., Buller, D.B. and Dellavalle, R.P., 2014. Mobile medical and health apps: state of the art, concerns, regulatory control and certification. Online journal of public healthcare informatics, 5(3), p.229.
Goldstein, S., MacDonald, N.E. and Guirguis, S., 2015. Health communication and vaccine hesitancy. Vaccine, 33(34), pp.4212-4214.
Grabenstein, J.D., 2013. What the world’s religions teach, applied to vaccines and immune globulins. Vaccine, 31(16), pp.2011-2023.
Gupta, A., Calfas, K.J., Marshall, S.J., Robinson, T.N., Rock, C.L., Huang, J.S., Epstein-Corbin, M., Servetas, C., Donohue, M.C., Norman, G.J. and Raab, F., 2015. Clinical trial management of participant recruitment, enrollment, engagement, and retention in the SMART study using a Marketing and Information Technology (MARKIT) model. Contemporary clinical trials, 42, pp.185-195.
Healy, C.M., Montesinos, D.P. and Middleman, A.B., 2014. Parent and provider perspectives on immunization: are providers overestimating parental concerns?. Vaccine, 32(5), pp.579-584.
Howard, D., Best, W. and Nickels, L., 2015. Optimising the design of intervention studies: Critiques and ways forward. Aphasiology, 29(5), pp.526-562.
Ioannidis, J.P., 2014. How to make more published research true. PLoS medicine, 11(10), p.e1001747.
Klabunde, C.N., Willis, G.B. and Casalino, L.P., 2013. Facilitators and barriers to survey participation by physicians: a call to action for researchers. Evaluation & the health professions, 36(3), pp.279-295.
Kuruvilla, S., Bustreo, F., Kuo, T., Mishra, C.K., Taylor, K., Fogstad, H., Gupta, G.R., Gilmore, K., Temmerman, M., Thomas, J. and Rasanathan, K., 2016. The Global strategy for women’s, children’s and adolescents’ health (2016–2030): a roadmap based on evidence and country experience. Bulletin of the World Health Organization, 94(5), p.398.
Lewis, S., 2015. Qualitative inquiry and research design: Choosing among five approaches. Health promotion practice, 16(4), pp.473-475.
Luthy, K.E., Thompson, K.E., Beckstrand, R.L., Macintosh, J.L. and Eden, L.M., 2015. Perception of safety, importance, and effectiveness of vaccinations among urban school employees in Utah. Journal of the American Association of Nurse Practitioners, 27(6), pp.313-320.
Mertens, D.M., 2014. Research and evaluation in education and psychology: Integrating diversity with quantitative, qualitative, and mixed methods. Sage publications.
Murad, M.H., Asi, N., Alsawas, M. and Alahdab, F., 2016. New evidence pyramid. BMJ evidence-based medicine, pp.ebmed-2016.
Palinkas, L.A., Horwitz, S.M., Green, C.A., Wisdom, J.P., Duan, N. and Hoagwood, K., 2015. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Administration and Policy in Mental Health and Mental Health Services Research, 42(5), pp.533-544.
Rosen, B.L., Goodson, P., Thompson, B. and Wilson, K.L., 2015. School nurses’ knowledge, attitudes, perceptions of role as opinion leader, and professional practice regarding human papillomavirus vaccine for youth. Journal of School Health, 85(2), pp.73-81.
Shiono, Y.N., Zheng, Y.F., Kikuya, M., Kawai, M., Ishida, T., Kuriyama, S. and Ohuchi, N., 2014. Participants’ understanding of a randomized controlled trial (RCT) through informed consent procedures in the RCT for breast cancer screening, J-START. Trials, 15(1), p.375.
Simon, M.K. and Goes, J., 2013. Assumptions, limitations, delimitations, and scope of the study.
Sobo, E.J., 2015. Social cultivation of vaccine refusal and delay among Waldorf (Steiner) school parents. Medical anthropology quarterly, 29(3), pp.381-399.
Wan, X., Wang, W., Liu, J. and Tong, T., 2014. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC medical research methodology, 14(1), p.135.
Ylitalo, K.R., Lee, H. and Mehta, N.K., 2013. Health care provider recommendation, human papillomavirus vaccination, and race/ethnicity in the US National Immunization Survey. American journal of public health, 103(1), pp.164-169.

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