Literature Review and Evidence-Based Practice Recommendation
According to Flu and Pneumonia (2017), vaccines play an important role in being healthy. As a person ages, vaccination becomes even more important because the body’s defense mechanism against diseases are weakened. Vaccinations contain a weakened form of a disease so it is not strong enough to cause a person to become sick. The immune system attacks these weakened disease cells and form antibodies. These antibodies will be ready to fight the disease whenever it enters the body (Sethi, 2002).
For the majority of the population, the flu is not a major problem, but for older adults, it could be dangerous or even fatal. An older adult’s immune system is not as strong and is more likely to acquire the flu if exposed to it, which may be difficult to recover from along with any other medical problems it may cause. The risk of death is associated with age and underlying chronic conditions such as obesity, diabetes, heart disease or any condition and medications that causes immunosuppression (Sethi, 2002). Yearly flu vaccinations is the most effective way to reduce this risk. Influenza can cause a number of complications, including pneumonia, bronchitis and sinus and ear infections. If vaccination efforts and prophylactic medication fails to prevent influenza, the next line of defense is early recognition, diagnosis of a possible complications, and to treat this complication promptly (Li, Norton, & Dow, 2004). Don't use plagiarised sources.Get your custom essay just from $11/page
Current Practice
Current practice is not only to receive the flu vaccine, but also to prevent the flu from spreading. The Centers for Disease Control and Prevention (CDC) suggests the annual flu vaccine to everyone who is older than six months as soon as the vaccine is available for the current season. Flu vaccinations are required for all health care professionals (Fiore et al., 2009). Infection control is another way to prevent the flu or the spread of flu (Vaccination roundup, 2016; Fiore et al., 2009). This includes coughing or sneezing on a tissue or elbow and disposing of the tissue properly, hand hygiene, and using gloves with contact with infectious fluids like sputum.
Practice concern
Vaccination rates remain low, and vaccination is recommended based on scientifically proven evidence and health care organizations (Li, Norton & Dow, 2004). This is concerning as vaccines protect the one being vaccinated as well as others around them. The more people vaccinated, the less risk a disease has to spread (Fiore et al., 2009).
PICO(T) Question
Are older adults (P) who have received the influenza vaccine (I) compared to older adults who are unvaccinated (C) have a decreased risk of developing pneumonia (O) during the flu season (T)?
Search Strategy
The databases used were CINAHL, EBSCOHost, PubMed, and Medline. The keywords used included: flu vaccine, influenza vaccine, flu shot, pneumonia, and older adults. The search modifiers used were PDF full text, academic journals, references available, and abstract available.
The number and the type of records found: 17 articles with full text, references available and 11 academic journals using “flu vaccine, flu shot, influenza vaccine, pneumonia” as the search. Six of those 17 articles had abstract available. Three full text, reference available and academic journal articles were found when “older adult” was included and two of three of those articles had abstract available.
Summary of Finding
Some articles discussed the benefits of getting a flu vaccine, and how it would help the elderly, those who are immunocompromised, and those who have comorbidities. Vaccinations are highly recommended by healthcare professionals because it helps individuals who are over the age of 65 maintain good health and can help prevent complications like pneumonia. The vaccines are about 60% to 70% effective (Fall Vaccination Roundup, 2013). The effectiveness of the flu vaccine in the elderly has been tested by comparing the percentage of people admitted to the hospital who got pneumonia who received the vaccine to those who did not receive the vaccine.
The incidence of hospitalization in people over the age of 65 who have one or more chronic diseases have a higher risk of being hospitalized due to influenza and pneumonia (Sethi, 2002). For this reason, healthcare professionals recommend the elderly to keep up to date with their immunizations, especially during the flu season. There are many factors that determine whether there is a decrease or an increase in getting pneumonia during the flu season, such as patients’ mast medical history, living environment, how well they manage their health, age, and their access to the health care system. Despite all of this, the flu vaccine help patients have a lower incidence of pneumonia and hospitalization. The rates of patients getting pneumonia regardless of receiving the influenza vaccine vary from state to state. According to Ying-Chun Li (2004), patients had higher pneumonia mortality rates in Massachusetts than in Nevada. Overall, there was an undeniable evidence that vaccines lower the incidence of pneumonia in the elderly during flu season.
Evidence-Based Practice Model Used
An evidence-based practice (EBP) model is problem-solving approach to decision making within a healthcare organization. It includes scientific evidence with the best available experimental evidence. EBP takes into consideration internal and external influences on current practices and promotes critical thinking in the application of such evidence to care for patients individually, a patient population, or a system. The model we will be using is the Johns Hopkins Evidence Based Practice Model (EBPM). The Johns Hopkins EBPM consists of three phases which are practice, evidence, and translation. For practice, it requires for you to develop and refine your question and your team. The evidence part you search, appraise, summarize, and synthesize internal and external sources of evidence. For translation, you create and implement an action plan, evaluate outcomes, and disseminate findings.
Statement of Level of Evidence of Literature Found
According to a clinical director and professor at Harvard medical school, “The flu vaccine isn’t perfect, but it’s 60% to 70% effective. While some years the flu is more severe than other years, we can’t predict a bad year” (Fall Vaccination Roundup, 2013). The researcher Ying-Chun Li (2004) said, “The mean influenza and pneumonia mortality rates in our sample ranged from a high of 4.5 per 10,000 population in Massachusetts to a low of 2.3 per 10,000 population in Nevada. There are also substantial differences across states in the year to year mortality changes” (p. 917). In research by Sethi (2002), it stated, “In a recent retrospective study of older patients with chronic lung disease, influenza vaccination was associated with a 52% reduction in hospitalizations for pneumonia and influenza and a 70% reduction in mortality” (p. 57).
Recommendation for Practice Change
Practice Recommendation
One of the recommendations that can be made is how frequent testing the incidence of the elderly getting pneumonia who are not vaccinated during the flu season versus those who are vaccinated. This will make the studies more accurate because the severity of the flu season varies from year to year. This recommendation will also put more awareness on the benefits of vaccines for people over the age of 65 and the decrease incidence of getting pneumonia.
What to Do
To complete this recommendation people over the age of 65 would be tested from different places and states to compare the data. Some states have a higher incidence of patients getting pneumonia compared to others. They can do similar samples that were discussed in the articles in comparing which patients got pneumonia who were hospitalized and verified if they received the vaccines or not.
Who Will Do It?
Researchers, clinics, medical staff, surveys, and volunteers would conduct these recommendations in different states.
How results/effectiveness Will Be Measured: What Outcomes Will Be Measured and How?
The results and effectiveness will be measured with observations and use of data on those who get admitted into the hospital who have pneumonia. It will be similar to what was done before but the frequency will be more to make sure that the data is current for patients to have access to it.
Conclusion and Recommendation for Further Research
Vaccinating individuals over the age of 65 for influenza and pneumococcal reduced the need for hospitalization for this population with these diseases, and there was a reduction in death rates (Christenson, Lundbergh, Hedlund, & Örtqvist, 2001; Li, Norton, & Dow, 2004). In research done by Christenson et al. (2001), a problem that was found was that in the unvaccinated cohort, there were several individuals who had previously received the vaccine outside the study. With individuals who had underlying conditions such as heart or lung disease, their providers usually educate on the importance of vaccination to prevent further complications. The recommendation is to evaluate health status to prevent having the unvaccinated cohort with previous vaccinations by gathering this information from the beginning.
Knowledge Gap and Recommend Areas for Further Research Study
According to Li, Norton, and Dow (2004), the threats of influenza did not increase the rates of pneumococcal vaccination. The vaccination of influenza rates were higher than those of the pneumococcal vaccine due to the heightened awareness of the influenza vaccine in older adults, but it is still recommended for physicians to vaccinate older adults with the pneumococcal vaccine when they visit their primary care physician. The recommended areas for further research is of how public health interventions can exploit disease threat-responsive behavior to increase vaccination rates and hence lower future influenza and pneumonia mortality.
Evidence Table
| Authors & Date | Evidence Type | Sample and setting | Key Findings | Limitations | Level of Evidence Johns Hopkins Nursing EBP Model |
| Fall Vaccination Roundup, 2013 | Report of EBP project | United States Brigham and Women’s Hospital and a professor at Harvard Medical School | up to 49,000 people in the United States die from the flu | Broad sample size Only one site | Level V |
| Flu and Pneumonia, 2017 | Report of EBP project | United States 300 million people with the flu | An elderly person who has chronic lung problems, heart disease, or cancer is more at risk for developing flu. CDC recommends a pneumonia vaccine for all persons older than age 65 more than 50,000 people die each year from pneumonia Although the flu does not cause pneumonia, it sets up the conditions for pneumonia
| Information is obtained for CDC Might have skewed the results | Level IV |
| Christenson, Lundbergh, Hedlund, & Örtqvist, 2001 | Cohort study | Individuals 65 years or older (259 627) All vaccine recipients (100 242) name, and date of birth, and whether they had been given both or one of the vaccines were recorded. All individuals ≥ 65 years admitted to hospital in Stockholm County with influenza and pneumonia related diagnoses. | The incidence (per 100 000 inhabitants per year) of hospital treatment was lower in the vaccinated than in the unvaccinated cohort for all diagnoses: 263 versus 484 for influenza; 2199 versus 3097 for pneumonia; 64 versus 100 for pneumococcal pneumonia; and 20 versus 40 for invasive pneumococcal disease. The total mortality was 57% lower in vaccinated than in unvaccinated individuals. | Unvaccinated cohort also included an unknown number of individuals who had been vaccinated with the pneumococcal vaccine before Older study | Level I |
| Blevins, 2017 | Report of EBP Project | Random size All of the U. S. | Influenza causes 23,000 deaths annually The pneumococcal vaccine is used to reduce complications related to community acquired pneumonia. For adults, recommended vaccinations are based on the patient’s age, immunization status, and medical conditions | Sample size too big and includes all ages.
| Level IV |
| Sethi, 2002 | Report of EBP Project | 100,000 174 adults older than 65 33 less than 65 | 2/3 of patients who die from pneumonia are over 65 and 90% have comorbid illness Patients older than 65 are five times more likely to be hospitalized for pneumonia than adults less than 65. | This is an older study Focus on adults with comorbid illness and not healthy 65 year old | Level V |
| Li, Norton, & Dow, 2004 | Meta synthesis | Individual-level information about the vaccination rates of 38,768 elderly persons are from the Behavioral Risk Factor Surveillance System, 1993–1998. Information on the combined influenza and pneumonia state mortality rates are measured from the Compressed Mortality File. | Influenza vaccination behavior responds positively to disease mortality. | Based on two data sets. mixed evidence on the role of (mis)perceptions | Level I |
| Vaccination Roundup, 2016 | Report of EBP project | United States Brigham and Women’s Hospital and a professor at Harvard Medical School | It’s best to get the shot when you feel well. People who are sick might have an impaired immune response to the vaccine. The CDC now recommends two pneumococcal vaccines for adults 65 and older | Findings are based on other studies | Level V |
| Fiore et al., 2009 | Randomized control trial | United States
| An annual average of approximately 36,000 deaths during 1990–1999 and 226,000 hospitalizations during 1979–2001 have been associated with influenza epidemics Hospitalization rates during the influenza season are substantially increased for persons aged >65 years. Over 65 years w/ underlying condition 560 influenza associated hospitalizations per 100,000 persons compared with approximately 190 per 100,000 healthy persons. | Broad sample Old study
| Level IV |
References
Blevins, S. H. (2017). Immunizations for the Adult Patient. MEDSURG Nursing, 26(2), 138–151.
Christenson B., Lundbergh P., Hedlund J., & Örtqvist Å. (2001). Effects of a large-scale intervention with influenza and 23-valent pneumococcal vaccines in adults aged 65 years or older: A prospective study. Lancet, 357 North American Edition(9261), 1008–1011.
Fall Vaccination Roundup. (2013). Harvard Health Letter, 38(11), 3.
Fiore A. E., Shay D. K., Broder K., Iskander J.K., Uyeki T.M., Mootrey G., … Cox NJ. (2009). Prevention and control of seasonal influenza with vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009. MMWR Recommendations & Reports, 58(RR-8), 1–52.
Flu and Pneumonia. (2017). CNA Training Advisor: Lesson Plans for Busy Staff Trainers, 25(1), 1–8
Li Y., Norton E. C., & Dow W. H. (2004). Influenza and pneumococcal vaccination demand responses to changes in infectious disease mortality. Health Services Research, 39(4p1), 905–925.
Sethi S. (2002). Bacterial pneumonia: Managing a deadly complication of influenza in older adults with comorbid disease. Geriatrics, 57(3), 56–61.
Vaccination roundup. (2016). Harvard Health Letter, 41(12), 7.