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EDITOR’S COMMENT

'Our own fears can help us understand our patients better'

  • 8 Comments

It’s hard to think of the onset of another cold winter while the sun is shining and the supermarkets are still stocked with Pimms and ice cream promotions.

But the nights are closing in, the last bank holiday until Christmas is less than a week away and so it’s time to start thinking about winter. For the health profession, that usually means coping with an onslaught of winter ailments and exposure to cold-related illnesses. In fact, NHS Employers has already launched its flu campaign for health professionals, as we announced on Nursingtimes.net.

But despite a hefty media campaign from NHS Employers, according to our Nursing Times Facebook page and nursingtimes.net forum, fear over picking up worse illnesses from the vaccine and just a lack of real belief in its power to protect seem to be the main motivators deterring nurses from getting the jab. NHS Employers says that the risk of having a serious reaction to the seasonal flu vaccine is less than one in a million. It is much lower than the risk of getting seriously ill from having the flu itself.

The seasonal flu vaccine is one of the safest vaccines in the world and is given to millions of people in the UK each year. The idea that so many nurses are not being vaccinated leaves some in the profession incredulous. “We are professionals. It’s about science not belief. Get jabbed!,” says @TomBolger on Twitter. “Nurses not getting flu jab is bonkers. Are they planning sickies to reduce work-related stress?”

He contends that suggesting that the vaccination may actually be bad for your health is unproven hokum. But the beliefs that many nurses have around the vaccine provides us with an insight into the psychology of many patients. Are your patients non-concordant because of fear? Misinformation? Urban legend?

If well-informed, well-educated and health-interested professionals can express such divided views over something that is intended to protect and preserve their wellbeing, then it’s little wonder that patients, who are given half as much information in a 10-minute appointment go away in disbelief about the importance of following their treatment regimen.

Scientific fact alone, it seems, is not convincing. What’s required is anecdotal evidence about the effects and a chance to discuss some of the views and opinions the patient may have heard from friends, colleagues and neighbours. The nurse’s role is not just about doling out medication and advice, but listening to possible concerns and criticisms, taking them on board where necessary or explaining - respectfully - why they are inaccurate or irrelevant in certain cases. Only when someone truly believes that the cure will work for them will they be resolved to follow that path.

And while we’re at it, make sure you’re well informed about the flu jab this coming winter season. Go to the NHS Employers website to find out more.

  • 8 Comments

Readers' comments (8)

  • Perhaps this is one of the general signs of how low nurse morale is......rather to have time off with a potentially life-threatening virus than risk not getting flu at all and having to stay at work all winter.

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  • Perhaps nurses are MORE aware than others and more likely to use proper scientific research to support their decisions?

    That may explain why there isn't much uptake.

    In fact, the kind of information upon which we base our own health-promotion is often NOT based on the best scientific evidence.

    Flu vaccine is a supremely remarkable case in point.

    Cochrane reviewed a host of research on flu vaccines and concluded that they have very little evidence to support their use. In fact, they issued warnings that many studies were flawed, biased and misleading. Cochrane and other researchers have found links between such vaccinations and disease. Yes, taking a scientific approach, vaccines cause diseases and the studies that say they are safe and effective cannot be trusted!

    Yet nurses and doctors placate patients all the time with 'party-line' platitudes and reassurances of safety and efficacy, backed up by a presumption that 'scientifically' all is well.

    I am sorry Jenni, but 'scientific fact' when bandied around as a bludgeon to bring others into line with mass consensus should be just that: 'scientific'. We should support our statements rather than repeating mantras - as we are expected to be able to do as practitioners. I am not impugning the author here, and I know that we all have only the best interests of others at heart.

    But how many of us are actually qualified to know for certain that the research upon which we base our 'evidence' for our practice is scientific fact? We are all at the mercy of our sources and rely on trust. And how many of us believe intrinsically in the truth of any number of popular mysths, believing them to be fact and will happily transmit erroneous factoids to others with the confidence of our status, qualifications, and the weight of mass consensus behind us? And we do so because we care.

    We, as nurses have a duty to ourselves, our families and our patients to give them the facts. And if the facts fly in the face of our organization's party-line, then we should challenge it.

    I have to emphasize that there are many sources of varying quality that rail against the uses of vaccines. Many are dubious and unscientific. Many make excellent cases against vaccines (I still cannot get my head around the idea that it's safe to put excipients such as mercury in certain vaccines, when the dangers of mercury are well-known) But when an organisation as respected as Cochrane finds against a case for seasonal flu vaccines, we have to sit up and take note.

    Here's a snippet from Cochrane:

    Main results

    We included 50 reports. Forty (59 sub-studies) were clinical trials of over 70,000 people. Eight were comparative non-RCTs and assessed serious harms. Two were reports of harms which could not be introduced in the data analysis. In the relatively uncommon circumstance of vaccine matching the viral circulating strain and high circulation, 4% of unvaccinated people versus 1% of vaccinated people developed influenza symptoms (risk difference (RD) 3%, 95% confidence interval (CI) 2% to 5%). The corresponding figures for poor vaccine matching were 2% and 1% (RD 1, 95% CI 0% to 3%). These differences were not likely to be due to chance. Vaccination had a modest effect on time off work and had no effect on hospital admissions or complication rates. Inactivated vaccines caused local harms and an estimated 1.6 additional cases of Guillain-Barré Syndrome per million vaccinations. The harms evidence base is limited.


    Authors' conclusions

    Influenza vaccines have a modest effect in reducing influenza symptoms and working days lost. There is no evidence that they affect complications, such as pneumonia, or transmission.

    http://www2.cochrane.org/reviews/en/ab001269.html

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  • Why do care workers resist the flu vaccine? Perhaps its because trust has been diminished-think of all the lies they have been told by government for example-start with the safety of beef not many years ago! What about eggs what about thalidomide or the nuclear experiments? So when we are constantly told the flu jab is safe it is not surprising that we dont automatically accept and believe. Also, nhs employers pushing propaganda-pictures of chief execs. etc getting the vaccine- does not help. The vaccine might be safe but you can hardly blame health professionals or otherwise from being sceptical having been lied to so often before. Besides, there are other issues that are not addressed-with the amount of immunisation health workers are expected to take on board no one has offered reassurance on the possible finite amount of messing about one can do with the immune system. What about compensation factors if the flu vaccine turns out not to be safe? Governments dont exactly have a reliable record on this of which gulf war syndrome vaccines are an example. Science is one thing-perhaps what health care workers need is a healthy dose of confidence before they take to the flu vaccine in the large numbers required.

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  • I resent being told by my faceless employer that I should have the vaccine, I spend much of my time avoiding eating foods with additives, not using preservative and chemical laden cosmetic and household products, so why should I feel guilty about making a choice not to have a vaccine, which has dubious efficacy simply because of my career choice?
    Patients have the right to say no, shouldn't we, the nurses, have the same human rights?

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  • We all know that 'the flu vaccine' culture is led by 'payment by results', as so many other unproven treatments. I have read many articles on this and others and will come to my own conclusions what is best for myself. I thought that was an aim, that we take resposibility for our own health, until, that is it seems, comes to not reaching targets. We are in a culture of scare mongering, blame and control, and not in just health issues.

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  • the "worried well" don't make good epidemiology, take out the selection bias then i'll take notice.

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  • I have nursed many patients over the years who have had reactions to the flu vaccine,and ended up in hospital-some in ICU!. Therefore I and many of my colleagues have chosen not to have it

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  • @TomBolger, i haven't had the jab, nor have i taken a single sickie for over two years. how's your sickness record, you patronising idiot?

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