MOTIVATIONAL INTERVIEWING AND VACCINE UPTAKE 1 Executive Summary: Utilizing Motivational Interviewing to Increase Pediatric Influenza Vaccine Uptake Alyssa Jane Nolan College of Nursing, East Carolina University Doctor of Nursing Practice Program MOTIVATIONAL INTERVIEWING AND VACCINE UPTAKE 2 Executive Summary: Utilizing Motivational Interviewing to Increase Pediatric Influenza Vaccine Uptake Key Points • The World Health Organization (WHO) (2019) deems vaccine hesitancy as a threat to global health amid declining pediatric influenza vaccination rates in the United States and North Carolina (Centers for Disease Control and Prevention [CDC], 2024). • Nurses are esteemed to lead vaccine conversations and motivational interviewing (MI) trained personnel are recognized to reduce vaccine hesitancy (Hofstetter et al., 2021; Schellenberg et al., 2023; Jamison et al., 2022; Labbé et al., 2022). • Bedside nurses at the project site lack interventional counseling confidence and training when encountering vaccine hesitancy (Project site pediatric nurses, personal communication, February 7, 2024). • The intervention of an electronic module on influenza vaccine education and introductory MI training overall increased nurses' comfort in using basic MI skills. • Participating nurses did not always use MI skills in patient encounters despite education completion and reports of seeing the value and importance of MI use. • Module implementation coincided with a 2.3% increase in influenza vaccinations for the implementation period versus the year prior. • Attention directed towards vaccines and communication promotes public health and rapport-building between healthcare personnel and patients. Background and Purpose Halting declining influenza rates is a public health priority, as Healthy People 2030 aims to vaccinate 70% of the population, including pediatrics, annually for influenza (Office of MOTIVATIONAL INTERVIEWING AND VACCINE UPTAKE 3 Disease Prevention and Health Promotion [ODPHP], n.d.). Improving the influenza vaccination rate is important as the lack of vaccination increases disease severity, infection sequelae, healthcare system burden, and healthcare personnel burnout (Neuzil & Fitzpatrick, 2019; White et al., 2023). Interventional categories to combat falling vaccination rates include using clinical decision support models, increased education, and augmenting enhanced communication methods (Kandaswamy et al., 2022; Cole et al., 2020; Scott et al., 2019). Motivational interviewing is efficacious for inducing change behaviors in a vaccine-hesitant person (Rollnick et al., 2023). Oftentimes, nurses are the healthcare personnel to initiate vaccine decision conversations and are trusted representatives to converse with patients about vaccine decisions (Hofstetter et al., 202l; Schellenberg et al., 2023). This Doctor of Nursing Practice (DNP) project aims to increase nurse comfort in utilizing motivational interviewing skills through education and subsequently increase inpatient pediatric influenza vaccination rates. Methodology Using the Iowa Model operational framework, the project began with a baseline data review of influenza vaccination administration data from all patients discharged from the project site from October 1st, 2023, to November 22nd, 2023 (Cullen et al., 2023). The data review verified suboptimal influenza vaccinations and supported the need for this DNP project. The primary learning tool was creating a 45-minute module on influenza vaccinations and introductory MI education. The module had an embedded pre-test and post-test to complete to assess knowledge. The module was open for 13 weeks; however, it was encouraged to be completed from August 2024 to October 1st, 2024, when influenza vaccines became available at the project site. MOTIVATIONAL INTERVIEWING AND VACCINE UPTAKE 4 Next, nurse surveys were developed. The surveys included Likert-scale and qualitative responses concerning nurse attitudes and behaviors about using the knowledge from the module education in practice. These Qualtrics surveys were administered via email one month after nurses started using the module education on November 1st, 2024. Surveys were only for nurses who completed the module. From gaps identified based on survey results, a badge buddy was created and distributed by email to the nurses to serve as a quick reference to the definition, steps, skills, and spirit of MI. Project implantation was completed by reviewing vaccination administration data for 2024. Results There were 24 participants in the online module education, 38% of the staff nurses. On the pre-test within the module, there was an average score of 65.42% and an average of 81.25% on the post-test, thus proving that participants gained knowledge on influenza vaccines and motivational interviewing through participation. There were then 11 participants who completed the attitudes and behaviors survey. All nurses agreed or strongly agreed that using MI skills during the influenza vaccine conversation enhances the nurse-patient relationship. When asked if they felt they had basic MI knowledge and comfort in using MI skills, 91% of respondents either agreed or strongly agreed. Despite this comfort, knowledge, and respect for MI use, 91% of nurses reported they sometimes used MI skills, and 9% reported they often used MI skills in the vaccine conversation. Additionally, when asked about the frequency of inquiring about influenza vaccination decisions without engaging with the patient first, 36% stated this often happened, 36% noted this sometimes happened, and 27% said it hardly ever happened. Despite nurses believing that MI enhances the nurse-patient relationship, MI skills were not always used. MOTIVATIONAL INTERVIEWING AND VACCINE UPTAKE 5 Simple random sampling from total discharges in 2023 and 2024 was used to maintain a manageable amount of data. In 2023, 6.8% of eligible patients received influenza vaccination before implementation. For the exact dates in 2024, 9.1% of patients received vaccination; there was a 2.3% increase in vaccinations. A Chi-Square Test for Independence (with Yate's Continuity Correction) revealed no significant difference between the two years or association between module implementation and an increase in influenza vaccination rates, 2 (1, n = 139) = .03, p = .86, phi = -.04 (Pallant, 2020). Despite no statistical significance, clinical significance remains as a slight increase in vaccinations and enhanced communication was highlighted. Strengths and Limitations Strengths of the project include the positive reception of project ideas from participants. Key stakeholders, including project site leadership, nurses, site liaison, and the principal investigator, maintained motivation for project success and promotion throughout the implementation, facilitating project uptake. Designing the module to have audio and visual learning platforms engaged a variety of learners. There was no option to skip through the module or speed it up, ensuring full completion for learners. Despite positive project reception at the site, limitations arose with uptake, with 38% of project site nurses completing the module. Participation was voluntary, and nurses were not invited to stay clocked in after shift hours to complete the module. Patient acuity and busy assignments took precedence over module completion. Despite learning, project results proved that MI was not always used in patient encounters. Recommendations for the future include cultivating ways to increase intrinsic motivation for nurses to use the MI techniques taught in the module. Overcoming limitations by increasing module participation and repeated use of MI techniques in the future can increase data significance and project impact. MOTIVATIONAL INTERVIEWING AND VACCINE UPTAKE 6 Implications and Conclusion Participants in the project were exposed to communication that increases rapport and trust by engaging with patients and families as the first step of interacting under MI (Rollnick et al., 2023). Engagement strengthens the relationship between nurses and patients. Enhanced communication in this aspect of the patient-caregiver interaction can infiltrate other aspects of care, increasing patient satisfaction. Project site leadership is optimistic that repeated administration of the education module will embed MI into the culture and improve patient outcomes and satisfaction scores. Embedding MI into unit culture can also lead to increased communication amongst the interprofessional team. The community can form a more trusting relationship with healthcare personnel when communication strengthens rapport. In addition to distributing an evidence-based form of communication to participants at the project site, the project highlighted awareness of vaccination efforts. Increased vaccinations are a chance to promote public health through increasing herd immunity, which can improve population health. Amid declining influenza vaccinations that are already below national metrics, it is vital to embed evidence-based interventions into healthcare practice (ODPHP, n.d.). It is recommended that module education be repeated to integrate project ideals into the culture and regular practice at the project site. As MI knowledge and skills are reinforced, there is potential for the nurse-patient relationship to strengthen, patient satisfaction to improve, herd immunity to increase, and relationships between healthcare personnel and community dwellers to be strengthened. MOTIVATIONAL INTERVIEWING AND VACCINE UPTAKE 7 References Centers for Disease Control and Prevention. (2024, May 24). Influenza vaccination coverage, children 6 months through 17 years, United States. Retrieved June 21, 2024 from https://tinyurl.com/bd3h3s9b Cole, J. W., Chen, A., McGuire, K., Berman, S., Gardner, J., & Teegala, Y. (2022). Motivational interviewing and vaccine acceptance in children: The MOTIVE study. Vaccine, 40(12), 1846-1854. https://doi.org/10.1016/j.vaccine.2022.01.058 Cullen, L., Hanrahan, K., Farrington, M., Tucker, S., & Edmonds, S. (2023). 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