Steps Toward Change to Promote Child Health Advocacy: A Service Learning Experience

Since the beginning of the 19^th Century, immunizations have saved millions of lives. Now routinely implemented worldwide as the cornerstone of public health, immunizations are regarded as one of the most important life-saving measures of all time (Rémy, Zöllner, & Heckmann, 2015). In American history, immunizations became a common practice with the mandate of the small pox immunization in 1827 (Cole & Swendiman, 2015). Since then, laws have continued mandatory school immunizations to prevent outbreaks of communicable diseases (Cole & Swendiman, 2015). However, there have been unforeseen consequence of immunization success; namely, many people lack firsthand experience with serious communicable diseases. Lack of experience with immunization preventable diseases has led parent to focus less on the overwhelming benefits of immunizations and more on possible adverse events (Rémy, Zöllner, & Heckmann, 2015). As the perceived benefits of immunizations decrease, parental requests for school immunization exemptions have increased (Seither et al., 2016).

Because school-age children typically have the highest rates of immunization preventable diseases, it is important that parents immunize their children on time to promote optimum immunity against these diseases (Centers for Disease Control and Prevention [CDC], 2018). School immunization requirements, while individually defined by each state, are largely based on the recommendations of the United States Department of Health and Human Services Advisory Committee on Immunization Practices (CDC, 2018). However, all states in the United States allow at least one type of immunization exemption, whether it be for medical, religious, or philosophical reasons (Luthy et al., 2016).

Utah is one of the 18 states allowing philosophical exemptions from immunizations (Utah Department of Health, 2015). As a result, Utah tends to have higher exemption rates than other states. Even more worrisome are the rising exemption rates each year in Utah (Utah Department of Health, 2014). In fact, exemptions in Utah for Kindergarten immunizations rose from 2.1% in 2007 to 4.4% in 2013, of which 95% were for philosophical reasons (Utah Department of Health, 2014). With this rise in Utah exemption rates, the integrity of the herd effect in Utah has been compromised. Additionally, only 75.2% of Utah’s children, at 2 years of age, have received all recommended vaccinations (Lampros, 2015). While herd immunity requires a 95% immunization rate to be effective, unimmunized infants and children are at greatest risk of acquiring highly virulent diseases, such as measles and pertussis (Bester, 2017). Consequently, Utah has experienced several outbreaks of immunization preventable diseases, such as measles and pertussis, during the last 5 years. While parental education on immunizations appears to reduce immunization exemption rates (Omer at al., 2018), there are no standard guidelines regarding education prior to immunization exemptions in Utah.

Purpose: The purpose of this project was to mentor nursing students through the process of creating and lobbying for new policy requiring standardized education of parents choosing to exempt their children from immunizations and to assist county health departments to fulfill exemption requirements. This community-wide project resulted in enriched service-learning environment for students while addressing an incredibly timely need in the community. Through this new policy requiring standardized education, it is anticipated that parents will have a greater understanding of how to protect their children from communicable diseases and decrease the spread of infection, thus protecting the health of all children in our communities. Additionally, the student nurse will recognize the influence they can have as empowered change agents.

Methods: Nurses have a plethora of experience as effective patient advocates, providing and coordinating care with successful outcomes. While the care nurses give their patients is vital to health outcomes, many aspects of health care are regulated through legislation. Many nurses play a very small role in the world of policy yet are armed with the knowledge and skills necessary to influence and guide lawmakers. It is imperative for nurses to become political activists for healthcare in their country. The purpose of nurse political activism is not only to advance the nursing profession but to advocate for the best interests of health care consumers (Buck-McFadyen & MacDonnell, 2017).

Results: To be effective patient advocates, nurses possess qualities that are also vital to successful policy implementation. For example, nurses are continually managing challenging personalities and conflicts through negotiating and communicating. Nurses use problem-solving skills on a daily basis and do so through teamwork. All of these skills give nurses an innate ability to successfully create, promote, and pass legislation (Woodward, Smart, & Benavides-Vaello, 2016). Although nurses recognize the need for political activism and possess the skills needed, many nurses have minimal involvement in policy due to time constraints, frustration, and burnout (Buck-McFadyen & MacDonnell, 2017). Another identified barrier to political involvement is the lack of understanding of complex political procedures (Lewinski & Simmons, 2018). Therefore, the purpose of this presentation is to clarify steps in political procedures and how to involve student nurses by: 1) describing the legislative progression to pass a bill, 2) outlining steps for successful drafting and lobbying of a bill; and 3) empowering nurses with knowledge to become politically savvy. With improved understanding of political activism, it is anticipated that nurses will more likely get involved in patient advocacy through policy change and combat health inequities.

Conclusion: The guidelines set forth in this presentation is unique because the steps were applied and successfully implemented by nurses during grassroots legislation (Utah State House Bill 308S2) in Utah during the 2017 legislative session. Specific examples from this experience will be shared throughout the presentation to give real-life application to the steps and guidelines provided.