ASSESSMENT

Healthy People 2010: Sustain elimination of vaccine-preventable disease -Healthy People 2010 Objective 14-24: Increase the proportion of young children and adolescences who have received all vaccines that have been recommended. Influenza hospitalization rates remain higher than expected for this time of year. Hospitalization rates highest in younger populations with the highest hospitalization rate reported in children 0-4 years old. 35 influenza-associated pediatric deaths have been reported. 27 are associated with H1N1. 7 are associated with influenza A virus (subtype undetermined) 1 associated with a seasonal influenza A (H1) virus Sept 8th, 2009, an estimated 2,500 possible H1N1 cases present among the nearly 18,000 students that make up WSU. -Healthy People 2010 Objective 14-29: Increase the proportion of adults who are vaccinated annually against influenza. General estimate of H1N1 vaccinations given in Pierce County: 75,700 doses distributed to Pierce County in total. 17,000 doses provided to Tacoma Health Department (most of these doses went out to private providers) 2,300 doses distributed at Puyallup vaccination clinic and 1,300 doses at Lakewood clinic Nov 11- Nov 14, 2009, 89.4% of influenza specimens reported to the World Health Organization are H1N1. November 15th-21st CDC provided the following data: 1,880 (20.5%) specimens tested by WHO & NREVSS were positive for influenza. Over 99% of all subtype influenza A viruses being reported to CDC were 2009 influenza A (H1N1) viruses. Visits to doctors for influenza-like illness has been decreasing nationally recently within all regions. The proportion of deaths attributed to pneumonia and influenza has been above the epidemic threshold for the past 8 weeks.

PLANNING
Short term goal: Pacific Lutheran University college students will provide information indicating why they have not received the H1N1 influenza vaccine through a short survey. Short term goal: Pacific Lutheran University college students will have a decreased level of fear through increased awareness and knowledge concerning the H1N1 influenza virus and the concomitant vaccine by identifying, and addressing, prevalent anxieties and beliefs related to the H1N1 vaccine. Long term goal: PLU college students will have a decreased number of students who do not receive the vaccine through the identification of attitudes, beliefs and practices, thus decreasing the total number of people infected with the H1N1 virus in the community.

EVALUATION
Objective for Diagnosis 1: Assess the Pacific Lutheran student body concerning reasons for not becoming vaccinated through a written survey by November 11, 2009 Met or Not Met: Met (short term)/Partially Met (long term) The short term goal of assessing and analyzing was accomplished through the survey that was completed on the PLU campus. This survey allowed us to assess and analyze the reasons that PLU students are not being vaccinated. This information is necessary to designing and implementing strategies to educate and vaccinate the public within the community. The long term goal of decreasing the number of students who are not vaccinated is partially met due to the time constraints placed on this project. It is too soon to assess the impact of our information gathering on the PLU community. We only recently shared our results with the other collaborating entities, and these organizations require time to implement the implications of the results into future marketing and delivery methods of vaccination. Objective for Diagnosis 2: Decrease the risk and spread of the H1N1 influenza virus through the sharing of results of the survey with the PLU Health Center, Tacoma Health Department, and the SoN by December 18, 2009 through a poster presentation and letter of findings. Met or Not Met: Partially Met The objective is only partially met for this section as the information regarding the results of the survey have been disseminated, but the impact of this information is yet not available for analysis. It is unclear whether or not the information we gathered will have any impact on the incidence of H1N1 within the PLU student body and the community at large regarding transmission and spread of the H1N1 virus. Objective for Diagnosis 3: Creation of a poster and sharing of findings regarding reasons students state for not receiving the H1N1 vaccine, provided to the aforementioned parties by December 18, 2009. Met or Not Met: Partially Met These goals are partially met as the evaluation and identification sections of this project are met, but the impact of this information is yet to be determined. Our overall goal for this project was to decrease the number of people infected with the H1N1 influenza virus through increased knowledge and awareness. The project has been completed including sharing our information and resources with the Tacoma Health Department, PLU SoN, and The PLU Health Center. The responsibility of utilizing this resource for current and future vaccination programs is the duty of these collaborative entities. Summary: This glimpse into the world of community health, has broadened our perspective and given new insight into the role of the nurse in the community. Our role in the vaccination clinics was not just as vaccine administrators, but as educators, supporters, and project coordinators. The clinics were run by nurses who functioned in all of these capacities and allowed us the opportunity to assist and perform these types of tasks as well. Our clinical experience has also affected the way in which we view education and delivery of health services to the public. Working with a larger demographic is quite diverse and expansive in comparison to caring for one person. We have learned that the process of community health is just that, a process. Through the development of our community health project we now know that the process involves many twists and turns and requires flexibility to accomplish the established goals.

ENVIRONMENT
Resident Halls Classroom Communal Spaces (dining, bathrooms, etc.)

INPUT
H1N1 influenza virus Outside community (family, friends, employees, etc.) Media Previous attitudes & beliefs regarding vaccines Outside agencies (THD, FHS, etc.) CDC Regulations

OUTPUT
H1N1 influenza virus spread to surrounding community Immunized students Correct info through college websites concerning H1N1 Awareness requiring disease transmission & hygiene practices

THROUGHPUT
High Risk Behaviors (sleep deprivation, poor diet, etc.) Social Proximity H1N1 Information (mass PLU emails, peer discussion, ads, etc.) Lower Income & Insufficient Healthcare Coverage Transmission of H1N1 virus

FEEDBACK

IMPLEMENTATION
Assess reasons for PLU students not receiving the H1N1 vaccine by using key informants from the School of Nursing student body, as well as faculty, members of the Medical Reserve Corps., and the Tacoma Health Department. Develop a survey based off of information provided by the key informants and submit to the PLU board for review. Upon approval of survey, set up a table in the University Center to distribute survey to PLU students. Obtain current documentation regarding PLU vaccination rates. Compare PLU vaccination data to other areas within Pierce County, as well as national statistics for this demographic. Assist the Tacoma Health Department and Medical Reserve Corps with local H1N1 vaccination clinics. Assess the surrounding community through our work at clinics provided by the Tacoma Health Department and Medical Reserve Corps. Use unofficial assessment data to guide our future research.

Hospitalizations and Deaths for all strains of influenza in WA

Hospitalizations
(9/19 to 11/28/2009)

Deaths
(9/19 to 11/28/2009)

Western Washington residents

807

40

Eastern Washington residents

425

17

Total

1232

57

CORE FUNCTION & LEVEL OF PREVENTION

Core Function: Assessment Level of Prevention: Primary Prevention

NURSING DIAGNOSIS
Diagnosis 1. Risk for H1N1 influenza exposure among college students related to close living quarters, class rooms and social activity. Diagnosis 2. Risk for acquiring H1N1 influenza among college students as evidenced by lack of vaccine availability/insufficient number of vaccines, lack of campus support for on-campus clinics, cost, lack of knowledge/fear related to getting the vaccine. Diagnosis 3. Knowledge deficit among college students related to refusal to get vaccine because of supposed medical risks (ingredients/preservatives), media perception/presentation, fear of live vaccine.

REFERENCES
Centers for Disease Control and Prevention, Initials. (2009, November 30). 2009 H1N1 flu: situations update. Retrieved from http://www.cdc.gov/h1n1flu/update.htm Craig , A., Hall , S., Lott, J., Lawson, B., & Schaffner, W. (2007). Mass distribution of free, intranasally administered influenza vaccine in a public school system. Pediatrics, 120(1), 172-177. Crobari, P., Esposito, S., Gasparini, R., Marchisio, P., & Principi, N. (2003). Socioeconomic impact of influenza on healthy children and their families. Pediatric Infectious Disease, 22(10), 207-210. Edelman, C., & Mandle, C. (2006). Health promotion throughout the life span. St. Louis: Mosby. Fedson, D., Glezen, P., Reichart, T., Sugaya, N., & Tashiro, M. (2001). The Japanese experience with vaccinating schoolchildren against influenza. New England Journal of Medicine, 344(12), 889-895. Go, G., Hlaing, T., McLaughlin, N., Purdy, T., & Wiggs-Stayner, K. (2006). The Impact of mass school immunization on school attendance. The Journal of School Nursing, 22(4), 219-222. Lancaster, J., & Stanhope, M. (2008). Public health nursing: population-centered health care in the community. St. Louis: Mosby. Washington State Department of Health, Initials. (11, 29 2009). H1N1 (swine flu). Retrieved from http://www.doh.wa.gov/h1n1/ Washington State University, Initials. (2009, November 15). H1N1 (swine) flu guidance home page. Retrieved from http://h1n1flu.wsu.edu/