Chapter Four: Level of Nurses Knowledge Regarding Adverse Events Post Immunization at the Health Care Centers in the Northwest of Jerusalem District
*Corresponding Author(s):
Hadi Dar BadwanFaculty Of Nursing And Health Sciences, Bethlehem University, Bethlehem, Palestine
Email:hadbad446@gmail.com
Abstract
Background: Childhood immunization against common childhood diseases is the most powerful public health strategy to keep children healthy. It has been the most cost-effective public health intervention, saving an estimated 2–3 million lives around the world each year. However, because no vaccine is 100% safe and effective, so adverse events post-immunization may occur. These adverse events are any untoward medical occurrences that occur following immunization and do not necessarily have a causal relationship with the use of the vaccine. Moreover, if not rapidly and effectively dealt with it, it can undermine confidence in a vaccine and ultimately have dramatic consequences for immunization coverage and disease incidence.
Purpose: The purpose of this study was to determine the level of nurse’s knowledge regarding adverse events post immunization at the health care centers in the northwest of Jerusalem district.
Methodology: Study designs: A descriptive cross-sectional study design was used. Study population: The study population consists of all of community health nurses who are working at health care centers in the northwest of Jerusalem district. Study sample: The study sample was consisted of community health nurses that working in this area and who did not administer the vaccination. A convenience sampling method was used to collect data, so, the number of nurses who enrolled in our study was 40 nurses. Setting: This study was conduct at health care centers in the northwest of Jerusalem district from 1st of December to the end of December of 2022. Study tools: The study tool that used in our study was the questionnaire tool. Study strategies for analysis: The collected data was analyzed by the Statistical Package for Social Sciences (SPSS) Version (28).
Results: The results of the research show that more than two-thirds of nurses were female and held Bachelor’s Degree, and more than half of nurses aged 21-30 years old and have 1-4 years old experience. Almost two-thirds of nurses 62.5% have good knowledge, while 37.5% of nurses have poor knowledge, also it found that the nurses who work in governmental clinics have more knowledge score than others nurses (p= < 0.001).
Recommendations: This study recommended to establish an educational program in health care centers to improve the nurse's knowledge regarding adverse events post-immunization and also for nursing students in universities and colleges. Furthermore, routinely validate staff's knowledge and competencies regarding vaccine administration and its adverse events were suggested.
Keywords
Adverse events post immunizations; Immunization; knowledge; Community health nurses; Vaccination; AEFI
Introduction
This chapter includes the description of the results for this study, and in order to facilitate the interpretation of the results, the research team relies on percentages. Moreover, this chapter tested the hypothesis.
Results
Table 1 illustrates the socio-demographic variables of nurses. More than two-thirds of nurses were female, and almost two-thirds held bachelor’s degrees. More than half of nurses are aged 21-30 years old and have 1-4 years of experience. 42.5% of nurses were in private health centers. Most nurses hear about the adverse events post immunization. Moreover, almost two-thirds of nurses have not attended any courses related to vaccination.
|
Variable |
|
N |
% |
|
Gender |
Male |
7 |
17.5 |
|
|
Female |
33 |
82.5 |
|
Age |
21-30 years old |
21 |
52.5 |
|
|
31-40 years old |
14 |
35.0 |
|
|
> 40 years old |
5 |
12.5 |
|
Educational level |
Diploma |
15 |
37.5 |
|
|
Bachelor’s Degree |
25 |
62.5 |
|
|
Master Degree |
0 |
0 |
|
|
PhD |
0 |
0 |
|
Years of experience |
1-4 years |
21 |
52.5 |
|
|
5-8 years |
2 |
5.0 |
|
|
9-12 years |
4 |
10.0 |
|
|
> 12 years |
13 |
32.5 |
|
Type of health care |
Governmental |
12 |
30.0 |
|
center |
UNURWA |
5 |
12.5 |
|
|
Private |
17 |
42.5 |
|
|
NGO’s |
6 |
15.0 |
|
Did you hear about the |
Yes |
38 |
95.0 |
|
Adverse Events Post |
No |
2 |
5.0 |
|
immunization? |
|
|
|
|
Previous course toward |
Yes |
15 |
|
|
vaccination |
No |
25 |
62.5 |
Table 1: Socio-demographic variables of nurses (n= 40).
Table 2 shows the frequency and percentages for each item related to general knowledge about vaccination among nurses. All nurses 100% were answered correctly that vaccinations stimulate the human body's natural immune system to combat pathogens such as bacteria and viruses. However, more than half of nurses incorrectly answered that vaccines are given by injection, either into a muscle or into a vein, while others are administered orally or by spraying them into the nose. More details are presented in table 2.
|
Information |
Correct |
Incorrect |
|||
|
|
|
N |
% |
n |
% |
|
1) |
Vaccinations stimulate the human body's naturalimmune system to combat pathogens such as bacteriaand viruses |
40 |
100.0 |
0 |
0 |
|
2) |
Vaccinations confer an individual's lifelongimmunity against the disease. |
21 |
52.5 |
19 |
47.5 |
|
3) |
Vaccination is a simple, safe, and effective way toprotect people from harmful diseases before they areexposed to them. |
37 |
92.5 |
3 |
7.5 |
|
4) |
Vaccines are given by injection, either into a muscleor into a vein, while others are administered orally orby spraying them into the nose. |
17 |
42.5 |
23 |
57.5 |
|
5) |
The vaccines contain germs that have been killed orweakened, and if they are given to a healthy person,they trigger the immune system to form immunity against these germs. |
37 |
92.5 |
3 |
7.5 |
Table 2: Frequency and percentages for each item toward general knowledge about vaccination among nurses (n=40).
Table 3 shows the frequency and percentages of correct and incorrect answers toward knowledge about the possible causes of adverse events post immunization among nurses. An 87.5% of nurses were answered correctly that one of the causes of adverse events post immunization is the use of improperly stored vaccine. However, almost two-thirds of nurses were incorrectly answered that adverse events post immunization cannot be related to anxiety that existed before taken the vaccine. More details are presented in table 3.
|
Information |
|
Correct |
|
Incorrect |
|
|
|
|
n |
% |
N |
% |
|
1) |
The wrong dose of vaccine is one of the causes of adverse events post immunization. |
28 |
70 |
12 |
30 |
|
2) |
Injection at the improper site or through the improper routs is one of the causes of adverse events post- immunization. |
28 |
70 |
12 |
30 |
|
3) |
Proper sterilization of the syringe, needle, and vaccination site helps to prevent the adverse events that may occur post-immunization. |
17 |
42.5 |
23 |
57.5 |
|
4) |
Reconstitution (dissolving) of vaccines with improper diluents is one of the causes of adverse events post immunization. |
21 |
52.5 |
19 |
47.5 |
|
5) |
Using the wrong amount of diluents is one of the causes of adverse events post immunization. |
20 |
50 |
20 |
50 |
|
6) |
Use of a vaccine suspected of being contaminated with another vaccine or diluents is not considered a cause of adverse events post immunization. |
30 |
75 |
10 |
25 |
|
7) |
One of the causes of adverse events post immunization is the use of improperly stored vaccine. |
35 |
87.5 |
5 |
12.5 |
|
8) |
Adverse events post immunization cannot be related to anxiety that existed before taken the vaccine. |
9 |
22.5 |
31 |
77.5 |
|
9) |
Adverse events post immunization as medical conditions are limited to vaccination alone. |
17 |
42.5 |
23 |
57.5 |
|
10) |
Giving vaccination to people with autoimmune disorders is one of the causes of adverse events post- immunization. |
11 |
27.5 |
29 |
72.5 |
|
11) |
The reaction of the immune system to the immunization process is the causes of adverse events post-immunization. |
34 |
85 |
6 |
15 |
|
12) |
One of the causes of adverse events post- immunization is storing vaccines in the refrigerator at a temperature between 10-15°C. |
16 |
40 |
24 |
60 |
|
13) |
One of the causes of adverse events post- immunization is storing opened vaccine vials in the refrigerator for the next day’s session. |
15 |
37.5 |
25 |
62.5 |
Table 3: Frequency and percentages for each item toward knowledge about the possible causes of adverse events post immunization among nurses (n=40).
Table 4 shows the frequency and percentages of correct and incorrect answerstoward knowledge about signs and symptoms of adverse events post immunization among nurses. An 95% of nurses were answered correctly that Pain, swelling, and redness are normal local reaction at the injection site post vaccination. However,more than two-thirds of nurses were incorrectly answered that vaccinations can leadto lung infection. More details are presented in table 4.
|
Information
|
Correct |
|
Incorrect |
|
|
|
n |
% |
N |
% |
||
|
1) |
GI symptoms and headache are the most common |
18 |
45 |
22 |
55 |
|
|
adverse events post-immunization. |
|
|
|
|
|
2) |
Shock and convulsions are usual to happen after |
26 |
65 |
14 |
35 |
|
|
vaccination. |
|
|
|
|
|
3) |
Generalized skin reactions such as rash and pruritus |
26 |
65 |
14 |
35 |
|
|
are common adverse events post-immunization. |
|
|
|
|
|
4) |
Chest pain and Tachypnea are a minor adverse |
32 |
80 |
8 |
20 |
|
|
events post-immunization. |
|
|
|
|
|
5) |
The diphtheria and pertussis vaccine increases the |
19 |
47.5 |
21 |
52.5 |
|
|
risk of sudden infant death syndrome. |
|
|
|
|
|
6) |
Swelling of the face and throat is abnormal signs |
25 |
62.5 |
15 |
37.5 |
|
|
after vaccination. |
|
|
|
|
|
7) |
Patients who are on immunosuppressive agents are at |
28 |
70 |
12 |
30 |
|
|
lower risk of having bad adverse events post- |
|
|
|
|
|
|
immunization. |
|
|
|
|
|
8) |
Vaccination can lead to cancer. |
35 |
87.5 |
5 |
12.5 |
|
9) |
All vaccines cause headaches, exhaustion, and a lossof appetite. |
26 |
65 |
14 |
35 |
|
10) |
Minor adverse events of the measles and MMRvaccine appear immediately after immunization. |
21 |
52.5 |
19 |
47.5 |
|
11) |
Vaccinations can lead to lung infection. |
9 |
22.5 |
31 |
77.5 |
|
12) |
Pain, swelling, and redness are normal localreaction at the injection site. |
38 |
95 |
2 |
5 |
|
13) |
Persistent crying following immunization thatlasts for three or more hours is consider normal. |
19 |
47.5 |
21 |
52.5 |
Table 4: Frequency and percentages for each item toward knowledge about signs and symptoms of adverse events post immunization among nurses (n=40).
Table 5 shows the frequency and percentages of correct and incorrect answers toward knowledge about the ways to reduce the appearance of adverse events post immunization among nurses. An 77.5% of nurses were answered correctly that putting a warm water compress on the injection site exacerbates the appearance of adverse events post-immunization. On the other hand, more than two-thirds ofnurses 72.5% was incorrectly answered that skin at injection site should be alwaysstretched during IM injection. More details are presented in table 5.
|
Information |
Correct |
Incorrect |
|||
|
|
|
n |
% |
n |
% |
|
1) |
The vaccination site should be rubbed after theimmunization process to reduce the appearance ofadverse events. |
26 |
65 |
14 |
35 |
|
2) |
Vaccines vials should be taken out from therefrigerator only at the arrival of the first child forthat immunization session. |
18 |
45 |
22 |
55 |
|
3) |
Giving vaccine intravenously is one of the ways toreduce the appearance of adverse events post- immunization. |
28 |
70 |
12 |
30 |
|
4) |
Skin at injection site should be always stretchedduring IM injection. |
11 |
27.5 |
29 |
72.5 |
|
5) |
All vaccines should be frozen. |
28 |
70 |
12 |
30 |
|
6) |
The nurse should wait for the alcohol to dry beforegiving the injection. |
28 |
70 |
12 |
30 |
|
7) |
Putting a warm water compress on the injection siteexacerbates the appearance of adverse events post- immunization. |
31 |
77.5 |
9 |
22.5 |
|
8) |
Some dissolved vaccine tube should be destroyedafter six to eight hours from the time of dissolution. |
30 |
75 |
10 |
25 |
Table 5: Frequency and percentages for each item toward knowledge about the ways to reduce the appearance of adverse events post immunization among nurses (n=40).
Table 6 shows the frequency and percentages of correct and incorrect answers toward knowledge about the possible precautions and contraindications for vaccinations in order to reduce the appearance of adverse events among nurses. An 95 % of nurses were answered correctly that vaccination of children suffering from colds and coughs should be postponed until they have fully recovered. On the otherhand, an 95% of nurses were incorrectly answered that necessary precautions shouldbe taken before giving MMR vaccine to children with severe allergy to eggs. Moredetails are presented in table 6.
|
Information |
|
|
Correct |
|
Incorrect |
|
|
|
N |
% |
n |
% |
|
1) |
People with permanent damage to the nervous system should not be vaccinated. |
17 |
42.5 |
23 |
57.5 |
|
2) |
Vaccinations should not be given to children with acute and severe diarrhea. |
33 |
82.5 |
7 |
17.5 |
|
3) |
Necessary precautions should be taken before giving MMR vaccine to children with severe allergy to eggs. |
2 |
5 |
38 |
95 |
|
4) |
Vaccination of children suffering from colds and coughs should be postponed until they have fully recovered. |
38 |
95 |
2 |
5 |
|
5) |
It is contraindicated to give a pertussis or measles vaccine to a person with a family history of convulsive disease or any other nervous system disease. |
11 |
27.5 |
29 |
72.5 |
|
6) |
A severe anaphylactic reaction to a vaccine contraindicates further doses of that vaccine. |
31 |
77.5 |
9 |
22.5 |
|
7) |
It is okay to give the vaccine to children with an oral temperature of less than 38 °C. |
21 |
52.5 |
19 |
47.5 |
|
8) |
The important Immunizations shall not be postponed in patient with febrile illness or acute infections. |
35 |
87.5 |
5 |
12.5 |
|
9) |
Vaccination is not contraindicated in children who suffer longstanding respiratory, cardiovascular, or liver diseases and having a stable health. |
27 |
67.5 |
13 |
32.5 |
|
10) |
Children who come into contact with a child who has measles should not receive the measles vaccination. |
28 |
70 |
12 |
30 |
|
11) |
One of the contraindications for reusing the same vaccine is redness and swelling after the first vaccination. |
28 |
70 |
12 |
30 |
Table 6: Frequency and percentages for each item toward knowledge about the possible precautions and contraindications for vaccinations in order to reduce the appearance of adverse events among nurses (n=40).
Figure 1 presented the level of knowledge toward vaccination among nurses. Almost two-thirds of nurses 62.5% have good knowledge, while 37.5% of nurses have poor knowledge.
Figure 1: Level of knowledge toward vaccination among nurses.
Figure 2 shows the average of correct answer toward vaccination knowledge domains. The highest average correct score were general knowledge and way to reduce the appearance of adverse events of vaccination with 76% and 62.5% respectively.
Figure 2: Level of knowledge toward each vaccination knowledge domains among nurses.
Testing The Hypothesis
- Hypothesis one
Table 7 illustrates the differences between nurse’s gender in terms of knowledge sum score. The Independent t-test indicated no significant differences among gender (p=0.094). This means male and female have same knowledge scores.
|
Variable |
|
N |
M |
SD |
t |
P- value |
|
Gender |
Male |
7 |
25.85 |
7.625 |
-1.933 |
0.094 |
|
|
Female |
33 |
31.66 |
4.909 |
|
|
Table 7: Differences between nurse’s gender in terms of knowledge sum score (n=40).
- Hypothesis two
Table 8 illustrates the differences between nurse’s age group in terms ofknowledge sum score. The One Way ANOVA indicated no significant differencesamong age group (p=0.072). This means all age group have same knowledge scores.
|
Variable |
|
N |
M |
SD |
F |
P-value |
|
Age |
21-30 years old |
21 |
28.66 |
6.311 |
|
|
|
|
31-40 years old |
14 |
32.92 |
4.746 |
2.827 |
.072 |
|
|
> 40 years old |
5 |
32.60 |
3.577 |
|
|
Table 8: Differences between nurse’s age group in terms of knowledge sum score (n=40).
- Hypothesis three
Table 9 illustrates the differences between nurse’s level of education in termsof knowledge sum score. The Independent t-test indicated no significant differencesamong education level (p=0.266). This means nurses held Diploma and Bachelor’sDegree have same knowledge scores.
|
Variable |
n |
M |
SD |
T |
P-value |
|
Educational levelDiploma |
15 |
31.8 |
3.468 |
|
|
|
Bachelor’s |
25 |
29.96 |
6.815 |
|
|
|
Degree |
|
|
|
1.392 |
0.266 |
|
Master |
- |
- |
- |
|
|
|
Degree |
|
|
|
|
|
|
PhD |
- |
- |
- |
|
|
Table 9: Differences between nurse’s level of education in terms of knowledge sum score (n=40)
- Hypothesis four
Table 10 illustrates the differences between nurse’s years of experience interms of knowledge sum score. The One Way ANOVA indicated no significantdifferences among years of experience (p=0.120). This means all nurses experiencehave same knowledge scores.
|
Variable |
|
n |
M |
SD |
F |
P-value |
|
|
Years of experience
|
1-4 years |
21 |
29 |
6.41 |
|
|
|
|
5-8 years |
2 |
27 |
4.242 |
2.077 |
0.12 |
||
|
9-12 years |
4 |
34.25 |
6.751 |
||||
|
|
|
||||||
|
> 12 years |
13 |
32.76 |
3.467 |
|
|
Table 10: Differences between nurse’s years of experience in terms of knowledge sum score (n=40).
- Hypothesis five
Table 11 illustrates the differences between health care types in terms ofknowledge sum score. The One Way ANOVA indicated a significant differencebetween type of health care center (p= < 0.001). The Tukey post-hoc test shown thatnurses work in governmental clinics have more knowledge score than private clinics.
|
Variable |
|
N |
M |
SD |
F |
P-value |
|
|
|
|
|
|
|
|
|
|
|
Type of health care center |
Governmental |
12 |
34.83 |
3.973 |
|
|
|
|
UNURWA |
5 |
30.20 |
5.019 |
9.058 |
<0.001* |
|
|
|
Private |
17 |
26.58 |
5.327 |
|
|||
|
|
|
|
|||||
|
NGO’s |
6 |
34.16 |
2.041 |
|
|
|
|
|
|
|
|
|
|
|
|
Table 11: Differences between types of health care center in terms of knowledge sum score (n=40).
- Hypothesis six
Table 12 illustrates the differences between hearing about the Adverse Events Post immunization interms of knowledge sum score. The Independent t-test indicated no significant difference between hearing about the Adverse Events Postimmunization (p=0.055). This means nurses who hear and who not hear about theAdverse Events Post immunization have same knowledge score.
|
Variable |
|
N |
M |
SD |
t |
P-value |
|
Did you hear about |
Yes |
38 |
31.05 |
5.362 |
|
|
|
the Adverse Events |
No |
2 |
23.00 |
11.313 |
1.982 |
.055 |
|
Post immunization? |
|
|
|
|
|
|
Table 12: Differences between hearing about the Adverse Events Post immunization in terms of knowledge sum score (n=40).
- Hypothesis Seven
Table 13 illustrates the differences between previous courses toward vaccination in terms of knowledge sum score. The Independent t-test indicated no significant difference between previous courses toward vaccination (p=0.901). This means nurses who have and who not have previous courses toward vaccination have same knowledge score.
|
Variable |
|
N |
M |
SD |
t |
P-value |
|
Previous course |
Yes |
15 |
30.80 |
5.226 |
|
|
|
Toward vaccination |
No |
25 |
30.56 |
6.232 |
0.125 |
.901 |
Table 13: Differences between hearing about the previous course toward vaccination in terms of knowledge sum score (n=40).
Summary
This chapter illustrated the results of the study and tested the seven hypotheses.
Acknowledgement
We appreciate the Almighty ALLAH for the courage, competence and protection to carry out this research project successfully.
We thank our families for supporting us and their efforts in order to reach this success.
We are grateful to our supervisor Mrs. Inas Zahran for her tireless efforts and enthusiasm that have always encouraged us to carry on with this study.
We do not forget to extend our thanks to teaching staff at Faculty of Nursing in Bethlehem University, especially Sister. Mary and Mr. Usama Zahran. Without their tireless efforts with us, we would not have reached here.
Thank you to the friends who shared the good and bad four years with us, thank them for their support, even in a simple word.
Finally, grateful thanks to the community health nurses who trust us and participate in this work.
Citation: Badwan HD, Jamhour S, Faqeeh A, Hoshia R, Taha L (2023) Chapter Three: Level of Nurses Knowledge Regarding Adverse Events Post Immunization at the Health Care Centers in the Northwest of Jerusalem District. J Pract Prof Nurs 7: 038.
Copyright: © 2023 Hadi Dar Badwan, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
