This is the fourth episode of our new Vaccine Confidence series on At the Core of Care. Over the course of four episodes, we explored the different facets of the COVID-19 vaccination effort, including education, advocacy, and community partnership.
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In this episode, we are closing out our special vaccine confidence coverage with Letha Joseph and Adeline Kline who are members of the National Nurse-Led Care Consortium’s Vaccine Confidence Advisory Committee (VCAC). Kline and Joseph discuss the importance of relationship-building with community members to help promote health and wellness goals.
Letha Joseph is a nurse practitioner from Durham, North Carolina. She is also a Program Director at the Durham VA Healthcare System and consulting associate at the Duke University School of Nursing. Adeline Kline is a family nurse practitioner and clinical educator for Hawai’i Keiki, which is a partnership between the University of Hawaii Mānoa School of Nursing and the Hawai‘i Department of Education.
Joseph, who co-authored the recently published journal Medical Misinformation and Healthy Information Environment: A Call to Action, reminds us that vaccine hesitancy is not new. Likewise, misinformation spreads about all kinds of scientific discoveries, and mistrust cultivates among patients who have experienced discrimination and shortcomings in their care. Because of these various phenomena, Joseph says we cannot expect everyone to automatically trust the COVID vaccine.
Mistrust between patients and providers is a separate and wider-reaching problem than resistance to COVID vaccines, according to Joseph and Kline. Focusing on restoring trust with patients opens the door for all forms of treatment recommendations, not just the COVID vaccine. Joseph and Kline share examples of their own experiences and strategies for building trust.
For example, Kline says relationship-building often happens in “non-sterile settings” like schools. As a school-based nurse, she keeps an open-door policy so staff and parents know they can come to her with questions. “It's always having that ability to be open and have those conversations and try and hold that space without judgment, which can be very hard,” says Kline.
Joseph is a proponent of motivational interviewing. She says that behind every piece of misinformation, there is a reason why the person believes it over their provider. Ask about the person’s previous healthcare experiences, or about the trusted friends and role models in the person’s life; this signals to the patient that you share an interest in what is best for them.
Both Kline and Joseph suggest letting the patient decide when they are ready to make a change. Kline compares it to smoking cessation. In a routine wellness visit, a provider asks, “do you smoke?” and uses that opportunity to tell the patient about the risks of smoking. One day, the patient might ask what they can do to stop smoking. Vaccines can be treated the same way. Using every encounter to ask, “are you vaccinated?” and to provide some quick facts about the benefits of vaccines can be enough for the patient to change their behavior over time.
The conversation ends with some recommendations for nurses, such as taking care of mental health, staying aware of current recommendations, such as the CDC’s booster calendar, and taking the proper precautions by social distancing and masking when appropriate.
Nurses and other health professionals across the country are using innovative methods to vaccinate their communities against COVID-19. Our four-part Vaccine Confidence Series has explored several professionals’ stories. Listen to the entire series on At the Core of Care.
This project was funded in part by a cooperative agreement with the Centers for Disease Control and Prevention (grant number NU50CK000580). The Centers for Disease Control and Prevention is an agency within the Department of Health and Human Services (HHS). The contents of this resource center do not necessarily represent the policy of CDC or HHS, and should not be considered an endorsement by the Federal Government.