Tennessee Nurse - May 2021

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Page 20 Tennessee Nurse May, June, July 2021 COVID-19 Vaccinations: Knowledge vs. Myth to Get Back to A New Normal Erin Morgan, DNP, FNP-BC In Tennessee, the COVID-19 virus has infected 826,371 people, and 12,022 individuals have lost their lives as of April 13, 2021. The virus has become the third leading cause of death in the United States for 2020. Now that multiple vaccinations are more widely available, nurses can educate the public about their options and dispel the myths surrounding these important tools to decrease future COVID-19 infections and deaths. Nurses have remained the most trusted profession throughout the pandemic, and therefore, must use this position to inform the public about their vaccine options. Understandably, individuals may remain hesitant to Erin Morgan obtain a new vaccine when they still have unanswered questions. Nurses have always provided detailed education to allow individuals to make the most informed choice for their health. Information surrounding COVID-19 vaccination is no different. Vaccine Options Currently, there are three COVID-19 vaccines approved for emergency use authorization (EUA) in the United States, two-dose Pfizer or Moderna Vaccines and the single-dose Johnson and Johnson-Janseen vaccine. Nurses should recommend individuals receive any vaccine that is available to them. The FDA has deemed all of the vaccines safe and effective to prevent infection and severe complications from COVID-19. This recommendation applies to all individuals, not just those who have co-morbidities. As more individuals are vaccinated against the virus, the number of available individuals COVID-19 can reside continues to decrease. mRNA Vaccines The Pfizer vaccine was first approved for use in December 2020, with the Moderna vaccine approval following shortly after. Both vaccines require two doses; 21 days between Pfizer doses and 28 days between Moderna doses. These two vaccines use messenger RNA to provide COVID-19 immunity. This mRNA technology has been studied for years and has already been used in some cancer treatments. These vaccines use mRNA to instruct cells to make a ‘spike protein’ similar to that of the COVID-19 virus. The recipient’s immune system responds to these new proteins by making antibodies. These new antibodies remain with the recipient to recognize the similar ‘spike protein’ if a COVID-19 infection occurs. The mRNA does not change the vaccine recipient’s DNA; instead, it trains the immune system how to respond if the virus is encountered. Side effects for the Pfizer and Moderna vaccines include pain or swelling at the vaccine site, fever, muscle aches, fatigue, or headache. These symptoms may occur after the first or second dose. Individuals who have had COVID-19 may have more side effects with the first dose. However, many individuals who have not had COVID-19 report more side effects after a second dose. Viral Vector Vaccine The Johnson and Johnson-Janssen vaccine is the most recent to receive approval. This vaccine is a single-dose injection that offers convenience and expediency compared to the other two vaccine options. This vaccine was tested later during the pandemic resulting in differing effectiveness data that should not be compared to the Pfizer or Moderna vaccines. Additionally, the Johnson and Johnson-Janssen vaccine was tested in locations where variants of COVID-19 were already circulating, affecting results of the study. The use of this vaccine was paused to examine six blood clotting events in women. Nevertheless, the Johnson and Johnson-Janssen vaccine has already been received by millions of individuals to date. The Johnson and Johnson-Janssen vaccine provides immunity through a viral vector instead of mRNA. Viral Vectors, non-infectious harmless viruses, are used to transmit information to the recipient’s immune system. The vector instructs the recipients’ immune system how to produce antibodies for the ‘spike protein’ recognizable on the COVID-19 virus. While considered effective after two weeks per the CDC, immunity increases up to 28 days past the single dose. Viral vector vaccines have already been used to treat cancer and the Ebola virus. Side effects are similar to the previous two vaccines and include pain or swelling at the vaccine site, fever, muscle aches, fatigue, or headache. The CDC recommends that women between the ages of 18-50 who receive the Johnson and Johnson-Janssen vaccine should be aware of the rare but increased risk of thrombocytopenia syndrome. Any individual who feels uncomfortable with this risk is recommended to obtain one of the other two vaccine options. Vaccine Hesitancy Many patients and fellow nurses have questions and concerns about these new vaccinations. These apprehensions are valid and may take time to overcome. One way to dispel myths and answer questions surrounding these vaccines is to provide evidence-based education from trusted sources and then let the patient or nurse choose for themselves. The process was rushed All medications and vaccines must go through an approval process with the FDA. All three vaccinations currently approved have undergone this process and received emergency use authorization (EUA). This approval does not mean that the steps for approval were shortened or skipped; instead, it provides approval for widespread use in the pandemic when benefit is demonstrated. Scientists were able to accelerate the development of these vaccines due to several factors. Scientists shared information between countries and between companies in an unprecedented effort to roll out multiple COVID-19 vaccine options at once. Cooperation occurred in the scientific community using methods that were already in progress, such as viral vector and mRNA technology, developed for a new purpose. Moreover, governments provided funding to help cover costs for the development of vaccines locally and abroad; in the United States, this was titled “Operation Warp Speed.” Additionally, many volunteers of varying ages and races enrolled in the vaccine trials decreasing the time to find participants. Finally, vaccine developers were able to move through the phases of vaccine development promptly. Phase 3 trials were completed relatively quickly due to the infectious and widespread nature of COVID-19, when many participants were exposed, proving effectiveness. All of these factors allowed multiple vaccines to be developed in a time of great need.
May, June, July 2021 Tennessee Nurse Page 21 Millions of individuals have received all three vaccines with few severe side effects. Extensive monitoring continues for each vaccine, which makes these vaccines the most scrutinized in recent history. During this writing, Johnson and Johnson- Janssen vaccine distribution was paused to examine the data for six patients who developed blood clots. The pause was brief; however, the examination demonstrates the ongoing commitment to safety surrounding these vaccines. It is understandable for individuals to have questions about a strongly recommended new therapy. Providing answers and resources to individuals who express concerns about the unprecedented process may alleviate their concerns. I’m healthy and don’t need it It is recommended that all individuals receive the COVID-19 vaccine when it is available to them. The risks associated with COVID-19 are higher than the risk associated with any side effects from the vaccine at this time, even for those who are young and healthy. Each time an individual becomes sick with COVID-19, there is a risk of severe disease to themselves and passing it along to others around them who can also become seriously ill. Vaccination is the safest way to obtain immunity to COVID-19 at this time. As more individuals become immunized, the virus will have fewer places to spread, decreasing overall illness and allowing a return to normal. I had COVID and don’t need the vaccine Scientists continue to study how long immunity to the disease lasts after a COVID-19 infection. While rare, it is possible individuals can become re-infected with the virus. Individuals who previously had COVID-19 may notice some side effects with the first dose of the twodose Pfizer or Moderna series; however, most side effects remain mild. Each time an individual becomes sick with COVID-19, there is a risk of severe disease, long-term health effects, and spreading the disease to others who can also become significantly ill. Conclusion Tennessee’s quickest way to emerge from this pandemic is through public health measures nurses have pioneered for years: vaccinations, handwashing, and education. Nurses themselves may have concerns and questions about receiving a vaccine after a year of difficulty and division. Conversations about COVID-19 vaccines should be held in a spirit of acceptance and inquiry, allowing individuals to ask questions and feel comfortable about the choices they are making for themselves. Shaming and embarrassing individuals will only foster ongoing resistance and suspicion. Instead, nurses should focus on the benefits of vaccination: A quicker return to normal, protection of patients and loved ones, and the ability to gather with others who are vaccinated without masks. Reference websites for nurses: - https://covidvaccinefacts4nurses.org/ - https://www.cdc.gov/coronavirus/2019-ncov/vaccines/ vaccine-benefits.html - https://www.hopkinsmedicine.org/health/conditions-anddiseases/coronavirus/is-the-covid19-vaccine-safe References available upon request. If This is Nursing, I Do Not Want It! Emily Messer, MSN, RN Nursing is the most trusted profession as voted by the public for two decades. What an amazing honor! However, behind the veil, nursing is known to have a culture comparable to hazing, and the phrase “eat our young” is commonly used. Unfortunately, this behavior is heaped upon the youngest of our profession. A phrase heard many times from nursing students is, Emily Messer “If this is nursing, I don’t want it!” When exploring the motivation for the statement, it is never the patients but fellow nurses. Students attend clinical, and they are so eager to follow a bedside nurse. Many come back with excited reports of observing procedures, getting to practice skills, and amazing nurses they followed. But, just as often, they report having negative clinical experiences because of uncivil nurses. Incivility is defined by the American Nurses Association (ANA) as “one or more rude, discourteous, or disrespectful actions that may or may not have a negative intent behind them” (2015). Students have reported having doors shut on them intentionally, nurses rolling their eyes and walking away after a student asks a question, being obviously ignored, and being spoken to poorly. Often, the student has no idea why they are being mistreated and is left wondering what they did wrong. So, what is the cause of the nurse’s uncivil behavior, and what is fostering the culture of incivility? Culture of Incivility Cultures develop when any group of people is together long enough to develop common practices, beliefs, and behaviors. A major contributor to developing negative traits is a lack of mutual respect. If members of the group are viewed as valuable with worthy contributions, that will be reflected in the treatment they receive. So often, novice and beginner nurses are viewed as noncontributing members of the group, and therefore have contentious experiences with future colleagues. It is common for this treatment to go unreported and simply accepted as the status quo. One reason not to report is to be accepted. People are social creatures, and the desire for belongingness is strong. Individuals will tolerate and adopt harmful behaviors if the potential result is acceptance (Samson- Mojares, 2014). Feeling connected results in improved overall well-being, as evidenced by lower rates of depression, improved physical health, and a longer life span. The inverse of that is true as well, with those struggling with isolation demonstrating signs of decreased well-being, decreased physical health, and higher risks for hastened mortality (Canevello & Crocker, 2017). According to Evans, another contributor to incivility in nursing is prolonged exposure to highly stressful work environments (2017). Parts of our profession are inherently stressful, which is to be expected when caring for individuals during their sickest times. This is only exacerbated by increasing patient complexity, pandemics, lack of proper supplies and equipment, If This is Nursing continued on page 22
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