“dirty toenails” comment by defense lawyer, goes beyond about feeling bad about common toenail problems

Infectious diseases

Nail Technicians

one of the most shock and provoking concepts discovered among health and beauty treatments was introduced to me during a client visit The concept of having uniquely shaped or eye appealing toenails and fingernails. Now, for many of you reading that statement you’d probably be thinking “that’s no big deal”. Not very long ago this surfaced as a phenomenon during the Ahmaud Arbery case murder case the trials defense lawyer made an egreous comment about the victim’s toenails referring to them as dirty toenails. Although that case has already been tried and the assailants have been convicted our prayers for the entire family’s endurance and strength remains among us without ceasing. It wasn’t until this event occurred that my attention was drawn to recognize this as a phenomenon. A phenomenon, which I describe in titling this book The Attractive Nail Phenomenon.

The attractive nail phenomenon has been around for quite some time if you consider how important beauty and appearance are among society. And, and without stagnation it has been a part of our cultural descriptions of human behavior. The nail whether it is on your hands managed by a manicurist or at that into of your feet to be addressed by a pedicurist the nail, as an anatomic structure, is a bed of defense against a number of potential disease. Cancer can form underneath the nail bed of both the hand and feet, the form or natural shape of the nails can take on the appearance of what is described as clubbing or nail discoloration usually seen as either red yellow or white. A healthy nail is a defense that protects the body through areas of discharge such as the terminal phalanx of the digit usually a signal from internal organ injury. Historically, digital finger and toenails have served as a tool for protection and for our survival. As civilizations developed, it attained the additional function of adornment. Nail beautification is a big industry today, with various nail cosmetics available, ranging from nail hardeners, polishes, extensions, artificial/sculpted nails, and nail decorations. Adverse events may occur either during the
nail-grooming procedure or as a reaction to the individual components of the nail cosmetics. This holds true for both the client and the nail technician. Typically, any of the procedures
involves several steps and a series of products. Separate “nail-bars or salons” have been set up and dedicated to serve women and men interested in nail beautification, the phenomenon. Here the goal is to comprehensively inform and educate people about dermatology available and the services offered, the products used, and the possible/potential negative effects related to nail-grooming, nail cosmetics, and the phenomenology of having attractive nails.

Fungal Infections

& Abstract Research Summaries

Part 1

Fungal infections can affect any part of the skin, hair or nails. They can mimic many other conditions. Ringworm (tinea corporis) is not always ring shaped and not all annular rashes are due to ringworm. Fungal infections are usually scaly, unilateral and asymmetrical. If there is any suspicion of fungal infection, skin scrapings, plucked hairs or nail clippings may be sent for fungal staining and culture. It can take a month to culture a fungus in the laboratory. If there is a high index of suspicion of a fungal infection and treatment is required immediately (e.g. scalp ringworm, painful tinea cruris, etc) empirical treatment should be started and the patient reviewed in a 4 weeks when the results of fungal culture are available. Potent topical steroids dampen down the inflammatory response to the fungus but usually promote its spread, resulting in a more widespread, unilateral, diffuse, nonspecific rash that may not be easily identified as fungal in origin (Tinea incognito).

Part 2

By conforming to ingroup norms, individuals coordinate with other group members, preserve cohesion, and avoid costs of exclusion. Experimental studies have reported that increased concerns about infectious disease increases conformity. However, coordination with other group members has myriad benefits, most of which exist independent of pathogenic infection. Accordingly, a strong causal effect of perceived infection risks on conformity appears suboptimal. In line with this theoretical concern, results from four studies (N=1142) showed no support for the hypothesis that experimentally increasing perceived infection risk influences conformity. The findings suggest that associations between prevalence of infectious disease and conformity observed at the cross-cultural level are unlikely to arise from a fast-acting psychological mechanism that regulates conformity as a function pathogen avoidance motivations.

Part 3

The study aimed to develop and validate a tool to recognize the presence and to evaluate the level of self-neglect in community-dwelling older people. The cross-sectional study included 2,894 face-to-face interviews with randomly selected individuals from among the general population, social service users, and hospital patients. In addition, specially trained interviewers assessed the physical appearance and standards of living. Reliability, content, and construct validity were assessed. The Item Response Theory was used. The following scales were developed: the Self-Reported Self-Neglect Scale (SRSNS), the Objective Assessment of the Level of Self-Neglect–Physical Appearance (OALSN-PA) scale, concerning physical health risks based on the appearance of an individual, and the Objective Assessment of the Level of Self-Neglect–Standards of Living Arrangements (OALSN-SLA) scale, which assesses the physical and personal living conditions. The brevity of the scales makes them useful for the daily practice of health care and social care professionals.

Part 4

Nail involvement is estimated to affect 80–90% of patients with psoriasis at some point in their lives and is often associated with severe disease. Patients with nail involvement experience pain, functional impairment and social stigma, with significant restriction of daily activities and quality of life. Nail psoriasis is also considered a risk factor for the development of psoriatic arthritis (PsA). Management of nail psoriasis is deemed challenging and as a result, it is often left untreated by physicians. Assessing the severity of nail disease can also be difficult in clinical practice. While the Nail Psoriasis Severity Index is used widely in trials, it is time-consuming and rarely used in the clinic, highlighting the need to develop a simplified disease severity score for nail psoriasis. All patients should be advised to keep their nails short, wear gloves for wet and dirty work, and regularly apply emollient to the nail folds and nail surface. Patients with mild nail psoriasis, without signs of severe cutaneous psoriasis or PsA, may benefit from topical treatment, while systemic treatment is indicated in patients with severe nail involvement. Evidence suggests that all anti-tumour necrosis factor (TNF)-α, anti-interleukin (IL)-17, and anti-IL-12/23 antibodies available for plaque psoriasis and PsA are highly effective treatments for nail psoriasis. This article aims to provide an up-to-date review of the therapeutic options currently available for the management of nail psoriasis in patients with or without skin psoriasis. Therapeutic options for the management of nail psoriasis in children will also be discussed.Part 5

Figure 3

Nail psoriasis is common, affecting up to 50% of patients with psoriasis, with a lifetime incidence of 80–90%.1 Nail involvement can be distressing for patients and causes a significant impairment in quality of life (QoL). The optimal treatment depends on patient and disease factors, and the hierarchy of treatments includes both topical and intralesional steroids, and systemic treatments, including biologic therapy (Table 1)

Part 6

Diagnostic, monitoring, response, predictive, risk, and prognostic biomarkers of disease are all widely studied, for the most part in biological fluids or tissues, but there is steadily growing interest in alternative matrices such as nails. Here we comprehensively review studies dealing with molecular or elemental biomarkers of disease, as opposed to semiological, pharmacological, toxicological, or biomonitoring studies. Nails have a long history of use in medicine as indicators of pathological processes and have also been used extensively as a matrix for monitoring exposure to environmental pollution. Nail clippings are simple to collect noninvasively as well as to transport and store, and the matrix itself is relatively stable. Nails incorporate, and are influenced by, circulating molecules and elements over their several months of growth, and it is widely held that markers of biological processes will remain in the nail, even when their levels in blood have declined. Nails thus offer the possibility to not only look back into a subject’s metabolic history but also to study biomarkers of processes that operate over a longer time scale such as the post-translational modification of proteins. Reports on ungual biomarkers of metabolic and endocrine diseases, cancer, and psychological and neurological disorders will be presented, and an overview of the sampling and analytical techniques provided.

Part 7

Health problems associated with essential trace metals can result from both inadequate (i.e., low intake) and excessive exposures (i.e., from environmental and/or occupational source). Thus, measuring the exposure level is a real challenge for epidemiologists. Among non-invasive biomarkers that intend to measure long-term exposure to essential trace metals, the toenail is probably the biological matrix with the greatest potential. This systematic review collects the current evidence regarding the validity of toenail clippings as exposure biomarker for trace metals such as boron, cobalt, copper, iron, manganese, molybdenum, selenium, silicon, vanadium and zinc. Special attention was paid to the time-window of exposure reflected by the toenail, the intraindividual variability in exposure levels over time in this matrix, and the relationship of toenail with other biomarkers, personal characteristics and environmental sources. Our search identified 139 papers, with selenium and zinc being the most studied elements. The variability among studies suggests that toenail levels may reflect different degrees of exposure and probably correspond to exposures occurred 3-12 months before sampling (i.e., for manganese/selenium). Few studies assessed the reproducibility of results over time and, for samples obtained 1-6 years apart, the correlation coefficient were between 0.26 and 0.66. Trace metal levels in toenails did not correlate well with those in the blood and urine and showed low-moderate correlation with those in the hair and fingernails. Available data suggests that for some elements (Se, Mn, Zn) toenail concentrations reflect long-term external exposures in fairly reproducible levels, while for other metals, this association has not yet been assessed. Among dietary factors, only toenail selenium showed clear associations with the intake of supplements or specific foods. The toenail levels could also represent occupational exposure, for instance, Mn exposure in welders. The scarcity of information on other essential trace elements, together with the great heterogeneity among studies makes the validation of the usage of toenails as biomarkers of exposure to these elements difficult. Standardization of sample collection, quality control, analytical techniques and reporting procedures might facilitate further research focused on the clear understanding of the significance of essential levels in this promising matrix and would enhance its utility in epidemiological research.

Part 8

Background: A unique syndrome affecting young adults of unexplained hearing loss often associated with uncorrectable poor visual acuity and lower extremity numbness is endemic in Dar es Salaam. This study characterized the hearing loss, associated it with other symptoms, and gathered information on potential causes.

Methods: Forty-seven patients (23 men, 24 women) <40 years old with a symptom consistent with the syndrome, negative syphilis test, and no head injury history were recruited from Muhimbili National Hospital. 18 controls (10 men, 8 women) were recruited from the same neighborhoods as patients. Hearing ability and cochlear outer hair cell function (distortion-product otoacoustic emissions (DPOAEs)) were assessed, as were visual acuity and color vision. Peripheral neuropathy was evaluated using the Michigan Neuropathy Screening Instrument (MNSI), and physical examination. Blood C-reactive protein levels and toenail trace metal concentrations were measured. Environmental exposures were elicited using a questionnaire. Patients with at least two of the following signs were defined as having the syndrome: poor hearing with normal DPOAEs, vision not correctable to better than 20/30, or a MNSI score greater than 4.

Results: 29 participants met the case definition. CRP levels did not differ between groups but manganese, cobalt and tin levels were each greater in the cases than controls. No other environmental exposure differences were noted.

Conclusions: Toenail manganese, cobalt, and tin levels were higher in those with the syndrome. These metals are potential neurotoxins suggesting a possible environmental origin for this unique and debilitating syndrome.

Part 9

Figure 1

Dermatology supplements, often marketed as “skin, hair, and nail” supplements, are becoming increasingly popular. However, many consumers lack an understanding of the science of dietary supplements or the specifics of the supplement industry. While certain supplements at the right dose in the right population may prove beneficial, the evidence is sparse for many supplements. In addition, the use of some supplements has resulted in serious adverse effects. From a regulatory standpoint, the US FDA recognizes dietary supplements as foods. This distinction has multiple ramifications, including the fact that manufacturers do not need to prove efficacy, safety, or quality prior to sale. Therefore, physicians and consumers must evaluate each supplement ingredient and formulation individually. This article outlines an evidence-based approach to assess dermatology supplements. As a starting point, all supplements should be evaluated for PPIES: purity, potency, interactions, efficacy, and safety.

Background and objective Dietary supplements advertised to “boost collagen” or for “skin, hair, and nail” health are becoming increasingly popular, despite a lack of evidence to support their use. These products are not regulated by the United States (U.S.) Food and Drug Administration (FDA), and hence there is no centralized database listing current products. The goal of this study was to document and examine the labeling and marketing methods of these products. Methods Supplements including the words “glow,” “beauty,” “skin,” “hair,” or “nails” on the label were included in the sample. Seven stores within a 3-mile radius were included. Results A total of 176 unique supplements were identified. It was found that most products lacked independent testing; many utilized outdated daily values (DVs) of nutrients. Some had confusing dosing instructions, and most products made health-related marketing claims. Conclusion Dermatologists and primary care providers should be aware of the marketing claims commonly made by these products. Patients should be educated that these claims are generally not verified by independent testing agencies, the U.S. FDA, or by high-quality randomized control trials.

Part 10

Figure 2

Skin, hair, and nail supplements, sometimes referred to as “beauty supplements” or “ingestible skin care,” are a large and growing industry. These products may contain vitamins and minerals, sometimes in very high doses. They may also contain herbs, hormones, microbes, or animal derivatives such as fish oils and collagen powders. Dietary supplements are regulated as foods, not as drugs, by the US Food and Drug Administration (FDA). Therefore, manufacturers do not need to provide any proof of safety, efficacy, or quality prior to sale. This is of serious concern, as many adverse effects due to supplement components have been reported. The potential risks cover multiple categories. These include acute toxicities, such as choking, as well as chronic toxicities, such as increased risk of diabetes. Teratogenicity and interactions with drugs and laboratory testing have been documented in research studies. Other risks include potentially increased risk of cancer with long-term use, allergic reactions, and others. It is vital that physicians educate their patients on these risks. As no post-marketing surveillance programs are required for supplements, our understanding of supplement risks is incomplete. Physicians should be wary of these risks and encourage further research and regulation.

Part 11

corynebacteriaceae - Keyword Search - Science Photo Library

Background: The human skin microbiome is represented by bacteria, fungi, viruses, and mites.

Aims: Every human being possess their own unique skin microbiome because intrinsic and environmental factors have a significant impact on the quality and quantity of microorganism. Every site of the body is a separate microbial niche.

Patients: The feet are one of the most unique and heterogeneous microbial niches of human body with areas that differ by skin thickness, anatomical features, distribution of sweat glands, pH, and the availability of oxygen.

Results: Healthy skin of the foot is inhabited by Corynebacteriaceae, Micrococcaceae, Propionibacteriaceae, Actinobacteria, Clostridiales, Lactobacillaceae, Streptococcaceae, Enterobacteriaceae, Moravellaceae, Neisseriaceae, Pastereullaceae, and Proteobacteria. The most common fungi present on the feet are Malassezzia, Cryptococcus, Aspergillus, Rhodotorula, Epicoccum, Saccharomyces, Candida, Epidermophyton Microsporum, and Trichophyton.

Conclusions: The disturbance of the foot microbiome causes dysbiosis and may lead to pitted keratolysis, fungal, and viral infections or even to protothecosis.

Healthy Therapeutics

Part 1

Several types of cutaneous fungal infections can affect the population worldwide, such as dermatophytosis, cutaneous candidiasis, onychomycosis, and sporotrichosis. However, oral treatments have pronounced adverse effects, making the topical route an alternative to avoid this disadvantage. On the other hand, currently available pharmaceutical forms designed for topical application, such as gels and creams, do not demonstrate effective retention of biomolecules in the upper layers of the skin. An interesting approach to optimise biomolecules’ activity in the skin is the use of nanosystems for drug delivery, especially solid lipid nanoparticles (SLN) and nanostructured lipid carriers (NLC), which in the past decade has shown advantages like increased adhesiveness, great occlusive properties and higher biomolecule deposition in stratum corneum when designed for topical application. Considering the demand for more effective therapeutic alternatives and the promising characteristics of SLN and NLC for topical application, the present study sought to gather studies that investigated the potential of using SLN and NLC for the treatment of cutaneous fungal infections. Studies demonstrated that these nanosystems showed optimisation, mostly, of the effectiveness of biomolecules besides other biopharmaceutical properties, in addition to offering potential occlusion and hydration of the applied region.

The aim of this study was to describe the safety and effectiveness associated with phenol matricectomy in patients with diabetes. To date, the medical literature is devoid of information regarding the use of chemical toenail matricectomies performed on patients with diabetes. Sixty-six consecutive patients with diabetes and ingrown toenails were evaluated. The procedure was performed on 57 of these patients. The results demonstrate a 5% regrowth rate, no significant complications, and limited risk in this patient population.

Phenol (also called carbolic acid) is an aromatic organic compound with the molecular formula C6H5OH. It is a white crystalline solid that is volatile. The molecule consists of a phenyl group (−C6H5) bonded to a hydroxy group (−OH). Mildly acidic, it requires careful handling because it can cause chemical burns.

Part 2

Background. In the last decades, phenol cauterization has been widely used with high success rates for the treatment of ingrowing toenails. However, unpredictable tissue damage and prolonged healing time are the disadvantages of this technique. Sodium hydroxide is an alternative chemical agent that causes less tissue damage.

Objective. In this study, long-term results and postoperative morbidity of two sodium hydroxide chemical matricectomy procedures carried out by different application times have been investigated.

Methods. A total of 156 partial chemical matricectomy procedures were performed with 10% sodium hydroxide in 60 patients divided into two groups. The first group (80 nail sides) received a 2-minute application of sodium hydroxide, whereas the second group (76 nail sides) received a combination of curettage of the lateral matrix area and 1-minute application of sodium hydroxide. Postoperative pain, drainage, and tissue damage were evaluated 2 days after the operation and at three more visits with weekly intervals. Long-term success rates of the methods were evaluated on the 6th month and at a further visit with a mean time of 16.83±2.18 months (range, 13 to 20).

Results. Partial matricectomy with 10% sodium hydroxide was found to be 100% successful in both of the groups (P>0.05). Postoperative pain and tissue damage were either absent or minimal in the great majority of the patients with no statistical difference between the two groups (P>0.05). On the 2nd day, more patients in the first group experienced mild drainage than the patients in the second group (P=0.001), but in the following control visits, this difference disappeared.

Conclusion. Matricectomy with 10% sodium hydroxide, either applied for 2 minutes or 1 minute combined with curettage, is equally effective in the treatment of ingrowing toenails with high success rates and minimal postoperative morbidity.

Is it taboo to talk about survival of the fittest and natural immunity?

Let’s talk about our bodies natural immunity intelligently, shall we? I stated in a previous article addressing the theme of Emotional Intelligence (EI), EI as something that could be described as reading the mind of a person and understanding exactly why people do what they do. In the age of Covid-19 and multiple SARS case,, the virulent, I’m hopeful proper perspectives would be reflected in our collective EI. However, it doesn’t appear so instead of a superhero effect of intelligently monitoring the clinical trends does in fact appear that we are becoming less intelligent and more emotional under a frenzy of confusion. And, I’m not intentionally diverting from political correctness ladies and gentlemen under these circumstances are civility is at stake! The dividing lines between vaccinated and non vaccinated, natural immunity, and immune compromised vulnerabilities have distinguished roles which are perceived as causation and problematic to the essence of this particular transcript-base germ warfare. It’s time we’ve called upon our skills as EI heroes and become ultimate conflict resolution organizers. Depending on your Emotional Quotient or EQ strength you’d become one among the greats. The character possessing the greatest skills in leadership would contend with the opposition, draw upon their superlative talents as the EI hero and voilà, the mastery would kick in (Trushell, 2004). EI is described as ability “to build relationships” (DuBrin, 2012, p. 481). Although, it would be great to be seen as having superior or super human capabilities as implied by writer John M. Trushell. EI as a pulp fiction does not totally to result in fictitious results, it will help save lives!EI is the motive to engage innate abilities as empathy and trust. Trust, however has to have some degree of disciplined control. Among capable leadership and those who are under the subjection EI can produce amazing collaboration and resolution. EI results in actions performed by and between individuals, groups or organizations making those who take steps to engage “constructive use of … emotion” more effective through their administrative processes (DuBrin, 2012, p.481). Imagine the difference among subordinate members of a group who have two persons to follow. One person is seen among the group as a leader and the other person is seen as an authority figure but, not a leader. The superior individual with the highest level of EI would be described as the person viewed as being aware of the needs of the subordinates. And, the title of leader may apply to anyone among this group possessing the advantage of emotional trust from members of the group. Identifying the second category of highly ranked heroes of administration can be difficult since, they aren’t necessarily specified by managerial appointment they are recognized by the way their peers engage with them.Scores that have been adopted to measure a level of EI such as MSCEIT, its scoring process determines a person’s EI based on a scale identified as a quotient. There are highly questionable methods to these measurements. Measurements that could determine if a person is able to control their anger must take into consideration more than the scope of anger management tools as psychometric assessments as the, HCR-20. Mayer, Salovey, Caruso & Sitarenios, (2003) contend there are concerns regarding the reliability of such tests. They challenge validity of emotional intelligence itself and whether results of tests will provide consistent results. In my own self-examination, I have been evaluated a having “Good EQ”, in theory. I do believe I have some degree of leadership abilities which would support good EQ results. However, I don’t believe my results would replicate if I would take a similar study under slightly different questions or different demands they might indicate some similarity but highly unlikely to be the same. DuBrin (2012) describes this as an ability to connect with people and understand their emotions” (p. 162). Is it truly necessary to connect? I believe having what is described to be emotional intelligence leads to a better understanding of what makes a great leader, better. Connecting to people is essential to administration and leadership even though EI claims are made to imply being first in this regard scientist credit Darwinian ideals as emotional expression as the central token of adaptive leadership traits.

Vaccine hesitancy & natural immunity

FIRST RESPONDERS TOOK “THE JAB” & STILL GET THE ILLNESS WHILE THE LAGGARDS HESITATE AND AND

Pilot #1: Behaviors Against Natural Immunity Concerns

Abstract

We have engaged upon a time when proactive participation is measured by the willingness of submissive support. The debate over viral inoculations or “THE JAB’S” best practice has caused a collision between homeopathic beliefs and evidence-based research of the former best practice beliefs.  These adverse ideals have also begun to thicken over a gulf-crisis between “THE JAB’s” best practice and homeopathy’s survival of the fittest. Collections of viral activity data under the 2017-18 surveillance by Centers for Disease Control and Prevention (CDC), National Respiratory and Enteric Viral Surveillance System (NREVSS), and the World Health Organization (WHO) present a rampant and growing trend of influenza-like activity spreading in the United States. Schisms and arguments opposing mandated vaccinations in hospital settings have been responsible for facilitating productivity cost factors, resulting in productivity and liability losses and greater economic burdens by simply not addressing the cyclical flu patterns among seasonal outbreaks and within organizational healthcare workers and the patients they are in contact with.  But, the resistant behavior should not be held as the sole perpetrator of influenza’s upward trend more investigation is required to see exactly what is responsible. In the meantime, to prevent continued upward shifts of viral activity nosocomial deterrent collaboration conjoined with modified behavioral practices opposed to the vaccination uptake movement, resistant arguments must no longer go unanswered. Here, I present the concern related to inclusion of influenza vaccinations as a prophylactic uptake for best practice standards of care while used as a component of nosocomial deterrents.

Introduction

Mandatory treatments are steadily resulting in less rejection rates among medical professional support groups and parental behavior of preschoolers, but less amongst role models in healthcare, the nursing staff (Davis & Gaglia, 2005; Naleway, Henkle, Ball, Bozeman, Gaglani, Kennedy, & Thompson, 2014).  A selection of four states California, Connecticut, Pennsylvania and Mississippi indicate health promotion programs which mandated flu shots are gaining more results in numbers but, also show the mandatory requirements creates agitation and argumentative discourse amongst many of healthcare’s professional teams.  In this paper, I will take a close look at the problem of these optional opinions and organizational choices to mandated vaccination policies.  Although, seeking community information from healthcare workers, adult students and participants of public service facilities such as libraries, shelters and police stations provides a general access to public information, it is the goal of this paper to discover a specific strategy that can be used to reduce the rate of noncompliant practices.  Current upward trends of influenza have demonstrated that resistance is futile and as a less effective strategy it should not be considered as a best practice in healthcare’s patient to patient exposure.  If mandated vaccinations are required in employment & hiring practices, inclusive staff training of added deterrents and patient safety practices are established as best practices evidence and necessary for patient safety.  Incorporating the vaccination with other standards of care will improve the outcome of delivering healthcare services according to the Ziegler study. 

In the Ziegler study, vaccines were determined essential deterrents for possible sepsis conditions, this was amongst the first successful adjuvant therapy as a prophylactic study in healthcare related to sepsis prevention (Cross, 2014).  Identifying the reasons for immunization rejections among select communities in healthcare, may lead to fashioning better strategies for preventing nosocomial disease.  Information discovery may be formatted to the requirements of participant state department of Health and Human Services and shelter base programs that have participation access to health promotion programs leading to national 2020 Healthy People and the developing 2030 Healthy People, CDC outreach goals.  In order to provide results for an endeavor to improve patient care services and risks reduction healthcare workers should familiarize themselves with the goals of the Healthy People campaign. 

Value Management

FAST DIAGRAM: figure 1

An organization who identifies a problem properly apart from its symptoms, has an obligation to clearly define the problem before seeking out a solution. In order to define the problem, you have to find out what it needs.  Symptom management, may inspire the right ideas in order to bring forth a proper solution to the problem – the right fix, to the need.  Kaufman (1998) discusses ideal strategies for a FAST remedy to improve an organizations response to the needs of its customers in his Value management: Creating competitive advantage culture. 

Identifying what the customer needs must always come first as a practice. Leadership will embrace actions necessary to promote resolution of the client needs; especially the foremost need of the customer at hand. In a healthcare environment, my focus on embracing every action designed to promote nosocomial deterrents, while reducing associated barriers, are synonymous to enhancing the safety of the patient and fulfilling their need.  Thus, incorporating healthcare vaccinations together with other nosocomial deterrent practices should be considered part of the medical service community’s embedded Quality Function Design (QFD).  QFD is rarely considered a possibility for the service industries according to researchers Lieuwe Dijkstra and Hans van der Bij, (2002).  But, as a possible function for this professional service towards achieving patient safety goals, vaccination uptake can be incorporated into a QFD as a best practice and nosocomial deterrent standard of care.

As a FAST response, embedded in practice for quick unanticipated burdens related to productivity loss, staffing shortages, and nosocomial outbreaks vaccination uptake is an essential tool to measure for effectiveness of quality care and functional deterrence. FAST, the value management strategy for functional analysis and systematic techniques, are also mapping techniques used in conjunction to value management strategies that addresses a plethora of issues which carry potential negative impacts on production design and service cost to business organizations. In his Value management: Creating competitive advantage article, Kaufman argues for the importance of rapid response in cost reduction and value improvement in achieving worthwhile objectives (Kaufman, 1998). Discovery of competitive advantages versus longer hospital stay durations for patients or rising productivity cost due to staff call-ins and shortages are added burdens of higher demands necessary for shift coverage.  QFD will promote resolute objectives unforeseen through improper value management which goes undetected during strategic planning operations. This form of an organizations capital investment management, where organizations fulfill the cost planning allocated and obligated to its membership productivity, patient stay minimalization, staff training, and skill deployment establishes vital components key to value management methods.

Job planning

As part of the value management system, an organizations job is to establish an effective method and approach that will consistently guide collaborative efforts through opportunities of problem resolutions. Pioneer and Value Management System Creator Lawrence D. Miles is quoted as saying, “all cost is for function … because the customer wants something done” (Kaufman, 1998, p. 3).  In his five-step job plan, Kaufman would suggest job planning begins first by evaluating all available and relevant information pertaining to project series. In a healthcare environment a cyclical pattern of nosocomial transmission and seasonal flu trends associated with viral diseases, such as influenza, have credible resources available through CDC, WHO, and NREVSS. Evaluation of information and data trends from these reputable agencies can provide preliminary steps to initiate QFD. The second step of the planning process is to develop a list of ideas that relate to QFD guidelines or performances but, not as solutions. Implementing nosocomial deterrents such as handwashing, isolation gowning, and flu vaccinations are reasonable ideas against potential hazards of disease transference. In step number three, planners should evaluate the list of ideas suitable for best practice. Improvement of vaccination uptake rates improves risk reduction potentials of shared exposure according to Centers for Disease Control and Prevention. Clustering the best practice methods, such as these nosocomial deterrents mentioned herein, can provide measurable components important to evaluation of scenarios that include financial risk and health-risk reduction during patient care events especially during seasonal flu outbreaks. Step five, brings proposed recommendations to stakeholders for approval and funding of these best practice ideals. Continual use of nosocomial deterrents including influenza vaccination uptake is a building block process, which over time will improve patient safety, awareness. and the overall quality of healthcare services.

QFD, requires step-by-step process evaluations in order to maintain and secure cost efficiency and to guide a successful and disciplined approach for opportunity or to overcome problems successfully. Kaufman, provides Miles’ five-step solution as a FAST response needed for unanticipated critical problems, which I believe can be applied to the healthcare workforce vaccination resistance movement. Development and practice of information building, builds shared support within the organization as collaborative knowledge, skills, and abilities among team participants continues to improve the patient care setting. Training designed to meet the environmental conditions surrounding quality efficiency can promote team-skill development and team confidence among participating members. Throughout each step of the evaluation process evaluation of the value of the training, goals and objectives of the QFD, and review of the idea development provides the opportunity for FAST resolutions. This is a valued lesson which allows for stakeholders and vulnerable patient exposed to unprotected contacts to gain experience from learned behavior vaccination resistant members and develop improvements to a conjoined workforce that will ultimately affect the medical cost’s return on investment (ROI) ultimately at the patient’s expense.

Trend tracking

H1N1, a viral contagion most often seen to cause infections amongst swine. In 2009, this “swine flu” outbreak was responsible for 1.9  per million deaths around the world according to (Chuang, Huang, Liu, Chou, Chang, Chiu, . . . Menéndez-arias, 2012).  In 2005, China succumbed to the “Bird flu.  The social impact of current noncompliant conditions according to Centers for Disease Control, allows potential outbreaks of influenza at pandemic levels.  At the CDC surveillance records of 4.8% to a minimal rate of 4.2% or more are indications of viral confirmed cases amassed.  Current indications suggest that the number of reported cases of influenza, as of February 5, 2017, have increased to 4.8%. This percentage is above the national baseline of 2.2% according to informative records as of February 12, 2017, (https://www.cdc.gov/flu/weekly/index.htm).

CDC INFLUENZA TRACKING: figure 2

The issue to provide healthcare and no harm, obligates its agents within every medical service group and members of the holistic reform to social responsibilities that ensure reduction rates of nosocomial infections.  A focus targeted on the duty to serve and providing quality patient care, critical urgent care, and patient safety measures can demonstrate effective planning of the healthcare role model and incorporate an evaluation system of best practice evidence.  In the service of healthcare obligations to maintain best practice successfully, intention to prevent the spread of nosocomial contagions is a vital practice of care, contingent on the witness of collaborative actions.  The action of nosocomial deterrent practice would be considered inclusive to the inherent standards; which, patients oftentimes are unaware of risks associated throughout the duration of care.  Practices such as handwashing and donning of gloves before and after personal contact with patients are a typical surveillance event with less than 50% compliance according to joint commission reviews (Sahud, Bhanot, Radhakrishnan, Bajwa, Manyam, & Post, 2010) a result most likely unknown by the inpatient status quo. Such efforts leading to improving practices of handwashing, isolation protocols, and donning gloves between patient-to-patient care and vaccination uptake are critical to ensure the reduction of transmitting pathogens within a healthcare clinical environment.  These deterrents shared in the goal to improve outcome results on a yearly basis are critical to patient care. There are other common practices depended upon location of services (i.e. ICU, OR, ER/ED) where wearing protective personal equipment, sterile techniques, and accurate diagnosis are recognized as higher quality-controlled environments and lean towards improved reduction of health risks associated to the patient’s admitting diagnoses.  The patient’s repetitive exposures to staff is less likely to be compromised by a cluster of nosocomial deterrent practice (Cross, 2014).

Following steps that include early access to medical care, smoking cessation participation, frequent handwashing, involvement in weight reduction, patient education, annual compliance to medical visits and early vaccination can provide reassurance for healthier outcome results another form of deterrent practice.  The National Institute of Health (NIH, 2017) offers suggestions to incorporate into lifestyle behavioral changes which, can be practiced daily (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5222627/).  But, during the time those infected with influenza and other viral contagions in the care of public health monitoring agencies, according to CDC and NIH epidemiology studies, vaccination is paramount to countering the rapid spread of seasonal outbreaks and other viral disease. 

Finkelstein, Hedberg, Hopkins, Hashmi, & Larson, (2011) describe events of states in demand for vaccines, waiting in anticipation for the uninfected to receive immune defensive prophylactic treatments, necessary to fight a threat for potential pandemic outbreak.  Currently a time at rest, crucial demands for preparedness nursing staff and inpatient vaccination are needed. What is already known about the seasonal outbreak of influenza becomes archaic and dated once agencies enter into the influenza cyclical pattern under duress of its effects on inpatient populations.

The existing knowledge of the H1N1 strain quickly became the scrutiny of 2017 according Potter 1, Stott, Roberts, Elder, O’Donnell, Knight, and Carman (1997) indicating no control studies in support of the effectiveness of vaccination uptake as best practice among healthcare workers. The study Influenza vaccination of health care workers in long-term-care hospitals reduces the mortality of elderly patients. Journal of Infectious Disease objectively dismisses claims that would support flu shot uptake as a remedy to reduce nosocomial exposures due to the lack of evidence-based research. In fact, arguments to this position would suggest a need more investigation to questions of accountability from both sides of influenza uptake and resistance debate to support improvement to the patient problem among seen by healthcare professionals.

An additional idea to present during the job planning of a nosocomial deterrent strategy to achieve stakeholders’ objectives against productivity cost burdens and steps toward improved prevention and a quality health maintenance system remains transparent to the customer.  H1N1’s viral distinction was first identified as a strain with a recognizable pattern which, traces back to the year 1918. Most notable is its distinct and unstable protein cytoplasmic structure.  Researchers Hrincius, Liedmann, Finkelstein, Vogel, Gansebom, Ehrhardt, & McCullers (2015) identify rapid development of cytoplasmic proteins, identified as Protein 1, during laboratory transference of the virus. According to these researchers it is the principal assumption, due to the final location of the tested pathogen, that results of viral contamination occur as a respiratory tract infection (caused by aerosols not necessarily air borne) and not necessarily a pathogenic sequence i.e. from hand to mouth. The majority of symptoms of H1N1 are due to “massive edema formation facilitated by secondary pneumonia” (Hrincius , etal., 2015). In close observation, of hospitalized patients, the researchers noted respiratory symptoms had distinct displays of variant cases from mild to extremely severe. These conditions were also influenced by three major pre-existing conditions such as diabetes, congenital respiratory defects and obesity; fundamental areas for patient education and transparency.

The social impact of efforts to improve preventative maintenance systems for seasonal outbreaks is faced with challenges that influence public safety. Virulent patterns of disease are constantly reemerging as new strains due to the instability of protein 1. The term “spatiotemporal” describes two influences which affect research outcomes in the investigations of vaccine development. According to researchers Bedford, Riley, Barr, Broor, Chadha, Cox & Smith (2015) the interval between space and time emergence creates repetitive challenges from laboratory to laboratory globally, that are faced with a variant of seasonal flu distributions. The importance of sharing knowledge in open forums of communication is expected to lead to a better preventative solution.

Literature review

Vaccination hesitancy and resistance have emerged as a result of distrust, misinformation, and a lack of public knowledge.  Yaqub, Castle-Clarke, Sevdalis, & Chataway (2014),provide details describing the prevalence of hesitation amongst the public at large and healthcare workers who willing may concede to vaccination.  Yaqub etal., in pursuit of an explanation of hesitancy prevalence inform readers of distinctions between hesitancy and resistance. The platform of healthcare related incidents finds an erosion of public trust can be attributed to fears influenced by threatened pandemic outbreaks such as those from 2009, which never occurred. The results from public health narratives may support hesitancy motives attributed to overstated claims pandemic threats and low perceived severity concerns as those debated over viral illnesses. 

self-vaccinating healthcare professionals’ attitudes and their citation frequency: figure 3  

Patient-vaccinating healthcare professionals’ attitudes and their citation frequency: figure 4

General population’s reasons for vaccination attitudes and the number of times such kinds of reasons are cited in the literature we reviewed: figure 5

Studies review

Studies have been conducted on each of these nosocomial interventions yielding results of various efficiencies.  However, considering possible threats and outbreaks of virulent diseases such as influenza, emergency protocols should be incorporated as standard practices of nosocomial prevention and training. Seasonal vaccinations among healthcare agents should be inclusive annual practices to ensure a continual reduction of hospital acquired disease risks are in place, in all areas of operation.  The case for mandatory vaccination treatments is feasible; since, resulting in vaccination rejection rates of 2% among vaccine healthcare workers according to a five-year study conducted at Virginia Mason Medical Center in Seattle, Washington. This first to be known infectious control mandate yielded a 98% uptake compliance rate among healthcare workers (HCW).  Policy accommodations for religious and other considerations were granted due to possible concerns relating specifically to medical diagnoses (Rakita, Hagar, Crome, & Lammert, 2010).  Although, the study highlights a significant percentage for vaccination uptake, it also pays to recognize the small percentage of vaccination resistant HCW which, includes a fewer number of most vaccination resistant healthcare workers in other national studies, who also willing to withdraw their employment further adding to healthcare’s productivity cost burdens.

This combines or bundles nosocomial deterrents into one collective practice including flu shots as an intent action toward best practice behavior and the prevention of influenza as a nosocomial disease.  This proposal suggests the implementation of vaccination uptake as a standard practice incorporated in the procedures for infection control (e.g. handwashing, personal protective equipment, sterile techniques, vaccination uptake) ensuring education of the HCW includes recognizing vaccination uptake, as part of standard infectious control procedures and healthcare no harm responsibility rule; cooperation will act as an added form of patient safety as a core public health value commitment.  After all, incorporating the standard practices of infectious control and uptake responsibility, vaccinating should be treated as a standard of care regardless of the adoption of one’s personal value. Absent from the core value measurement debate surrounding vaccinations, public health is stirred into a melting pot mixture of divergent medical practice ideals from which, agents of healthcare share less responsibility toward effective deterrent actions. Eventually, the accepted reconciliation and collaborate efforts on behalf of patient care must outweigh the diversities which divert the possibility of an efficient QFD.

A perception by the patient-clients of best practice implementation and prioritization demonstrated by the healthcare agents can lead to determining factors that help educate patients about the spread of nosocomial infections. If a vaccination resistant worker, during an active seasonal outbreak of influenza is seen wearing a face mask during patient care, he or she may experience greater collaboration in their patient service. If vaccination uptake workers also wore facemasks while providing patient care during seasonal outbreaks the practice would be an effective demonstration of collaboration by the healthcare team membership. Evidence of best practice would condone collaborative efforts such as these over values of the elitist perspective of resistance. Such recognition in behavior can be an effective tool to provide the highest standards of care amongst an agent’s duty to serve.  This practice when implemented as a standard of care could be taught, expressed, and considered as a professional practice counteracting an inverse of care among vulnerable patient populations.

Prevalence review

TB skin tests, rubella, rubeola, hepatitis B, and varicella vaccinations are required by a large percentage of employers in the United States and rarely rejected under organizational compliance requirements.  Pandemic results of the past are now drawing attention to the sequence of potential risks to require more aggressive preventative strategies (Swan, 2016).   However, according to a (2016) research study by Megan Ziegler, a large majority of these vaccination sequenced refusals, existed among several states opposed to mandating shots of any kind including polio.  This paper seeks to focus on building an effective communication circuit; which, will be key to improving nosocomial deterrent practice and collaboration. In an article published by Centers for Disease Control (CDC), surveillance of seasonal flu vaccination is closely monitored among pregnant women and health care professionals (HCP).  In this study, the CDC has helped build preventative maintenance indicators which, are currently used to monitor outbreak potentials (see https://www.cdc.gov/vaccines/). Taking steps to improve the understanding of why other ideals promote an objective sequence especially relating to flu vaccinations, an established preventative health maintenance strategy, may provide in-depth information necessary to design improvement to vaccination compliance as seen among other routine vaccination.  Routine vaccination screening for virulent contagions such as tuberculosis, rubella, rubeola, hepatitis B, and varicella vaccines are given regularly and often with less levels of rejection as seen with influenza.  In most cases, we may conclude these vaccine preventative measures are also required by a large percentage of employers and educational systems in the United States.

Epidemiologists, according to researchers have witnessed huge reductions in these pathogenic gateways. Diphtheria, smallpox and polio have seen as high as 100% reduction among each of these cases (Ventola, 2016).  However, among flu vaccines a myriad of ideals has developed into a pattern of recognizable vaccination noncompliant groups. Cohen, & Casken, (2012) identify in their literature review a number of health care providers (HCP), namely nurses, have the most frequent and direct contact with patients.  And, they are number one amongst the highest refusal group of compliance studies when compared to physicians and supplementary medical staff. In the Cohen & Casken lit review it further identifies pre-deposing factors such as “beliefs, knowledge and values” as primary resistant ideals used by all non-compliant persons.  In the planning stage of this endeavor, I have reviewed related literature regarding the hazards of supply shortages and ideals related to members of the medical profession and vaccination hesitancy.  In a review of “A warning shot: The 2004 Influenza Vaccine Shortage” Donya C. Arias provides reasonable arguments in support of preventative measures to avoid vaccine shortages due to underestimated trends of vaccination hesitancy, we include this information along with Cohen & Casken to identify ideals that support hesitancy behaviors and the sustainment of hazardous environmental conditions among healthcare workers and public hesitancy. 

Behavioral theory

As the Theory of Planned Behavior is quite expectant as a hallmark and descriptive behavior of vaccination resistance, according to author Gregg J. (2011) an outcome determined under three spontaneous conditions resulting in a planned behavioral action. First, Gold states is an individual’s perspective of his current situation’s impediments or the facilitators intent to take responsive action. Second, Gold states a relationship to a perspective of consequences for taking action.  Third, are the expected norms resulting from taking consequential actions. These three contingency factors are conditions resulting from an individual’s capacity to make choice decisions based on what is determined to be a self-efficacy principle. Identifying rationale rejections for vaccination coverage; will be identified through participant studies and survey outcomes; sampling will be compared as indicated by standards presented in the Ziegler study.

Research among these conditions will provide a focused review of the opinions these communities believe to be reasonable subjective arguments for their noncompliance to the preventative care measure of vaccination uptake.  Bandura (1977) adds self-effective behavior among an individual’s peer group of a planned behavior is more likely to result into an outcome of change (Bandura, 1977).  Recognizing particular noncompliant ideals may provide a broader solution to engulf concerns regarding preventative outbreak strategies of influenza. But, a continuance to take a bandwagon approach against preventative healthcare maintenance strategies enables us also irresponsibly fail collaborative behavioral risks reductions which, also interferes with preventative standards of care. Simple tasks for the healthcare personnel, should avoid risks potentials and participate in the march towards effective reduction of the spread of influenza. Personnel are not limited to this idea only but, as aforementioned, should adopt early access to care preventions, smoking cessation by example, observable handwashing, weight reduction, patient demonstration & education, annual compliance to medical visits, and early vaccinations.

The National Institute of Health (NIH) offers suggestions for these behavioral change strategies which, each medical personnel can practice independently and routinely during patient access to care (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5222627/). Exposure to an environment that has limited access to prophylactic vaccine therapy produces a cross-contaminant risk correlation.  High area pollution will along with non-compliant behaviors as smoking, inactive lifestyles leading to obesity, as mentioned earlier will instill “herd affect” patterns among patient behavior potentials; which, vaccination may not be a presented benefit (Kim, Johnstone, & Loeb, 2011).  The sequence of risks potential for patient individuals are anticipated to be less likely as promotional ideals of health than otherwise presented as role model teaching of best practice beneficial strategies.  It would be inappropriate to bypass these concerns and treat only cases that carry better potential outcomes.

However, vaccination uptake in collaborative support to protect patients in hospital care should be a decision established on the principles of Emotional Intelligence (EI) from the goal of public healthcare organizations.  EI arises as conceptual awareness from leadership values that may occur during nurse-to-patient interactions, Patients may take notice of why the caregiver didn’t wash their hands prior to providing care.  Or, patients may request a provider for a spouse or trusted family member to remain at bedside in overnight situations.   The importance of emotional engagement performed between patient individuals, medical participant groups and their organizations is to help establish a quality of leadership needed to reinforce steps toward a safer and improved healthcare system. As a principle engagement of leadership transforming behaviors through dynamics of EI, strong feelings demand attention and are likely to affect cognitions and behavioral processes (Yukl, 2010).  Leaders who take steps to engage constructive use of emotion will become more effective in transforming behaviors of opposition through emotional intelligence.  Their talents shared by supportive organizational processes focused upon using evidence-based practices seek task performance improvements.  Deterring nosocomial outbreaks is essential within the practice of quality leadership centered upon intelligent awareness (DuBrin, 2012). 

Socialization tenets may be key to bringing results sought after by the CDC Health People 2020 90% compliance goal among minority groups of healthcare workers.  Participation or compliance with vaccination through the perceptive intel of protecting patient rights through the recovery processes is an effort that will improve the value management processes of protection for vulnerable patient populations.  Vaccinating voluntarily as well as voluntary compliance of handwashing, wearing gloves between patient to patient contact, and adhering to isolation protocols builds social intelligent engagement between agents having opposing beliefs including artificial ones (Herzig, Lorini, & Pearce, 2017).

State wide collaboration may also demonstrate a great awakening when public response to efforts thwart against medical efforts to improve vaccination response rates fall as a result from the intelligence buy in collaboration of healthcare workers.  Organization values and management commitment must share equally with its membership stakeholders, the mission to build a quality healthcare system in this nation.  Its system must then reflect the connection each of its stakeholder share in agreement towards building a better public healthcare system to protect its citizens nationally. Emotional passions and personal experiences designed by moral persuasion have shown rates for vaccination uptake compliance can be improved.  2013 vaccination coverage improved to 75% from previous 2011 of 67% according to CDC reports researchers Thompson, Shay, Zhou, Bridges. Cheng, etal (2010).  The rates revealed that compliance over mandates were possible.  And, continue trending towards a 90% compliance rate.  The goal of the CDC Healthy People 2020 campaign is attainable as more healthcare workers and staff view their participation as a collaborative support for safer patient care environments.

If there is capable leadership and those who are under the influence of EI it can produce amazing collaboration and resolution according many researchers. However, in opposition to these potentials others perceive EI results are mere “constructive use of … emotion” (DuBrin, 2012, p.481).  Imagine these two differences as seen by subordinate members of a group who have these two personalities to follow,  One leader is seen as an authority figure but, not a leader is seen as having a better understanding by the membership.  The individual with the highest level of EI would be described as the person viewed as being aware of the needs of the membership.  And, that title of Leader could apply to either in title alone, but among this group the one possessing the advantage is the individual who receives the emotional trust from the major portion of members in the group.  Identifying this category of leaders within an organization may be difficult since, they aren’t necessarily specified by managerial appointment or designation.  They are recognized in the way their peers and supportive members engage with them.

Systems adopted to measure levels of emotional intelligence such as MSCEIT, its scoring process determines a person’s EI based on a scale identified as a quotient are highly questionable.  For instance, EI opposition questions can a person who is able to control their anger also manipulate this scoring tool?  We can take into consideration that this and more possibilities exists and manipulating these tools are no better guarantee of emotional measuring outside of human perception. Anger management tools as the psychometric assessment HCR-20.  Mayer, Salovey, Caruso & Sitarenios, (2003) contend there are concerns regarding the reliability of such tests yet, they are still used.  Those who challenge the validity of emotional intelligence itself and whether results of any test can provide consistent results have some degree of concerns about the overall capability of leadership.  DuBrin (2012) suggests, oppositional ideas cannot dismiss that some leaders are more efficient in the use of their skills than others who possess those same skills.  This is the ability which must be shared in order to improve a behavior that responds positively to enforcing all nosocomial deterrents.  A connection with people and understand their emotions is necessary to connect better engagement of what makes a better operating system, healthcare’s goal. 

The CDC report for the 2012–2013 influenza season, there was a modest increase in the vaccination coverage rate among healthcare workers from 67% in 2011–2012, to 72% in 2012–2013 to the current 75% coverage. This is still far from reaching the US National Healthy People 2020 goal of 90% hospitals vaccination rates. The reported increase in coverage is attributed to the growing number of healthcare facilities with vaccination requirements with average rates of 96.5%. However, a few other public health interventions stir so much controversy and debate as vaccination mandates. The opposition stems from the belief that a mandatory flu shot policy violates an individual right to refuse unwanted treatment. This article outlines the historic push to achieve higher vaccination rates among healthcare professionals and a number of ethical issues arising from attempts to implement vaccination mandates. It then turns to a review of cognitive biases relevant in the context of decisions about influenza vaccination (omission bias, ambiguity aversion, present bias etc.) The article suggests that a successful strategy for policy-makers and others hoping to increase vaccination rates is to design a “choice architecture” that influences behavior of healthcare professionals without foreclosing other options. Nudges incentivize vaccinations and help better align vaccination intentions with near-term actions.  Evidence from observational studies suggests that a vaccine mandate increases vaccination rates, but evidence on clinical outcomes is lacking. Although challenging, large healthcare employers planning to implement a mandate should develop a strategy to evaluate HCP and patient outcomes. Further studies documenting the impact of HCP influenza vaccination on clinical outcomes would inform decisions on the use of mandatory vaccine policies in HCP.

Risk Factors

In seeking to identify relative risk factors relating to pre-existing health conditions genetics and genetic risk factors are identified to be most hazardous to the body’s immune systems.  Genetic risk factors first acknowledged as comorbidities result in greater challenges for inpatient influenza exposure.  For the asthmatic, pregnant, and respiratory ailment patient, the flu creates a slight delay in the immune system’s response secondary to a pre-existing health deterrent resulting systematically different by case.  An infected person may or may not show signs and symptoms or even the presence of influenza; however, if there are certain pre-existing conditions, which may enhance the infectious course of the disease contagion it may result in the cause death.  According to the CDC new studies highlight ratios of risk for patients who contract other virulent forms of influenza.  Immune systems processes are needed to recognize and code against viral and bacterial infections.  However, the MBL2 gene part of the body’s genetic coding is responsible for producing a coating of mannose binding lectin 2, an enzyme responsible for the body’s chemical system’s complementary pathway.  In adequate levels of response by the MBL2 allows for invasive secondary infections and is frequently found to be abnormally low in cases resulting in fatality (Ferdinands, 2011).

Implications

Recognizing particular noncompliant ideals may provide a broader solution to engulf these concerns regarding preventative outbreak strategies of influenza. However, as we continue to take the bandwagon approach to incrementally improve preventative healthcare maintenance strategies let’s also respond collaboratively to the behavioral risks that interfere with prevention standards of care must be urgently addressed.  The challenge remains according to the Ziegler (2016) study, that refusals go beyond the frequency of regular immunization and behavioral change to stir up and yield high rates of viral flu balances these continue to remain in dispute.  In the January issue of Environmental Health Perspectives researchers argued that exposure to an environment that has limited access to vaccination therapies establishes a correlation between pollutants and viruses which, may increase hazardous risks for viral mutations.  High area pollution will along with such behaviors as smoking, inactive lifestyles leading to obesity, as mentioned earlier will instill “herd affect” behavior when witness by medical personnel noncompliant patterns.  Risk potential among public scrutiny, where vaccination results may appear to not be beneficial, results of sickness may increase to dangerous levels of viral mutations among the public (Kim, Johnstone, & Loeb, 2011). 

The Conclusion – “but not really!”

The sequence of hazardous risks potentials associated with vaccination resistance, among the role models of healthcare may contribute to the result of vaccination resistance among patients and other non compliant actors.  Such events as supportive arguments defaced in the present of recurring sickness among the vaccinated. In my opinion it would be inappropriate to bypass this reality as a possibility to justify hesitancy. No attempts to expand preventative healthcare strategies to at-risk patient populations can be a result when healthcare workers resent vaccination uptake in their own life status. Their refusal to uptake may extend to choosing not to offer flu shots or other deterrents during their patient care.  Tenacity’s to researched and recorded deterrent practices by overseers of healthcare organizations, public health’s most critical issues regarding viral efficiencies are affecting workplace safety especially in patient-to-patient contact situations.  And, where practicing strict adherence to deterrent strategies to reduce all measurable actions and pandemic threats overcoming and preventing disastrous nosocomial potentials is essential to deploying a fast response in the event of an outbreak.  Collaborative deterrents to improve annual vaccination rate outcomes amongst healthcare workers will set the stage for the CDC’s 2020 Healthy People results.  Targeting vaccination uptake behaviors versus vaccination resistant attacks that offer solutions to improve congruent practices between nosocomial deterrents and external compliances incorporating vaccination.

Yet, continued debates over vaccination uptake versus vaccination resistance as whether shots will provide acceptable protection for personal immune system protection and essential good health-keeping practices, vulnerable population problems have not begun to resolve but, grow.  This discussion synthesizes a valuable need for medical personnel’s embrace of nosocomial deterrent practices.  The effort should stand against threatening potentials of spreading the disease agents within the confines of their direct patient care; environmental participation and cross-contamination.  Recognize the benefits of vaccination uptake over resistance it facilitates evidence-based best practice discussions nationally and must be considered for its potential as a nosocomial deterrent.  HCW should support staff collaboration toward vaccine uptake if feasible and take into consideration its best practice potential to put care for their patient first.

Reference

Bandura, A. (1977). Self-efficacy: toward a unifying theory of behavioral change. Psychological review, 84(2), 191.   

Bedford, T., Riley, S., Barr, I. G., Broor, S., Chadha, M., Cox, N. J., & … Smith, D. J. (2015). Global circulation patterns of seasonal back porch l influenza viruses vary with antigenic drift. Nature, 523(7559), 217-220. doi:10.1038/nature14460

Centers for Disease Control. (2017).Weekly U.S. Influenza Surveillance Report [Data file]. Retrieved from  https://www.cdc.gov/flu/weekly/index.htm      

Chuang, J., Huang, A., Liu, W., Chou, M., Chang, J., Chiu, F., . . . Menéndez-arias, Luis. (2012). Nationwide Surveillance of Influenza during the Pandemic (2009–10) and Post-Pandemic  (2010–11) Periods in Taiwan (2009–11 Nationwide Flu Surveillance in Taiwan). PLoS  ONE, 7(4), E36120.

Cohen, D. L., & Casken, J. (2012). Why are Healthcare Workers so Resistant to the Acceptance of Influenza Vaccine? a Review of the Literature to Examine Factors that Influence Vaccine Acceptance. International Journal Of Caring Sciences, 5(1), 26-35. Louie, J. K.,  Cross, A. (2014). Anti-endotoxin vaccines. Virulence, 5(1), 219-225. 

Davis, M. M., & Gaglia, M. A. (2005). Associations of daycare and school entry vaccination requirements with varicella immunization rates. Vaccine, 23(23), 3053-3060.   

DuBrin, A. J. (2012). Ethics and corporate social responsibility:  In essentials of  management. Mason,  OH: Cengage Learning.

Ferdinands, J. M. (2011). A Pilot Study of Host Genetic Variants Associated with Influenza- associated Deaths among Children and Young Adults1-Volume 17, Number 12— December 2011-Emerging Infectious Disease journal-CDC. 

Finkelstein, S., Hedberg, K., Hopkins, J., Hashmi, S., & Larson, R. (2011). Vaccine availability in the United States during the 2009 H1N1 outbreak. American  Journal Of Disaster Medicine, 6(1), 23-30.

Hennessy, T. W., Bruden, D., Castrodale, L., Komatsu, K., Erhart, L. M., Thompson, D., the Investigative Team. (2016). A Case Control Study of Risk factors for death from 2009 pandemic Influenza A (H1N1): Is American Indian racial status an independent Risk factor? Epidemiology and Infection, 144(2), 315–324. 

http://doi.org/10.1017/S0950268815001211    Herzig, A., Lorini, E., & Pearce, D. (2017). Social Intelligence. AI & Society,1. Hrincius, E. R., Liedmann, S., Finkelstein, D., Vogel, P., Gansebom, S., Ehrhardt, C., & …  

McCullers, J. A. (2015). Nonstructural Protein 1 (NS1)-Mediated Inhibition of c-Abl  Results in Acute Lung Injury and Priming for Bacterial Co-infections: Insights Into 1918   H1N1 Pandemic?. Journal Of Infectious Diseases, 211(9), 1418-1428.   \    doi:10.1093/infdis/jiu609

Kaufman, J. (1998). Value management: Creating competitive advantage (Crisp management library; 21). Menlo Park, Calif.]: Crisp Publications.    Kim, T., Johnstone, J., & Loeb, M. (2011). Vaccine herd effect. Scandinavian Journal of  Infectious Diseases, 43(9), 683-689.

Lieuwe Dijkstra, Hans van der Bij, (2002) “Quality function deployment in healthcare: Methods for meeting customer requirements in redesign and renewal”, International Journal of   Quality & Reliability Management, Vol. 19 Issue: 1, pp.67-89,   https://doi.org/10.1108/02656710210413453

Naleway, A. L., Henkle, E. M., Ball, S., Bozeman, S., Gaglani, M. J., Kennedy, E. D., & 

Thompson, M. G. (2014). Barriers and facilitators to influenza vaccination and vaccine coverage in a cohort of health care personnel. American journal of infection control, 42(4), 371-375.

Rakita, R., Hagar, B., Crome, P., & Lammert, J. (n.d.). Mandatory Influenza Vaccination of Healthcare Workers: A 5‐Year Study. Infection Control and Hospital Epidemiology, 31(9), 881-888. 

Swan, J. (2016). Influenza: Seasonal Flu 2016–2017. Thompson, M. G., Shay, D. K., Zhou, H., Bridges, C. B., Cheng, P. Y., Burns, E., … & Cox, N. J. (2010). Estimates of deaths associated with seasonal influenza-United States, 1976- 2007. Morbidity and Mortality Weekly Report, 59(33), 1057-1062.

Ventola, C. L. (2016). Immunization in the United States: Recommendations, Barriers, and Measures to Improve Compliance: Part 1: Childhood Vaccinations. P&T: A Peer- Reviewed Journal For Managed Care & Formulary Management, 41(7), 426-436.    

Yaqub, O., Castle-Clarke, S., Sevdalis, N., & Chataway, J. (2014). Attitudes to vaccination: a critical review. Social Science & Medicine, 112, 1-11. 

Yukl, G. (2010). Leadership in organizations (7th ed.). Upper Saddle River, N.J.: Prentice Hall.Ziegler, Megan (2016) Vaccines: how requirements and exemptions affect vaccination rates, disease prevalence, and herd immunity within the United States? Master Essay, University of Pittsburgh.

DANG!
GET THE SHOT!

EMOTIONAL INTELLIGENCE

EMOTIONAL-INTELLIGENCE-PRESENTATION Emotional Intelligence and the Trump Administration may not have as much in common as the prior administration of Barak Obama but, the Trump administration does put forth a great opposing view of how emotional intelligence or EI can be understood.  What I am suggesting is having a high EQ as opposed to IQ would serve as an ability allowing you to understand the folks under your leadership and those exposed to the environments, affected by your choice decisions.  No one can read minds, but if you could, reading the minds of a person and understanding exactly why they do what they do, the logical idea in a child’s mind might suggest you’d use that power as a super hero or X Men. I’m not intentionally diverting from political correctness X Lady doesn’t quite have the same conditional tone, does it? But, if you, DNA mutant for good knew when the time called upon your skill as the Emotional Intelligence (EI) hero you would become the ultimate conflict resolution-ist.  And, depending on your quotient or EQ strength you’d become one among the greats.  I’m sure this would be a good point to discuss political views between the former Obama administration and the current Trump administration but, I’m not one to lead you to making the decisions my EQ isn’t quite that high, yet.  But, if you realize which of these characters possessing the greatest skills in leadership would contend with the opposition, draw upon their superlative talents as the EI hero and voilà, the student would emerge to enter the mastery of understanding, emotional intellect would kick in (Trushell, 2004).  Emotional Intelligence is described as ability “to build relationships” (DuBrin, 2012, p. 481).  Although, it would be great to be seen as having superior or super human capabilities as implied by writer John M. Trushell.  Emotional intelligence as a fantasy of American pulp fiction as I allude to in the opening does not totally have to result in fictitious results.

EI, is the motive to engage innate abilities as empathy and trust.  Trust, however has to have some degree of disciplined control.  Among capable leadership and those who are under the subjection EI can produce amazing collaboration and resolution.  EI results in actions performed by and between individuals, groups or organizations making those who take steps to engage “constructive use of … emotion” more effective through their administrative processes (DuBrin, 2012, p.481).  Imagine the difference among subordinate members of a group who have two persons to follow.  One person is seen among the group as a leader and the other person is seen as an authority figure but, not a leader.  The superior individual with the highest level of EI would be described as the person viewed as being aware of the needs of the subordinates.  And, the title of leader may apply to anyone among this group possessing the advantage of emotional trust from members of the group.  Identifying the second category of highly ranked heroes of administration can be difficult since, they aren’t necessarily specified by managerial appointment they are recognized by the way their peers engage with them.

Scores that have been adopted to measure a level of emotional intelligence such as MSCEIT, its scoring process determines a person’s EI based on a scale identified as a quotient.  There are highly questionable methods to these measurements.  Measurements that could determine if a person is able to control their anger must take into consideration more than the scope of anger management tools as psychometric assessments as the, HCR-20.  Mayer, Salovey, Caruso & Sitarenios, (2003) contend there are concerns regarding the reliability of such tests.  They challenge validity of emotional intelligence itself and whether results of tests will provide consistent results.  In my own self-examination, I have been evaluated a having “Good EQ”, in theory.  I do believe I have some degree of leadership abilities which would support good EQ results.   However, I don’t believe my results would replicate if I would take a similar study under slightly different questions or different demands they might indicate some similarity but highly unlikely to be the same.  DuBrin (2012) describes this as an ability to connect with people and understand their emotions” (p. 162).  Is it truly necessary to connect?  I believe having what is described to be emotional intelligence leads to a better understanding of what makes a great leader, better.  Connecting to people is essential to administration and leadership even though EI claims are made to imply being first in this regard scientist credit Darwinian ideals as emotional expression as the central token of adaptive leadership traits.  For further edification, I have taken liberty to provide you with reference resources, until next time I sit with my pen – ENJOY THE SITES! 

You can judge me by the following references: 

Bar-On, R. (2001). Emotional intelligence and self-actualization. Emotional intelligence in everyday life: A  scientific inquiry, 82-97. 

DuBrin, A. J. (2012). Ethics and corporate social responsibility:  In essentials of  management. Mason,  OH: Cengage Learning. 

Mayer, J. D., Salovey, P., Caruso, D. R., & Sitarenios, G. (2003). Measuring emotional intelligence with     the MSCEIT V2. 0. Emotion, 3(1), 97.    

Trushell, J. M. (2004). American Dreams of Mutants: The X‐Men—“Pulp” Fiction, Science Fiction, and  Superheroes. The Journal of Popular Culture, 38(1),

149-168.

MICDROP FLIX VULNERABLE POPULATIONS

The issue to provide healthcare and no harm, obligates agents within every medical platoon and members of reform measures to social responsibilities that ensure reduction rates of nosocomial infections, through a focus targeted on the duty to serve.  In this service, obligation to maintain quality efforts that successfully prevent the spread of nosocomials are the inherent standard. Practices such as handwashing and donning of gloves before and after personal contact with patients is a typical surveillance event with less than 50% compliance according to a joint commission review (Sahud, Bhanot, Radhakrishnan, Bajwa, Manyam, & Post, 2010). Such efforts leading to improve the practice of both handwashing and donning of gloves is critical to ensure the reduction of transmitting pathogens within a healthcare clinical environment and they share goals to improve on a consistent basis. There are other common practices such as wearing protective personal equipment, sterile techniques, and accurate diagnosis, all must be recognized as quality concerns for reduction of risks in their repetitive practice.  Studies have been conducted on each of these interventions yielding results of various efficiencies.

However, considering possible threats and outbreaks of virulent diseases such as Ebola and Flu, emergency protocols should be incorporated as standard practices of nosocomial prevention and training. Seasonal vaccinations among healthcare agents should be inclusive annual practices to ensure a continual reduction of hospital acquired diseases in all areas.  The case for mandatory vaccination treatments is feasible; resulting in vaccination rejection rates of 2% among vaccine healthcare workers according, to a five-year study conducted at Virginia Mason Medical Center in Seattle, Washington. This first to be known infectious control mandate yielded a 98% uptake compliance rate among Health Care Workers (HCW).  Policy accommodations for religious and other considerations were granted due to possible concerns relating specifically to medical diagnoses (Rakita, Hagar, Crome, & Lammert, 2010).  Although, the study highlights a significant percentage for vaccination uptake, it also pays to recognize the small percentage of vaccination resistant HCW which, includes a fewer number of vaccination resistant workers who withdrew their employment.

This proposal intends to suggest the best practice to ensure a reduction of influenza as a nosocomial disease is to implement vaccination uptake as part of standard training procedures for infection control (e.g. handwashing, personal protective equipment, sterile techniques, vaccination uptake) ensuring education of the HCW recognizes that vaccination uptake, when considered part of standard infectious control procedures and healthcare no harm responsibility rule, will act as an additional form of patient protection in hopes to coincide with core public value.  After all, incorporating the standard practices of infectious control and uptake responsibility, vaccinating should be treated as a standard of care regardless of one’s personal value.  From the core debate surrounding vaccinations, public value has been stirred into a melting pot mixture of divergent medical practice ideals from which, agents of healthcare must eventually accept reconciliation and collaborate on behalf and presence of clients.

CONCLUSION: A perception of best practice and prioritization among healthcare agents can lead to determining factors that reduce the spread of nosocomial infections. If wearing a face mask  during patient care, he or she may experience greater collaboration if vaccination uptake workers would also wear face masks while providing patient care during seasonal outbreaks, a practice would condone collaborative efforts over values of elitist. Such recognition in behavior can be an effective tool to provide the highest standards of care amongst the agents duty to serve. This practice when implemented as standard could be taught and expressed as professional practice counteracting inverse care among vulnerable patient populations. Recognizing parameters of these established behaviors and values for nosocomial or hospitalization case designs are warranted for preventive inquiries and investigations into expected and anticipated behaviors of laggard resistance and of laggard hesitancy in non-nosocomial environments should greater events or threats occur. Review by gap analysis for productive gains of gene delivery through systems of modern Nano-technology vaccine deliveries would benefit from aforetime observances of laggard adaptations.

References

Talbot, T.R., & Schaffner, W. (2010). On being the first: Virginia Mason Medical Center and mandatory influenza vaccination of healthcare workers. 

Sahud, A.G., Bhanot, N., Radhakrishnan, A., Bajwa, R., Manyam, H., & Post, J.C. (2010), An electronic hand hygiene surveillance device:  a pilot study exploring hand hygiene surveillance device: a pilot study exploring surrogate markers for hand hygiene  compliance. Infection Control & Hospital Epidemiology, 31(6), 634-63 

VIRAL UPTAKE & RESISTANCE

Abstract

We have engaged upon a time when proactive participation is measured by the willingness of submissive support. The debate over viral inoculations has caused a collision between homeopathic beliefs and evidence-based research.  These adverse ideals have begun to thicken over a gulf-crisis between medical’s best practice and homeopathy’s survival of the fittest. Collections of viral activity data under the 2017-18 surveillance by Centers for Disease Control and Prevention (CDC), National Respiratory and Enteric Viral Surveillance System (NREVSS), and the World Health Organization (WHO) present a rampant and growing trend of influenza-like activity spreading in the United States. Schisms and arguments opposing mandated vaccinations in hospital settings have been responsible for facilitating productivity cost factors, resulting in productivity and liability losses and greater economic burdens by simply not addressing the cyclical flu patterns among seasonal outbreaks and within organizational healthcare workers and the patients they are in contact with.  But, the resistant behavior should not be held as the sole perpetrator of influenza’s upward trend more investigation is required to see exactly what is responsible. In the meantime, to prevent continued upward shifts of viral activity nosocomial deterrent collaboration conjoined with modified behavioral practices opposed to the vaccination uptake movement, resistant arguments must no longer go unanswered. Here, I present the concern related to inclusion of influenza vaccinations as a prophylactic uptake for best practice standards of care while used as a component of nosocomial deterrents.

Keywords

Nosocomial deterrents, vaccination uptake, vaccination resistance, hand hygiene, standard precautions

Table of Contents

Introduction                                                                                                                            4

Value Management                                                                                                                 5

Job planning                                                                                                                            7

Trend tracking                                                                                                                         9

Literature review                                                                                                                     14

Studies review                                                                                                                        18       

Prevalence review                                                                                                                   20

Behavioral theory                                                                                                                    21

Risk Factors                                                                                                                            27

Implications                                                                                                                            27

Conclusion                                                                                                                              28

Reference page                                                                                                                       30

Appendix                                                                                                                                33                                                                                                                   

Vaccination Uptake, Improving Nosocomial

Deterrent Best Hygiene Practice

Introduction

Mandatory treatments are steadily resulting in less rejection rates among medical professional support groups and parental behavior of preschoolers, but less amongst role models in healthcare, the nursing staff (Davis & Gaglia, 2005; Naleway, Henkle, Ball, Bozeman, Gaglani, Kennedy, & Thompson, 2014).  A selection of four states California, Connecticut, Pennsylvania and Mississippi indicate health promotion programs which mandated flu shots are gaining more results in numbers but, also show the mandatory requirements creates agitation and argumentative discourse amongst many of healthcare’s professional teams.  In this paper, I will take a close look at the problem of these optional opinions and organizational choices to mandated vaccination policies.  Although, seeking community information from healthcare workers, adult students and participants of public service facilities such as libraries, shelters and police stations provides a general access to public information, it is the goal of this paper to discover a specific strategy that can be used to reduce the rate of noncompliant practices.  Current upward trends of influenza have demonstrated that resistance is futile and as a less effective strategy it should not be considered as a best practice in healthcare’s patient to patient exposure.  If mandated vaccinations are required in employment & hiring practices, inclusive staff training of added deterrents and patient safety practices are established as best practices evidence and necessary for patient safety.  Incorporating the vaccination with other standards of care will improve the outcome of delivering healthcare services according to the Ziegler study. 

In the Ziegler study, vaccines were determined essential deterrents for possible sepsis conditions, this was amongst the first successful adjuvant therapy as a prophylactic study in healthcare related to sepsis prevention (Cross, 2014).  Identifying the reasons for immunization rejections among select communities in healthcare, may lead to fashioning better strategies for preventing nosocomial disease.  Information discovery may be formatted to the requirements of participant state department of Health and Human Services and shelter base programs that have participation access to health promotion programs leading to national 2020 Healthy People and the developing 2030 Healthy People, CDC outreach goals.  In order to provide results for an endeavor to improve patient care services and risks reduction healthcare workers should familiarize themselves with the goals of the Healthy People campaign. 

Value Management

FAST DIAGRAM: figure 1

An organization who identifies a problem properly apart from its symptoms, has an obligation to clearly define the problem before seeking out a solution. In order to define the problem, you have to find out what it needs.  Symptom management, may inspire the right ideas in order to bring forth a proper solution to the problem – the right fix, to the need.  Kaufman (1998) discusses ideal strategies for a FAST remedy to improve an organizations response to the needs of its customers in his Value management: Creating competitive advantage culture. 

Identifying what the customer needs must always come first as a practice. Leadership will embrace actions necessary to promote resolution of the client needs; especially the foremost need of the customer at hand. In a healthcare environment, my focus on embracing every action designed to promote nosocomial deterrents, while reducing associated barriers, are synonymous to enhancing the safety of the patient and fulfilling their need.  Thus, incorporating healthcare vaccinations together with other nosocomial deterrent practices should be considered part of the medical service community’s embedded Quality Function Design (QFD).  QFD is rarely considered a possibility for the service industries according to researchers Lieuwe Dijkstra and Hans van der Bij, (2002).  But, as a possible function for this professional service towards achieving patient safety goals, vaccination uptake can be incorporated into a QFD as a best practice and nosocomial deterrent standard of care.

As a FAST response, embedded in practice for quick unanticipated burdens related to productivity loss, staffing shortages, and nosocomial outbreaks vaccination uptake is an essential tool to measure for effectiveness of quality care and functional deterrence. FAST, the value management strategy for functional analysis and systematic techniques, are also mapping techniques used in conjunction to value management strategies that addresses a plethora of issues which carry potential negative impacts on production design and service cost to business organizations. In his Value management: Creating competitive advantage article, Kaufman argues for the importance of rapid response in cost reduction and value improvement in achieving worthwhile objectives (Kaufman, 1998). Discovery of competitive advantages versus longer hospital stay durations for patients or rising productivity cost due to staff call-ins and shortages are added burdens of higher demands necessary for shift coverage.  QFD will promote resolute objectives unforeseen through improper value management which goes undetected during strategic planning operations. This form of an organizations capital investment management, where organizations fulfill the cost planning allocated and obligated to its membership productivity, patient stay minimalization, staff training, and skill deployment establishes vital components key to value management methods.

Job planning

As part of the value management system, an organizations job is to establish an effective method and approach that will consistently guide collaborative efforts through opportunities of problem resolutions. Pioneer and Value Management System Creator Lawrence D. Miles is quoted as saying, “all cost is for function … because the customer wants something done” (Kaufman, 1998, p. 3).  In his five-step job plan, Kaufman would suggest job planning begins first by evaluating all available and relevant information pertaining to project series. In a healthcare environment a cyclical pattern of nosocomial transmission and seasonal flu trends associated with viral diseases, such as influenza, have credible resources available through CDC, WHO, and NREVSS. Evaluation of information and data trends from these reputable agencies can provide preliminary steps to initiate QFD. The second step of the planning process is to develop a list of ideas that relate to QFD guidelines or performances but, not as solutions. Implementing nosocomial deterrents such as handwashing, isolation gowning, and flu vaccinations are reasonable ideas against potential hazards of disease transference. In step number three, planners should evaluate the list of ideas suitable for best practice. Improvement of vaccination uptake rates improves risk reduction potentials of shared exposure according to Centers for Disease Control and Prevention. Clustering the best practice methods, such as these nosocomial deterrents mentioned herein, can provide measurable components important to evaluation of scenarios that include financial risk and health-risk reduction during patient care events especially during seasonal flu outbreaks. Step five, brings proposed recommendations to stakeholders for approval and funding of these best practice ideals. Continual use of nosocomial deterrents including influenza vaccination uptake is a building block process, which over time will improve patient safety, awareness. and the overall quality of healthcare services.

QFD, requires step-by-step process evaluations in order to maintain and secure cost efficiency and to guide a successful and disciplined approach for opportunity or to overcome problems successfully. Kaufman, provides Miles’ five-step solution as a FAST response needed for unanticipated critical problems, which I believe can be applied to the healthcare workforce vaccination resistance movement. Development and practice of information building, builds shared support within the organization as collaborative knowledge, skills, and abilities among team participants continues to improve the patient care setting. Training designed to meet the environmental conditions surrounding quality efficiency can promote team-skill development and team confidence among participating members. Throughout each step of the evaluation process evaluation of the value of the training, goals and objectives of the QFD, and review of the idea development provides the opportunity for FAST resolutions. This is a valued lesson which allows for stakeholders and vulnerable patient exposed to unprotected contacts to gain experience from learned behavior vaccination resistant members and develop improvements to a conjoined workforce that will ultimately affect the medical cost’s return on investment (ROI) ultimately at the patient’s expense.

Trend tracking

H1N1, a viral contagion most often seen to cause infections amongst swine. In 2009, this “swine flu” outbreak was responsible for 1.9  per million deaths around the world according to (Chuang, Huang, Liu, Chou, Chang, Chiu, . . . Menéndez-arias, 2012).  In 2005, China succumbed to the “Bird flu.  The social impact of current noncompliant conditions according to Centers for Disease Control, allows potential outbreaks of influenza at pandemic levels.  At the CDC surveillance records of 4.8% to a minimal rate of 4.2% or more are indications of viral confirmed cases amassed.  Current indications suggest that the number of reported cases of influenza, as of February 5, 2017, have increased to 4.8%. This percentage is above the national baseline of 2.2% according to informative records as of February 12, 2017, (https://www.cdc.gov/flu/weekly/index.htm).

INFLUENZA Virus Isolated

CDC INFLUENZA TRACKING: figure 2

The issue to provide healthcare and no harm, obligates its agents within every medical service group and members of the holistic reform to social responsibilities that ensure reduction rates of nosocomial infections.  A focus targeted on the duty to serve and providing quality patient care, critical urgent care, and patient safety measures can demonstrate effective planning of the healthcare role model and incorporate an evaluation system of best practice evidence.  In the service of healthcare obligations to maintain best practice successfully, intention to prevent the spread of nosocomial contagions is a vital practice of care, contingent on the witness of collaborative actions.  The action of nosocomial deterrent practice would be considered inclusive to the inherent standards; which, patients oftentimes are unaware of risks associated throughout the duration of care.  Practices such as handwashing and donning of gloves before and after personal contact with patients are a typical surveillance event with less than 50% compliance according to joint commission reviews (Sahud, Bhanot, Radhakrishnan, Bajwa, Manyam, & Post, 2010) a result most likely unknown by the inpatient status quo. Such efforts leading to improving practices of handwashing, isolation protocols, and donning gloves between patient-to-patient care and vaccination uptake are critical to ensure the reduction of transmitting pathogens within a healthcare clinical environment.  These deterrents shared in the goal to improve outcome results on a yearly basis are critical to patient care. There are other common practices depended upon location of services (i.e. ICU, OR, ER/ED) where wearing protective personal equipment, sterile techniques, and accurate diagnosis are recognized as higher quality-controlled environments and lean towards improved reduction of health risks associated to the patient’s admitting diagnoses.  The patient’s repetitive exposures to staff is less likely to be compromised by a cluster of nosocomial deterrent practice (Cross, 2014).

Following steps that include early access to medical care, smoking cessation participation, frequent handwashing, involvement in weight reduction, patient education, annual compliance to medical visits and early vaccination can provide reassurance for healthier outcome results another form of deterrent practice.  The National Institute of Health (NIH, 2017) offers suggestions to incorporate into lifestyle behavioral changes which, can be practiced daily (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5222627/).  But, during the time those infected with influenza and other viral contagions in the care of public health monitoring agencies, according to CDC and NIH epidemiology studies, vaccination is paramount to countering the rapid spread of seasonal outbreaks and other viral disease. 

Finkelstein, Hedberg, Hopkins, Hashmi, & Larson, (2011) describe events of states in demand for vaccines, waiting in anticipation for the uninfected to receive immune defensive prophylactic treatments, necessary to fight a threat for potential pandemic outbreak.  Currently a time at rest, crucial demands for preparedness nursing staff and inpatient vaccination are needed. What is already known about the seasonal outbreak of influenza becomes archaic and dated once agencies enter into the influenza cyclical pattern under duress of its effects on inpatient populations.

The existing knowledge of the H1N1 strain quickly became the scrutiny of 2017 according Potter 1, Stott, Roberts, Elder, O’Donnell, Knight, and Carman (1997) indicating no control studies in support of the effectiveness of vaccination uptake as best practice among healthcare workers. The study Influenza vaccination of health care workers in long-term-care hospitals reduces the mortality of elderly patients. Journal of Infectious Disease objectively dismisses claims that would support flu shot uptake as a remedy to reduce nosocomial exposures due to the lack of evidence-based research. In fact, arguments to this position would suggest a need more investigation to questions of accountability from both sides of influenza uptake and resistance debate to support improvement to the patient problem among seen by healthcare professionals.

An additional idea to present during the job planning of a nosocomial deterrent strategy to achieve stakeholders’ objectives against productivity cost burdens and steps toward improved prevention and a quality health maintenance system remains transparent to the customer.  H1N1’s viral distinction was first identified as a strain with a recognizable pattern which, traces back to the year 1918. Most notable is its distinct and unstable protein cytoplasmic structure.  Researchers Hrincius, Liedmann, Finkelstein, Vogel, Gansebom, Ehrhardt, & McCullers (2015) identify rapid development of cytoplasmic proteins, identified as Protein 1, during laboratory transference of the virus. According to these researchers it is the principal assumption, due to the final location of the tested pathogen, that results of viral contamination occur as a respiratory tract infection (caused by aerosols not necessarily air borne) and not necessarily a pathogenic sequence i.e. from hand to mouth. The majority of symptoms of H1N1 are due to “massive edema formation facilitated by secondary pneumonia” (Hrincius , etal., 2015). In close observation, of hospitalized patients, the researchers noted respiratory symptoms had distinct displays of variant cases from mild to extremely severe. These conditions were also influenced by three major pre-existing conditions such as diabetes, congenital respiratory defects and obesity; fundamental areas for patient education and transparency.

The social impact of efforts to improve preventative maintenance systems for seasonal outbreaks is faced with challenges that influence public safety. Virulent patterns of disease are constantly reemerging as new strains due to the instability of protein 1. The term “spatiotemporal” describes two influences which affect research outcomes in the investigations of vaccine development. According to researchers Bedford, Riley, Barr, Broor, Chadha, Cox & Smith (2015) the interval between space and time emergence creates repetitive challenges from laboratory to laboratory globally, that are faced with a variant of seasonal flu distributions. The importance of sharing knowledge in open forums of communication is expected to lead to a better preventative solution.

Literature review

Vaccination hesitancy and resistance have emerged as a result of distrust, misinformation, and a lack of public knowledge.  Yaqub, Castle-Clarke, Sevdalis, & Chataway (2014),provide details describing the prevalence of hesitation amongst the public at large and healthcare workers who willing may concede to vaccination.  Yaqub etal., in pursuit of an explanation of hesitancy prevalence inform readers of distinctions between hesitancy and resistance. The platform of healthcare related incidents finds an erosion of public trust can be attributed to fears influenced by threatened pandemic outbreaks such as those from 2009, which never occurred. The results from public health narratives may support hesitancy motives attributed to overstated claims pandemic threats and low perceived severity concerns as those debated over viral illnesses. 

self-vaccinating healthcare professionals’ attitudes and their citation frequency: figure 3  

Patient-vaccinating healthcare professionals’ attitudes and their citation frequency: figure 4

General population’s reasons for vaccination attitudes and the number of times such kinds of reasons are cited in the literature we reviewed: figure 5

Studies review

Studies have been conducted on each of these nosocomial interventions yielding results of various efficiencies.  However, considering possible threats and outbreaks of virulent diseases such as influenza, emergency protocols should be incorporated as standard practices of nosocomial prevention and training. Seasonal vaccinations among healthcare agents should be inclusive annual practices to ensure a continual reduction of hospital acquired disease risks are in place, in all areas of operation.  The case for mandatory vaccination treatments is feasible; since, resulting in vaccination rejection rates of 2% among vaccine healthcare workers according to a five-year study conducted at Virginia Mason Medical Center in Seattle, Washington. This first to be known infectious control mandate yielded a 98% uptake compliance rate among healthcare workers (HCW).  Policy accommodations for religious and other considerations were granted due to possible concerns relating specifically to medical diagnoses (Rakita, Hagar, Crome, & Lammert, 2010).  Although, the study highlights a significant percentage for vaccination uptake, it also pays to recognize the small percentage of vaccination resistant HCW which, includes a fewer number of most vaccination resistant healthcare workers in other national studies, who also willing to withdraw their employment further adding to healthcare’s productivity cost burdens.

This combines or bundles nosocomial deterrents into one collective practice including flu shots as an intent action toward best practice behavior and the prevention of influenza as a nosocomial disease.  This proposal suggests the implementation of vaccination uptake as a standard practice incorporated in the procedures for infection control (e.g. handwashing, personal protective equipment, sterile techniques, vaccination uptake) ensuring education of the HCW includes recognizing vaccination uptake, as part of standard infectious control procedures and healthcare no harm responsibility rule; cooperation will act as an added form of patient safety as a core public health value commitment.  After all, incorporating the standard practices of infectious control and uptake responsibility, vaccinating should be treated as a standard of care regardless of the adoption of one’s personal value. Absent from the core value measurement debate surrounding vaccinations, public health is stirred into a melting pot mixture of divergent medical practice ideals from which, agents of healthcare share less responsibility toward effective deterrent actions. Eventually, the accepted reconciliation and collaborate efforts on behalf of patient care must outweigh the diversities which divert the possibility of an efficient QFD.

A perception by the patient-clients of best practice implementation and prioritization demonstrated by the healthcare agents can lead to determining factors that help educate patients about the spread of nosocomial infections. If a vaccination resistant worker, during an active seasonal outbreak of influenza is seen wearing a face mask during patient care, he or she may experience greater collaboration in their patient service. If vaccination uptake workers also wore facemasks while providing patient care during seasonal outbreaks the practice would be an effective demonstration of collaboration by the healthcare team membership. Evidence of best practice would condone collaborative efforts such as these over values of the elitist perspective of resistance. Such recognition in behavior can be an effective tool to provide the highest standards of care amongst an agent’s duty to serve.  This practice when implemented as a standard of care could be taught, expressed, and considered as a professional practice counteracting an inverse of care among vulnerable patient populations.

Prevalence review

TB skin tests, rubella, rubeola, hepatitis B, and varicella vaccinations are required by a large percentage of employers in the United States and rarely rejected under organizational compliance requirements.  Pandemic results of the past are now drawing attention to the sequence of potential risks to require more aggressive preventative strategies (Swan, 2016).   However, according to a (2016) research study by Megan Ziegler, a large majority of these vaccination sequenced refusals, existed among several states opposed to mandating shots of any kind including polio.  This paper seeks to focus on building an effective communication circuit; which, will be key to improving nosocomial deterrent practice and collaboration. In an article published by Centers for Disease Control (CDC), surveillance of seasonal flu vaccination is closely monitored among pregnant women and health care professionals (HCP).  In this study, the CDC has helped build preventative maintenance indicators which, are currently used to monitor outbreak potentials (see https://www.cdc.gov/vaccines/). Taking steps to improve the understanding of why other ideals promote an objective sequence especially relating to flu vaccinations, an established preventative health maintenance strategy, may provide in-depth information necessary to design improvement to vaccination compliance as seen among other routine vaccination.  Routine vaccination screening for virulent contagions such as tuberculosis, rubella, rubeola, hepatitis B, and varicella vaccines are given regularly and often with less levels of rejection as seen with influenza.  In most cases, we may conclude these vaccine preventative measures are also required by a large percentage of employers and educational systems in the United States.

Epidemiologists, according to researchers have witnessed huge reductions in these pathogenic gateways. Diphtheria, smallpox and polio have seen as high as 100% reduction among each of these cases (Ventola, 2016).  However, among flu vaccines a myriad of ideals has developed into a pattern of recognizable vaccination noncompliant groups. Cohen, & Casken, (2012) identify in their literature review a number of health care providers (HCP), namely nurses, have the most frequent and direct contact with patients.  And, they are number one amongst the highest refusal group of compliance studies when compared to physicians and supplementary medical staff. In the Cohen & Casken lit review it further identifies pre-deposing factors such as “beliefs, knowledge and values” as primary resistant ideals used by all non-compliant persons.  In the planning stage of this endeavor, I have reviewed related literature regarding the hazards of supply shortages and ideals related to members of the medical profession and vaccination hesitancy.  In a review of “A warning shot: The 2004 Influenza Vaccine Shortage” Donya C. Arias provides reasonable arguments in support of preventative measures to avoid vaccine shortages due to underestimated trends of vaccination hesitancy, we include this information along with Cohen & Casken to identify ideals that support hesitancy behaviors and the sustainment of hazardous environmental conditions among healthcare workers and public hesitancy. 

Behavioral theory

As the Theory of Planned Behavior is quite expectant as a hallmark and descriptive behavior of vaccination resistance, according to author Gregg J. (2011) an outcome determined under three spontaneous conditions resulting in a planned behavioral action. First, Gold states is an individual’s perspective of his current situation’s impediments or the facilitators intent to take responsive action. Second, Gold states a relationship to a perspective of consequences for taking action.  Third, are the expected norms resulting from taking consequential actions. These three contingency factors are conditions resulting from an individual’s capacity to make choice decisions based on what is determined to be a self-efficacy principle. Identifying rationale rejections for vaccination coverage; will be identified through participant studies and survey outcomes; sampling will be compared as indicated by standards presented in the Ziegler study.

Research among these conditions will provide a focused review of the opinions these communities believe to be reasonable subjective arguments for their noncompliance to the preventative care measure of vaccination uptake.  Bandura (1977) adds self-effective behavior among an individual’s peer group of a planned behavior is more likely to result into an outcome of change (Bandura, 1977).  Recognizing particular noncompliant ideals may provide a broader solution to engulf concerns regarding preventative outbreak strategies of influenza. But, a continuance to take a bandwagon approach against preventative healthcare maintenance strategies enables us also irresponsibly fail collaborative behavioral risks reductions which, also interferes with preventative standards of care. Simple tasks for the healthcare personnel, should avoid risks potentials and participate in the march towards effective reduction of the spread of influenza. Personnel are not limited to this idea only but, as aforementioned, should adopt early access to care preventions, smoking cessation by example, observable handwashing, weight reduction, patient demonstration & education, annual compliance to medical visits, and early vaccinations.

The National Institute of Health (NIH) offers suggestions for these behavioral change strategies which, each medical personnel can practice independently and routinely during patient access to care (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5222627/). Exposure to an environment that has limited access to prophylactic vaccine therapy produces a cross-contaminant risk correlation.  High area pollution will along with non-compliant behaviors as smoking, inactive lifestyles leading to obesity, as mentioned earlier will instill “herd affect” patterns among patient behavior potentials; which, vaccination may not be a presented benefit (Kim, Johnstone, & Loeb, 2011).  The sequence of risks potential for patient individuals are anticipated to be less likely as promotional ideals of health than otherwise presented as role model teaching of best practice beneficial strategies.  It would be inappropriate to bypass these concerns and treat only cases that carry better potential outcomes.

However, vaccination uptake in collaborative support to protect patients in hospital care should be a decision established on the principles of Emotional Intelligence (EI) from the goal of public healthcare organizations.  EI arises as conceptual awareness from leadership values that may occur during nurse-to-patient interactions, Patients may take notice of why the caregiver didn’t wash their hands prior to providing care.  Or, patients may request a provider for a spouse or trusted family member to remain at bedside in overnight situations.   The importance of emotional engagement performed between patient individuals, medical participant groups and their organizations is to help establish a quality of leadership needed to reinforce steps toward a safer and improved healthcare system. As a principle engagement of leadership transforming behaviors through dynamics of EI, strong feelings demand attention and are likely to affect cognitions and behavioral processes (Yukl, 2010).  Leaders who take steps to engage constructive use of emotion will become more effective in transforming behaviors of opposition through emotional intelligence.  Their talents shared by supportive organizational processes focused upon using evidence-based practices seek task performance improvements.  Deterring nosocomial outbreaks is essential within the practice of quality leadership centered upon intelligent awareness (DuBrin, 2012). 

Socialization tenets may be key to bringing results sought after by the CDC Health People 2020 90% compliance goal among minority groups of healthcare workers.  Participation or compliance with vaccination through the perceptive intel of protecting patient rights through the recovery processes is an effort that will improve the value management processes of protection for vulnerable patient populations.  Vaccinating voluntarily as well as voluntary compliance of handwashing, wearing gloves between patient to patient contact, and adhering to isolation protocols builds social intelligent engagement between agents having opposing beliefs including artificial ones (Herzig, Lorini, & Pearce, 2017).

State wide collaboration may also demonstrate a great awakening when public response to efforts thwart against medical efforts to improve vaccination response rates fall as a result from the intelligence buy in collaboration of healthcare workers.  Organization values and management commitment must share equally with its membership stakeholders, the mission to build a quality healthcare system in this nation.  Its system must then reflect the connection each of its stakeholder share in agreement towards building a better public healthcare system to protect its citizens nationally. Emotional passions and personal experiences designed by moral persuasion have shown rates for vaccination uptake compliance can be improved.  2013 vaccination coverage improved to 75% from previous 2011 of 67% according to CDC reports researchers Thompson, Shay, Zhou, Bridges. Cheng, etal (2010).  The rates revealed that compliance over mandates were possible.  And, continue trending towards a 90% compliance rate.  The goal of the CDC Healthy People 2020 campaign is attainable as more healthcare workers and staff view their participation as a collaborative support for safer patient care environments.

If there is capable leadership and those who are under the influence of EI it can produce amazing collaboration and resolution according many researchers. However, in opposition to these potentials others perceive EI results are mere “constructive use of … emotion” (DuBrin, 2012, p.481).  Imagine these two differences as seen by subordinate members of a group who have these two personalities to follow,  One leader is seen as an authority figure but, not a leader is seen as having a better understanding by the membership.  The individual with the highest level of EI would be described as the person viewed as being aware of the needs of the membership.  And, that title of Leader could apply to either in title alone, but among this group the one possessing the advantage is the individual who receives the emotional trust from the major portion of members in the group.  Identifying this category of leaders within an organization may be difficult since, they aren’t necessarily specified by managerial appointment or designation.  They are recognized in the way their peers and supportive members engage with them.

Systems adopted to measure levels of emotional intelligence such as MSCEIT, its scoring process determines a person’s EI based on a scale identified as a quotient are highly questionable.  For instance, EI opposition questions can a person who is able to control their anger also manipulate this scoring tool?  We can take into consideration that this and more possibilities exists and manipulating these tools are no better guarantee of emotional measuring outside of human perception. Anger management tools as the psychometric assessment HCR-20.  Mayer, Salovey, Caruso & Sitarenios, (2003) contend there are concerns regarding the reliability of such tests yet, they are still used.  Those who challenge the validity of emotional intelligence itself and whether results of any test can provide consistent results have some degree of concerns about the overall capability of leadership.  DuBrin (2012) suggests, oppositional ideas cannot dismiss that some leaders are more efficient in the use of their skills than others who possess those same skills.  This is the ability which must be shared in order to improve a behavior that responds positively to enforcing all nosocomial deterrents.  A connection with people and understand their emotions is necessary to connect better engagement of what makes a better operating system, healthcare’s goal. 

The CDC report for the 2012–2013 influenza season, there was a modest increase in the vaccination coverage rate among healthcare workers from 67% in 2011–2012, to 72% in 2012–2013 to the current 75% coverage. This is still far from reaching the US National Healthy People 2020 goal of 90% hospitals vaccination rates. The reported increase in coverage is attributed to the growing number of healthcare facilities with vaccination requirements with average rates of 96.5%. However, a few other public health interventions stir so much controversy and debate as vaccination mandates. The opposition stems from the belief that a mandatory flu shot policy violates an individual right to refuse unwanted treatment. This article outlines the historic push to achieve higher vaccination rates among healthcare professionals and a number of ethical issues arising from attempts to implement vaccination mandates. It then turns to a review of cognitive biases relevant in the context of decisions about influenza vaccination (omission bias, ambiguity aversion, present bias etc.) The article suggests that a successful strategy for policy-makers and others hoping to increase vaccination rates is to design a “choice architecture” that influences behavior of healthcare professionals without foreclosing other options. Nudges incentivize vaccinations and help better align vaccination intentions with near-term actions.  Evidence from observational studies suggests that a vaccine mandate increases vaccination rates, but evidence on clinical outcomes is lacking. Although challenging, large healthcare employers planning to implement a mandate should develop a strategy to evaluate HCP and patient outcomes. Further studies documenting the impact of HCP influenza vaccination on clinical outcomes would inform decisions on the use of mandatory vaccine policies in HCP.

Risk Factors

In seeking to identify relative risk factors relating to pre-existing health conditions genetics and genetic risk factors are identified to be most hazardous to the body’s immune systems.  Genetic risk factors first acknowledged as comorbidities result in greater challenges for inpatient influenza exposure.  For the asthmatic, pregnant, and respiratory ailment patient, the flu creates a slight delay in the immune system’s response secondary to a pre-existing health deterrent resulting systematically different by case.  An infected person may or may not show signs and symptoms or even the presence of influenza; however, if there are certain pre-existing conditions, which may enhance the infectious course of the disease contagion it may result in the cause death.  According to the CDC new studies highlight ratios of risk for patients who contract other virulent forms of influenza.  Immune systems processes are needed to recognize and code against viral and bacterial infections.  However, the MBL2 gene part of the body’s genetic coding is responsible for producing a coating of mannose binding lectin 2, an enzyme responsible for the body’s chemical system’s complementary pathway.  In adequate levels of response by the MBL2 allows for invasive secondary infections and is frequently found to be abnormally low in cases resulting in fatality (Ferdinands, 2011).

Implications

Recognizing particular noncompliant ideals may provide a broader solution to engulf these concerns regarding preventative outbreak strategies of influenza. However, as we continue to take the bandwagon approach to incrementally improve preventative healthcare maintenance strategies let’s also respond collaboratively to the behavioral risks that interfere with prevention standards of care must be urgently addressed.  The challenge remains according to the Ziegler (2016) study, that refusals go beyond the frequency of regular immunization and behavioral change to stir up and yield high rates of viral flu balances these continue to remain in dispute.  In the January issue of Environmental Health Perspectives researchers argued that exposure to an environment that has limited access to vaccination therapies establishes a correlation between pollutants and viruses which, may increase hazardous risks for viral mutations.  High area pollution will along with such behaviors as smoking, inactive lifestyles leading to obesity, as mentioned earlier will instill “herd affect” behavior when witness by medical personnel noncompliant patterns.  Risk potential among public scrutiny, where vaccination results may appear to not be beneficial, results of sickness may increase to dangerous levels of viral mutations among the public (Kim, Johnstone, & Loeb, 2011). 

Conclusion

The sequence of hazardous risks potentials associated with vaccination resistance, among the role models of healthcare may contribute to the result of vaccination resistance among patients and other noncompliant actors.  It would be inappropriate to bypass this as a possibility, no attempts to expand preventative healthcare strategies to at-risk patient populations can be a result when healthcare workers resent vaccination uptake in their own life status. Their refusal to uptake may extend to choosing not to offer flu shots or other deterrents during their patient care.  Tenacity’s to researched and recorded deterrent practices by overseers of healthcare organizations, public health’s most critical issues regarding viral efficiencies are affecting workplace safety especially in patient-to-patient contact situations.  And, where practicing strict adherence to deterrent strategies to reduce all measurable actions and pandemic threats overcoming and preventing disastrous nosocomial potentials is essential to deploying a fast response in the event of an outbreak.  Collaborative deterrents to improve annual vaccination rate outcomes amongst healthcare workers will set the stage for the CDC’s 2020 Healthy People results.  Targeting vaccination uptake behaviors versus vaccination resistant attacks that offer solutions to improve congruent practices between nosocomial deterrents and external compliances incorporating vaccination.

Yet, continued debates over vaccination uptake versus vaccination resistance as whether shots will provide acceptable protection for personal immune system protection and essential good health-keeping practices, vulnerable population problems have not begun to resolve but, grow.  This discussion synthesizes a valuable need for medical personnel’s embrace of nosocomial deterrent practices.  The effort should stand against threatening potentials of spreading the disease agents within the confines of their direct patient care; environmental participation and cross-contamination.  Recognize the benefits of vaccination uptake over resistance it facilitates evidence-based best practice discussions nationally and must be considered for its potential as a nosocomial deterrent.  HCW should support staff collaboration toward vaccine uptake if feasible and take into consideration its best practice potential to put care for their patient first.

Reference

Bandura, A. (1977). Self-efficacy: toward a unifying theory of behavioral change. Psychological               review, 84(2), 191.   

Bedford, T., Riley, S., Barr, I. G., Broor, S., Chadha, M., Cox, N. J., & … Smith, D. J. (2015).                  Global circulation patterns of seasonal back porch l influenza viruses vary with antigenic 

drift. Nature, 523(7559), 217-220. doi:10.1038/nature14460

Centers for Disease Control. (2017).Weekly U.S. Influenza Surveillance Report [Data  

            file]. Retrieved from  https://www.cdc.gov/flu/weekly/index.htm      

Chuang, J., Huang, A., Liu, W., Chou, M., Chang, J., Chiu, F., . . . Menéndez-arias, Luis. (2012).  

Nationwide Surveillance of Influenza during the Pandemic (2009–10) and Post-Pandemic  

(2010–11) Periods in Taiwan (2009–11 Nationwide Flu Surveillance in Taiwan). PLoS  

ONE, 7(4), E36120.

Cohen, D. L., & Casken, J. (2012). Why are Healthcare Workers so Resistant to the Acceptance 

of Influenza Vaccine? a Review of the Literature to Examine Factors that Influence 

Vaccine Acceptance. International Journal Of Caring Sciences, 5(1), 26-35. Louie, J. K.,  

Cross, A. (2014). Anti-endotoxin vaccines. Virulence, 5(1), 219-225. 

Davis, M. M., & Gaglia, M. A. (2005). Associations of daycare and school entry vaccination 

            requirements with varicella immunization rates. Vaccine, 23(23), 3053-3060.   

DuBrin, A. J. (2012). Ethics and corporate social responsibility:  In essentials of  management. 

Mason,  OH: Cengage Learning.

Ferdinands, J. M. (2011). A Pilot Study of Host Genetic Variants Associated with Influenza- 

associated Deaths among Children and Young Adults1-Volume 17, Number 12—   

December 2011-Emerging Infectious Disease journal-CDC. 

Finkelstein, S., Hedberg, K., Hopkins, J., Hashmi, S., & Larson, R. (2011). Vaccine availability 

in the United States during the 2009 H1N1 outbreak. American  Journal Of Disaster 

Medicine, 6(1), 23-30.

Hennessy, T. W., Bruden, D., Castrodale, L., Komatsu, K., Erhart, L. M., Thompson, D., … the 

Investigative Team. (2016). A Case Control Study of Risk factors for death from 2009 

pandemic Influenza A (H1N1): Is American Indian racial status an independent Risk 

factor? Epidemiology and Infection, 144(2), 315–324. 

http://doi.org/10.1017/S0950268815001211    

Herzig, A., Lorini, E., & Pearce, D. (2017). Social Intelligence. AI & Society,1. 

Hrincius, E. R., Liedmann, S., Finkelstein, D., Vogel, P., Gansebom, S., Ehrhardt, C., & …  

            McCullers, J. A. (2015). Nonstructural Protein 1 (NS1)-Mediated Inhibition of c-Abl  

            Results in Acute Lung Injury and Priming for Bacterial Co-infections: Insights Into 1918    

            H1N1 Pandemic?. Journal Of Infectious Diseases, 211(9), 1418-1428.   \    doi:10.1093/infdis/jiu609

Kaufman, J. (1998). Value management: Creating competitive advantage (Crisp management 

library; 21). Menlo Park, Calif.]: Crisp Publications.    

Kim, T., Johnstone, J., & Loeb, M. (2011). Vaccine herd effect. Scandinavian Journal of  

Infectious Diseases, 43(9), 683-689.

Lieuwe Dijkstra, Hans van der Bij, (2002) “Quality function deployment in healthcare: Methods 

for meeting customer requirements in redesign and renewal”, International Journal of   

Quality & Reliability Management, Vol. 19 Issue: 1, pp.67-89,   

https://doi.org/10.1108/02656710210413453

Naleway, A. L., Henkle, E. M., Ball, S., Bozeman, S., Gaglani, M. J., Kennedy, E. D., & 

Thompson, M. G. (2014). Barriers and facilitators to influenza vaccination and vaccine 

coverage in a cohort of health care personnel. American journal of infection control,

42(4), 371-375.

Rakita, R., Hagar, B., Crome, P., & Lammert, J. (n.d.). Mandatory Influenza Vaccination of 

Healthcare Workers: A 5‐Year Study. Infection Control and Hospital Epidemiology, 

31(9), 881-888. 

Swan, J. (2016). Influenza: Seasonal Flu 2016–2017. 

Thompson, M. G., Shay, D. K., Zhou, H., Bridges, C. B., Cheng, P. Y., Burns, E., … & Cox, N. 

J. (2010). Estimates of deaths associated with seasonal influenza-United States, 1976- 

2007. Morbidity and Mortality Weekly Report, 59(33), 1057-1062.

Ventola, C. L. (2016). Immunization in the United States: Recommendations, Barriers, and 

Measures to Improve Compliance: Part 1: Childhood Vaccinations. P&T: A Peer- 

Reviewed Journal For Managed Care & Formulary Management, 41(7), 426-436.    

Yaqub, O., Castle-Clarke, S., Sevdalis, N., & Chataway, J. (2014). Attitudes to vaccination: a 

critical review. Social Science & Medicine, 112, 1-11. 

Yukl, G. (2010). Leadership in organizations (7th ed.). Upper Saddle River, N.J.: Prentice Hall.

Ziegler, Megan (2016) Vaccines: how requirements and exemptions affect vaccination rates,   

            disease prevalence, and herd immunity within the United States? Master Essay,    

            University of Pittsburgh.

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WRITTEN REPORTS

It’s not hard if you enjoy writing and are good at it.  I’m referring to ghost writing, what’s hard about it is getting paid!  There are endless reasons that make something so pleasant for writers turn ghastly.  If you’ve done your research in an organized manner, do expect to encounter a few disruptions in the trail leading to the bank.  Getting a paycheck is the reason a writer should be “very selective” for whom they write.  Here, are some of my favorite employers:

Visit the Writers Digest Website

The Writer

Writer’s Market

The Renegade Writer

Worldwide Freelance

Poets & Writers

Mashable

to name a few…

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