Shellie Ray CRNP
Health Promotion-Shingles ImmunizationShellie RayAuburn University/ Auburn University MontgomeryHealth Promotion-Shingles ImmunizationNurse Practitioners play a major role in promoting health with their patients. What is health? According to the World Health Organization (2011), health is defined as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” Nurse Practitioners fulfill this role of health promotion by ordering health screenings, prescribing preventive therapies such as immunizations, promoting lifestyle changes such as weight loss and smoking cessation, and educating patients on disease prevention. Health promotion provides learning experiences that enhances awareness, increases motivation, and builds skills to enable a person to take control of their health, and ideally improve their health and prevent disease. The health promotion topic that will be discussed in this paper is the importance of the shingles vaccination in the elderly.ShinglesShingles (herpes zoster) is a painful, blistering skin rash caused by the varicella-zoster virus, the same virus that causes chickenpox. If you had chickenpox, the virus becomes dormant in the cells of the nervous system and may not cause problems for many years. You can develop shingles at any age, however as you age your immune system weakens so your risk of developing shingles increases with age. This virus is different from the chickenpox in the fact that you cannot catch shingles from anyone; however, if anyone has contact with the shingles and did not have chickenpox as a child or the chickenpox vaccine, they can develop chickenpox, not shingles. Persons mostly at risk for developing shingles are those individuals older than 60, those who had the chickenpox before age 1, and those with weakened immune systems. The initial symptom of shingles is usually a unilateral pain on the body. It is described as a burning or shooting pain that is tingling or itchy and can be moderate to severe. A rash appears as a red patch followed by small blisters. The rash often extends from the spine around to the abdomen/chest area however the rash may appear on the face, eyes, mouth and ears. The blisters eventually break and form dry crusty areas which fall off in 2-3 weeks. Additional symptoms experienced with a shingles outbreak may include: abdominal pain, fever, chills, headache, body aches and joint pain, swollen lymph nodes and genital sores. If the rash appears on the face the following symptoms may appear: difficulty moving some muscles in the face, drooping of the eyelid, hearing loss, loss of eye motion, vision and taste problems. The pain of shingles may last for weeks, months or even years after the blisters have healed. One in four people will experience one or more complications of shingles (Johnson, Bouhassira, & Kassianos, 2010). Complications include: post herpetic neuralgia (PHN), scarring, bacterial super infection, pneumonia, cranial and motor neuron palsies, visual impairment, and hearing loss. PHN is a chronic pain that follows shingles that can last months, even years.There is no cure for shingles. When diagnosed early your health care provider can prescribe medications that can help fight the virus and control the pain. The best treatment against shingles is a vaccination that may prevent shingles or lessen its effects. The Advisory Committee on Immunization Practices of the Centers for Disease Control (2011) recommends Zostavax for people 60 years and older to help prevent shingles. According to the National Immunization Survey, approximately 78% of patients ages 60 and older reported they would get the shingles vaccination if their health care provider recommended it (Lu, Harpaz, & Jumaan, 2009). This is a one-time vaccination and there is no maximum age for getting the vaccine. The vaccine should be given regardless of whether they can recall ever having the chickenpox. Individuals who have had the shingles should still get vaccinated to help prevent future occurrences of the disease. There are individuals who should not get the shingles vaccine. Any individual with a weakened immune system due to disease, medications, or cancer treatments with chemotherapy or radiation should not be vaccinated. If one has ever had a severe allergic reaction to gelatin, the antibiotic neomycin, or any other component of the shingles vaccine should not be vaccinated. Also pregnant women should not receive the vaccine.No serious problems have been identified with the shingles vaccine. Common side effects are redness, soreness, swelling or itching at the injection site and headache. Some individuals may develop a chickenpox like rash around the injection site which should be covered with a bandage until the rash disappears. It is safe to be around infants, children, pregnant women and those with weakened immune systems after you get the vaccine.Health Promotion ProjectImplementationThe project was implemented at Anniston Family Practice under the preceptorship of Jeannie Stanko CRNP. This clinic sees a large number of elderly patients and during the month of October, all patients with Blue Cross Blue Shield Blue Advantage had a health risk assessment (HRA) and wellness exam. These HRA’s were conducted by the CRNP and student NP in the clinic. This included a lengthy interview process which was conducted by the student. While reviewing immunization status with the patients, it was noted by the student that most patients were educated regarding influenza and pneumonia vaccinations but lacking in knowledge regarding the shingles vaccination. Many patients were under the impression that if they had the chickenpox as a child that they could not get the shingles. Others reported that they had already had an outbreak of shingles so they did not need to have the vaccination. This provided an area of need for health promotion and education. DesignThe design of the project is focused on clinic visits in individuals ages 60 and older seen by the nurse practitioner student during a week in October. The goal is to educate all individuals over the age of 60 with information on the shingles vaccine so that they can make an educated decision regarding whether or not they will receive the shingles vaccination. Education will be provided by the student on the shingles virus including how one acquires the shingles, symptoms, and complications. Education also provided regarding the shingles vaccine, individuals who should not receive the vaccine, and side effects. A brochure is given to the patient with information regarding shingles and the vaccination. The patients have the opportunity to receive the vaccination during the clinic visit if they choose to do so.DeliveryNola Pender’s Health Promotion Model was used to design the health promotion project. The purpose of this model is to help nurses in understanding the major determinants of health behaviors as a basis for behavioral counseling to promote a healthy lifestyle (Pender, Murdaugh, & Parsons, 2011). There are three components to this model: individual characteristics and experiences, behavior-specific cognitions and affect, and behavioral outcomes. The first component, individual characteristic and experiences would include previous experience with vaccinations, family and friends experience with the shingles vaccine, and their view on vaccinations. Have they had good experiences in the past? The second component, behavior-specific cognitions and affect would include their perceptions of the positive/negative effects of the vaccination, cost of vaccination, and their opinions regarding health promotion. The third component of the model, behavioral outcomes, would be their desired outcome with receiving the shingles vaccination.EvaluationDuring the week that the health promotion project was implemented, 15 patients were educated on the shingles vaccine. An evaluation survey was constructed by the student and given to each patient. Questions were asked as followed: 1. Was the material presented in a format that you could understand?2. Was the education provided sufficient to answer questions regarding shingles?3. In your opinion, has the instructor provided you with information to help you decide on whether or not you will receive the shingles vaccine?4. Were the training aids (brochure) helpful?5. What are some other health topics you would be interested in learning more about?As a result of the education 12 patients decided to receive the vaccine. One patient was unable to receive the vaccine due to allergies to components in the vaccine. Another patient was not vaccinated due to immunosuppression due to steroids she took for lupus. The last patient chose to receive the flu and pneumonia vaccination and under collaboration with the CRNP the decision was made for the patient to return to the clinic in 4 weeks for the shingles vaccination. The patients receiving the vaccine were given Zostavax 0.65 ml SQ injection to the deltoid region of the upper arm.ConclusionNurse practitioners play a major role in the health of their patients. Health education and promotion issues should be addressed with patients during every clinic visit. Nurse practitioners assume the role as patient educators and are responsible to our patients to provide education regarding health maintenance and disease prevention. Nurse practitioners empower individuals to become active participants in their health care and encourage them to participate in decisions regarding their healthcare. The evidence of these roles was identified during the student’s health risk assessments where a need was identified regarding the shingles vaccination. Patients were not educated regarding the vaccination as evidence by their incorrect information of the virus. Education was provided through verbal teaching and an information brochure. Patients reported satisfaction with the education and most were immunized.ReferencesCenters For Disease Control 2011 Shingles Vaccination: What You Need to KnowCenters for Disease Control (2011, January). Shingles Vaccination: What You Need to Know. Retrieved November 2, 2012, from 201211021309221273604632Johnson R W Bouhassira D Kassianos G 2010 impact of her.pes zoster and post-herpetic neuralgia on quality-of-life.Johnson, R. W., Bouhassira, D., & Kassianos, G. (2010). The impact of herpes zoster and post-herpetic neuralgia on quality-of-life. BMC Medicine, 8(37). 201211090828241701796770Lu P J Harpaz R Jumaan A O 2009 Herpes zoster vaccination among adults aged 60 years and older in the United States. 2007: Uptake of the first new vaccine to target seniors.Lu, P. J., Harpaz, R., & Jumaan, A. O. (2009). Herpes zoster vaccination among adults aged 60 years and older in the United States. 2007: Uptake of the first new vaccine to target seniors. Vaccine, 27(6), 882-887. 20121109082100873222709Pender N J Murdaugh C L Parsons M A 2011 Health Promotion in Nursing PracticePender, N. J., Murdaugh, C. L., & Parsons, M. A. (2011). Health Promotion in Nursing Practice (6th ed.). Boston, MA: Pearson. 20121102123400504448294World Health Organization 2011 Definition of healthWorld Health Organization (2011). Definition of health. Retrieved November 2, 2012, from 20121102131642150658011 ................
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