BackgroundSchool-located influenza vaccination (SLIV) programs can substantially enhance the sub-optimal coverage achieved under existing delivery strategies. Randomized SLIV trials have shown these programs reduce laboratory-confirmed influenza among both vaccinated and unvaccinated children. This work explores the effectiveness of a SLIV program in reducing the community risk of influenza and influenza-like illness (ILI) associated emergency care visits.MethodsFor the 2011/12 and 2012/13 influenza seasons, we estimated age-group specific attack rates (AR) for ILI from routine surveillance and census data. Age-group specific SLIV program effectiveness was estimated as one minus the AR ratio for Alachua County versus two comparison regions: the 12 county region surrounding Alachua County, and all non-Alachua counties in Florida.ResultsVaccination of ∼50% of 5–17 year-olds in Alachua reduced their risk of ILI-associated visits, compared to the rest of Florida, by 79% (95% confidence interval: 70, 85) in 2011/12 and 71% (63, 77) in 2012/13. The greatest indirect effectiveness was observed among 0–4 year-olds, reducing AR by 89% (84, 93) in 2011/12 and 84% (79, 88) in 2012/13. Among all non-school age residents, the estimated indirect effectiveness was 60% (54, 65) and 36% (31, 41) for 2011/12 and 2012/13. The overall effectiveness among all age-groups was 65% (61, 70) and 46% (42, 50) for 2011/12 and 2012/13.ConclusionWider implementation of SLIV programs can significantly reduce the influenza-associated public health burden in communities.

School-based influenza immunization programs are increasingly recognized as a key component of community-based efforts to control annual influenza epidemics. Computer modeling suggests that immunizing 70% of schoolchildren could protect an entire community from the flu. Most of the school-based influenza immunization programs described in the literature have had support from industry or federal grants. This article describes a program that used only community resources to administer live, attenuated influenza vaccine supplied by the state health department. Beginning in 2006, the Alachua County Health Department and school system, working in collaboration with the University of Florida, began exploration of a non-mandatory community-wide school-based influenza immunization program, with the goal of achieving high levels of immunization of the ~22,000 public and private pre-K through grade 8 students in the county. In 2009-10 the program was repeated. This report describes the procedures developed to achieve the goal, the barriers that were encountered, and solutions to problems that occurred during the implementation of the program. Preliminary data suggest that the crude immunization rate in the schools was approximately 55% and that at least 10% more students were immunized by their health providers. At an operational level, it is possible to achieve high immunization rates if the stakeholders share a common vision and there is extensive community involvement.

Informal caregiving occurs among communities in all socioeconomic strata and is largely provided by women. Although an extensive amount of research focusing on caregiver burden has been conducted within nursing, little is known about informal caregiving among low-income women, particularly within the context of welfare reform. This study examined the extent of informal caregiver burden in low-income women transitioning off welfare and the relationship between informal caregiving and maintaining employment. A random sample of 32 adults who had recently received welfare was obtained (n = 31 women), although there was significant difficulty locating potential subjects. Sixty-three percent of participants were providing nonparental forms of informal caregiving. Caregiver burden scores among this group were highest in the time-dependence dimension of caregiving. Over 30% of participants reported having to leave a job within the past year because of their caregiving responsibilities. These findings suggest that the informal caregiving responsibilities of low-income women may be an overlooked aspect of welfare reform policy. Given the emphasis on case management and policy advocacy in their roles, public health nurses are uniquely positioned to partner with local welfare-to-work organizations, educate program staff, and further develop existing assessment processes to better address caregiving responsibilities within low-income families.

The need for palliative care is growing along with a rapidly aging population. To meet this need, the American Association of Colleges of Nursing developed palliative care competencies that all nurses should achieve before graduation. Many of these competencies rely on direct experience in caring for patients facing serious illness, leading to an increased emphasis on experiential learning in nursing curricula. Experiential learning is the process of creating knowledge through transformative experiences outside the traditional classroom setting. The Comfort Shawl Project is a service learning project that provides senior nursing students with a yearlong immersion in palliative care. Experiential learning activities include attending the interdisciplinary palliative care team meeting, gifting handcrafted shawls to patients, writing reflections, participating in extracurricular events, and sharing the impact of the project through written papers and presentations. The project has been successful in helping nursing students achieve palliative care competencies, including communicating effectively and compassionately with patients and families and recognizing one’s own beliefs about serious illness and death. This project addresses the need to achieve primary palliative care competencies for nursing students. Clinical experiences in palliative care are vital to supplementing didactic learning, and this project could be replicated in a variety of academic settings.