Elaine Chang is an infection control nurse at a community hospital. She has been in her position for over 6 years, since

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Elaine Chang is an infection control nurse at a
community hospital. She has been in her position for over 6 years,
since finishing her master's degree in community health
nursing.
She has noted that the annual influenza immunization
rate for employees has been decreasing each year after reaching a
high in 2009 of 78%. The rate in 2016 to 2017 dipped under 55% for
all employees. In addition, this past year, there was a large
outbreak of influenza with multiple staff and patients
affected.
Ms. Chang has decided she needs to review the situation
using Pender's Health Promotion Model and develop a plan to educate
staff and increase immunization rates.
1. If Ms. Chang wanted to assess the reasons for the decline in
immunization rates, what types of things should she ask about?
2. Ms. Chang developed a survey that was distributed by each
unit manager. After analyzing her results, she identified three
major reasons that many in the staff declined the flu vaccine:
I. A large number (over 40%) believed that the vaccine might
give them the flu. They believed this because either they or a
family member had become sick with some sort of illness around the
time they took a flu shot.
II. About 25% of those surveyed would have taken the flu
vaccine, but it was only available at the hospital Monday to Friday
between 10 AM and 2 PM.
III. About 10% of those surveyed believed that all vaccines are
bad for one's health because they introduce something unnatural
into the body.
The remainder had a variety of reasons for declining the
vaccine, from religious beliefs to inconvenience.
From Pender's model, what motivational factors might each of
these be?
3. Using Pender's model, what actions might Ms. Chang take to
improve the immunization rates?