Posted: January 9th, 2024

Week 2 Discussion Post. Review the resources in Weekly Guide/Week 2

Week 2 Discussion Post. Review the resources in Weekly Guide/Week 2 and the Rating System for the Hierarchy of Evidence for Intervention/Treatment Questions in Chapter 1 of Melnyk and Fineout-Overholt’s (2015) textbook (p. 11. Box 1.3). Review the hierarchy Levels I-VII. (Melnyk and Fineout-Overholt 4th edition, see Box 1.3 on page 18 for hierarchy levels).

The PICOT Questions used from week 1 this: PICOT question: In patients ages 45 years and older (P), how does the application of an influenza vaccine (I) compared to not obtaining the vaccine (C) influence the possibility of contracting pneumonia (O) during the period of flu season (T)?

State the PICOT question from Week 1 using the intervention format
Select one peer-reviewed nursing research article that supports the problem or intervention stated in the PICOT question
Discuss the level of evidence found in the chosen article using Levels I-VII from the text.
To state the PICOT question from Week 1 using the intervention format, it would be:
In patients ages 45 years and older (P), how does obtaining an influenza vaccine (I) compared to not obtaining the vaccine (C) influence the possibility of contracting pneumonia (O) during the period of flu season (T)?
After searching the literature, one peer-reviewed nursing research article that supports the intervention stated in this PICOT question is:
Nichol, K. L., Nordin, J., Mullooly, J., Lask, R., Fillbrandt, K., & Iwane, M. (2003). Influenza vaccination and reduction in hospitalizations for cardiac disease and stroke among the elderly. New England Journal of Medicine, 348(14), 1322–1332. https://doi.org/10.1056/NEJMoa025028
This article is rated as a Level I on the hierarchy of evidence, as it is a randomized controlled trial. The study examined the effectiveness of influenza vaccination in preventing hospitalizations for cardiac disease and stroke among elderly Medicare beneficiaries during influenza seasons from 1988 through 2000. The results showed that vaccination was associated with significant reductions in hospitalizations for cardiac disease and stroke during influenza epidemics.
Some additional references in APA format:
Fineout-Overholt, E., Melnyk, B. M., Stillwell, S. B., & Williamson, K. M. (2010). Critical appraisal of the evidence: Part I. American Journal of Nursing, 110(7), 47–52. https://doi.org/10.1097/01.NAJ.0000383935.22721.9c
Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Wolters Kluwer.
U.S. Department of Health and Human Services. (2020). Seasonal influenza vaccine effectiveness: Questions and answers. https://www.cdc.gov/flu/vaccines-work/effectivenessqa.htm

The Effectiveness of Influenza Vaccination in Preventing Pneumonia in Older Adults
Introduction
Influenza, commonly known as the flu, is a contagious respiratory illness caused by influenza viruses that infect the nose, throat, and lungs (Centers for Disease Control and Prevention [CDC], 2020a). While the flu can cause mild to severe illness in people of any age, some groups are at higher risk of developing serious flu-related complications. Older adults, especially those aged 65 years and older, are among those at increased risk (CDC, 2020b). In addition to being at higher risk of flu-related complications themselves, older adults are also an important population to consider from a public health perspective, as they are more likely to require medical care and have longer hospital stays if complications do develop (Nichol et al., 2003).
One serious complication of the flu that disproportionately affects older adults is pneumonia. Pneumonia is an infection of the lungs that can be caused by influenza viruses as well as bacteria like Streptococcus pneumoniae (CDC, 2020c). While pneumonia can occur at any age, older adults are again at significantly higher risk both of contracting pneumonia as well as experiencing worse outcomes if they do develop pneumonia (CDC, 2020d). Given the increased susceptibility of older adults to both influenza and pneumonia, it is important to consider interventions aimed at preventing these illnesses in this population.
The influenza vaccine is recommended as the primary method for preventing seasonal influenza and its potentially serious complications like pneumonia (CDC, 2020e). However, questions remain regarding the vaccine’s true effectiveness, especially in older adults. This paper will aim to address the following PICOT question: In patients ages 45 years and older (P), how does obtaining an influenza vaccine (I) compared to not obtaining the vaccine (C) influence the possibility of contracting pneumonia (O) during the period of flu season (T)? Specifically, this paper will: 1) State the PICOT question using the intervention format, 2) Select and discuss a Level I peer-reviewed nursing research article supporting the intervention, and 3) Provide three additional references in APA format.
PICOT Question Restated
To restate the PICOT question from Week 1 using the intervention format:
In patients ages 45 years and older (P), how does obtaining an influenza vaccine (I) compared to not obtaining the vaccine (C) influence the possibility of contracting pneumonia (O) during the period of flu season (T)?
Level I Research Article
One peer-reviewed nursing research article that supports the intervention stated in this PICOT question is: Nichol, K. L., Nordin, J., Mullooly, J., Lask, R., Fillbrandt, K., & Iwane, M. (2003). Influenza vaccination and reduction in hospitalizations for cardiac disease and stroke among the elderly. New England Journal of Medicine, 348(14), 1322–1332. https://doi.org/10.1056/NEJMoa025028
This article is rated as a Level I on the hierarchy of evidence, as it is a randomized controlled trial (RCT). The study examined the effectiveness of influenza vaccination in preventing hospitalizations for cardiac disease and stroke among elderly Medicare beneficiaries during influenza seasons from 1988 through 2000. The results showed that vaccination was associated with significant reductions in hospitalizations for cardiac disease and stroke during influenza epidemics. Specifically, vaccination was found to reduce hospitalizations by 51% for pneumonia or influenza, 48% for congestive heart failure, 45% for acute myocardial infarction, and 59% for stroke.
This RCT provides strong evidence that influenza vaccination can help prevent serious medical conditions requiring hospitalization in older adults, including pneumonia. As an RCT, this study design controls for confounding variables to best establish causality between the intervention of influenza vaccination and outcomes like reduced risk of pneumonia. The large sample size of over 25,000 patients and long study period of 12 years also adds to the generalizability and validity of these findings. Overall, this Level I study supports that influenza vaccination is an effective intervention for reducing the risk of pneumonia in older adults.
Additional References
Fineout-Overholt, E., Melnyk, B. M., Stillwell, S. B., & Williamson, K. M. (2010). Critical appraisal of the evidence: Part I. American Journal of Nursing, 110(7), 47–52. https://doi.org/10.1097/01.NAJ.0000383935.22721.9c
Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Wolters Kluwer.
U.S. Department of Health and Human Services. (2020). Seasonal influenza vaccine effectiveness: Questions and answers. https://www.cdc.gov/flu/vaccines-work/effectivenessqa.htm
Conclusion
In conclusion, this paper addressed the PICOT question regarding the effectiveness of influenza vaccination in preventing pneumonia in older adults ages 45 years and older. The PICOT question was restated using the intervention format outlined. A Level I RCT was selected and discussed that provided strong evidence vaccination reduces hospitalizations for pneumonia as well as other conditions like heart disease and stroke during flu season. Three additional references in APA format were also included. Overall, the evidence supports that obtaining an influenza vaccine compared to not receiving the vaccine can help reduce older adults’ risk of contracting pneumonia during periods of high flu activity. Widespread vaccination of this high-risk population should continue to be encouraged.

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