孕婦接種流感疫苗－護理人員的因應策略探討

Exploring Coping Strategies of Nursing Staff for Influenza Vaccination Among Pregnant Women

10.6224/JN.201908_66(4).10

張雅雯(Ya-Wen CHANG)；周汎澔(Fan-Hao CHOU)；簡淑媛(Shu-Yuan JIAN)

流感疫苗 ； 疫苗接種 ； 孕婦 ； 護理人員 ； 因應策略 ； influenza vaccine ； vaccination ； pregnant women ； nursing staff ； coping strategy

護理雜誌

66卷4期（2019 / 08 / 01）

79 - 86

繁體中文

孕婦接種流感疫苗除了能夠有效降低孕婦罹患流感的風險及衍生後續併發症的危險外，所產生的抗體亦可保護出生6個月內的新生兒免於流感威脅。許多研究顯示流感疫苗對孕婦及胎兒是安全且有益的，世界衛生組織及國家防疫政策也皆建議孕婦接種，但國內孕婦對於接種流感疫苗的意願仍普遍偏低。鑑於護理人員在孕婦接種流感疫苗執行策略上有著舉足輕重的第一線角色，本文將從實務面上探討如何強化護理人員的專業能力及服務效能，以提升疫苗接種的覆蓋率（coverage rate），相關建議包括提升護理人員與孕婦對接種流感疫苗的專業知識及正面態度、加強孕婦及其家屬的衛教品質與溝通技巧、落實孕婦流感疫苗接種嚴重疫苗不良事件通報機制及正確訊息等，期能藉此強化孕婦對接種流感疫苗的信心及意願，以維護母體與胎兒的健康。

Influenza vaccinations may decrease the risk of contracting influenza and its complications significantly in pregnant women and effectively help infants less than six months of age avoid hospitalization. Based on scientific evidence supporting the safety and benefits of the influenza vaccination for pregnant women and fetuses, the epidemic prevention policy of both the World Health Organization and Taiwan's Ministry of Health and Welfare recommend that pregnant women receive the influenza vaccination. However, low acceptance of the influenza vaccine among pregnant women is an ongoing concern in Taiwan. Nursing staffs play a key role in implementing the influenza vaccination program for pregnant women. Therefore, strengthening the professional competency and service effectiveness of nursing staffs may be expected to significantly improve the vaccination coverage rate. This article offers practical methods for achieving this, including promoting nursing staffs' professional knowledge and positive attitudes regarding influenza vaccinations for pregnant women, improving nursing staffs' related education and skills in communication with pregnant women and their families, and improving the implementation of the notification mechanism for disseminating accurate information regarding the vaccine and vaccine adverse events. Our ultimate goal is to enhance the confidence and willingness of pregnant women with regard to receiving influenza vaccinations in order to promote the health of mothers and their fetuses.

1. Bisset, K. A.,Paterson, P.(2018).Strategies for increasing uptake of vaccination in pregnancy in high-income countries: A systematic review.Vaccine,36(20),2751-2759.
2. Eick, A. A.,Uyeki, T. M.,Klimov, A.,Hall, H.,Reid, R.,Santosham, M.,O’Brien, K. L.(2011).Maternal influenza vaccination and effect on influenza virus infection in young infants.Archives of Pediatrics & Adolescent Medicine,165(2),104-111.
3. Ellingson, M.,Chamberlain, A. T.(2018).Beyond the verbal: Pregnant women's preferences for receiving influenza and Tdap vaccine information from their obstetric care providers.Human Vaccines & Immunotherapeutics,14(3),767-771.
4. Håberg, S. E.,Trogstad, L.,Gunnes, N.,Wilcox, A. J.,Gjessing, H. K.,Samuelsen, S. O.,Stoltenberg, C.(2013).Risk of fetal death after pandemic influenza virus infection or vaccination.The New England Journal of Medicine,368(4),333-340.
5. Jamieson, D. J.,Honein, M. A.,Rasmussen, S. A.,Williams, J. L.,Swerdlow, D. L.,Biggerstaff, M. S.,Olsen, S. J.(2009).H1N12009 influenza virus infection during pregnancy in the USA.The Lancet,374(9688),451-458.
6. Lutz, C. S.,Carr, W.,Cohn, A.,Rodriguez, L.(2018).Understanding barriers and predictors of maternal immunization: Identifying gaps through an exploratory literature review.Vaccine,36(49),7445-7455.
7. MacDougall, D. M.,Halperin, S. A.(2016).Improving rates of maternal immunization: Challenges and opportunities.Human Vaccines & Immunotherapeutics,12(4),857-865.
8. Marsh, H. A.,Malik, F.,Shapiro, E.,Omer, S. B.,Frew, P. M.(2014).Message framing strategies to increase influenza immunization uptake among pregnant African American women.Maternal and Child Health Journal,18(7),1639-1647.
9. McCarthy, E. A.,Pollock, W. E.,Nolan, T.,Hay, S.,McDonald, S.(2012).Improving influenza vaccination coverage in pregnancy in Melbourne 2010-2011.Australian and New Zealand Journal of Obstetrics and Gynaecology,52(4),334-341.
10. Mertz, D.,Geraci, J.,Winkup, J.,Gessner, B. D.,Ortiz, J. R.,Loeb, M.(2017).Pregnancy as a risk factor for severe outcomes from influenza virus infection: A systematic review and meta-analysis of observational studies.Vaccine,35(4),521-528.
11. Nunes, M. C.,Madhi, S. A.(2018).Prevention of influenzarelated illness in young infants by maternal vaccination during pregnancy.F1000Research,7,122.
12. Office of Disease Prevention and Health Promotion. (2008). Increase the percentage of pregnant women who are vaccinated against seasonal influenza. Retrieved from https://www.healthypeople.gov/node/4660/data_details
13. Panda, B.,Stiller, R.,Panda, A.(2011).Influenza vaccination during pregnancy and factors for lacking compliance with current CDC guidelines.The Journal of Maternal-Fetal & Neonatal Medicine,24(3),402-406.
14. Song, Y.,Zhang, T.,Chen, L.,Yi, B.,Hao, X.,Zhou, S.,Greene, C.(2017).Increasing seasonal influenza vaccination among high risk groups in China: Do community healthcare workers have a role to play?.Vaccine,35(33),4060-4063.
15. Vishram, B.,Letley, L.,Jan Van Hoek, A.,Silverton, L.,Donovan, H.,Adams, C.,Campbell, H.(2018).Vaccination in pregnancy: Attitudes of nurses, midwives and health visitors in England.Human Vaccines & Immunotherapeutics,14(1),179-188.
16. Wiley, K. E.,Massey, P. D.,Cooper, S. C.,Wood, N. J.,Ho, J.,Quinn, H. E.,Leask, J.(2013).Uptake of influenza vaccine by pregnant women: A cross-sectional survey.The Medical Journal of Australia,198(7),373-375.
17. World Health Organization(2012).Vaccines against influenza WHO position paper - November 2012.Weekly Epidemiological Record,87(47),461-476.
18. Zaman, K.,Roy, E.,Arifeen, S. E.,Rahman, M.,Raqib, R.,Wilson, E.,Steinhoff, M. C.(2008).Effectiveness of maternal influenza immunization in mothers and infants.The New England Journal of Medicine,359(15),1555-1564.
19. 台灣護理學會（2018）．護理師是預防接種的主要倡導者─ 強化教育、覆蓋率及安全性． 取自https://www.twna.org.tw/frontend/un07_international/webPages_1/file/2018/20180424_cht.pdf [Taiwan Nurses Association. (2018). The main advocates of vaccinations are nurses-Education reinforcement, coverage, and safety. Retrieved from https://www.twna.org.tw/frontend/un07_international/web Pages_1/file/2018/20180424_cht.pdf]
20. 行政院性別平等會（2019）．95年後之孕婦產前檢查之平均利用率． 取自https://www.gender.ey.gov.tw/gecdb/Stat_Statistics_DetailData.aspx?sn=iGZNg9VGCQqgVUqoT%2FiZ7w%3D%3D [Gender Equality Committee of the Executive Yuan. (2019). Average utilization rate of prenatal care among pregnant women after 2006.Retrieved from https://www.gender.ey.gov.tw/gecdb/Stat_Statistics_DetailData.aspx?sn=iGZNg9VGCQqgVUqoT%2FiZ7w%3D%3D]
21. 邵亦, Y.(2010)。台新流感接種不良反應多—民眾心慌。新紀元周刊，156
22. 疾病管制署（2016，8月31日）．104年度流感疫苗接種計畫成果．取自http://bit.ly/2UiPeF4 [Centers for Disease Control, Taiwan, ROC. (2016, August 31). 2015 influenza vaccination program results. Retrieved from http://bit.ly/2UiPeF4]
23. 疾病管制署（2011）．認識流感疫苗． 取自https://www.cdc.gov.tw/uploads/files/9229ebe8-c089-4ab3-980afe0e38b1d16f.pdf [Centers for Disease Control, Taiwan, ROC. (2011). Influenza vaccine. Retrieved from https://www.cdc.gov.tw/uploads/files/9229ebe8-c089-4ab3-980afe0e38b1d16f.pdf]
24. 疾病管制署（2017，8月31日）．105年度流感疫苗接種計畫成果．取自http://bit.ly/2UkXtR2 [Centers for Disease Control, Taiwan, ROC. (2017, August 31). 2016 influenza vaccination program results. Retrieved from http://bit.ly/2UkXtR2]
25. 疾病管制署（2019a）．傳染病統計資料查詢系統．取自https://nidss.cdc.gov.tw/ch/ [Centers for Disease Control, Taiwan, ROC. (2019a). Taiwan National Infectious Diseases Statistics System. Retrieved from https://nidss.cdc.gov.tw/ch/]
26. 疾病管制署（2015，8月31日）．103年度流感疫苗接種計畫成果．取自http://bit.ly/2UjQiZo [Centers for Disease Control, Taiwan, ROC. (2015, August 31). 2014 influenza vaccination program results. Retrieved from http://bit.ly/2UjQiZo]
27. 疾病管制署（2019b）．預防接種受害救濟相關規定．取自https://www.cdc.gov.tw/professional/list.aspx?treeid=5b0231beb94edffc&nowtreeid=6aad42cc03fc0a6c [Centers for Disease Control, Taiwan, ROC. (2019b). Regulations governing the vaccine injury compensation program.Retrieved from https://www.cdc.gov.tw/professional/list.aspx?treeid=5b0231beb94edffc&nowtreeid=6aad42cc03fc0a6c]
28. 疾病管制署（2014，9月23日 ）．10月1日起公費流感疫苗開打，孕婦及50歲以上慢性病患也受惠．取自https://www.cdc.gov.tw/Bulletin/Detail/wE5_wlnwGVeMMsM0iJSBuA?typeid=9 [Centers for Disease Control, Taiwan, ROC. (2014, September 23). Pregnant women and chronic patients over 50 years of age eligible to receive government-funded influenza vaccination from October 1st, 2014. Retrieved from https://www.cdc.gov.tw/Bulletin/Detail/wE5_wlnwGVeMMsM0iJSBuA?typeid=9]
29. 郭秀娥, H. O.,林惠賢, H. S.,周心寧, H. N.,康慧怡, H. Y.,張肇松, C. S.,沈孟娟, M. C.(2009)。醫療機構工作人員對流感與流感疫苗的認知，態度及接種流感疫苗行為之探討。感染控制雜誌，19(2)，69-80。
30. 陳孟妤, M. Y.,黃薇伊, W. I.,陳逸瑄, Y. H.,黃婉婷, W. T.(2017)。2015年臺灣醫療人員對季節性流感疫苗接種後不良事件之知識，態度與行為調查。疫情報導，33(17)，315-323。
31. 廖盈婷（2006，1月22日）．五千護士拒打疫苗—防疫現空窗期．TVBS新聞． 取自https://news.tvbs.com.tw/focus/377095 [Liao, Y. T. (2006, January 22). 5000 nurses refused to vaccinate so that there was a possibility of epidemic prevention window period. TVBS News. Retrieved from https://news.tvbs.com.tw/focus/377095]
32. 蔡容喬（2018，10月30日）．眼尖發現⋯護理師打針前「驚見白膜漂浮」．聯合新聞網．取自https://udn.com/news/story/11311/3449816 [Tasi, R. Q. (2018, October 30). Nurse sees white floating blotch prior to giving influenza vaccination. Und.com. Retrieved from https://udn.com/news/story/11311/3449816]