Running head: SHINGLES IMMUNIZATION
Health Promotion-Shingles Immunization
Shellie Ray
Auburn University/ Auburn University Montgomery
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Health Promotion-Shingles Immunization
Nurse 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.
Shingles
Shingles (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
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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.
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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 Project
Implementation
The 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.
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Design
The 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.
Delivery
Nola 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, behaviorspecific 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.
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Evaluation
During 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.
Conclusion
Nurse 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
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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.
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References
Centers for Disease Control (2011, January). Shingles Vaccination: What You Need to Know.
Retrieved November 2, 2012, from http://http://www.cdc.gov/vaccines/vpdvac/shingles/vacc-need-know.htm
Johnson, R. W., Bouhassira, D., & Kassianos, G. (2010). The impact of herpes zoster and postherpetic neuralgia on quality-of-life. BMC Medicine, 8(37).
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.
Pender, N. J., Murdaugh, C. L., & Parsons, M. A. (2011). Health Promotion in Nursing Practice
(6th ed.). Boston, MA: Pearson.
World Health Organization (2011). Definition of health. Retrieved November 2, 2012, from
http://www.who.int/about/definition/en/print.html
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