8 RESEARCH UPDATE
Complicated grief and Covid vaccine acceptance
Nurses can help patients to resolve complicated grief and reassure those who are unsure about vaccinations , writes Louise Winton Schreuders
Complicated grief in older people
Grief is a natural response for people during the period in which they are adjusting to the death of a loved one .
The ways that people experience grief vary enormously , though there are some emotions and behaviours that are more commonly experienced by those who are grieving . Normally , the process of mourning will lead to adaptation and the bereaved person will adjust and begin to learn to live with the grief of their loss .
Complicated grief is said to occur when a person ’ s grief continues for an extended period of time and begins to affect their daily functioning and quality of life .
Complicated grief has been associated with increased risk of morbidity and mortality ( ill-health and death ). The mechanisms that might explain this association are not yet fully understood .
Authors Annie Peng and Susan Renz describe how older people are at particular risk for complicated grief , in a narrative review . They also note that studies suggest experiences of complicated grief may not be recognised in older adults living in long-term care settings .
Research has revealed there are physiological changes associated with grief , including functional changes , as well as cardiovascular changes and harmful changes to the body ’ s stress response .
Health professionals in primary care have an important role in supporting people to achieve a healthy adaptation to their grief . Between 30 % and 50 % of older adults seek grief support from health professionals in primary care before or after their bereavement . Screening tools have been validated that can support primary care health professionals in their important role of identifying grief early to help the patient adapt . When complicated grief is identifi ed or suspected , the primary care health professional can provide support , referral and encouragement to access treatments to help the patient resolve the effects of their complicated grief and facilitate their adaptation .
Reference Perng A , Renz S . Identifying and treating complicated grief in older adults . The Journal for Nurse Practitioners 2018 ; 14 : 289-95
Louise Winton Schreuders is a postdoctoral research fellow in health and social care workforce at the University of Leeds
Vaccine acceptance , vaccine hesitancy
Vaccination is a globally recognised health intervention strategy that has been instrumental in improving population health outcomes and life expectancy . In 2020 and 2021 , the years of the Covid-19 pandemic , hopes for return to normal life have hinged on the development and distribution of a vaccine to protect against this novel coronavirus .
Despite the hardships faced by communities worldwide due to the pandemic , Jeffrey Lazarus and colleagues found future vaccine acceptance of a safe and effective Covid-19 vaccine varied in a survey of 13,426 people across 19 countries .
In the majority of countries , at the time of data collection , the observed levels of vaccine acceptance would not be enough to achieve community immunity . Further developments since data collection indicate acceptance may have fallen even further .
We have an opportunity to learn from earlier studies of vaccine hesitancy , an issue identifi ed by the World Health Organization in the top 10 threats to global public health in 2019 . Noni MacDonald and colleagues identify that vaccine hesitancy is hugely varied , risk perception and vaccine decision-making are often strongly infl uenced by emotions and beliefs , rather than facts . Primary care health practitioners are highly trusted and make a signifi cant contribution to vaccine acceptance .
It is important primary care health practitioners do not dismiss the concerns of people who are hesitant about vaccination and use effective communication strategies to understand the specifi c reasons behind a person ’ s hesitancy because reasons may vary widely .
Once these reasons have been diagnosed , targeted respectful and evidence-based approaches can be used to break down the barriers to vaccine acceptance .
Reference Lazarus J , Ratzan S , Palayew A et al . A global survey of potential acceptance of a Covid-19 vaccine . Nature Medicine 2020 1124-9 rdcu . be / cdcKX MacDonald N , Budler R , Dubé E . Addressing barriers to vaccine acceptance : an overview . Human Vaccines & Immunotherapies 2018 ; 14:218-4 nursinginpractice . com Winter 2021