Improving Influenza Vaccination Rates Among Pediatric Hematology and Oncology Inpatients

Ashley Duvall


Pediatr Nurs. 2019;45(3):142-154+ (box o. 

In This Article

Theoretical Framework

Lewin's Change Theory provides a model to guide successful change and has been widely used in clinical practice and other healthcare operations (Shirey, 2013). This theory is based upon three key concepts: unfreeze, change, and refreeze (Shirey, 2013). The theory proposition from Lewin's Change Theory is that the process of implementing change is transitional and moves from the stages of unfreezing to refreezing, with change occurring in between (Lewin, 1951). This proposition can be used to organize the necessary steps taken to implement change at a large hospital because it helps to understand an organization's perspective on making a change in current practice; thus, recognizing change is complex and influenced by behaviors of many individuals.

The unfreezing stage can be defined as getting ready for change and creating a sense of urgency for change (Lewin, 1951). This stage can be directly applied to implementing change at this large pediatric hospital (Kaminski, 2011; Suc, Prokosch, & Ganslandt, 2009). Unfreezing the current practice started with recognizing pediatric hematology/oncology patients as high-risk patients for developing complications of influenza. Unfreezing providers meant presenting the evidence to support inpatient vaccination, seeking approval of automated triggers to communicate with the provider, acknowledging potential barriers, and working to overcome these barriers by addressing the necessary stakeholders. Support from key stakeholders (nursing educators, chief medical residents, informatics specialists, and pharmacy department) was elicited to aid in unfreezing the current influenza vaccine process through team collaboration. This stage also included collecting and analyzing pre-intervention data to support changing the current practice. The process of unfreezing was conducted prior to the start of the project implementation phase.

Lewin's next proposition addresses the stage of change. This transitioning stage implies creating a detailed plan of action and engaging providers to comply with the proposed change (Shirey, 2013). This involved identifying nurses' and providers' roles in carrying out the new vaccine screening and administration process. This stage of change focused on utilizing the EMR and establishing an efficient screening process with automated triggers to communicate with the provider in which nurses would be compliant. Nurses and providers on the hematology/oncology unit were educated on the new process through presentations, mandatory demonstration, easily accessible resource binders, and frequent reminders from nursing leadership.

Lastly, the refreezing stage works to stabilize the change so it becomes embedded into the existing culture, policy, and practice (Shirey, 2013). Refreezing means working to maintain an efficient influenza vaccine screening and administration process. This included reinforcing education as discussed above, auditing influenza vaccine screening compliance, measuring influenza vaccine rates, and providing immediate feedback to nurses and providers.