From Pathophysiology to Prevention: Implementing a Vaccine-Preventable Diseases Project for Pre-Nursing Students

Abstract

Background

Information about vaccine-preventable diseases (VPDs) and vaccinations should be included throughout nursing curricula to prepare future nurses to promote vaccination with patients and combat misinformation.

Method

In a large, pre-nursing course, faculty designed a self-directed activity focused on VPDs and vaccinations that required students to analyze various sources and create presentations about these topics.

Results

Student feedback indicated the learning outcomes of this educational intervention were largely met and that students felt positive about this type of activity overall.

Conclusion

Including information in early nursing courses regarding VPDs and vaccinations can positively influence students' knowledge, confidence, and perceptions of these topics. Independent student projects involving higher cognitive domain levels can be successfully integrated into large pre-nursing courses. [J Nurs Educ. 2025;64(5):e13–e15.]

The development of safe and effective vaccines to prevent multiple infectious diseases has had major impacts on childhood health and overall life expectancy. Since the development of smallpox vaccination in the late 1700s, effective vaccination campaigns have drastically reduced or eliminated many infectious diseases. However, over the last 6 to 8 years, decreasing vaccination rates are contributing to worrisome public health trends across the United States. Periodic reports of measles outbreaks, once considered eradicated, are just one example of a disease being inadequately prevented or re-emerging due to a lack of uptake of available, safe, and effective vaccines (^{Hotez, 2019}). Varying public acceptance of vaccines for coronavirus disease 2019 (COVID-19), especially in the U.S., is a more recent example of vaccine mistrust and denial.

Based on nationwide Gallup polling data, nurses in the U.S. have been consistently identified as the most trusted profession for over two decades (^{Brenan, 2023}). Compared to other health professions, nurses have the most frequent and extended contact with the public across many parts of the health care system. High public trust, frequent interactions, and high visibility with the public mean that nurses can positively affect patients' perceptions and acceptance of available vaccines. To ensure that nurses are prepared with accurate information about vaccine-preventable diseases (VPDs) and vaccinations, nurses should be educated on these topics, as they may also be vulnerable to misinformation from irreputable sources. Information about vaccines and the promotion of vaccination should be threaded throughout nursing curricula, and students should be prepared with communication skills to educate patients on the importance of vaccination.

In a sophomore-level pathophysiology course in a large prelicensure program, faculty developed a project focusing on VPDs and the associated vaccines. The faculty felt strongly that connecting VPDs and vaccination to pathophysiology concepts early in the program, before clinical courses begin, would begin to normalize discussing these topics as within the purview of the student's future nursing roles. Long-term, we hope that assisting students to better understand VPDs and vaccinations will improve their confidence and better prepare them to educate patients on these topics, thereby positively influencing public health.

Influenced by the course level and the enrollment of approximately 350 students, most learning activities in this course engage students at lower levels of the cognitive domain, with assessments traditionally consisting of online quizzes and exams. On course evaluations, students frequently request a project or other creative assignment to supplement quizzes and exams. Therefore, a secondary goal of this project was to develop a learning activity that engaged students in higher levels of the cognitive domain, for example, analyzing and evaluating multiple sources of information and creating presentations that synthesized that information in their own words, providing an opportunity for students to self-direct some of their learning.

Method

Course faculty met several weeks before the semester to conceptualize and plan the VPD project. Aligning with the learning outcomes of the course, four student learning outcomes were identified for this project: (1) describe the pathophysiology of a selected VPD, (2) summarize the effectiveness of available vaccinations for the selected VPD, (3) explain important facts about the available vaccine(s) for the selected VPD, and (4) discuss how nurses providing vaccine education to the public demonstrates application of provisions from the American Nurses Association (ANA) Code of Ethics for Nurses (^{ANA, 2015}). Exempt status was obtained by the University of South Carolina's Institutional Review Board.

Students selected one of four VPDs for the project: measles, human papilloma virus (HPV), influenza, and COVID-19. Faculty chose these VPDs based on historical importance, potential interest by undergraduate students, and timeliness in 2022. Course faculty and a graduate instructional assistant (GIA), a registered nurse, selected six to seven evidence-based resources of different formats for each VPD and created links to each resource in the learning management system (LMS). Students were limited to these posted resources and the course textbook as references for this project. Students could complete the project solo or with a partner of their choosing. Students could create an electronic poster or a brief narrated audiovisual presentation to upload to the LMS. A detailed grading rubric that aligned with the four learning outcomes, plus an additional section for the quality of the writing or narration and citation format, was shared with students.

Once all projects were submitted to the LMS, course faculty and the GIA independently graded the same two presentations using the grading rubric and met to compare scores. This provided some validation of consistency in scoring (all graders were within a 4% variation) and an opportunity to discuss shared interpretations of rubric sections. After this initial review, faculty and the GIA divided the projects by topic. This was efficient and provided for reliable grading, as it allowed graders to familiarize themselves with the content of the posted resources for the specific VPD and recognize any inconsistencies with the presentations. The grading rubric was integrated into the LMS, which allowed graders to leave comments on specific sections easily, and the LMS automatically calculated the total project grade. Grading of the presentations took approximately three weeks.

During the last week of the semester, an optional feedback survey was posted in the LMS for students. The survey contained six Likert-scale items, with five choices ranging from strongly agree to strongly disagree. The Likert-scale items assessed students' perceptions of logistical aspects of the project and whether the project's learning outcomes were met. Five open-ended questions sought student feedback on what they liked and did not like about the project, suggestions for future semesters, and how what they learned from this project might apply to their future nursing practice. The surveys were downloaded from the LMS into a spreadsheet, and one of the authors conducted a content analysis to identify patterns across the responses. All authors reviewed the survey responses for accuracy after themes were identified and grouped by student comments.

Results

Three hundred and forty-two students completed the VPD project with an average earned score of 93.6%. Most students, 59%, completed the project with a partner. Of the presentation format choices, 62.6% of the projects submitted were posters, and 37.4% were narrated audiovisual presentations. Student choices among the four available VPDs for the project were uneven: 49.3% of the presentations were on HPV, 26% were on influenza, 15.4% were on measles, and 9.3% of the presentations focused on COVID-19.

Integration of the feedback survey into course activities in the final week yielded a response rate of 93.9% (n = 321). The Likert-scale responses for the first six questions were converted to an ordinal number scale for analysis, with strongly agree = 5 and strongly disagree = 1. The first two questions assessed the logistical aspects of the assignment, and the remaining four assessed the content-related learning outcomes. On those four questions, students felt that the project helped them develop a better understanding of the pathophysiology of their selected VPD (mean = 4.51), that the project helped them develop a better understanding of using evidence-based statistics to promote vaccines and combat misinformation (mean = 4.36), that the project helped them understand the ANA Code of Ethics and how it relates to providing vaccine education to patients (mean = 4.44), and that the project impacted their thinking, judgment, and perception regarding VPDs (mean = 4.51).

The open-ended survey questions sought students' opinions on the perceived successes of the project, how the knowledge gained from this project would affect their future nursing practice, and suggestions to improve the project. Several themes emerged regarding the successes of the project: application of the ANA Code of Ethics; freedom of creativity; integration of nursing concepts; linkage of topics from class and teaching while learning; positive impact on their course grades; and self-confidence. Many students shared that incorporating the ANA Code of Ethics was informative, increased their understanding of the Code of Ethics, and allowed them to apply ethical concepts to vaccinations and education of their patients, thereby making the Code of Ethics more practically meaningful. Another success mentioned by many students was the several choices built into the project, which gave them the ability to be creative and select a topic of personal interest.

Reinforcing the high mean scores on the related Likert-scale questions, several students shared in their narrative comments that the project helped them learn the pathophysiology of the disease processes discussed in class and engage in critical thinking to connect the project topics to nursing practice. In addition, students enjoyed having a project that created more balance in their grades and that differed from the quizzes and examinations commonly used in large didactic courses. Some students stated that completing the VPD project improved their understanding of the value of research and knowledge in nursing practice. It gave them insight into teamwork and experience respecting another's viewpoints.

Student comments about how completing this project would affect their future nursing practice were overwhelmingly positive. Many students reported that due to this project, they better understand the importance of vaccine education and that the knowledge they gained will lead to improved patient education. Multiple comments mentioned the ability to advocate for patients by providing accurate information on the availability and effectiveness of the different types of vaccines. Many students realized the importance of patient education using numerical data from evidence-based, reputable sources and stated that they would apply the information they learned about VPDs and vaccinations in their professional and personal lives.

For project improvements, a few students requested a clearer grading rubric with an example of a VPD project, additional information on reference style, and more resources to use for the project because they struggled to find statistics on the selected VPD and available vaccines. A few students felt that the project required too much time and effort for the 4% of the overall course grade that was assigned.

Conclusions

Strengths of this project included the timeliness of the topic, unique design, and multiple points of student choice to direct their own learning. Options for the project format allowed for student preference based on their learning styles. Many students chose partners for this project, which provided peer support and the opportunity for professional collaboration. Based on the overall survey responses, students were very satisfied with this project being included in the course, and the narrative comments indicated that many of the student learning outcomes were met.

From the faculty perspective, the success of this project encourages that it is possible to include a student-directed, active learning assignment in a large didactic course. Enthusiasm of the entire course team for the project, careful planning for due dates, creation of a clear and objective rubric integrated into the LMS, and availability of adequate graders were all important for the project's success and student satisfaction.

There were some limitations to this project. Some students struggled to understand the criteria presented within the rubric and experienced uncertainty and anxiety regarding whether their project met all the criteria as stated. Additionally, some students lacked the skills to create a multimedia presentation or struggled to save electronic files in a format necessary for upload to the LMS or for collaboration with their partner. These observations indicate that despite the ubiquity of social media and personal use of technology, students may need instruction on the application of technology for professional and educational purposes.

Overall, this project was an important and successful active learning assignment. Completing this project challenged students at higher levels of the cognitive domain, introduced them to a timely and important public health topic early in their nursing program, before clinicals begin, and incorporated ethical principles of the nursing profession. Worsening societal trends with vaccine misinformation and denial, made more evident with the COVID-19 pandemic, require effective and clear communication and patient education from the health care community, especially nurses. Implementing activities early in nursing curricula that engage students, ensure they have accurate knowledge regarding vaccination principles, and normalize discussion about vaccinations with their patients will help prepare them for this essential future role.

References

American Nurses Association. (2015). Code of ethics for nurses. https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/

Brenan, M. (2023, January). Nurses retain top ethics rating in U.S., but below 2020 high. Gallup. https://news.gallup.com/poll/467804/nurses-retain-top-ethics-rating-below-2020-high.aspx

Hotez, P. (2019). America and Europe's new normal: The return of vaccine-preventable diseases. Pediatric Research, 85(7), 912–914. 10.1038/s41390-019-0354-3 PMID: 30812027

The authors thank Kathrina Codilla, a former graduate instructional assistant for the course, for her help with the project during the semester.