title: Nurses' knowledge, attitudes and practices regarding influenza vaccination: an integrative review.
abstract: OBJECTIVE
  To critically analyse the literature describing nurses' knowledge, attitudes and practices regarding influenza vaccination.
  
  
  BACKGROUND
  Influenza is a serious illness that has significant impacts on productivity, health outcomes and healthcare costs. Despite the recommendations for nurses to be vaccinated annually against influenza, the vaccination rates remain suboptimal.
  
  
  METHODS
  Integrative literature review.
  
  
  METHODS
  An integrative review was conducted as described by Whittemore and Knafl (2005). A search of CINAHL, Cochrane Library, ProQuest Central, ClinicalKey, ScienceDirect, Wiley Online Library, and Informit was undertaken to identify relevant papers. Given the heterogeneity of included studies, a narrative approach was used to analyse the data.
  
  
  RESULTS
  There was limited research available on this topic area, with only 10 papers identified as meeting the inclusion criteria. Five themes were identified: the relationship between knowledge and influenza vaccination, perception of risk, motivators for influenza vaccination, barriers to influenza vaccination and impact of demographics on vaccination.
  
  
  CONCLUSIONS
  Despite the evidence for the protective effects of influenza vaccination, rates of vaccination among nurses remain sub-optimal. Nurses' influenza vaccination practices likely relate to their level of knowledge and perception of risk; the greater nurses' knowledge regarding influenza and influenza vaccination the higher their perception of risk and the more likely they are to be vaccinated. This also translates to the advice that they give patients with vaccinated nurses more inclined to recommend vaccination than those unvaccinated.
  
  
  CONCLUSIONS
  The practices of nurses related to influenza vaccination may translate to the advice that they give their patients. Understanding the knowledge levels, practices and attitudes of nurses can assist in developing strategies to enhance education of nurses.
authors.affiliation: School of Nursing, University of Wollongong, Wollongong, NSW, Australia. ss889@uowmail.edu.au.
authors.forename: Sarah
authors.initials: S
authors.lastname: Smith
authors.affiliation: School of Nursing, University of Wollongong, Wollongong, NSW, Australia.
authors.forename: Jenny
authors.initials: J
authors.lastname: Sim
authors.affiliation: School of Nursing, University of Wollongong, Wollongong, NSW, Australia.
authors.forename: Elizabeth
authors.identifier: http://orcid.org/0000-0001-8099-986X
authors.initials: E
authors.lastname: Halcomb
mesh_terms: D001291:Attitude of Health Personnel; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage; D007251:Influenza, Human / Q000451:nursing / Q000517:prevention & control*; D008875:Middle Aged; D024802:Nurse's Role; D014611:Vaccination
chemical_list: D007252:Influenza Vaccines
keywords: attitude; belief; immunisation; integrative review; knowledge; nurse; opinion; perception; vaccination