title: Nurses' attitudes towards enforced measures to increase influenza vaccination: A qualitative study.
abstract: Despite studies demonstrating that the annual influenza vaccination of healthcare workers reduces morbidity and mortality among vulnerable patients, vaccination rates remain very low, particularly in nursing staff. Educational programmes have failed to improve rates, which has led to a diverse range of enforced approaches being advocated and implemented.
  
  
  
  To examine the attitudes of non-vaccinated nursing staff towards various enforced measures aimed at increasing rates of influenza vaccination.
  
  
  
  Semi-structured qualitative interviews with a purposive sample of 18 non-vaccinated nurses, working in units with high-risk patients at two hospitals in Switzerland. Analysis of interviews was done using conventional content analysis.
  
  
  
  Nurses were critical of enforced measures. However, measures that include an element of choice were perceived as more acceptable. Declination forms and mandatory vaccinations as part of the employment requirements were found to be the most accepted measures.
  
  
  
  The perception of choice is crucial to the acceptance of a measure. Respect for choice and autonomy has a positive effect on behavioural change. Mandatory influenza vaccination as a condition of new (and perhaps ongoing) employment could be a feasible, effective and ethical measure to increase vaccination rates among nurses who oppose vaccination.
authors.affiliation: Institute for Biomedical Ethics, University of Basel, Basel, Switzerland.
authors.forename: Anina
authors.initials: A
authors.lastname: Pless
authors.affiliation: Institute for Biomedical Ethics, University of Basel, Basel, Switzerland.
authors.forename: David
authors.initials: D
authors.lastname: Shaw
authors.affiliation: Institute for Biomedical Ethics, University of Basel, Basel, Switzerland.|Institute for History, Ethics and Philosophy of Medicine, Medizinische Hochschule Hannover, Hannover, Germany.
authors.forename: Stuart
authors.initials: S
authors.lastname: McLennan
authors.affiliation: Institute for Biomedical Ethics, University of Basel, Basel, Switzerland.|Center for Legal Medicine, University of Geneva, Geneva, Switzerland.
authors.forename: Bernice S
authors.initials: BS
authors.lastname: Elger
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage / Q000276:immunology; D007251:Influenza, Human / Q000276:immunology / Q000517:prevention & control* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009726:Nurses / Q000523:psychology*; D010342:Patient Acceptance of Health Care; D013557:Switzerland; D014611:Vaccination / Q000523:psychology*
chemical_list: D007252:Influenza Vaccines
keywords: enforced measures; healthcare workers; influenza; nosocomial infection; qualitative research; vaccination