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Research: vaccination acceptance and complicated grief

Research: vaccination acceptance and complicated grief

Nurses can reassure those who are unsure about vaccinations and help patients to resolve complicated grief, writes Louise Winton Schreuders

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 identified 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
influenced by emotions and beliefs, rather than facts. Primary care health practitioners are highly trusted and make a significant 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 specific 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.


Lazarus J, Ratzan S, Palayew A et al. A global survey of potential
acceptance of a Covid-19 vaccine. Nature Medicine 2020
MacDonald N, Budler R, Dubé E. Addressing barriers to vaccine
acceptance: an overview. Human Vaccines & Immunotherapies

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 identified 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.


Perng A,Renz S. Identifying and treating complicated grief in older adults. The Journal for Nurse Practitioners 2018;14: 289-95

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