Sherry Brabon Elements of Reasoning Table 1 1-3 sentences describing your thoughts on the issue related to that element

It is now required that all staff at Central Michigan District Health Department receive a flu shot by December 1st of each year per new union contract negotiations and policy. If staff members do not receive their flu shot, they are required to wear a mask everyday until the end of flu season. I think wearing a mask is not the most effective way to prevent spread of flu and it breaches the confidentiality of that staff member who chooses to not be vaccinated. Vaccination is the single most effective way to prevent flu. People have the right to choose their healthcare options and they have a right to confidentiality. Is there a way to prevent spread of infection and protect confidentiality? If a staff member chooses refuses the flu vaccine, the agency saves approximately $18 per dose; however, if that staff member gets ill with flu the agency will pay out up to $200 per day in employee sick wages. Staff is required to receive the vaccine, possibly against medical or religious beliefs; also staff members will be readily identified as being unvaccinated, which breaches their confidentiality as a patient. Michigan passed a law this year regarding flu vaccination of healthcare workers; employers may require unvaccinated staff to wear masks when

1.

Purpose (all reasoning has a purpose)

2.

Questions at issue or central problem (all reasoning is an attempt to figure something out, to settle some question, solve some problem)

3.

Point of view (all reasoning is done from some point of view; think about the stakeholders)

4.

Information (all information is based on data, information, evidence, experience,

research)

in contact with agency customers or patients. CDC does not recommend routine wearing of surgical masks as they do not filter out aerosolized particles that can remain infectious to others. CDC provides other, less identifying ways to prevent influenza transmission such as hand hygiene, cough etiquette and staying home when ill.

5.

Concepts and ideas (all reasoning All patients, including staff members, is expressed through, and have a right to confidentiality. Masks shaped by, concepts and ideas) may not prevent spread of flu virus; there is other, more effective measures one can utilize to prevent illness transmission. Flu vaccine is not 100% effective against flu virus furthermore; the flu vaccine only covers three flu strains. Assumptions (all reasoning is based on assumptions-beliefs we take for granted) I am assuming those who refuse vaccination will not want to wear a mask. I, also, assume that a mask will not be effective in spread of the virus. Another assumption I am making is that there is no law requiring flu vaccination. If staff is not required to obtain flu vaccine and they do not wear a mask, flu may spread. With the spread of the flu virus, health care resources may be taxed. On the other hand, choice, free will and maintaining confidentiality is part of the basics of nursing care. Law surrounding flu vaccination among healthcare workers give employers the option to mandate wearing a surgical mask when in contact with customers or patients of that facility. The CDC recommends more effective measures such as hand hygiene, cough etiquette and staying

6.

7.

Implications and consequences (all reasoning leads somewhere. It has implications and when acted upon, has consequences)

8.

Inference and interpretation (all reasoning contains inferences from which we draw conclusions and give meaning to data and situations)

home when ill. Furthermore, the CDC does not recommend wearing a surgical mask as a prevention measure or to prevent active illness transmission; there are no studies to conclude this is an effective strategy to prevent influenza transmission. This agency policy is not founded on sound research and should be reconsidered.

Article Annotations Centers for Disease Control and Prevention. (2009). Interim guidance for the use of masks to control influenza transmission. Retrieved from: http://www.cdc.gov/flu/professionals/infectioncontrol/maskguidance.htm The Centers for Disease Control and Prevention (CDC) is the leading authority on health care practice in the United States. The general public, through the Internet, may access this article. However, the terminology contained in the article leads me to believe it is intended for those with a higher education or health care personnel. This article supports my claim that wearing a mask does not prevent influenza transmission. Furthermore, it clearly states there are no studies that have proven this theory. Additionally, this article confirms my statements that other, more effective actions prevent influenza transmission. Hand hygiene, isolation precautions, cough etiquette and vaccination remain the most effective ways to prevent influenza infection. Once flu symptoms are present, the CDC encourages the use of antiviral medication and staying home, away from public places, for best infection control practices. These prevention measures should also be practiced in any place of employment. Centers for Disease Control and Prevention. (2010). Prevention strategies for seasonal influenza in healthcare settings. Retreived from: http://www.cdc.gov/flu/professionals/infectioncontrol/healthcaresettings.htm The Centers for Disease Control and Prevention (CDC) is the leading authority on health care practice in the United States. The article targets health care personnel, though the information is readily accessed through the Internet. Since the authors are the same as the article previously reviewed, this information supports the same influenza control measures. CDC reviews ways influenza is transferred from person to person; respiratory droplet transmission, indirect contact with contaminated articles and aerosolized airborne transmissions of body fluids are all sources of illness transmission. Vaccination remains the number one prevention strategy. Cough etiquette, hand hygiene and staying home when sick are additional ways in which one may prevent transmission of influenza. A mask is suggested only when symptoms of influenza are present. Furthermore, this article confirms surgical masks only prevent transmission of large droplets; it does nothing to prevent transmission of aerosolized particles. This article further supports my argument against wearing surgical masks as a primary prevention measure.

Michigan House of Representatives. (2012). House bill 5605. Retreived from: http://www.legislature.mi.gov/documents/2011-2012/billintroduced/House/pdf/2012HIB-5605.pdf Bob Genetski introduced this bill to the house May 9, 2012. It was then referred and supported by the Committee on Health Policy. Mr. Genetski and supporting house member, Dave Agema, are representatives on the Community Health subcommittee. Both Michigan House and Senate approved this bill. House Bill 5605 of the Public health code states that employers cannot mandate employees receive a seasonal flu shot, but if an employee chooses remain unvaccinated the employer may require that employee to wear a surgical mask or take other overt action if that employee is in contact with customers of that health facility. This bill is intended for all health agencies and the residents of Michigan. While this bill clearly states the employer may require the mask be worn, it does not mandate that the employer enforce this action. This supports my idea that employees do not have to wear a mask if they are not vaccinated. Evaluation How did the planning process, where you thought about what you wanted to change, prepare you for the EBPP? My topic has been an issue in my mind for some time. When I first read the criteria for this project, I knew right away what my topic of concern would be. The table used to organize my thoughts was a nice way to organize the information. However, the one to three sentence limitations were difficult, as I wanted to write more to clarify my point. This challenged me to focus concisely on my main concern. How did the peer evaluation process prepare you for the EBPP? The peer evaluation process was very slow, I have only had one peer at this time review my proposal. The suggestions offered from this student were helpful. She pointed out areas that were weak and offered alternate ideas I had not considered. She also pointed out areas that required clarification. Peer review is a great way to ensure thoughts are being expressed in the manner the author intends. Additional peer evaluation would have been appreciated. Do you feel you are prepared to elicit change in your practice with your proposal? How does it fit into quality health care? My proposal is certainly sound enough to present to my supervisor and, subsequently, health officer. There is no evidence that the recent instituted policy is effective against influenza transmission. My sources are reputable and support my theory. When quality of health care is considered, if an employee is ill, they should stay home. If they are not ill, a mask is irrelevant in disease transmission. The workplace policy should focus on more measures that are proven to prevent illness transmission. I continue feel that by mandating an employee to wear a mask is, at the least, an invasion of privacy if not confidentiality. Furthermore, wearing a mask prevents effective communication by blocking non-verbal communication. As a patient, I would not want to visit my health care provider and discuss my concerns while that provider is wearing a mask. I am certain other patients would feel the same. What could you have done better? My research could have been more thorough regarding confidentiality and employee comment. When I was reviewing HIPPA and

confidentiality articles, there was no reference to employees and this felt awkward to correlate these topics. Though, while researching confidentiality, I found the phrase invasion of privacy which seems to fit this issue more appropriately. Also, I have asked other employees their thoughts on this new policy and they agree that this policy should be reconstructed to fit the intended outcome; reduced influenza transmission. How well do you think you are using the EOR? Do they make sense to you (why or why not?) The process challenged me to focus on my topic and prevented me from going off on tangent with information or facts that were not directly related to my topic of concern. However, I may not have provided the right information in some of the boxes, as it seemed like I was writing the same thing, just in a different way. Also, by separating out the components of the argument, it helped me organize my thoughts in a professional manner and made me consider any faulty logic in my thought process. So yes, it does make sense. The one to three sentence limits was very difficult and I used semicolons to pack in more information I felt needed to be included. This project has been beneficial and I will use this process for other topics of concern I may have.