Research: Student Nurses’ Immunization Knowledge and Confidence

Janelle L. B. Macintosh, Assistant Professor, RN, PhD

Vaccines are likely the most significant public health initiative the world has ever seen outside of clean water. Vaccinations are relatively inexpensive, minimally invasive, and highly effective against deadly diseases. According to the World Health Organization, regular immunizations prevent between four and five million deaths each year.[1] Associate professor Dr. Janelle Macintosh has been working on vaccine research for over 10 years at BYU, often with Dr. Beth Luthy (BS ’03, MS ’05), Dr. Renea Beckstrand (AS ’81, BS ’83, MS ’87), and several student research assistants. Dr. Macintosh teaches undergraduate and graduate classes on ethics, writing, research, and interdisciplinary connections for the honors program. This fall, she is also teaching a pediatrics course.

            In a continuation of her vaccine research, Macintosh recently surveyed second- and fourth-semester BYU nursing students. They were asked questions about pediatric immunization schedules, their confidence in their knowledge of immunizations, and their ability to administer immunizations. Students were surveyed at the beginning of the semester then again at the end of the semester, and the responses were recorded.

            At the end of the semester, the mean number of CDC-recommended pediatric vaccines that students correctly identified increased significantly. Recognition of some vaccines decreased, and there were several that less than 50 percent of students identified correctly during both surveys. Yet overall, there was more knowledge about which vaccines should be administered after students attended pediatrics or public health classes.

            In one of the knowledge questions, students were asked where they primarily obtained information about vaccines. The percentage who responded “from friends and family” decreased dramatically between the beginning and end of the semester—something Macintosh thought was thrilling. Students were also asked several information-based questions about illness and vaccines: Is the flu spread via cold temperatures? Are gloves required to administer a shot? Is mild illness a reason to delay immunization? These questions had a correct answer and were scored. Again, scores improved significantly from pre- to post-assessments.

            Generally, students felt confident in their immunization knowledge and abilities. There were significant increases in six of the ten confidence-based questions, even though students may not have known more or had more skills. Dr. Macintosh will need to conduct an additional study to determine whether clinical skills had improved. However, the increase does show that students are learning about vaccines in their classes and retaining enough information that they feel better prepared.

            The study has been submitted for publication and is expected to be published later this year.

The main takeaway from the results is that the College of Nursing teaches its students about pediatric vaccinations, but there is still room for growth and improvement. As Macintosh prepares to lead the pediatric nursing course, she is applying these findings and adjusting the curriculum to incorporate more emphasis on vaccinations. Macintosh explains, “It’s exciting to say, ‘Hey, there was a hole—here’s this gap in our knowledge. Now we can do something about it because we’ve identified it.’” A follow-up study may be conducted in the future to determine how well Macintosh’s changes were implemented and what effect they had on nursing students’ knowledge and confidence.

            Macintosh hopes that nursing students will be more prepared to be on the frontlines of protecting people from deadly diseases wherever they end up. She adds, “If we can make a change with such low effort and we are a strong army of people who can do this, what a great and powerful opportunity we have to be the Lord’s hands in treating all of His children.”

[1] “Immunization Coverage.” World Health Organization, World Health Organization, 15 July 2020,

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