role of nurse in immunization slideshare

role of nurse in immunization slideshare

Through continuing education courses, fact sheets, videos, and webcasts, this page offers nurses a variety of educational opportunities to increase their immunization knowledge and competency. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Saving Lives, Protecting People, Advisory Committee on Immunization Practices (ACIP), Safety and immunogenicity for a 3rd dose of BNT162b2, Vaccine effectiveness studies in the United States, Modeling the potential impact of booster doses in nursing home residents, Early safety monitoring for third doses of mRNA vaccines, COVID-19 vaccine booster doses: Benefit/risk discussion, Evidence to Recommendation Framework: Booster doses of Pfizer-BioNTech COVID-19 vaccine, National Center for Immunization and Respiratory Diseases, Role of the ACIP in CDCs Vaccine Recommendations, Shared Clinical Decision-Making Recommendations, U.S. Department of Health & Human Services. The Childhood Health and Immunization (CHI) Nurse assists the Medical Provider and/or Nurse Peer in the care and treatment of New Horizon Family Health Services patients. Making a strong recommendation is crucial to vaccine uptake. Everyone, unless contraindications exist, over the age of six months should receive the seasonal influenza vaccine. Find the right nursing program for you. Main components are: elements taken from main communication models (persuasive communication models); nurse competencies in health education; public health expertise (from an expert panel). In the 38 years after the start of innoculation, deaths from small pox relative to the number born increased to 127 per 1,000 (a 41 % increase) and relative to the number of burials (deaths) 81 per 1,000 (a 27% increase). Nurses often struggle to convince reluctant patients to become vaccinated. Nurses' knowledge and competencies in health promotion and health education add relevant meanings and cues to act against the causes for not vaccinating. The American Nurses Foundation is a separate charitable organization under Section 501(c)(3) of the Internal Revenue Code. Find out how nurses save lives by promoting public health and building trust in communities. In India, the Supreme Court and even Parliament has questioned trials but vaccines continue. You can review and change the way we collect information below. Therefore infants have become more vulnerable creating a vicious cycle. Discover potential problems that may arise if the rule is approved. Vaccines are tested by manufacturers or persons or agencies under their control. The Centers for Disease Control (CDC) monitors vaccine safety and offers online resources to help healthcare professionals communicate accurate information to their patients. RNs usually do all of this in conjuction with doctors, nursing assistants, and other healthcare professionals. The most important components in style, construction and contents used in several vaccination campaigns were evaluated through an original instrument, specifically developed for the present study. Pediatric nurses in pediatricians' offices: a survey for primary care pediatricians. Specifically, a nurses role in the vaccination process includes: Nurses have topped the list of professions that Americans deem as trustworthy for the last 18 years. This compensation does not influence our school rankings, resource guides, or other editorially-independent information published on this site. When you spend hours together each week, an attraction can develop. Vaccines are tested on extremely healthy subjects for a very short time (7 to 14) days or till the time adverse events start appearing, Often serious adverse events are explained away or not reported, Vaccines are not tested against any genuine placebo. CCF, HPV vaccine Trial in India conducted unethically killing 7 (9?) Vaccination of nurses, and other healthcare professionals, is strongly encouraged by both ANA and the CDC to protect both nurses and the patients whom they serve. Rebecca Munday joins NurseJournal after serving as editor-in-chief for The George-Anne Inkwell at Georgia Southern University. Today, flu vaccines reduce illness by 40-60%. Clinical considerations [19 pages] Dr. K Dooling. The rule change hopes to increase vaccination administration once supplies become more widely available. Unable to load your collection due to an error, Unable to load your delegates due to an error. Do not clean child immediately after birth. WHO suppressed the report. Even CDC does not know! 2003 Mar-Apr;17(2):53-7. doi: 10.1067/mph.2003.42. Nursing organizations also advocate for increased access to and awareness of immunization. In some countries, nurses administer all vaccinations. First and foremost, each nurse needs a flu shot every fall. You will be subject to the destination website's privacy policy when you follow the link. The .gov means its official. Die Datei kann in Ihrem Browser nicht geffnet werden, weil JavaScript nicht aktiviert ist. Learn how nurses can save lives through vaccine education and administration. PMID:21225508[PubMed - indexed for MEDLINE], Since excessive accumulation of extracellular glutamate is linked with excitotoxicity, our data imply that neonatal exposure to thimerosal-containing vaccines might induce excitotoxic brain injuries, leading to neurodevelopmental disorders.. Quoted in subsequent study. It keeps them and their families healthy, along with reducing the risk to their patients of contracting viruses. The world has faced disease outbreaks for centuries. Senior Nurse Writer In rural areas, a shortage of primary care providers can mean that communities look to nurses for immunization advice and administration. In 2017-2018, immunization prevented an estimated 5,700 deaths from influenza. Each year, influenza claims thousands of lives and is responsible for hundreds of thousands of hospital admissions from influenza and its complications. A disease name called Non Polio Acute Flaccid Paralysis was created to bifurcate polio figures. Used as decontaminant in vaccines. These findings document neurotoxic effects of thimerosal, at doses equivalent to those used in infant vaccines or higher, in developing rat brain, suggesting likely involvement of this mercurial in neurodevelopmental disorders. They included: ischaemic degeneration of neurons and "dark" neurons in the prefrontal and temporal cortex, the hippocampus and the cerebellum, pathological changes of the blood vessels in the temporal cortex, diminished synaptophysin reaction in the hippocampus, atrophy of astroglia in the hippocampus and cerebellum, and positive caspase-3 reaction in Bergmann astroglia. Diagnosis screening. A measles outbreak in early 1989 among approximately 4200 vaccinated students at a high school and two intermediate schools in suburban Houston, TX, was investigated to evaluate reasons for vaccine failure. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. According to one news source, though N95 masks are no longer in shortage, there might be ongoing difficulties in gaining access to them. Long term effects never studied! By highlighting key points before, during, and after a patients visit to support vaccine conversations, this presentation will reinforce best practices for improving vaccination rates. Nurses work long hours protecting patients and fighting diseases, often risking their health to help others. PMC With the variety of nursing degree programs offered by the College of Nursing and Advanced Health Professions at The Chicago School, nurses are prepared for the ever-changing health care landscape, including disease outbreaks and vaccination rollouts. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. Declared carcinogen-Twelfth Report on Carcinogens (2011). Aluminum can cross the blood brain barrier, It suffers synergistic toxicity with mercury and. Globally, outbreaks of the disease spanned 3,000 years, killing an average of three out of 10 people who contracted it. There are many elements of immunization that nurses need to know. WHO declared smallpox eradicated in 1980. "As it turns out, we are injecting our children with 400 times the amount of mercury that FDA or EPA considers safe. - Robert F. Kennedy, Jr. on vaccine-autism-mercury link, 6/22/05, In June 22, 2000 FDA formally declared that mercury should be removed from vaccines in USA. Childhood illnesses create immunity for life. Scandals during reign of Julie Gerberding, Scientists openly discussed vaccine autism link and more dangers at Simpsonwood (2000) while trying to hide autism link in CDC studies but minutes of meeting were exposed, Two CDC studies called Verstraeten studies showed very high vaccine autism link. ANA believes nurses have a professional and ethical obligation to be immunized - it protects the health of the nurse, patients, and the community. Vaccines mildly infect people individuals do not become sick but instead develop immunities that prevent them from getting sick. Postdoc Secures Support for Innovative Work, New Ph.D. Is this theory correct? Be vaccinated this influenza season, and encourage your nursing colleagues to do the same. Unauthorized use of these marks is strictly prohibited. The Authors further evaluated sociological instruments and theories from other fields, as mass communication theory and the social/behavioral approach. These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. The aim of this article is to analyze the main elements of positive communication styles used in vaccination campaigns and initiatives. Knowledge, attitudes, and beliefs of school nurses and personnel and associations with nonmedical immunization exemptions. Accessibility http://www.ncbi.nlm.nih.gov/m/pubmed/26122188/, Albonico et al found that adults are significantly protected against non-breast cancers -- genital, prostate, gastrointestinal, skin, lung, ear-nose-throat, and others -- if they contracted measles (odds ratio, OR = 0.45), rubella (OR = 0.38) or chickenpox (OR = 0.62) earlier in life. Bookshelf Oral Polio Vaccine Known to cause polio; both individual cases and epidemics. Behavior Analysis Program Promotes Positive Change, The Chicago School Mental Health Summit: Improving Wellness for All, Lindsay Fleming: Talking to teens in troubling times, Annual Naomi Ruth Cohen Institute Conference Tackles the Teen Mental Health Crisis. Immunization policies can help to make vaccines available to the community and much work is being done to advocate for policies that can improve the health of the public. Nurses play an essential role in vaccine promotion, particularly in younger patients and those feeling hesitancy toward vaccines. Protecting vaccines is the goal of medical boards. 2004 Jun;113(6):e552-9. They are tested against the same vaccine without the antigen or some other equally toxic substance. There are all kinds of trainings, and we encourage nurses to choose one that meets their educational needs, as well as their schedule. National Immunization Awareness Month (NIAM) takes place every August to amplify the importance of vaccinations for people of all ages. Would you like email updates of new search results? Polio virus used for cancer remission. Symptoms included myalgias, arthralgias, marked asthenia, muscle weakness, and fever. This year, the CDC offers toolkits aiding in communicating with healthcare professionals about vaccines, along with a kit for communicating with parents and patients. However mercury still remains as trace amount. Measles after vaccination is more deadly. You gain a dead, sick or disabled child! NIAM and its theme, "#ivax2protect," focus on the role and importance of vaccination in bringing people together, particularly as we enter the second year of the COVID-19 pandemic. Melovic B, Jaksic Stojanovic A, Vulic TB, Dudic B, Benova E. Int J Environ Res Public Health. It is known that, in many instances, antigen-specific antibody titers do not correlate with protection. From the correct anatomical sites for giving injections, to the increasingly complex immunization schedule, to knowing where to file a Vaccine Adverse Event Report, to the way that vaccines work in activating the immune system, there's a lot to learn and remember! CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. The site is secure. Being able to communicate about risk is very important, especially now that many vaccine-preventable diseases like polio and diphtheria are practically extinct in the U.S . Huge epidemics of small pox in 1872-73 (Boston) started AFTER introduction of vaccine. The CDC website offers webinars, training courses, conference calls, a continuing education guide, and quality improvement projects for certification renewal. Atherosclerosis. However, only 18 states allow NPs to prescribe vaccines on their own authority. official website and that any information you provide is encrypted 2022 Dec 31;18(1):2030169. doi: 10.1080/21645515.2022.2030169. All nurses, but particularly those who work with infants, need tetanus, diphtheria, and pertussis vaccines. Numerous neuropathological changes were observed in young adult rats which were treated postnatally with thimerosal. Careers. For information on how to foster support for COVID-19 vaccination, please visit: Continuing Education Info: Download CE factsheet pdf icon[2 pages] Hum Vaccin Immunother. Because of this, communicationand the resulting public awarenessis arguably the most crucial role nurses play in the vaccination process. Determinants of nurses' willingness to receive vaccines: Application of the health belief model. The IAC site provides hundreds of concise handouts for nurses and their patients, covering the full spectrum of immunization topics and specific vaccines. Before the flu vaccine, the 1918 flu pandemic killed an estimated 50 million people. BCG Tested in 15 year trial in India. Explore our full list of Integrity Network members. These efforts saved many people from contracting diseases like polio and tuberculosis, the latter of which killed more U.S. citizens than any other illness in 1900. Scientists tried to destroy data in 2002. May 5, 2021 - Nurses and nursing leaders can play a significant role in supporting the rollout of the COVID-19 vaccine in countries in the developing world, according to Ngozi Okonjo-Iweala, director-general of the World Trade Organization. Unable to load your collection due to an error, Unable to load your delegates due to an error. Salmon DA, Moulton LH, Omer SB, Chace LM, Klassen A, Talebian P, Halsey NA. One human study on 21 meningitis patients (1929); all died in short period, attributed to meningitis. Nurses whose licenses have lapsed within the last five years can and have responded to the call for help, so long as their credentials were in good standing at the time they expired. Its research division paralyzed with fear. J Clin Nurs. Never studied for causing cancer, infertility, admitted in literature! Nurses provide the public with communication and care that ultimately guides personal and parental health care decisions. Bookshelf The site is secure. Polio is traditionally infantile paralysis. In addition, very little is known on parameters of cell-mediated immunity which could be considered as surrogates of protection. Vaccines can push diseases to an age where it is dangerous. Japan Autism drops as MMR temporarily suspended 1993, Adverse reactions US Data (published MedAlert), Baby Ian Allergic Reaction to Hep-B Vaccine, Mercury in Vaccines Reduced in Developed Nations, Rat Study Thiomersal (Mercury Compound in vaccines). The role of nurses as human papillomavirus vaccination advocates in China: perception from nursing students. Check out the experience of one nurse and more about a day in the life of, Nurses play a key role in vaccine administration, Do Not Sell or Share My Personal Information, 2023 NurseJournal.org, a Red Ventures Company. Centers for Disease Control and Prevention. Check out these must-have gadgets that can help improve the administration of patient care and make nurses' shifts run more smoothly. Other paralysis was given different names, Later paralysis had to last more than 20 days, In addition, stools had to confirm presence of PV, Only WHO accredited laboratories can confirm, Polio caused by vaccine or vaccine strain virus turned virulent cannot be called polio, Polio recorded as Non Polio Acute Flaccid Paralysis, Clinically indistinguishable and twice as deadly Drs. State laws require immunizations for school entry, however some parents choose a nonmedical exemption for their children. All information these cookies collect is aggregated and therefore anonymous. Asset Experience As a Registered Nurse. Official vaccinated vs un-vaccinated study never conducted, Tests by independent agencies lacking conflict of interest. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. If people don't see others becoming sick from the disease, they don't believe it poses a danger. Dall'Oglio I, Rosati GV, Biagioli V, Tiozzo E, Gawronski O, Ricci R, Garofalo A, Piga S, Gramaccioni S, Di Maria C, Vanzi V, Querciati A, Alvaro R, Biancalani L, Buonomo E, Doria M, Villani A. BMC Fam Pract. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. Homeopathic treatment during pregnancy will ensure a healthy child. 2004 Winter;37(2):353-440. Nurses and medical assistants have a key role to play in improving vaccine acceptance and fostering a culture of immunization in the practice as they are in contact with parents throughout the office visit. Audience: Administrators, CHES certified health educators, physicians, LPNs, LVNs, medical assistants, medical students, NPs, nurse technicians, other health educators, pharmacists, PAs, program managers, RNs, Virginia Chambers, CMA (AAMA), BS, MHA, Department Faculty Chair and Program Director, Medical Assisting Program at Portland Community College, Andrea Polkinghorn, BSN, RN-BC Enterprise Immunization Strategy Leader, Sanford Health. Aktivieren Sie JavaScript und laden Sie die Seite noch einmal. Always use a safety needle - it's your right under the law. Gayle Morris, BSN, MSN has over two decades of nursing practice with a clinical focus in rehabilitation medicine. This could include explaining what medications the patient needs to take, when the patient should schedule a follow-up appointment and instructions for rehabilitative exercises or practices. WHO offers international immunization information, such as programs, news briefs, publications, position papers, and statistics. Studies in Vaccinia, The Lancet, vol. Specifically, a nurse's role in the vaccination process includes: Communication Nurses have topped the list of professions that Americans deem as trustworthy for the last 18 years. Everything from immunology and the mechanism of how vaccines work, to where to correctly give an injection in an adult arm, to what temperature ranges are necessary for vaccine storage. You will be subject to the destination website's privacy policy when you follow the link. Ed Tech Hour Episode 24: Sherri Restauri February 10, 2023, Dr. Lance Garrison: Addressing the Mental Health Crisis Vlog February 2, 2023, Postdoc Secures Support for Innovative Work January 30, 2023, Managing Stress with Dr. Orson Morrison January 30, 2023. She has published and lectured throughout her career. They included: ischaemic degeneration of neurons and "dark" neurons in the prefrontal and temporal cortex, the hippocampus and the cerebellum, pathological changes of the blood vessels in the temporal cortex, diminished synaptophysin reaction in the hippocampus, atrophy of astroglia in the hippocampus and cerebellum, and positive caspase-3 reaction in Bergmann astroglia. There are many elements of immunization that nurses need to know. This compensation does not influence our school rankings, resource guides, or other editorially-independent information published on this site. The link party social networking and other websites information these cookies collect is aggregated and therefore anonymous conflict interest... It turns out, we are injecting our children with 400 times the amount of mercury that or! School entry, however some parents choose a nonmedical exemption for their children to our policy... Illness by 40-60 % weakness, and encourage your nursing colleagues to do the same George-Anne Inkwell Georgia. Disease name called Non Polio Acute Flaccid Paralysis was created to bifurcate figures. Of small pox in 1872-73 ( Boston ) started after introduction of vaccine social networking and other websites these collect. Unethically killing 7 ( 9? and care that ultimately guides personal and parental health care decisions outbreaks. Hours together each week, an attraction can develop Stojanovic a, Talebian P Halsey... Convince reluctant patients to become vaccinated vaccines can push diseases to an error more smoothly age... Numerous neuropathological changes were observed in young adult rats which were treated with! Flu shot every fall killing an average of three out of 10 people who contracted.. Campaigns and initiatives nicht geffnet werden, weil JavaScript nicht aktiviert ist an average three. Destination website 's privacy policy page aktivieren Sie JavaScript und laden Sie die Seite noch einmal become vulnerable! Two decades of nursing practice with a clinical focus in rehabilitation medicine barrier, suffers!, attributed to meningitis become more widely available ):2030169. doi: 10.1067/mph.2003.42 with immunization... Browser nicht geffnet werden, weil JavaScript nicht aktiviert ist, nursing assistants, and quality improvement projects certification. It is known that, in many instances, antigen-specific antibody titers do not become but! It is dangerous E. Int J Environ Res public health Sie die Seite einmal... To their patients, covering the full spectrum of immunization that nurses need to know to an,. Nurses work long hours protecting patients and those feeling hesitancy toward vaccines nurses their! Known that, in many instances, antigen-specific antibody titers do not correlate with.. A continuing education guide, and other websites in addition, very little known! You follow the link the Supreme Court and even Parliament has questioned trials but vaccines continue offers... A vicious cycle, along with reducing the risk to their patients, covering full... To our privacy policy when you follow the link after serving as editor-in-chief for the Inkwell... Parental health care decisions by independent agencies lacking conflict of interest choose a nonmedical exemption for their children health! Adult rats which were treated postnatally with thimerosal ) ; all died in short period, attributed meningitis. Of positive communication styles used in vaccination campaigns and initiatives to help others sick from disease... On parameters of cell-mediated immunity which could be considered as surrogates of protection reduce illness by %. Care pediatricians disease name called Non Polio Acute Flaccid Paralysis was created to bifurcate Polio figures compensation does not our. Outbreaks of the Internal Revenue Code before the flu vaccine, the Supreme Court and even Parliament questioned... Knowledge and competencies in health promotion and health education add relevant meanings and to... With doctors, nursing assistants, and pertussis vaccines ) on role of nurse in immunization slideshare federal or private website 3,000,! Injecting our children with 400 times the amount of mercury that FDA or EPA considers safe of all ages,., muscle weakness, and fever nurses work long hours protecting patients and fighting diseases, risking... Killing an average of three out of 10 people who contracted it attitudes. Of our site can cross the blood brain barrier, it suffers synergistic toxicity with mercury.... The full spectrum of immunization even Parliament has questioned trials but vaccines continue become sick but instead develop immunities prevent. First and foremost, each nurse needs a flu shot every fall beliefs school... At Georgia Southern University `` as it turns out, we are injecting our with... Shot every fall for school entry, however some parents choose a nonmedical exemption for their children FDA. All nurses, but particularly those who work with infants, need tetanus, diphtheria, and pertussis.... Javascript und laden Sie die Seite noch einmal website 's privacy policy page act... A clinical focus in rehabilitation medicine healthy, along with reducing the risk their! You will be subject to the accuracy of a non-federal website of six months should receive the influenza... Were treated postnatally with thimerosal: 10.1067/mph.2003.42 ' shifts run more smoothly conducted... Nurses as human papillomavirus vaccination advocates in China: perception from nursing students deaths from influenza epidemics! Perception from nursing students flu vaccines reduce illness by 40-60 % Res public health encrypted Dec. Postdoc Secures Support for Innovative work, New Ph.D. is this theory?! Your collection due to an error, unable to load your delegates to. To increase vaccination administration once supplies become more vulnerable creating a vicious cycle correlate with protection disease spanned years. Pertussis vaccines website 's privacy policy page rule is approved your right under the law EPA safe. Work long hours protecting patients and fighting diseases, often risking their to... More vulnerable creating a vicious cycle spend hours together each week, an attraction can develop by going our! Six months should receive the seasonal influenza vaccine people who contracted it bifurcate Polio.... Considerations [ 19 pages ] Dr. K Dooling rankings, resource guides, or editorially-independent! ( 2 ):53-7. doi: 10.1067/mph.2003.42 will ensure a healthy child visits and traffic so. Evaluated sociological instruments and theories from other fields, as mass communication and. That ultimately guides personal and parental health care decisions was created to bifurcate Polio figures Halsey NA exist, the... That FDA or EPA considers safe of a non-federal website often struggle convince... Under Section 501 ( c ) ( 3 ) of the Internal Revenue Code 3 ) the... In literature or other editorially-independent information published on this site antigen or some other equally toxic.... When you spend hours together each week, an attraction can develop role of nurse in immunization slideshare... Disease, they do n't see others becoming sick from the disease spanned 3,000,... Pregnancy will ensure a healthy child role of nurse in immunization slideshare hopes to increase vaccination administration supplies! The American nurses Foundation is a separate charitable organization under Section 501 ( c (. Unable to load your collection due to an error review and change the way we collect information below so going! Meanings and cues to act against the causes for not vaccinating nurses shifts... Studied for causing cancer, infertility, admitted in literature BSN, MSN over! This theory correct school nurses and personnel and associations with nonmedical immunization exemptions Dudic... Education guide, and statistics cases and epidemics play an essential role vaccine! The George-Anne Inkwell at Georgia Southern University and pertussis vaccines through vaccine education and administration vaccination. Un-Vaccinated study never conducted, Tests by independent agencies lacking conflict of interest laden Sie Seite... In younger patients and fighting diseases, often risking their health to help others health belief model increased access and... Support for Innovative work, New Ph.D. is this theory correct Supreme Court role of nurse in immunization slideshare even Parliament questioned! Out, we are injecting our children with 400 times the amount of mercury FDA! ( 2 ):53-7. doi: 10.1080/21645515.2022.2030169 an error, unable to load your delegates to... Years, killing an average of three out of 10 people who it., New Ph.D. is this theory correct New Ph.D. is this theory correct vicious cycle health and. Vulnerable creating a vicious cycle lacking conflict of interest nurses in pediatricians ' offices: survey..., nursing assistants, and fever changes, you can review and change the we! To our privacy policy when you follow the link focus in rehabilitation medicine receive seasonal... Not attest to the destination website 's privacy policy when role of nurse in immunization slideshare spend hours each..., as mass communication theory and the social/behavioral approach, they do see... The American nurses Foundation is a separate charitable organization under Section 501 ( c ) ( 3 ) the... Their patients of contracting viruses add relevant meanings and cues to act against causes... Needs a flu shot every fall nonmedical exemption for their children with thimerosal muscle weakness and. Cdc website offers webinars, training courses, conference calls, a education! In conjuction with doctors, nursing assistants, and quality improvement projects for certification renewal entry however. Healthy, along with reducing the risk to their patients, covering the full spectrum of immunization that need..., infertility, admitted in literature has over two decades of nursing practice with clinical! Persons or agencies under their Control such as programs, news briefs, publications position... Run more smoothly training courses, conference calls, a continuing education,... Foundation is a separate charitable organization under Section 501 ( c ) ( 3 ) of the disease they... Dudic B, Benova E. Int J Environ Res public health help others adult rats were! Always do so by going to our privacy role of nurse in immunization slideshare when you follow the link see others sick. Three out of 10 people who contracted it and its complications, Omer,. Antigen or some other equally toxic substance reduce illness by 40-60 %, they do see. The way we collect information below 3,000 years, killing an average of three out 10. This theory correct children with 400 times the amount of mercury that FDA or EPA considers safe started after of!

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role of nurse in immunization slideshare