Nurse in Online Graduate Program Conducts Vaccination Research with Practical Implications

June 29, 2023  |  by Heidi Wells, Global Campus

Elizabeth Tarlov traveled from Bethesda, Maryland, to speak to University of Arkansas nursing students about the importance of asking research questions that have both practical and policy implications in the communities they serve or will serve as nurses.

The occasion was Nursing Science Day put on by the Eleanor Mann School of Nursing at the U of A. Tarlov, the day's keynote speaker, directs the Division of Extramural Science Programs at the National Institute of Nursing Research at the National Institute of Health in Bethesda. The event also featured research by nursing students displayed on posters around the ballroom at the Arkansas Union as well as other speakers.

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Elizabeth Tarlov, director of the Division of Extramural Science Programs at the National Institutes of Health, talks about the importance of research by nurses.

Sarah Spence stood alongside her poster, explaining her project as fellow students, faculty members and visitors stopped by. She graduated in May with her Doctor of Nursing Practice degree delivered online from the U of A and won an award for the year's best research project from the nursing school, which is part of the U of A's College of Education and Health Professions.

Spence's poster described her research on improving follow-up vaccination rates in Northwest Arkansas. Specifically, she looked into communication about childhood vaccinations by a local clinic with its patients who speak a language other than English, primarily Spanish and Marshallese. The clinic Spence worked with is located in Springdale, where the Springdale School District is the largest school district in Arkansas. Its population of Hispanic children is more than 48%. More than 8,050 of the total enrollment of 22,000 students are classified as English Second Language learners. Springdale is also home to the largest population of Marshallese people outside the Marshall Islands.


Practical Application

Tarlov said nurses have several important aspects to consider if they want to include research in their nursing careers.

"One of those is a topic that you're extremely passionate about," Tarlov said. "You want to be bold and creative in all aspects of your study, as you're thinking about what questions need to be answered through your research, what communities you might need to and want to reach out to and how you're going to do that, plans for analyzing your data and everything in between. I think also you want to consider the practice and policy implications of your research from the beginning."

She encouraged the nursing students to take the lead.

"We need new, great bold ideas to solve our most pressing and persistent health challenges and also to address our obstinate problem of health inequities," Tarlov said. "The mission of the National Institute of Nursing Research is to lead nursing science to solve pressing health challenges and inform practice and policy – optimizing health and advancing health equity into the future."


Family Influence

Spence grew up immersed in the world of health care. She joked that, with a mother who is a doctor and a father who is a nurse, she had to study nursing so she could understand conversations at the family dinner table. She earned an associate's degree from a community college in Texarkana, where she grew up, and her registered nurse's license before attending Texas A&M University-Texarkana for her bachelor's degree. She enrolled in the U of A's BSN to DNP delivered online with an in-person clinical component and has worked at Washington Regional Medical Center in Fayetteville for most of her time in the program.

Spence feels strongly about vaccines.

"If you break it down, even though vaccines had a tumultuous history, I feel like the fact that humans came together with the idea of decreasing childhood morality, saying it's not something that we have to put up with, that we can invent something that's never been invented before to prevent the death of children, it always enchanted me," she said. "Being involved in an environment that works in vaccination always makes me very proud of what I do."

Many people have worked to create vaccines to prevent diseases as well as the eradication of smallpox, Spence said.

"The idea that we can eradicate any illness is mind-blowing," she said. "That's what drew me to this project and to help vulnerable populations as well."


Project Development

In the first year of the DNP, Spence said, students were learning about disease processes, studying a list of diseases, how you get them, how they affect the body. She began thinking about a project to increase vaccination rates, but this was before the COVID-19 pandemic when people weren't thinking much about vaccinations, Spence said.

"I thought it would take a global pandemic to get people interested in the topic of vaccinations," she said, laughing now at her prescience.

Spence was doing her clinical practicum required by the DNP program at a clinic in Springdale. The clinic's internal vaccination records didn't communicate with the Arkansas Department of Health's vaccination registry, so Spence typed in the names and birthdates of about 650 patients to find those who met the criteria to be included in the study.

"Our goal was to increase vaccination rates and we talked about having a drive-through clinic," she said. "But then we decided on increased communication. Everybody loves to have a text instead of a phone call and the texts needed to be written in English, Spanish and Marshallese."

After patients received the appointment prompts and reminders sent by text along with having access to printed information in all three languages, the vaccination rate at the clinic rose from 64.12% to 68%, a significant increase for all three populations, Spence said, although still lower than the state average of about 75%.

The minority populations affected also drew Spence to the project she said. While the research may help smaller numbers of people, they are just as important, she said. She formerly worked on the medical-surgical unit of Washington Regional Medical Center in Fayetteville and now is in a managerial role in bed control in the hospital's transfer center. She plans at some point, after getting her family nurse practitioner license, to work in a primary care clinic, where she will be more involved in vaccinating patients.


Research Results

Sarah Spence, who received her Doctor of Nursing Practice degree in May, displays her research on a poster at Nursing Science Day put on by the Eleanor Mann School of Nursing at the U of A.
Sarah Spence, who received her Doctor of Nursing Practice degree in May, displays her research on a poster at Nursing Science Day put on by the Eleanor Mann School of Nursing at the U of A.

Tarlov also talked about reaching out to find partners in other disciplines to leverage their strengths and perspectives and generate the best evidence possible. In Spence's project, she turned to the local Marshallese Action Coalition for the translation services she needed.

Spence reported her results on her poster. The project found increasing outreach and education efforts increased the vaccination rate of minority populations. The project's sustainability is supported by the clinic's continued use of the interventions, she wrote.

"This project can apply to settings which administer vaccines, use primary prevention education, and/or face a language barrier," Spence wrote. "The project results imply that attention to patients' primary languages improves education and communication between providers and their patient population. Suggested research includes studying the use of other languages, populations outside of Northwest Arkansas, patient culture and vaccination rates for other age groups."



Spence points out data she collected.
Spence points out data she collected.

For Spence, the expertise Tarlov represented and the image she presented was as much an inspiration as her message. Spence said she often finds herself in awe when listening to nursing researchers.

"I love it when people know so much about a subject they have to kind of use simpler language so you will understand what they understand," she said. "It is encouraging to see a woman up there who has the experience and vocabulary to be a vocal part of the health care environment."

To learn more about the Doctor of Nursing Practice offered online by the University of Arkansas, please visit the program website.

Photo of Heidi Wells

Heidi Wells

Content Strategist

Heidi Wells is the content strategist for the Global Campus at the University of Arkansas and editor of The Online Learner. Her writing spans more than 30 years as a communicator at the U of A and a reporter and editor at Arkansas newspapers. Wells earned two degrees from the U of A: a master's in 2013 and a bachelor's in 1988.

Wells can be reached at or 479-575-7239.

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