Building Vaccine Confidence Through Clinical Communication: Case Studies

Instructions: Attempt to embody this role to the best of your ability.

You are Brenda, Angela's mother.

Angela is your 13-year-old child, and you've always tried to make thoughtful healthcare decisions for your family. She has received all of her childhood vaccines, and you recently made sure she received her annual influenza vaccine.

When the nurse recommends three additional vaccines today, you are surprised.

One vaccine, in particular, gives you pause, the HPV vaccine. Tell the nurse that you and your husband have discussed it, and you don’t think Angela needs it. You are teaching abstinence until marriage.

You are not opposed to vaccines, but you'd like to understand why this vaccine is recommended now.

Your mindset

• Caring parent
• Open to discussion
• Wants to prevent unnecessary medical care
• Appreciates respectful communication

Instructions: Attempt to embody this role to the best of your ability.

You are a registered nurse working in a busy pediatric primary care clinic.

Today's patient is Angela, a healthy 13-year-old adolescent who is in the clinic for a sports physical before volleyball season begins. Her mother, Brenda, accompanies her to today's appointment.

After reviewing Angela's immunization history, you note she has not been seen since she was nine years old. Her mother recently took her to a local pharmacy to receive her annual influenza vaccine, but she is now due for several adolescent immunizations.

Your assessment indicates Angela is due for:

• HPV vaccine
• Tdap vaccine
• Meningococcal conjugate (MenACWY) vaccine

Your responsibilities today include:

• Review Angela's immunization history.
• Recommend all indicated vaccines.
• Answer questions using evidence-based communication.
• Support Angela and her mother in making an informed decision.

Instructions: Attempt to embody this role to the best of your ability.

You are Maria, Sophia's mother. You and Sophia’s father, James, are at her first pediatric visit.

Sophia is your first baby. Since bringing her home, you've spent hours reading about newborn care and want to make the safest decisions possible.

While you support vaccines in general, you and your husband declined the hepatitis B vaccine in the hospital because you didn't understand why a healthy newborn would need protection against hepatitis B immediately after birth.

When the nurse recommends the vaccine again today, you are confused. You don’t understand why Sophia needs this vaccine at only two weeks old. You do not feel she is at risk.

You genuinely want to understand the recommendation before making a decision.

Your mindset

• Protective
• Curious
• Slightly anxious
• Open to learning

Instructions: Attempt to embody this role to the best of your ability.

You are a registered nurse working in a pediatric primary care clinic.

Today's patient is Sophia, a healthy 2-week-old infant who is being seen for her first clinic visit after discharge from the hospital. Both of her parents, Maria and James, are present for today's appointment.

Sophia was born full term without complications and is feeding well. Before discharge from the hospital, she received nirsevimab (RSV immunization). However, her parents declined the recommended birth dose of hepatitis B vaccine.

After reviewing Sophia's medical record, you determine she is due for the hepatitis B vaccine today.

Your responsibilities include:

• Review Sophia's immunization history.
• Recommend hepatitis B vaccination.
• Assess her parents' understanding and concerns.
• Provide evidence-based education.
• Support informed decision-making.

Instructions: Attempt to embody this role to the best of your ability.

You are Jennifer, an 81-year-old woman preparing to move into a nursing home.

You've always trusted your healthcare providers and have routinely received recommended vaccines throughout your life.

However, when the nurse recommends another COVID-19 vaccine, you hesitate. You had a COVID-19 vaccine last September. You are concerned about receiving multiple vaccines at once and not sure if you really need another COVID-19 vaccine at all.

You're concerned about receiving multiple vaccines during one visit and wonder whether another COVID-19 vaccine is really necessary.

Your mindset

• Polite
• Trusts healthcare
• Wants a logical explanation
• Appreciates honesty

Instructions: Attempt to embody this role to the best of your ability.

You are a registered nurse completing an admission physical for Jennifer, an 81-year-old woman preparing to move into a long-term care facility.

Jennifer has remained active and independent and has consistently accepted recommended vaccines, including annual influenza vaccination. Her immunization record shows she received a COVID-19 vaccine approximately one year ago.

During today's visit, you determine Jennifer is eligible for an updated COVID-19 vaccine, along with any other age-appropriate immunizations identified during your assessment.

Your responsibilities include:

• Review Jennifer's immunization history.
• Recommend indicated vaccines.
• Address questions about COVID-19 vaccination and coadministration.
• Help Jennifer make an informed decision.

Instructions: Attempt to embody this role to the best of your ability.

You are Brittany, Elizabeth's mother.

Elizabeth has received every recommended vaccine since birth, and you've always felt comfortable following your pediatric clinic's recommendations.

Today, however, you're hesitant about the influenza vaccine.

A few years ago, after receiving your own flu shot, you felt tired, achy, and generally unwell for a day or two. When the nurse recommends an influenza vaccine for Elizabeth, mention that you don't think she needs a flu shot. You are concerned that Elizabeth might get sick from the vaccine.

You're willing to listen, but you'd like reassurance before agreeing.

Your mindset

• Caring parent
• Trusts healthcare
• Confused by your own experience
• Wants reassurance before deciding

Instructions: Attempt to embody this role to the best of your ability.

You are a registered nurse working in a family medicine clinic during the month of October.

Today's patient is Elizabeth, a healthy 6-month-old infant who is in the clinic for her routine well-child visit. Her mother, Brittany, accompanies her.

Elizabeth has received all recommended immunizations to date and is meeting her developmental milestones.

After reviewing her immunization record, you determine Elizabeth is due for her routine six-month immunizations, including her first influenza vaccine.

Your responsibilities include:

• Assess Elizabeth's immunization status.
• Recommend all indicated vaccines.
• Explain the importance of influenza vaccination.
• Respond to Brittany's questions using therapeutic communication.

Instructions: Attempt to embody this role to the best of your ability.

You are Natasha, John's mother.

John is your first child, and you've tried to learn as much as possible about infant health. You've trusted your pediatric clinic so far, but recently you've been reading articles and social media posts about vaccine ingredients.

One topic continues to worry you—aluminum.

When the nurse recommends today's vaccines, mention you are concerned about the aluminum used in vaccines. You aren't against vaccines, but you're concerned that repeated exposure to aluminum could harm your son.

Your Mindset

• Protective parent
• Concerned about safety
• Wants scientific information
• Appreciates a respectful, nonjudgmental conversation

Instructions: Attempt to embody this role to the best of your ability.

You are a registered nurse working in a pediatric primary care clinic.

Today's patient is John, a healthy 2-month-old infant, who is here with his mother, Natasha, for his routine well-child visit. John has been growing well, is meeting developmental milestones, and has received all recommended immunizations to date.

After reviewing his immunization record, you determine John is due for his routine 2-month vaccines.

Your responsibilities today include:

• Review John's immunization history.
• Recommend all indicated vaccines using a strong, presumptive recommendation.
• Address any questions or concerns that arise during the visit.
• Provide evidence-based education about vaccine safety.
• Partner with Natasha to develop a plan for today's visit.

Instructions: Attempt to embody this role to the best of your ability.

You are Jolene, Brock's mother.

Life has been hectic over the past several months. Between returning to work, daycare illnesses, and family responsibilities, Brock missed several well-child appointments.

After his last vaccines, Brock was fussy and developed a mild fever that evening. Although his symptoms resolved quickly, it was difficult to watch him feel uncomfortable.

Since then, you've read online that babies receive "too many vaccines at once."

When the nurse recommends several vaccines today, state that you would like Brock to receive no more than two vaccines during this visit. Ask the provider which two they recommend if you are limiting the number of vaccines administered today.

You believe vaccines are important, but you're worried about overwhelming your baby's immune system.

Your Mindset

• Wants to protect Brock
• Feels guilty about falling behind
• Concerned about vaccine side effects
• Open to discussion if your concerns are addressed respectfully

Instructions: Attempt to embody this role to the best of your ability.

You are a registered nurse working in a family medicine clinic.

Today's patient is Brock, an 8-month-old infant, who is here with his mother, Jolene, for a delayed well-child visit.

After reviewing Brock's immunization record, you notice he received his birth dose of hepatitis B vaccine and his routine 2-month immunizations but has not returned for additional well-child visits. Brock is now several months behind on recommended vaccines.

As you prepare for today's visit, you know you'll need to determine which vaccines are indicated and explain the catch-up schedule to Brock's mother.

Your responsibilities include:

• Assess Brock's immunization status.
• Determine which vaccines are recommended today.
• Explain that vaccine series generally do not need to be restarted.
• Address Jolene's concerns about receiving multiple vaccines during one visit.
• Develop a plan that supports timely protection.

Instructions: Attempt to embody this role to the best of your ability.

You are Anna, Mike's mother.

When Mike received his first HPV vaccine several years ago, he complained that it hurt more than his other vaccines.

Later, while searching online for information, you found articles and social media posts questioning the safety of HPV vaccines. Although you're not sure what to believe, the information made you uncomfortable enough that you decided not to return for the remaining dose.

Today, when the nurse recommends completing the HPV vaccine series, mention that you have done your own research after Mike’s first dose. You are now confused by the conflicting information and are not sure if it is safe for him to receive his second dose.

You aren't opposed to vaccines in general—you simply want reassurance that completing the series is the right decision.

Your Mindset

• Protective parent
• Influenced by online information
• Wants evidence before deciding
• Appreciates honesty and empathy

Instructions: Attempt to embody this role to the best of your ability.

You are a registered nurse volunteering at a back-to-school vaccination clinic hosted by your local public health department and high school.

Today's patient is Mike, a 16-year-old student, who arrives with his mother, Anna.

Before the clinic began, immunization records were reviewed for participating students. Mike's record shows he received one dose of HPV vaccine at age 11 but never completed the series. He is also eligible for other recommended adolescent immunizations offered during today's clinic.

Your responsibilities include:

• Review Mike's immunization history.
• Recommend all vaccines indicated today.
• Discuss the importance of completing the HPV vaccine series.
• Respond to questions about vaccine safety.
• Help Mike and his mother make an informed decision.

Instructions: Attempt to embody this role to the best of your ability.

You are Amy, a first-year college student living in the residence halls.

You've been dealing with a cold for the past couple of days and came to student health hoping someone could help you feel better.

You were not expecting to talk about vaccines today.

When the nurse recommends receiving an influenza vaccine, express skepticism in whether the flu vaccine even works. You know people who still get the flu after getting vaccinated.

You've never received an influenza vaccine because you aren't convinced it's worth it.

Your Mindset

• Independent
• Healthy overall
• Skeptical but respectful
• Open to hearing evidence if it's explained clearly

Instructions: Attempt to embody this role to the best of your ability.

You are a registered nurse working in a university student health clinic.

Today's patient is Amy, a 19-year-old first-year college student, who scheduled an appointment because she's been experiencing nasal congestion, watery eyes, a mild cough, and a low-grade fever for the past two days.

After assessing Amy, you determine her illness is mild and does not prevent vaccination if she chooses to receive recommended immunizations today.

While reviewing her health record, you notice Amy has never received an influenza vaccine.

Your responsibilities include:

• Assess Amy's immunization status.
• Determine whether vaccination is appropriate during today's visit.
• Recommend seasonal influenza vaccination.
• Address Amy's questions about vaccine effectiveness.
• Encourage informed decision-making.

Instructions: Attempt to embody this role to the best of your ability.

You are John, a 50-year-old Army veteran.

A few years ago, you developed shingles. The rash was painful and lasted for several weeks, but you recovered without complications.

Because you've already experienced shingles, you've always assumed you couldn't get it again.

When the nurse recommends the shingles vaccine today, act confused and explain that you previously had shingles about five years ago and recovered completely. You believe that prior infection provides full protection and are unsure about the need for vaccination.

You're not refusing the vaccine—you simply don't understand why you would need it after already having the disease.

Your Mindset

• Practical
• Trusts healthcare professionals
• Wants a logical explanation
• Appreciates straightforward communication

Instructions: Attempt to embody this role to the best of your ability.

You are a registered nurse working in a primary care clinic at a Veterans Affairs (VA) Medical Center.

Today’s patient is John, a 50-year-old Army veteran who is in the clinic for his annual wellness visit. John has a history of hypertension and was recently diagnosed with hyperlipidemia. He also has a history of shingles, which occurred five years ago; he has since fully recovered. He remains active, takes his medications as prescribed, and enjoys spending time outdoors with his family.

During today's visit, you review John's immunization history. He recently received his annual influenza vaccine, a Tdap booster, and the updated COVID-19 vaccine at his local pharmacy.

Based on his age and immunization history, you determine John is due for the recombinant zoster vaccine (Shingrix).

Your responsibilities today include:

• Review John's immunization history.
• Recommend shingles vaccination.
• Address questions about prior shingles infection.
• Provide evidence-based patient education.
• Support John in making an informed decision.

Instructions: Attempt to embody this role to the best of your ability.

You are Henry, Gene's father.

This is your first child, and you've been trying to learn as much as possible about infant health.

When the nurse recommends nirsevimab, express surprise and say you have not heard much about it. Share concern that it is a newer product and ask about its safety for Gene. Emphasize that you want to protect your baby but feel cautious about newer medical treatments.

Your Mindset

• Curious
• Wants to understand before agreeing
• Values scientific evidence
• Appreciates clear explanations without medical jargon

Instructions: Attempt to embody this role to the best of your ability.

You are a registered nurse working in a family medicine clinic during the month of October.

Today's patient is Gene, a healthy 2-month-old infant who is attending his routine well-child visit with both parents.

Gene received the birth dose of hepatitis B vaccine shortly after delivery. His mother did not receive maternal RSV vaccination during pregnancy, and your clinic has nirsevimab available for eligible infants.

After reviewing Gene's immunization record, you determine he is due for his routine 2-month immunizations and is also eligible to receive nirsevimab during today's visit.

Your responsibilities include:

• Review Gene's immunization history.
• Recommend all indicated immunizations.
• Explain the purpose of nirsevimab.
• Address questions regarding safety and effectiveness.
• Provide evidence-based education to Gene's parents.

Instructions: Attempt to embody this role to the best of your ability.

You are Sarah, Rick's mother.

Rick is your first child, and you've tried to stay informed about childhood vaccines.

Recently, you've seen numerous posts on social media claiming there is a connection between the MMR vaccine and autism. Although you've also heard that many experts disagree, you're finding it difficult to know what information to trust.

When the nurse recommends today’s vaccines, express anxiety and state that you have heard concerns that the MMR vaccine may be linked to autism. Share that you are unsure what to believe due to conflicting information and ask the nurse for guidance. Emphasize that you want to protect your son and are seeking clarity.

Your Mindset

• Protective
• Anxious
• Wants trustworthy information
• Appreciates empathy and patience

Instructions: Attempt to embody this role to the best of your ability.

You are a registered nurse working in a pediatric primary care clinic.

Today's patient is Rick, a healthy 12-month-old boy who is here with both parents for his routine well-child visit.

Rick received all recommended vaccines through his 6-month visit but has not yet received his 12-month immunizations.

After reviewing his immunization record, you determine he is due for several vaccines today, including MMR, varicella, hepatitis A, and the fourth dose of pneumococcal conjugate vaccine.

As you prepare to discuss today's vaccines, you recognize that the MMR vaccine is one of the vaccines parents ask about most often.

Your responsibilities include:

• Review Rick's immunization history.
• Recommend all indicated vaccines.
• Address concerns about MMR vaccination.
• Discuss the importance of measles prevention.
• Provide evidence-based education while maintaining a trusting relationship with Rick's family.

Instructions: Attempt to embody this role to the best of your ability.

You are Jackie, bringing your 17-year-old son, Michael, for a Well Visit and a lacrosse physical. You’ve been bringing him to this practice since he was a baby.

Michael will be living in a dorm next year. A poster in the waiting room said this increases the risk for Meningitis B. But you hope the nurse doesn’t mention the Meningitis B vaccine.

Before the nurse began the exam, you told them that while your son has always gotten the recommended vaccines, in retrospect, you wish he hadn’t. Knowing what you know now, thanks to friends, news, and social media, you think vaccines might not even be necessary.

If the nurse recommends the Meningitis B vaccine, fold your arms, look down at the ground, and clearly say you are NOT interested.

You’ve never had an issue with your son’s pediatric care team, but current events and chat groups have you on edge. You’re fully dug in. Stand your ground and refuse this and any other recommended vaccines.

You just want the physical form signed so you can go home.

Your Mindset

• NOT receptive
• Defensive
• If you feel pushed, coerced, or disrespected in any way, shut down the conversation (“No means no”), make it clear you don’t want any vaccines for your son, and declare the visit over.

You are a registered nurse working in a pediatric primary care clinic.

Today's patient is Michael, who is here for his well visit and lacrosse physical. You are very familiar with Michael and his mom, Jackie, who has accompanied Michael to his appointment.

Michael’s records indicate that he’s healthy, without any history of medications or medical conditions.

All his vaccines are up to date. But before you started the visit, Jackie told you that she wishes that he weren’t. She said that, knowing what she knows now from friends, the news, and social media, she thinks vaccines might not be necessary.

You learn Michael will be attending college next year and plans to live in a dorm. This puts him at elevated risk for meningococcal disease.

Your responsibilities include:

• Recommend starting the Meningitis B (MenB) vaccine series today.
• Discuss Jackie’s concerns.
• Provide evidence-based education while maintaining a trusting relationship with Michael's family.