Background: To explore reasons of non-vaccinated nursing staff for declining seasonal influenza vaccination. The\nannual influenza vaccination of healthcare workers reduces morbidity and mortality among vulnerable patients. Still,\nvaccination rates remain very low, particularly in nursing staff. While several studies have explored barriers for\nhealthcare workers to get vaccinated, most have used a quantitative approach.\nMethods: Data were collected by in-depth individual semi-structured interviews with 18 nurses from a range of\nfields, positions in organizational hierarchy, work experience and hospitals in two German-speaking cantons in\nSwitzerland. Interviews were transcribed and analysed using conventional content analysis.\nResults: Three interconnected themes explaining why nurses decline influenza vaccination were identified: Firstly,\nthe idea of maintaining a strong and healthy body, which was a central motif for rejecting the vaccine. Secondly,\nthe wish to maintain decisional autonomy - especially over one's body and health. Thirdly, nurses' perception of\nbeing surrounded by an untrustworthy environment, which restricts their autonomy and seemingly is in opposition\nto their goal of maintaining a strong and healthy body.\nConclusion: Nurses tend to rely on conventional health beliefs rather than evidence based medicine when making their\ndecision to decline influenza vaccination. Interventions to increase influenza vaccination should be tailored specifically for\nnurses. Empowering nurses by promoting decision-making skills and by strengthening their appraisal may be important\nfactors to consider when planning future interventions to improve vaccination rates. The teaching of evidence-based\ndecision-making should be integrated on different levels, including nurses' training curricula, their workspace and further\neducation.
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