IMMUNIZING CHILDREN WHO FEAR NEEDLES
Immunizing Children Who Fear and Resist Needles: Is it a Problem for Nurses?
Despite increasing evidence that immunization procedures can be stressful for children, little is
known about what the experience of immunizing frightened and needle resistant children can be
like for nurses. This article presents findings from a qualitative research project designed to
explore public health nurses’ feelings towards immunizing needle resistant children. A
constructivist theoretical perspective and an action research approach framed the study. Data
sources included two survey questions and audio recorded transcribed data from three focus
groups. Participants included 35 public health nurses from five different health units in one
Canadian province. The data was analyzed for themes and confirmed with participants through
ongoing member checking. The following four overarching themes were identified and are used
to explain and describe significant features of the immunization experience that were stressful
and problematic for nurses: 1) Nurses experience stress when immunizing children who fear and
resist needle injection; 2) the strength of child resistance and some adult behaviour creates an
ethical dilemma for nurses; 3) some adult responses make immunizing difficult and unsafe; 4)
resources to help nurses cope with these situations are inconsistent.
Keywords: immunization, fear of needles, resistance to needles, nurse stress
This article describes findings from a qualitative research project that investigated the
experiences, reflections and feelings of public health nurses who immunize fearful and needle
resistant children. While the main purpose of the study was to explore nurses’ ideas about the
experience of immunizing children who are frightened of needles, a secondary purpose was to
consider approaches that are helpful in decreasing nurse stress. The research was guided by the
question: What is it about immunizing children who strongly resist needle injection that is a
problem for public health nurses?
A literature review revealed that a significant number of children and adults are frightened of
procedures involving needle injections. Considerable research has been undertaken to investigate
adult responses that are both non-helpful and helpful in easing children’s distress during these
procedures (Duff, 2003; Cohen, Manimala and Blount, 2000; Smalley, 1999; Milgrom,
Coldwell, Getz, Weinstein and Ramsay, 1997; Frank, Blount, Smith, Manimala and Martin,
1995; French Painter and Coury, 1994; Schecter, N.L., Bernstein, B.A., Beck, A., Hart, L. &
Scherzer, L. (1991). Yet few resources are available to help nurses understand their own
responses or to cope with their feelings of stress. Ives (2007) emphasized how health care
agencies can begin to address the problem by creating a culture of empathy and respect and
outlining clear policies on the use of force during immunizations. There is a “gap,” however, in
our understanding of how nurses themselves perceive the experience of immunizing frightened
and resistive children.
Fear of Needles
Literature from the fields of psychology, nursing, pharmacology, medicine, and dentistry reveal
fear of needles as one of children’s greatest fears with claims that up to 93% of some groups of
children experience serious immunization associated stress (Gaskel, Binns, Heyhoe & Jackson,
2005; Uman, Chambers, McGrath & Kisely, 2005; Jacobson et al., 2001; Peretz & Efrat, 2000;
Bowen & Dammeyer, 1999; Smalley, 1999; Polillio & Kiley, 1997; Marten, Ramsay, Whitney,
Fiset & Weinstein, 1994). Research reflects that as many as 10% of adults experience needle
phobia (Bowen and Dammeyer, 1999; Smalley, 1999; Polillo and Keley, 1997; Hamilton, 1995).
Clearly, nurses can expect to encounter both children who are frightened and resistant to needles
as well as parents or caregivers who are also fearful.
In his seminal work exploring needle phobia, Hamilton (1995) hypothesized that needle
phobia is learned as well as inherited. He noted how negative experiences associated with
immunization, lab work, dental visits and other medical procedures can condition children and
even those who witness the events towards becoming fearful of needles. Physical restraint and
verbal abuse by health care personnel during children’s medical procedures can lead to life-long
fears of situations associated with needles, such as physicians, nurses, examination rooms and
even antiseptic smells (Hamilton, 1995). Later, Duff (2003) argued that needle fear centers on
anticipatory and procedural stress and advocated for inclusion of psychological approaches to
help children actively gain a sense of control over their reactions.
Non-helpful and Helpful Adult Responses
Parent and caregiver responses, particularly anxiety related behaviors, influence how children
can reduce stress, gain control and cope with immunization. Some adult responses have been
found to be non-helpful. Parents or caregivers who overly reassured, overly empathized,
apologized, criticized or gave children control of the procedure at the beginning increased
children’s stress (Cohen, Manimala & Blount, 2000; Frank, Blount, Smith, Manimala & Martin,
1995). Further, parents and caregivers who criticized or asked the child to indicate readiness to
receive the needle also increased children’s stress (Devine, Benoit, Simons, Cheng, Seri &
Blount, 2004). Children coped best when their mothers were present but ‘watched only’ and
remained minimally involved. Most children found the presence of their parents during a needle
procedure to be helpful (Duff, 2003; O’Laughlin & Ridley-Johnson, 1995).
Distraction strategies were consistently identified as helpful for short-lived pain (Gaskel,
Binns, Heyhoe & Jackson, 2005; Duff, 2003; Lawton & Rose, 2003; Sparks, 2001). With infants,
playing with an object, sucking, belly-to-belly contact and nonprocedural talk were helpful
(Blount, Devine, Cheng, Simons, Hayutin, 2008). Similarly, with infants, adult verbalizations
associated with better pain outcomes reduced crying (Bustos, Jaaniste, Salmon, Champion,
2008). With children ages 4 to 6, watching cartoons and being coached to attend to the movie
helped (Cohen, Blount & Panopoulos, 1997). With children ages 5 to 18, bubbles, books, music
table, virtual reality glasses, or handheld video games helped (Sjoberg, Dale, Eshelman &
Guzzetta, 2007). With most children, preparing ahead (Duff, 2003), offering limited choices
(Ellis, Sharp, Newhook & Cohen, 2004) and giving permission to cry (Cohen et al 2000) reduced
stress. Deferring the procedure or referral to an alternate source such as play therapy helped to
avoid conflict and coercion (Duff, 2003; Smalley, 1999; Milgrom, Coldwell, Getz, Weinstein
and Ramsay, 1997; French, Painter and Coury, 1994). Distinguishing among adult responses
that are helpful and those that are non-helpful offers important guidance to nurses when they
work with children who resist needles. However, responses to nurse stress are not as clearly
Stress can be experienced when demands exceed the personal and social resources an individual
is able to mobilize (Lazarus & Folkman, 1984). While it is beyond the scope of this article to
present a detailed literature review of nurse stress, a snapshot of current work in the area reveals
limited attention to nurses immunizing frightened and resistant children. The apparent need to
“force” an immunization has been identified as an ethical dilemma for nurses, even constituting
“a human rights burden” (Hodges, Svoboda & Van Howe, 2002, p. 12). Nurses remembered
moral dilemmas, when they were left to wonder ‘Could I have done anything else?’ even years
later, continuing to justify and absolve themselves from blame (Gunther & Thomas, 2006).
Nurses felt powerlessness, angry, exhausted and even burned out following their participation in
situations they believed were ethical and moral dilemmas (Thomas, 2009). Coping with the
emotional needs of patients and families has consistently been highly stressful for nurses
(McVicar, 2003; Sherman, 2004). Avoiding coping rather than identifying that a problem exists
and focusing on coping with it were found to be significant predictors of mood disturbance for
nurses (Healy & McKay, 2000). Given our limited understanding of links that may exist
between negative immunization experiences and nurse stress, it is essential to explore the
The Research Approach
This project was framed from a constructivist theoretical perspective (Appleton and King, 2002)
and a naturalistic action research design (Kemmis & McTaggart, 1988; Kemmis & McTaggart,
1990; Stringer &Genat, 2004). Action research is a reflective, spiral process where nurses use
research techniques to examine their own practice carefully, systematically and with the
intention of applying their findings directly to their own and other nurses’ every day practice.
Kemmis and McTaggart (1988) offered the seminal explanation that action research is deliberate,
solution-oriented investigation that is group or personally owned and conducted. It is
characterized by spiralling cycles of problem identification, systematic data collection,
reflection, analysis, data-driven action taken, and, finally, problem redefinition. The linking of
the terms “action” and “research” highlights the essential features of this method: trying out
ideas in practice as a means of increasing knowledge (Kemmis and McTaggart, 1988). Kemmis
and McTaggart (1990) also suggested that the participatory nature of action research, where
researchers collaborate with participants in order to understand and improve practice, can reduce
the distance between researchers and participants and the “. . . problems they intend to solve, or
the lived experience they intend to interpret” (p. 28).
Data sources included two survey questions and audio recorded transcribed data from three focus
groups. The survey was distributed anonymously via employee e-mail to 58 nurses from five
different health units in one Canadian province. Survey Question One: Does your practice
involve immunizing children? Survey Question Two: “Sometimes children who present for
immunization strongly resist needle injection. Based on your experience, what is it about this
situation that is a problem for you?” This survey generated 35 (60%) responses, all of whom
confirmed that their practice did include immunizing children.
The survey was followed by three audio taped and transcribed focus groups. The focus groups
were two weeks apart, each with five to six female, English speaking, Caucasian and Indo
Canadian nurses, from five different health units in one Canadian province. The participants
were those who had responded to the survey and their experience ranged from novice (less than
one year experience) to expert (up to 25 years experience) in two groups. The third group had no
novice participants. Focus groups are flexible, cost efficient, generate rich data and tend to have
high face validity (Krueger& Casey, 2009; Morrison-Beedy, Cote-Arsenault, Feinstein, 2001;
Speziale & Carpenter, 2001; Webb & Kevern, 2000). The following questions guided the
1. When you hear the phrase, “a child who is strongly resistant to needle injection,” what
comes to mind?
2. What is it about these situations that is challenging for you?
3. What sorts of things have made it easier for you to immunize children who resist the
4. What sorts of things have made it harder?
5. Do you have any thoughts on how these situations can be improved?
Content from these data sources were analyzed for themes. The transcripts were thoroughly read
and re-read and a systematic process of content analysis was developed (Loiselle, Profetto-
McGrath, Polit, & Beck, 2007; Speziale & Carpenter, 2003) to create the categorization and
coding scheme that led to the themes. Trustworthiness was established through ongoing
interaction and member checking with participants to confirm authenticity. Full ethical approval
was granted by a university and a health authority.
The following four themes emerged from analyzing the survey and focus group data collected
from and confirmed with nurses who routinely immunized children. The themes represent
nurses’ perceptions of what it was about immunizing frightened and resistant children that was a
problem for them. Verbatim comments are italicized. The themes are: 1) nurses experience
stress when immunizing children who fear and resist needle injection; 2) the strength of child
resistance and some adult behaviour creates an ethical dilemma for nurses; 3) some adult
responses make immunizing difficult and unsafe; and 4) resources to help nurses cope with these
situations are inconsistent.
Theme One: Nurses experience stress when immunizing children who fear and resist
Nurses used the word “dread” in all three focus groups to describe their apprehension about
immunizing needle resistant children, especially as a new practitioner. They described the
situations as awkward, difficult and complex, with “too many pieces” or variables. Nurses
frequently recounted actual experiences to illustrate specific points. Feeling “flustered” and
fearful of making a medication error or harming the child, as well as fear for the nurses’ own
safety was reported in the survey and across all groups. Empathy for the child’s “incredible
panic and fear” was articulated, noting the child’s “terror” and “screaming, kicking, and biting”
behaviours as very disturbing. “I think of how hard it is to be scared. Like that’s so much work
on the child’s part. It takes so much energy.”
Crying was not seen as particularly difficult, but “acting out” behaviours, “struggling to get
away, to get out of the room” were problems. “The child’s terror, that’s what gets to me.” “I
feel really badly for the child because they’re embarrassed…and they’re kind of shamed.” The
nurses felt “torn” about the process. They found it “very disturbing” to witness the child’s
distress and felt “complicit in an assault.” They described feelings of helplessness and
uncertainty, wondering how “it might have been done differently.” One nurse wrote, “I don’t
know how to make these situations more comfortable.” Nurses felt “…pressured to just finish the
job, no matter how much the child resists.” Novice practitioners were more likely to feel
pressured. “Throughout my orientation it was very heavily implied, it does not matter the
situation, you always vaccinate children for as many vaccines as they’re eligible for. And I just
feel a lot of pressure to do that during that clinic visit.” Sometimes, the pressure comes from
parents. “I’ve had two, three different scenarios where…the anger from the parents like,
“Whaddya mean... And they’re going to argue with you. “I (parent) will hold them down and
you will do it.”
The nurses reported feeling drained, emotionally exhausted, fatigued and unsupported. A
sense of failure, guilt, “heavy heartedness” and frustration was expressed, as well as a “scary”
feeling of being “out of control.” One group likened the situation to “a circus” with “moms
chasing (children) around to try to get them in and there is a waiting room full of people.”
Nurses described feeling hurt and annoyed when parents blamed and labelled them “the mean
nurse” or “the stabber”. Nurses were troubled by the potential for “emotional scarring” and
serious erosion of trust in the child’s relationship with health professionals. They suspected that
past experiences strongly influenced the present and believed children deserve to be better
prepared for immunization.
Theme Two: The strength of child resistance as well as some adult behaviour creates an
ethical dilemma for nurses.
A major theme that emerged was the conflict around the child’s right to refuse versus the
right to be protected from preventable disease. “I think as a nurse, the challenge is combining
that gentle persuasion but with letting them make their own decision.” “And we’re taught in our
profession you know, do no harm. So you feel like you’re doing harm when you encounter
situations where there’s such strong resistance.” A nurse wanted to find “a balance between
helping the child find courage and protecting him from very dangerous diseases.” Another
stated the problem as:
“…the lack of respect it demonstrates to a child. In deciding on their behalf what is best
for them I don’t understand what makes that okay and at what age we give the child the
control to make that decision. A problem for me is the subjectivity of deciding what’s in
the child’s best interest; subjectivity in assessing potential harm to child versus benefit of
Within each group, two or more nurses recounted stories of especially challenging situations they
thought had been handled poorly and felt regret about their involvement in the process. “There’s
some where you’re going - oh that was awful! That didn’t feel right. I don’t feel good about
that.” Children kindergarten age and older were viewed as the most challenging although some
nurses also identified “strong toddlers” as difficult.
Nurses wondered, “How much restraint is too much?” A survey responder stated:
“The problem becomes one of the child’s right to object and refuse… some parents like to talk
their children into shots; this takes quite a bit of time. Others are quite physical in their restraint
methods and I don’t know exactly when to step in and say - that’s enough!”
One nurse remarked:
“I don’t think the end always justifies the means. Because I had a father who came in with
a son and he was really quite brutal with him. And we were really part of that because,
you know, it was our end that we wanted to go to and that was the reason why. And I
thought, I’m never doing that again. I’m just going to say, “I’m sorry, I can’t do this. This
is beyond what I can be part of.”
Another recalled “… a mother actually physically sat on her child and restrained him and
slapped his face and told him how much she loved him and told him to just do it. Okay, and
that’s always going to come to my mind. It was like an assault, us actually harassing him.”
A colleague added:
Right, and then being torn between, Do I follow through, give it to him, get it over with for
him? Will he have to go through this again? Or do I hold back and say, “Not under these
circumstances.” …It was a very awkward situation. And we…you had said, “What do I
do?” And I thought, “Let’s get it over with for him. He’ll have to go through that all over
again or be bullied at home.” But somehow we were then part of that.
“It almost kind of reminds you, you know, of One Flew over the Cuckoo’s Nest, where they
have to bind them down and they give them the electrical shock treatments and they don’t want
A survey responder commented: “Immunization of children is recommended, not mandatory,
therefore children may have the right to refuse.” Another wrote:
“The problem I have is with the three to five year olds who clearly verbalize they don’t
want the shot. We hold them down and do it anyways. From a young age we teach
children to use their words. We teach them to say “no” to a stranger who offers candy,
rides etc. We teach them to kick, scream, and run when a stranger touches them or they
feel threatened by them, yet I am a stranger to this child who is saying “no” to me and I
proceed and hurt the child. What message are we sending these children?”
Children with developmental delays were particularly challenging. A nurse recalled immunizing
a grade six boy with developmental delays, “It was really hard, because he wasn’t going to sit
still on his own. So we had a lot of hard decisions to make with that and mom held him down. It
In one group, a few of the more experienced nurses initially seemed somewhat dismissive of
the issue as a sort of necessary evil; yet even these nurses acknowledged with some surprise after
the group “how much there was to talk about” on the topic. Challenging variables included:
“sheer number” of vaccines, complexities of vaccine administration, language barriers, lack of
privacy in mass immunization clinics, circulating myths about needles getting stuck or breaking
off in people’s arms, unpredictability of some resistance, noise levels, too many people involved,
and lack of time.
Theme Three: Some adult responses make immunizing more difficult and unsafe.
Non-helpful responses by adults such as parents, school staff or other caregivers were defined
across all data sources as a burden to nurses. “So often what I find makes it really difficult,
because I don’t know so much that I lose patience, but I’m not quite sure where to go with it
when the parenting responses are so inappropriate.”
Most frequently cited non-helpful responses were: either inadequate or overly forceful restraint
by the parent; shaming, threatening, yelling, slapping, lying; or alternatively, pitying, placating,
bribing, wishy-washy, and helpless parental behaviours. Nurses complained of getting kicked
and hit by a struggling child and expressed frustration with parents who have not explained the
purpose of the visit to the child.
In school situations, nurses felt frustrated when well-meaning adults interfered with the process
by attempting to take control.
It isn’t suddenly about being poked anymore. There’s a bunch of family dynamics there as
well and they get the power stuff going, and you put the child in the school situations,
sometimes it’s with the classroom teacher, you know, that’s involved as well, and you
think, ‘Oh boy, how many do we need involved in this really?’ We sort of bring in all the
skills you have, not just the needle part, but the kind of group skills too.
“It’s tough for the nurse because, ultimately… we are in charge.” Nurses reported that adults
sometimes tease students in a way that increases anxiety, and that students often “rile up” each
Nurses disliked having competitive elements introduced into the situation. For example, parents
may complain if the nurse chooses not to proceed with the immunization with comments such as:
“She couldn’t do it so I need another nurse.” One nurse described her dismay if a parent would
tell her, “‘my baby didn’t cry at all last time… with the other nurse she didn’t cry at all.’ I don’t
know why they say that to me because it hurts, it jinxes me.” And finally, nurses were frustrated
with parents who project their own fears onto the child or communicate to the child expectations
of resistant behaviour thus generating a self-fulfilling prophecy.
Theme Four: Resources to help nurses cope effectively with these situations are
inconsistent and inadequate.
Nurses voiced how existing strategies and resources to consistently support a positive
immunization outcome were inadequate, inconsistently available and poorly disseminated.
Nurses described strategies they used to help in these situations with mixed results. Most of the
strategies were learned through trial and error or direct observation. A nurse with more than ten
years of immunization experience stated: “In a school setting, I see it as a learning opportunity
of just sitting back and seeing how somebody else handles it. I’m thinking, Thank God, I’m not
the one who has to deal with it.”
Nurses reported that crude forcible restraint is no longer as common as it once was. Linda
related: “I remember a principal holding a kid against the wall actually, believe that?”
“I think we’re better at saying we can’t do it than, let’s say, fifteen years ago. I think we
used to sit on kids more than we do now. I certainly, more now than I used to, just will say,
‘I can’t do this’…whereas before… we used to get a couple of us in there and really, with
the parent’s permission of course, but were more forceful.”
Several nurses described how they learned, sometimes through bitter experience, where to set
“And also, the holding down or the forcing, I think… I do not have to give that, force that
on that child. So I think that’s something I’ve come to in my practice is that the child does
not have to have it. We will not force this child to have it… and so that, yes, it is in your
best interest to have this. So let’s work together with parents and help them to do this. But
as far as the forcing, I will not be a party to this.”
“We sort of learn like where we draw the line too, and that’s hard sometimes.” A nurse with
less than two years experience said: “It’s different in different places… like its okay for me here,
to say we don’t do that and I’m comfortable with that. But in another environment there might
be more pressure I think, to get the thing done in a time frame.”
The nurses described being supported in choosing to defer a vaccine as very important. A novice
practitioner, stated, “I don’t think it’s made clear to us that we can say no, that we don’t have to
do it.” One survey response stated:
“Trying to put the child at ease who has become very anxious. This can be very draining
and it can be difficult to know when to call it off. If you call it off, then the parent (if a
kindergarten immunization) is then quite often angry. Sometimes it seems like there should
be a policy or a sign that backs this up. The sign or policy stating we will not use force to
Collaborating with colleagues and being able to debrief were highly valued. Occasionally nurses
recruited each other to assist with restraint, yet as one nurse pointed out, “It’s the same thing
again, like if you’re getting another nurse. And then there are two of you holding the kid down.”
Another agreed, “Yeah, it makes it like a gang mentality.” You know, we’re all ganging up on
The nurses discussed what sorts of things could make it easier for them to effectively manage
situations with resistant children. They recommended combination vaccines, labelled trays to
hold pre-filled syringes, well-ventilated, soundproof clinic rooms, separate waiting rooms for
before and after, and time to debrief after a difficult session. Strategies identified as helpful
included: giving limited choices, using a calm voice, preparing parents for crying and giving
children permission to cry, remaining firm but not threatening, using stickers to celebrate effort
and having distraction and calming tools such as puppets, bubbles, comfort dolls and cartoon
videos in waiting areas. Giving children time to express themselves but without engaging in
endless negotiation is also important. Anaesthesia was not discussed except in one survey
response suggesting pre-procedural child sedation.
Nurses desire skills to effectively manage immunization procedures. “I don’t have enough
skills to know what the best response or techniques are to get the immunization done in a way
that is most positive for everyone involved.”
“I must admit, I’m better… more compassionate with kids that I perceive as being truly
afraid (than with) those that I think are… just being smart alecks. Sometimes you get a
child where you think, ‘Oh, you’re just trying to pull my chain and get things riled up here.
Or you see a child that is truly just terrified and I’m better with the kids that are (truly
terrified), and maybe I might not even be reading it right.”
“(I)… would like to learn about more techniques for self-calming;” Another wrote, “Parents
are often unaware of their child’s ability to learn some of these skills and at how young an age it
can be taught.” Nurses viewed the clinic visit as an opportunity for children to acquire adaptive
coping skills and experience mastery in an honest, respectful, supportive environment.
Having enough time to prepare and also to debrief with parent and child was seen as important.
“There has been no time to prepare them in anticipation of them being that way (so wound
up, not being able to focus and calm down). We have nothing to offer these families. No
opportunity to teach the parents… we’re rushed and the parents are in a hurry and there’s
nothing else in place in another time to prepare them. We wind up being a part of it.”
They identified a need to provide parents with clear direction about positioning, secure hold and
what not to say to their child, e.g., limit bribes and threats, and avoid projecting parent fears onto
the child. Referral to parent education sessions was a strategy employed where available. One
nurse identified the focus group session itself as a useful opportunity to “troubleshoot” and
“brainstorm ideas.” Another talked about “building up your repertoire of tools” and explained
how she benefited by learning strategies from other nurses that would have “never occurred to
me.” The nurses expressed strong interest in educational materials that could be used by parents
and children to better prepare for an immunization appointment.
These four themes, developed from discussions with nurses who routinely immunize children
who fear and resist needles, illustrate how this procedure is problematic and stressful for nurses.
The intensity of nurse stress is reflected in the language participants used to describe their
experiences and the vividness of their memories. The words “dread,” “awful,” “traumatizing,”
“failure,” “assault,” “terror,” “fear,” and “shame” appeared frequently in the data. Casting
this response against Lazarus and Folkman’s (1984) classic explanation that stress results when
‘demands exceed the personal and social resources an individual is able to mobilize’- study
findings lead us to question whether other nurses are also feeling that the demands of
immunizing needle resistant children exceed their ability to cope.
The comments reflect how the experience of forcing compliance from children generates ethical
and moral dilemmas for nurses. Bioethicists Hodges, Svoboda & Van Howe (2002) emphasized
how heightened scrutiny is essential in situations where children, who are unlikely to be able to
provide meaningful consent, are subjected to prophylactic interventions such as immunization.
And yet, the issue may not be formally addressed with explicit policies and procedures in the
practice arena. With the exception of the present study, the literature has not yet begun to
acknowledge that a problem exists.
Nurses’ descriptions of their memories of immunizing needle resistant children were consistent
with the moral distress Gunther and Thomas (2006) described in their exploration of patient care
events that were unforgettable to nurses. In both studies, nurses wondered whether they could or
should have done things differently even years later. Descriptions of their memories in the
present study also reflected a sense of powerlessness. Feelings of moral distress, powerlessness,
anxiety and anger all contribute to the stress and burnout Thomas (2009) identified as a
persistent issue among nurses. However, nurses’ stress related to immunizing needle resistant
children has not previously been included in discussions of moral distress.
This article presented findings from a naturalistic action research study that explored nurses’
perceptions of immunizing frightened and resistant children. In contrast to other studies that
focused mainly on recipients of vaccines, this project extends existing knowledge by describing
nurses’ reflections on their own experiences with immunizing by identifying four overarching
themes. This research found nurses experience stress when immunizing children who fear and
resist needle injection, the strength of child resistance and some adult behaviour creates an
ethical dilemma for nurses, some adult responses make immunizing difficult and unsafe and
resources to help nurses cope with these situations are inconsistent. This article calls for the
creation of more opportunities to explore whether or not immunizing needle resistant children is
a problem for other nurses. Articulating that a problem exists, that needle procedures are often
stressful and that the experience can leave nurses feeling morally and ethically conflicted is an
important first step. Further study could lead to more consistent support for nurses who are
responsible for immunizing children and to more positive outcomes for all.
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