Immunizing Children Who Fear and Resist Needles: Is It a Problem for Nurses?

Chilliwack Health Unit, Chilliwack, British Columbia, Canada.
Nursing Forum 01/2010; 45(1):29-39. DOI: 10.1111/j.1744-6198.2009.00161.x
Source: PubMed


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 toward 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 were analyzed for themes and were 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: (a) nurses experience stress when immunizing children who fear and resist needle injection; (b) the strength of child resistance and some adult behavior creates an ethical dilemma for nurses; (c) some adult responses make immunizing difficult and unsafe; and (d) resources to help nurses cope with these situations are inconsistent.

    • "Consequently, the strength of children's resistance can create an ethical dilemma for healthcare providers (Ives & Melrose 2010). Healthcare providers who restrain might feel that they have to choose between causing harm and promoting health (McGrath & Huff 2003, Lloyd et al. 2008, Ives & Melrose 2010). "
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    • "This in turn can lead to physical harm for the nursing staff (Lambrenos & McArthur, 2003) and children respectively, and Llyod, Urquhart, Heard, and Kroese (2008) find that nurses experience negative emotions during this action. In a study by Ives and Melrose (2010), the nurses described a feeling of powerlessness when the children had to endure those trying NRMP. Similarly, the nurses in our study reflected upon the negative consequences of a difficult procedure for the children but also for themselves. "
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    ABSTRACT: Children state that among their worst fears during hospitalization are those related to various nursing procedures and to injections and needles. Nurses thus have a responsibility to help children cope with needle-related medical procedures (NRMP) and the potentially negative effects of these. The aim of the study is to describe the lived experience of supporting children during NRMP, from the perspective of nurses. Fourteen nurses took part in the study, six of whom participated on two occasions thus resulting in 20 interviews. A reflective lifeworld research approach was used, and phenomenological analysis was applied. The result shows that supporting children during NRMP is characterized by a desire to meet the child in his/her own world and by an effort to reach the child's horizon of understanding regarding these actions, based on the given conditions. The essential meaning of the phenomenon is founded on the following constituents: developing relationships through conversation, being sensitive to embodied responses, balancing between tact and use of restraint, being the child's advocate, adjusting time, and maintaining belief. The discussion focuses on how nurses can support children through various types of conversation and by receiving help from the parents' ability to be supportive, and on whether restraint can be supportive or not for children during NRMP. Our conclusion is that nurses have to see each individual child, meet him/her in their own world, and decide on supportive actions while at the same time balancing their responsibility for the completion of the NRMP. This work can be described as "balancing on a tightrope" in an unpredictable situation.
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