Children’s fear of needle injections: a qualitative study of training sessions for children with rheumatic diseases before home administration

Abstract

Background Treatment of rheumatic diseases in children often includes long-term needle injections, which represent a risk for refusing medication based on potential needle-fear. How nurses manage children’s fear and pain during the initial educational training session of subcutaneous injections, may affect the management of the subsequent injections in the home settings. The aim of this study was to explore how children expressed fear and pain during these training sessions, and how adults’ communication affected children’s expressed emotions. Methods This qualitative explorative study used video observations and short interviews during training sessions in a rheumatic hospital ward. Participants were children between five and fifteen years (n = 8), their parents (n = 11) and nurses (n = 7) in nine training sessions in total. The analysis followed descriptions of thematic analysis and interaction analysis. Results The children expressed fears indirectly as cues and nonverbal signs more often than direct statements. Three children stated explicit being afraid or wanting to stop. The children worried about needle-pain, but experienced the stinging pain after the injection more bothersome. The technical instructions were detailed and comprehensive and each nurse shaped the structure of the sessions. Both nurses and parents frequently offered coping strategies unclearly without sufficient time for children to understand. We identified three main adult communication approaches (acknowledging, ambiguous and disregarding) that influenced children’s expressed emotions during the training session. Conclusions Children’s expression of fear was likely to be indirectly, and pain was mostly related to the injection rather than the needle stick. When adults used an acknowledging communication and offered sufficient coping strategies, children seemed to become involved in the procedure and acted with confidence. The initial educational training session may have a great impact on long-term repeated injections in a home setting by providing children with confidence at the onset.

I don’t want to think about it: a qualitative study of children (6 -18 years) with rheumatic diseases and parents' experiences with regular needle injections at home

“…This study con rmed ndings from a previous study (21) that emphasized the importance of the quality of the rst training session and the need for follow-up sessions related to needle injections after being discharged from the hospital. The rst training session and follow-up session are often performed by nurses alongside a physician consultation.…”

“…This study was part of a larger research project investigating children's fear and pain related to long-term needle injections. The rst study of the project used video observations to explore children's pain and fear during training sessions at the hospital (21). The current study used an explorative design with individual interviews and focus groups to capture the complexity of drug administration at home.…”

“…The fact that physical restraint was not reported in individual interviews may indicate a change in clinical practice and better awareness of this topic. Focusing on adult communication, acknowledging children's fear, and supporting engagement may strengthen the choice of coping strategy and improve children's decisional control (21). Many families experienced a very brief education during short hospital stays, which gave them insu cient con dence to handle the technical and emotional challenges associated with the injections.…”

<p>Young Minds: Mental Health and Transitional Care in Adolescent and Young Adult Rheumatology</p>

“…The initial training session may have a great impact on long-term repeated injections by providing CYP with confidence from the outset. 47 Finally, addressing both child and parental anxieties about painful procedures is just as important as adequate analgesia.…”

I don’t want to think about it: a qualitative study of children (6–18 years) with rheumatic diseases and parents’ experiences with regular needle injections at home

“…The health care of chronic illness has developed towards an increased emphasis on self-management, where a patient’s condition and the subsequent treatment are taken care of at home [ 20 ]. Children with RD and their parents normally have a short hospital stay, during which examination, initiation of treatment, and injection training take place [ 21 ]. Children and parents are expected to conduct regular needle injections at home.…”