Practices and Perceptions Regarding Pain and Pain Management during Routine Childhood Immunizations: Findings from a Focus‐Group Study with Nurses Working at Toronto Public Health, Ontario

Kikuta, Andrew; Gardezi, Fauzia; Dubey, Vinita; Taddio, Anna

doi:10.1155/2011/381864

Cited by 21 publications

(26 citation statements)

References 13 publications

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“…The results confirm earlier reports that children regard needle procedures as frightening and painful, and are preoccupied with pain (9,12–17). They also provide new information regarding children’s experiences with implementation of the CPG in a school setting.…”

Section: Discussionsupporting

confidence: 90%

“…The present findings have important implications for stakeholders involved in immunization including children, health care providers, policy makers, parents and teachers. By simply providing children and parents with information about how to mitigate pain ahead of time, and making alterations to the physical environment and the process of vaccination, children’s concerns about pain can be addressed (9,11). This has the potential to significantly improve children’s vaccination experience, attitudes toward health care providers and vaccination, and future compliance with vaccination.…”

Section: Discussionmentioning

confidence: 99%

“…Analgesic interventions used during vaccination included topical anesthetics and distraction agents (eg, computers, smartphones and books). Modifications in the physical environment, informed in part by discussions with regional public health nurses (9), included: using a private classroom for all injections, and vaccinating children independently and out of view of their peers; hiding anxiety-provoking equipment, such as needles, from view; and providing cookies and juice after vaccination, and pizza at lunchtime. Students provided feedback during the pilot by rating their pain from the procedure.…”

mentioning

confidence: 99%

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From the Mouth of Babes: Getting Vaccinated Doesn’t Have to Hurt

Taddio

Ilersich

et al. 2014

Canadian Journal of Infectious Diseases and Medical Microbiolog

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BACKGROUND:Analgesic interventions are not commonly administered during childhood vaccination, despite the fact that two-thirds of children are afraid of needles and one-tenth are noncompliant with immunization.OBJECTIVE:To explore children’s experiences of vaccination and preferences for analgesia.METHODS:A total of 17 children (four to 14 years of age) at an independent school in Toronto (Ontario) participated in three focus-group interviews. The majority had previous experience with pain management interventions during vaccination. Thematic content analysis was used to analyze interview transcripts.RESULTS:The findings were categorized into three main themes: experience of vaccination; roles and responsibilities regarding pain management; and impact of pain management. Children easily recalled previous vaccinations and discussed fear and distress experienced by themselves and others. Children believed that parents and immunizers should prepare them ahead of time and use interventions to manage and monitor pain. They also wanted adults to support their efforts to lead pain management. Children discussed benefits of managing pain, including reduced unnecessary suffering, improved vaccination experience, reduced risk of developing needle fears and reduced noncompliant behaviours. They were knowledgeable about strategies for reducing pain including distraction, topical anesthetics and injection techniques. They contrasted vaccination with and without pain management, and indicated a preference for pain management.CONCLUSION:Children reported that managing vaccination pain is important and that analgesic interventions should routinely be used. Incorporating pain management in the process of vaccination has the potential to improve children’s experiences with vaccination and promote more positive attitudes and behaviours.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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From the Mouth of Babes: Getting Vaccinated Doesn’t Have to Hurt

Taddio

Ilersich

et al. 2014

Canadian Journal of Infectious Diseases and Medical Microbiolog

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“…In this present study, the mean AE SD total vaccination appointment time from when the child arrived in the Well-baby Paediatric Clinic until they received their first vaccine injection was 57.08 AE 16.65 min for the total study population, which was an adequate application time for EMLA Õ . Although the delayed onset of action of EMLA Õ cream was cited by healthcare providers as one of the major barriers against the routine use of this pain-relieving strategy for immunization in the office setting, 3,9,19 the development of a protocol for cream application by the nurses on the child's arrival helped to overcome this obstacle. In addition, the mean total vaccination appointment time after administering the EMLA Õ cream did not differ markedly from the mean AE SD waiting time at the King Khalid University Hospital, which was previously found to be 47.34 AE 20.47 min based on performance monitoring (personal communication).…”

Section: Discussionmentioning

confidence: 99%

EMLA® cream: A pain-relieving strategy for childhood vaccination

et al. 2014

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Objectives: To evaluate the effectiveness of topical eutectic mixture of local anaesthetics (EMLA Õ ) cream in reducing the pain associated with vaccination injections. Methods: This was a randomized, double-blind, placebo-controlled study that included children who presented for routine immunization. Eligible children were randomly assigned to receive either EMLA Õ or placebo cream. The Modified Behavioural Pain Scale (MBPS) was used to assess baseline and postvaccination pain scores, while a visual analogue scale (VAS) was used to assess pain at the time of the needle prick and at the end of the injection. Results: A total of 107 children were enrolled in the EMLA Õ group and 109 children in the placebo group. The difference between the pre-and postvaccination MBPS scores was significantly lower in the EMLA group than in the placebo group (2.56 AE 1.96 versus 3.95 AE 2.20, respectively). The VAS scores at the time of the needle prick and after the injection were significantly lower in the EMLA Õ group compared with the placebo group (1.60 AE 1.67 versus 3.24 AE 2.01; 3.29 AE 2.27 versus 4.86 AE 2.20; respectively). Conclusions: Application of EMLA Õ cream can be effectively incorporated as a routine painrelieving intervention within routine vaccination appointments.

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“…Despite being home to most of the world's families living with HIV, literature addressing the health care support needed by HIV-affected families in South and southern Africa is minimal [3,12,[16][17][18]. Most has focused on the utilization of health services by sick people [13,14,17,19,20] and suggests that children are often marginalised as they find health care facilities frightening [21,22] and do not understand the terminology being used [23,24].…”

Section: Introductionmentioning

confidence: 99%

Mothers’ and health workers’ perceptions of participation in a child-friendly health initiative in rural South Africa

Mkwanazi¹,

Rochat²,

Coetzee³

et al. 2013

Health

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Background: Primary health care clinics promote health in addition to treating illness, but are often perceived as unfriendly and frightening places for children. This research aimed to improve child-friendliness in primary health care settings in a rural, high HIV prevalence area in South Africa. Methods: As part of a larger intervention ("Amagugu" Intervention) health staff in nine primary health care clinics were trained in a child-friendliness approach. 281 enrolled mothers were invited to attend clinic with their primary school-aged children and assessed childfriendliness via structured questionnaires administered by independent assessors; a subgroup also participated in in-depth interviews. Post intervention, focus groups were conducted with 87 primary health staff to determine their experiences of providing child-friendly services. Results: Mothers rated 65% of clerks and 70% of nurses as "very friendly". Qualitative data showed that heavy clinical loads, limited human resources and inadequate infrastructure were perceived as barriers to child-friendliness, while good clinic leadership and appropriate resources facilitated child-friendliness. Post intervention most health workers reported that child-friendly health promotion activities were rewarding. Conclusions: Providing child-friendliness training and support to primary health care facilities in low-resource settings is feasible, acceptable and yielded encouraging results.

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Practices and Perceptions Regarding Pain and Pain Management during Routine Childhood Immunizations: Findings from a Focus‐Group Study with Nurses Working at Toronto Public Health, Ontario

Cited by 21 publications

References 13 publications

From the Mouth of Babes: Getting Vaccinated Doesn’t Have to Hurt

From the Mouth of Babes: Getting Vaccinated Doesn’t Have to Hurt

EMLA® cream: A pain-relieving strategy for childhood vaccination

Mothers’ and health workers’ perceptions of participation in a child-friendly health initiative in rural South Africa

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