| 1. Acknowledging communication |
| Nurse activities | Communication and interaction | Child response |
| Addressing fear | Nurse: “So, what you might do when I give you the shot; is to choose to look at it, or you can look at mummy or daddy, but it might hurt, right?” | Becoming engaged |
| Suggesting coping-strategy; time to reflect | Child: “Yes” (nods) | |
| Nurse: “When you feel the needle stick, you might squeeze your mother’s hand as hard as you feel it” | |
| Guiding the child (and parents) | Child: “And I can think that when its finished; it’s finished, and it’s a week until next time..” | |
| Nurse: “Yes” | Showing confidence |
| Child: “… and then, it might not hurt so much …” (Case1) |
| 2. Ambiguous communication |
| Nurse activities | Communication and interaction | Child response |
| Addressing fear | Child: “Shows an insecure smile (non-verbal fear) | |
| Nurse: “I do understand if you worry about the needle-injection, it might hurt” | Not time to become engaged |
| Suggesting coping-strategy; unclear, no time to reflect | Nurse: “Do you want to look at it or to mummy or ….?” | |
| Child: “I don’t know” | |
| Nurse: “You do as you like, what you think is best – okay? (no answer) here it is; just like a pen don’t you think? The medication is in here; not so much - and you can see that this is the one getting yellow – right? (hearing the nurse take a deep breath) -, then it’s nice and quiet” |
| Taking control | Child: Whispers something impossible to hear | |
| Nurse: “Shall we just have it done? Yes, I will give it here” | Crying |
| Child: “Oh – (cries quietly)” | Surrendering |
| Praising the child | Nurse: “Do you want me to count before I do it? | |
| Child: (no answer) | |
| Nurse: (Gives the shot). There we are (with laud voice) – very brave!” | |
| Talking about the experience | Child: “Yes” | Showing relief and embarrassment (confused) |
| Nurse: “How does it feel? Was it painful?” |
| Child: “It didn’t hurt so much” (Case 7) |
| 3. Disregarding communication |
| Nurse activities | Communication and interaction | Child response |
| Reassuring | Child: “The needle stick will hurt” | Continuing to express fear |
| Parent 1: “It will be over soon” |
| Child: Speaks in a very low voice | |
| Suggesting coping strategy; unclear, and persuading | Nurse: “You will hardly notice anything” | |
| Child: “Yes, but I don’t dare” | |
| Parent 2: “Come on, you can hold on to me” | Crying |
| Child: “I don’t dare” –(cries) | Protesting |
| Parent 2: “Breath” | |
| Child: “I don’t want to” – (cries) | |
| Offering a prize | Nurse: “I will find you a prize afterwards” | |
| Child: “I don’t want to” – (cries softer) (Case5) | Surrendering |
