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Table 4 Examples of three different main approaches by the adults towards the child’s fear

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

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