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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