IIMPACT in Health, The University of South Australia, Adelaide, South Australia, Australia.
Department of Psychology, The University of Calgary, Calgary, Alberta, Canada.
Eur J Pain. 2022 Sep;26(8):1702-1722. doi: 10.1002/ejp.1992. Epub 2022 Jul 1.
Negative experiences of needle procedures in childhood can lead to medical avoidance and vaccine hesitancy into adulthood. We evaluated the feasibility of two new interventions provided by clinical nurses to reduce the negative impact of vaccinations: divided attention (DA) and positive memory reframing (PMR).
Children (8-12 years) were randomized into four groups: usual care (UC), DA, PMR or combined (DA + PMR). To evaluate feasibility, we undertook in-depth analysis of video-recorded interventions, nurse experiences (phone interviews) and child/parent memory recall of interventions (phone interviews at 2 weeks post-vaccination). Key clinical outcomes included child and parent ratings of needle-related pain intensity and fear assessed at baseline, immediately post-vaccination and 2 weeks post-vaccination (recalled).
A total of 54 child-parent dyads were screened, with 41 included (10/group, except PMR [n = 11]). The interventions were not always completed as intended: 10%-22% of participants received complete interventions and two had adverse events related to protocol breach. Preliminary within-group analyses showed no effects on child/parent pain ratings. However, children in DA + PMR had reduced recalled fear (p = 0.008), and PMR (p = 0.025) and DA + PMR (p = 0.003) had reduced fear of future needles. Parent ratings of child fear were also reduced immediately post-vaccination for UC (p = 0.035) and PMR (p = 0.035).
The interventions were feasible, although enhanced nurse training is required to improve fidelity. Preliminary clinical results appear promising, particularly for reducing needle-related fear.
Protocol number ACTRN12618000687291 at ANZCTR.org.au SIGNIFICANCE: Two new nurse-led interventions to reduce negative impacts of vaccinations in children, divided attention and positive memory reframing, were feasible and may reduce needle-related fear. Nurses were able to deliver the interventions in various environments including non-clinical settings (schools). These interventions have potential to facilitate broader dissemination of vaccinations for children in a manner that minimizes distress.
儿童时期对针具操作的负面体验可能会导致成年后对医疗的回避和对接种疫苗的犹豫。我们评估了临床护士提供的两种新干预措施（分散注意力和积极记忆重构）减少接种疫苗负面影响的可行性。
将 8-12 岁儿童随机分为四组：常规护理（UC）、分散注意力（DA）、积极记忆重构（PMR）或联合干预（DA+PMR）。为了评估可行性，我们对视频记录的干预措施、护士的经验（电话访谈）以及儿童/家长对干预措施的记忆回忆（接种后 2 周的电话访谈）进行了深入分析。主要临床结局包括儿童和家长在基线、接种后即刻和接种后 2 周（回忆时）对与针具相关的疼痛强度和恐惧的评分。
共对 54 对儿童-家长进行了筛查，其中 41 对（每组 10 对，除 PMR[n=11]外）纳入研究。干预措施并非总是按计划完成：10%-22%的参与者接受了完整的干预措施，有两例出现了与方案违反相关的不良事件。初步的组内分析显示，对儿童/家长的疼痛评分没有影响。然而，在 DA+PMR 组中，回忆时的恐惧减少（p=0.008），PMR 组（p=0.025）和 DA+PMR 组（p=0.003）对未来针具的恐惧减少。UC 组（p=0.035）和 PMR 组（p=0.035）的家长对孩子恐惧的评分也在接种后即刻减少。
这些干预措施是可行的，尽管需要加强护士培训以提高保真度。初步的临床结果有希望，特别是在减少与针具相关的恐惧方面。
ACTRN12618000687291 在 ANZCTR.org.au 上注册。
两种新的护士主导的干预措施可减轻儿童接种疫苗的负面影响，包括分散注意力和积极记忆重构，这两种措施具有可行性，且可能会降低与针具相关的恐惧。护士可以在各种环境中（包括非临床环境，如学校）提供这些干预措施。以这种最小化痛苦的方式，这些干预措施有可能促进儿童更广泛地接种疫苗。
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