Relaxation and guided imagery do not reduce stress, pain and unpleasantness for 11‐ to 12‐year‐old girls during vaccinations

Abstract

Relaxation and guided imagery do not reduce stress, pain and unpleasantness for 11-to 12-year-old girls during vaccinations, 2015, Acta Paediatrica, (104) Abstract AimRelaxation and guided imagery is a distraction technique known to reduce discomfort during paediatric medical procedures. We examined whether its use decreased the stress experienced by 11 to 12-year-old girls receiving the human papilloma virus vaccination, as well as the intensity and unpleasantness of any pain. MethodA randomised crossover trial was conducted with 37 girls. During the first vaccination, each girl was randomised to receive either relaxation and guided imagery or standard care. They then received the other form of care during the second vaccination. Salivary cortisol was measured before each vaccination and 30 minutes after it was administered. The girls reported pain intensity and pain unpleasantness before and directly after each vaccination and stress after each vaccination. ResultsOn a group level, relaxation and guided imagery did not decrease cortisol levels, selfreported stress, pain intensity and pain unpleasantness. Salivary cortisol levels decreased significantly in both groups during the second vaccination. ConclusionRelaxation and guided imagery did not prove beneficial during the vaccination of 11 to 12-year-old girls and is not recommended as a regular nursing intervention. However, further research is needed into effective techniques to help children who experience pain unpleasantness in connection with needle procedures. Key notes Relaxation and guided imagery is a distraction technique known to reduce discomfort during paediatric medical procedures. 3 We found that its use did not decrease the stress experienced by a group of 11 to 12-year-old girls receiving the human papilloma virus vaccination, as well as the intensity and unpleasantness of any pain. However, further research is needed into effective techniques to help children who experience pain unpleasantness with needle procedures. BACKGROUND

Experiences of communication in the caring process by children aged 7–13 where there is a requirement for nitrous oxide for needle related procedures

“…[1] A childcentred qualitative improvement with increased pain knowledge among the healthcare professionals can be beneficial in child care. [13] The children perceived the encouraging comments from the mother and healthcare professionals as positive and reassuring. This communication led the children to feel calmer, and they were able to undergo the needle-related procedure more easily.…”

“…This is in accordance with earlier research, which found that children's experiences of similar procedures have proved significant in their experience of stress. [13] Accordingly, pain memories can be interpreted as an important factor in their undergoing the procedure without resistance. Another study showed that children's expectations of a needle-related procedure are based on their previous experiences, knowledge, and self-image.…”

Nursing practices in vaccination: An integrative review

“…[13-18, 20-33, 35, 37, 38, 43, 44, 46-52, 55, 58-60] The studies identi-fied with randomization, [19,34,56,57] level III, represented the second most frequent type of study (10.20%, 5/49). The studies found with a higher level of evidence, level II, [41,45,53,54] The publications were grouped according to similarity criteria into four categories: (i) vaccine coverage (42.86%, 21/49), (ii) vaccine administration (28.58%, 14/49), (iii) vaccination (14.28%, 7/49), (iv) management/supervision (14.28%, 7/49) (see Figure 3).…”

“…[42] In adolescents from 11 to 12 years old, the technique of "relaxation and imagination" was used to reduce pain during the HPV vaccine. [45] It was not effective and was not indicated in the routine. The technique of music therapy [53] was employed, reducing the suffering of the children, however, was not able to reduce the pain.…”

Dynamics on the field: A focused ethnographic study of pediatric pain management at four Ghanaian hospitals

“…Inadequately treated pain can lead to both short-term and long-term biopsychosocial consequences on affected children. These include: activation of the stress response [5], impaired functional ability [6], delayed recovery, prolonged hospitalization, increased cost of healthcare [7], absence from school [8], post-traumatic stress [9], isolation [10], chronic pain and negative impact on children's quality of life [11]. Unrelieved children's pain also affects the social, psychological and financial aspects of the family and society [12].…”