Vaccination Pain Management Research Articles

Factors associated with parents\u2019 experiences using a knowledge translation tool for vaccination pain management: a qualitative study

BackgroundVaccination is a common painful procedure for children. Parents’ concern regarding vaccination pain is a significant driver of vaccine hesitancy. Despite the wealth of evidence-based practices available for managing vaccination pain, parents lack knowledge of, and access to, these strategies. Knowledge translation (KT) tools can communicate evidence-based information to parents, however little is known about what factors influence parents’ use of these tools. A two-page, electronic KT tool on psychological, physical, and pharmacological vaccination pain management strategies for children, was shared with parents as part of a larger mixed methods study, using explanatory sequential design, exploring factors related to uptake of this KT tool. The aim of this qualitative study was to understand what influenced parents’ perceptions of the relevance of the KT tool, as well as their decision as to whether to use the tool.MethodsA qualitative descriptive design was used. A total of 20 parents of children aged 0–17 years (n = 19 mothers) reviewed the KT tool ahead of their child’s upcoming vaccination and participated in a semi-structured interview at follow-up. Interviews were recorded, transcribed verbatim, and analyzed with reflexive thematic analysis using an inductive approach.ResultsThe analysis generated three interrelated themes which described factors related to parents’ use of the KT tool: (1) Relevance to parents’ needs and circumstances surrounding their child’s vaccination; (2) Alignment with parents’ personal values around, and experiences with, vaccination pain management (e.g., the importance of managing pain); and (3) Support from the clinical environment for implementing evidence-based strategies (e.g., physical clinical environment and quality of interactions with the health care provider).ConclusionsSeveral factors were identified as central to parents’ use of the KT tool, including the information itself and the clinical environment. When the tool was perceived as relevant, aligned with parents’ values, and was supported by health care providers, parents were more inclined to use the KT tool to manage their children’s vaccination pain. Future research could explore other factors related to promoting engagement and uptake when creating parent-directed KT tools for a range of health-related contexts.

The feasibility, acceptability and preliminary efficacyof parent-targeted interventions in vaccination pain management of infants: a pilot randomized control trial (RCT).

Aim: To evaluate the feasibility, acceptabilityand preliminary efficacy of parent interventions for improving the use of pain management strategies during vaccination of infants, a two-armed pilot randomized control trial (RCT) was conducted. Materials & methods: 151 parents were randomized in two groups: Group 1) 'Be Sweet to Babies' videos and a tip sheet (n=76);Group 2) As per Group 1 plus a motivational interviewing informed Affirmative Statements and Questions (AS&Q) (n=75). Results & conclusion: Feasibility was evaluated by success of the recruitment (151 people in a week), rates of completed consent forms (85%), and surveys (59%). Over 94% satisfaction with interventions, processes and 88% intention to recommend the strategies to others determined the acceptability. Preliminary efficacy was evident by over 95% use of pain management strategies following the interventions. Clinical trial registration number: NCT03968432.

Understanding parents' use of a knowledge translation tool to manage children's vaccination pain.

Although several evidence-based strategies for managing children's vaccination pain exist, many parents report being unaware of them. Knowledge translation (KT) tools present evidence-based information in plain language. This two-phase study assessed parents/caregivers' uptake of evidence-based pain management strategies via a KT tool and considered factors related to parents' planned, actual, and future use of these strategies. In phase 1, parents were exposed to an online KT tool on physical, psychological, and pharmacological vaccination pain management strategies, and their impressions were assessed by questionnaires including the Information Assessment Method for Parents. In phase 2, after vaccination, parents completed a follow-up survey on their uptake and experiences using the information. A total of 312 participants reported their plans for KT tool use. Parents who found the KT tool relevant were more likely to plan to use it at their child's upcoming vaccination. A total of 128 parents (93% mothers) completed both surveys. Nearly all parents who planned to use the information did so during their child's subsequent vaccination (90%). When the KT tool was relevant to their needs, parents were more likely to use the information during their child's vaccination. Parents who felt confident using the tool were significantly more likely to report plans for future tool use. This study demonstrates the effectiveness of a KT tool that was relevant to parents' needs and built confidence to increase parent-reported uptake of evidence-based strategies. Proper pain management could positively impact parents' uptake of vaccinations for children.

Parent Targeted Interventions in Vaccination Pain Management of Infants

Parent Targeted Interventions in Vaccination Pain Management of Infants

Effects of Breastfeeding and Sensorial Saturation on Physiological Parameters of Infants after Administration of Pentavalent Vaccine at Four and Six Months of Age: A Field Trial

vaccination pain management in infants may prevent short-term and long-term physical and mental consequences in them. As a result, this study aimed to determine and investigate the effect of breastfeeding and sensorial saturation on physiological parameters of infants after administration of pentavalent vaccine at four and six months of age. Materials and Methods: This randomized controlled field trial was conducted on 171 four-month-old infants. The infants were randomized into three groups. The first group was breastfed for two minutes before vaccination (Breastfeeding group =55 infants). In the second group, the five senses of the infants were stimulated for two minutes before vaccination (Sensorial Saturation group =57 infants). The third group did not receive any intervention (Control group = 59 infants). In all groups, physiological parameters of the infants at four and six months of age were measured and recorded one minute after the vaccination. Data was analyzed using descriptive and inferential statistics in SPSS version 21.0 software. Results: Results showed no significant difference was observed in demographic variables of research samples including gender and weight at four and six months of age,and statistically significant between groups difference in three physiological parameters (respiratory rate, heart rate, and peripheral oxygen saturation) of the infants at four and six months of age (p=0.001). Although sensorial saturation was more effective than breastfeeding, this difference was not statistically significant; whereas, these interventions were significantly more effective than the control. Conclusion: Both breastfeeding and sensorial saturation practices resulted in the stability of physiological parameters of the infants after vaccination at four and six months of age; however, no significant within-group difference was observed after vaccination at four and six months of age in these two groupsand both methods had identical effects.

Setting the Stage for Improved Practices During Vaccine Injections: A Knowledge Synthesis of Interventions for the Management of Pain and Fear.

Setting the Stage for Improved Practices During Vaccine Injections: A Knowledge Synthesis of Interventions for the Management of Pain and Fear.

Why are children still crying? Going beyond "evidence" in guideline development to improve pain care for children: the HELPinKIDS experience.

The failure to translate research evidence into day-to-day clinical practices is identified as a significant reason for suboptimal quality care across the health system, including procedural pain management in children. Clinical practice guidelines (CPGs) have been developed to assist in this process by synthesizing and interpreting research evidence for end users. Numerous CPGs have been developed for procedural pain management in children, yet gaps persist in the adoption of best practices. This article reviews the experience and approach of 1 guideline development group, the Help ELiminate Pain in KIDS Team (HELPinKIDS), in incorporating implementation considerations and knowledge translation (KT) strategies within the process of guideline development for the HELPinKIDS CPG about childhood vaccination pain management to facilitate greater uptake of the CPG. Specific areas that will be addressed include partnerships with stakeholders, rigor of guideline development, issues of implementation, and editorial independence. The work of HELPinKIDS was guided by a KT map, which identified, at a high level, the target audiences, key messages, tools, and strategies that could be used to communicate, disseminate, and implement the CPG into diverse settings. Examples of impact at both the individual and systems levels from HELPinKIDS KT activities are also presented.

Usability and knowledge testing of educational tools about infant vaccination pain management directed to postnatal nurses.

BackgroundAdapting educational tools to meet user needs is a critical aspect of translating research evidence into best clinical practices. The objectives of this study were to evaluate usability and effectiveness of educational tools about infant vaccination pain management directed to postnatal nurses.MethodsMixed methods design. A template pamphlet and video included in a published clinical practice guideline were subjected to heuristic usability evaluation and then the revised tools were reviewed by postnatal hospital nurses in three rounds of interviews involving 8 to 12 nurses per round. Nurses’ knowledge about evidence-based pain management interventions was evaluated at three time points: baseline, after pamphlet review, and after video review.ResultsOf 32 eligible postnatal nurses, 29 agreed to participation and data were available for 28. Three overarching themes were identified in the interviews: 1) utility of information, 2) access to information, and 3) process for infant procedures. Nurses’ knowledge improved significantly (p < 0.05) from the baseline phase to the pamphlet review phase, and again from the pamphlet review phase to the video review phase.ConclusionsThis study demonstrated usability and knowledge uptake from a nurse-directed educational pamphlet and video about managing infant vaccination pain. Future studies are needed to determine the impact of implementing these educational tools in the postnatal hospital setting on parental utilization of analgesic interventions during infant hospitalization and future infant vaccinations.

Impact of parent-directed education on parental use of pain treatments during routine infant vaccinations: a cluster randomized trial.

Educating parents about ways to minimize pain during routine infant vaccine injections at the point of care may positively impact on pain management practices. The objective of this cluster randomized trial was to determine the impact of educating parents about pain in outpatient pediatric clinics on their use of pain treatments during routine infant vaccinations. Four hospital-based pediatric clinics were randomized to intervention or control groups. Parents of 2- to 4-month-old infants attending the intervention clinics reviewed a pamphlet and a video about vaccination pain management on the day of vaccination, whereas those in the control clinics did not. Parent use of specific pain treatments (breastfeeding, sugar water, topical anesthetics, and/or holding of infants) on the education day and at subsequent routine vaccinations 2 months later was the primary outcome. Altogether, 160 parent-infant dyads (80 per group) participated between November 2012 and February 2014; follow-up data were available for 126 (79%). Demographics did not differ between groups (P > 0.05). On the education day and at follow-up vaccinations, use of pain interventions during vaccinations was higher in the intervention group (80% vs 26% and 68% vs 32%, respectively; P < 0.001 for both analyses). Educating parents about pain management in a hospital outpatient setting leads to higher use of pain interventions during routine infant vaccinations.

Impact of prenatal education on maternal utilization of analgesic interventions at future infant vaccinations: A cluster randomized trial

Analgesic interventions are not routinely used during vaccine injections in infants. Parents report a desire to mitigate injection pain, but lack the knowledge about how to do so. The objective of this cluster-randomized trial was to evaluate the effect of a parent-directed prenatal education teaching module about vaccination pain management on analgesic utilization at future infant vaccinations. Expectant mothers enrolled in prenatal classes at Mount Sinai Hospital in Toronto were randomized to a 20-30minute interactive presentation about vaccination pain management (experimental group) or general vaccination information (control group). Both presentations included a PowerPoint (Microsoft Corporation, Redmond, WA, USA) and video presentation, take-home pamphlet, and “Question and Answer” period. The primary outcome was self-reported utilization of breastfeeding, sugar water, or topical anaesthetics at routine 2-month infant vaccinations. Between October 2012 and July 2013, 197 expectant mothers from 28 prenatal classes participated; follow-up was obtained in 174 (88%). Maternal characteristics did not differ (P>0.05) between groups. Utilization of one or more prespecified pain interventions occurred in 34% of participants in the experimental group, compared to 17% in the control group (P=0.01). Inclusion of a pain management module in prenatal classes led to increased utilization of evidence-based pain management interventions by parents at the 2-month infant vaccination appointment. Educating parents offers a novel and effective way of improving the quality of pain care delivered to infants during vaccination. Additional research is needed to determine if utilization can be bolstered further using techniques such as postnatal hospital reinforcement, reminder cards, and clinician education.

Implementation of a new clinical practice guideline regarding pain management during childhood vaccine injections

To determine the impact of a multifaceted knowledge translation strategy for a new vaccination pain management guideline on public health immunizers' attitudes, beliefs and use of pain-relieving strategies during childhood vaccination. Using a randomized controlled pre-post study design, public health nurses (PHNs) at intervention sites received a multifaceted knowledge translation intervention about new pain management guidelines incorporated in the British Columbia Immunization Program Manual, including education, supplies and online support. Attitudes and beliefs of PHNs toward immunization pain and pain management, and use of pain-relieving strategies were compared for the intervention sites between the pre- and postimplementation phases. A total of 516 children were immunized by 31 PHNs pre- and postimplementation in the intervention sites. Postimplementation, satisfaction and confidence with ability to manage pain and willingness to use newly recommended strategies were significantly more positive (P<0.05) in the intervention sites, and overall use of at least one newly recommended strategy increased from 49.8% preintervention to 77.6% postimplementation (P<0.001). The knowledge translation intervention improved PHN immunizers' attitudes, beliefs and practices regarding paediatric vaccination pain management. Reducing pain may result in a better immunization experience for children, caregivers and immunizers.

A Randomized Clinical Trial to Evaluate the Impact of a Fact Sheet About Infant Vaccination Pain Management on Parental Knowledge Uptake

A Randomized Clinical Trial to Evaluate the Impact of a Fact Sheet About Infant Vaccination Pain Management on Parental Knowledge Uptake

2360 – Infants’ vaccination pain management and effect of breast feeding, sucking the pacifier and mother's hug: a randomized control trial

Infants’ vaccination pain management by using lowest side effect methods is very important. The aim of this study was to examine pain relieving effect of breast- feeding, sucking pacifier or being in mother's hug during DPT vaccination. This controlled trial study, was performed on 152) healthy2- 4 months term infants, whom was brought to the health centers of west of Tehran for DPT vaccination and their parents filled in informed consent. (Year 2008–2010) By randomized collection infants divided to three intervention group (Breast feeding, Sucking pacifier and being in mothers hug, and each group had intervention 2 minutes before, during, and 15 seconds after the injection) and control group, whom lied on the examining bed as routine of clinics (38 in each group). Objective changes in appearance of Neonates were assessed by Modified Behavioral Pain Scale (MBPS) during 5 second before immunization to 15 second after it. Descriptive and inferential statistics were used. All ethical points were considered and approved by Research ethics committee of TUMS and had registered in Iranian Registry of Clinical Trials (IRCT). Equality of age, gender and the time of feeding prior to vaccination were controlled. There were significant differences in Behavioral Pain Scores of four groups. (P < 0.0001) and routine group had highest pain score. Breast feeding is more analgesic than pacifier use with maternal holding. Maternal holding had less effect, but had more significant effect than routine. It is suggested to use these simple interventions during infant's vaccination.

Walking the tightrope

Most Canadians have long-standing familiarity with images of Jean Francois Gravelet crossing the Niagara River (Niagara, Ontario) on a tightrope on June 30, 1855. Pictures of the famous incident show the ‘Great Blondin’, as he was known, balanced precariously over the Niagara River Gorge. In fact, the Great Blondin made many crossings of ever increasing difficulty, either by walking, running or cycling. On one occasion, he pushed a wheelbarrow to the centre of the rope where he stopped, cooked and ate an omelette made on a small stove. The culmination of his efforts came with carrying his manager across in a special shoulder harness. We have chosen Blondin’s feats as a metaphor for the hazards of drug prescribing for children. How good is this metaphor? Even funambulists, or tightrope walkers, do not venture forth without some substantial aids. For starters, they have the fundamental support of a stout rope or wire, and a balancing bar that serves to distribute the risk. Often they enjoy the additional security afforded by a safety net. Those who prescribe drugs for infants and children enjoy far less tangible support and, in many cases, lack the safety net that might be provided through research. It is a fact almost as astonishing as the achievements of Blondin that, 100 years into the modern medical era, children are still treated in most parts of the world without the benefit of adequate scientific evidence to support therapeutic decisions. Unfortunately, prescribers have been left to be guided by anecdotal advice and their own therapeutic intuition. Not only are prescribers deprived of new therapeutic guidance, they must frequently fall back on knowledge acquired at an earlier time, which is almost certainly past its ‘best before date’. Many have estimated that medical knowledge expires at a rate of 25% per decade after the time that it is acquired. Of course, some might argue that at least an additional 25% of medical knowledge is incorrect at the moment when teaching occurs. Can we do more to protect infants and children who require modern therapy? Daredevilry in therapeutics is not an admirable activity, but neither is therapeutic nihilism defensible. All practitioners who serve childhood populations can and must contribute to the creation of new knowledge that will guide future treatment guidelines. Their impact will come through participation in clinical trials addressing major therapeutic questions, and through careful objective reporting of adverse events in keeping with the approaches highlighted by two of the articles in the present theme issue. Two common scenarios of therapeutic interventions in children are also addressed in the present issue. One is vaccination pain management, where we learn that pharmacological intervention is effective, but even more effective if combined with non-pharmacological approaches. The other is the use of acetaminophen. In fact, it makes us nervous to know that we know so little about this old remedy. Above all, physicians and pharmacists who care for children must become more effective advocates for their charges. One hundred years of waiting for improvements in the environment for a choice in childhood therapies is simply too long. A society that can afford billions of dollars for the purchase of fighter jets can surely afford to provide better evidence-based care for its children, and indirectly for the more than two billion children living outside our borders. The continuing feat of attempting to walk the paediatric therapeutic tightrope will not be applauded by future generations who will be left deprived of safe and effective treatments.

Infant Vaccination Pain Management: Comparing the Effect of Mother's Hug and Breast Feeding, Tehran, 2009-2010

Infant's nervous system is much more sensitive to pain than adult and cause more complications. Health professionals must consider the best and low risk pain management.Aim: To compare the effect of breast feeding with being in the mother's hug on infants' immunization pain.Material and Methods: This is a controlled trial study, which was performed on 76 healthy term infants with 2- 4 months years old, during DPT vaccination in public clinics in west of Tehran (Year 2009). After signing informed consent by infants' mothers, samples by randomized collection divided to two groups (1- Breast- fed group, 2 minutes before, during, and 15 seconds after the injection, 2- Group were in their mother's hug 2 minutes before, during, and 15 seconds after the injection). Tools of this study had two main parts of personal characteristics and Modified Behavioral Pain Scale (MBPS), which assess objective changes in appearance of neonates (facial expression, cry and movements) during 5 second before immunization to 15 second after it. The scores for each behavior were calculated and compared in two groups.Results: There was no difference between ages, gender, and time of breast feeding prior to the procedure, therefore two groups had equality. Regarding to MBPS there were significant differences in behavioral pain scores of breast- fed group (4.6±1.8) and mother's hug (6.7±1.2). Also there were significant differences between each facial expression (p=0.032), cry (p=0.0001) and movements (p=0.0001) of MBPS.Conclusion: Breast- feeding may have an analgesic effect during immunization injections in healthy neonates.