Immunisation pain in infants : a Jordanian study

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NO FULL TEXT AVAILABLE. Access is restricted indefinitely. ----- Infant immunisation is the most commonly performed health-related procedure in Jordan and other developed countries. Pain associated with immunisation, and other pain exposures, may be harmful because we do not know what painful experiences the infant has already had and whether this pain might contribute to a cumulative pain experience. Although healthy infants undergoing immunisation often do so with minimal pain relief, immunisation pain can be managed using non-pharmacological interventions, such as oral sweet solutions. The primary focus of this research was to establish the effectiveness of a particular sweet solution, glucose, given orally, in reducing infant immunisation pain. This was achieved through a double-blind, randomised controlled trial conducted in two immunisation clinics in Irbid, Jordan. Recruitment of infants started on 26th May 2007 and ended on 14th July 2007. The participants were 120 healthy infants attending the immunisation clinics to receive their 2-month immunisation injections. Sixty infants were randomised to receive, 2mls of oral glucose solution immediately prior to their immunisation. Their outcomes were compared with 60 infants randomised to the control group who received 2mls of oral sterile water. The procedure was videotaped in order to assess primary and secondary outcomes. The primary outcome measure was pain, as assessed by the Modified Behavioural Pain Scale (MBPS), which included the coding of three behavioural dimensions from the videotape. Secondary outcome measures included full-lung crying and crying time, which were measured during immunisation and up to two minutes after injections. Comparison of demographic characteristics and prior painful procedures showed no significant differences between the two groups of infants. Compared to the control group, infants in the intervention group experienced statistically and clinically significant reduction in behavioural pain responses supported by the MBPS after immunisation (Median (IQR) 4 (1) vs. 6 (3) p<0.001), and spent less time crying up to two minutes after the procedure (Mean difference (SD) 38 (17.8) vs. 77.9 (26) seconds). Therefore, the RCT has established that a 2mls oral dose of glucose given immediately before an immunisation procedure can reduce pain in 2- month old infants. In order to explore the applicability of these findings in Jordan, a further qualitative study was undertaken to explore Jordanian nurses’ perceptions and knowledge of infant pain and pain management. Three group interv iews were conducted, with 12 paediatric nurses' from different clinical and educational backgrounds. Clinical scenarios and a questionnaire were used to explore infant pain management practices among the nurses. The group interviews were audio taped and transcribed and subjected to thematic content analysis. The findings revealed that the nurses and nurse academics in the study were not aware that infants experience pain, or that early pain experiences can negatively impact infant responses to pain generally. They were also unaware of currently available non-pharmacological interventions to manage infants’ pain. The literature suggests this is common amongst nurses worldwide. Jordanian nurses have an important role in pain management to reduce immunisation pain in infants in their community. Changes in the education of nurses may be required to improve knowledge and practice. These findings may also resonate with nurses in other settings throughout the world. The findings of the RCT conducted in Jordan may increase the confidence of Jordanian nurses in applying this intervention in their clinics. The results of the RCT are not only generalisable to the Jordanian context but also have international relevance. The application of such a simple and quick intervention will minimise the stress and discomfort associated with immunisation pain and can thus help health providers consider and develop a planned approach to the management of such pain. As glucose is a non-pharmacological intervention, it will address nurses’ concerns about the adverse reactions and toxic effects of pharmacological interventions. This intervention provides an effective strategy for nurses to use, to improve the well-being of developing infants.
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