Pain Pain Go Away: Improving the vaccination experience at school

FOREWORD

Needle pain and related fear have been identified as concerns for students undergoing school-based vaccinations (1). Vaccinations delivered at school are efficient in reaching large numbers of children and youth. However, many students are afraid of needles and associated pain which leads to worrying ahead of time, more pain during vaccination, and an increased risk of fainting (2). Negative experiences with needles can lead to vaccination hesitancy and vaccine refusal in the future in both the students themselves as well as their own children because needle-related anxiety and negative attitudes about vaccination are passed down from generation to generation (2,3). Mitigating pain and fear are therefore important aspects of vaccination delivery to optimize student experiences during the acute procedure and to promote vaccination in the long-term.

In 2015, we conducted a knowledge synthesis and developed a Clinical Practice Guideline (CPG) with recommendations for pain, fear, and fainting mitigation during vaccine injections (4). We included tools to assist health care providers with uptake of recommendations for different age groups, including adolescents; however, a gap in research prevented us from providing specific advice for the school vaccination setting. In 2016, selected authors of the CPG partnered with regional public health units and school boards to tackle this issue. Specifically, we undertook a Knowledge Translation (KT) project aimed at facilitating the uptake of CPG recommendations in school-based vaccination programs in order to improve the vaccination experience at school.

The project was guided by two frameworks: the Knowledge to Action (KTA) (5) cycle, and the Consolidated Framework for Implementation Research (CFIR) (6). With input from all the relevant stakeholders involved in school-based vaccinations—students, nurses, school staff, and parents—we developed and implemented a novel multifaceted KT intervention called The CARD™ System (C-Comfort, A-Ask, R-Relax, D-Distract) that provides a framework for a student-centred approach to planning and delivering school-based vaccinations. Each letter of the word C-A-R-D represents a category of evidence-based interventions that reduces pain, fear, and fainting during vaccination. Students are engaged as active participants in their health care and choose which CARDs to play (i.e., intervention categories they will utilize) to promote coping during vaccinations. This Paediatrics & Child Health issue includes six manuscripts describing the process used to guide this work, the key tools and preliminary evidence base supporting this multifaceted KT intervention (7–12). Figure 1 provides an overview of the project, the six manuscripts, and their intersection with the knowledge creation and action cycles of the KTA framework. Together, this issue offers readers of the journal: 1) a model for implementing similar processes in their clinical settings; 2) the scientific evidence base supporting the multifaceted KT intervention; and 3) tools from the KT intervention that they can use for reducing pain, fear and fainting during vaccination. By sharing our processes, key tools, and learnings, we hope to give others that are looking for ways to improve vaccination delivery in their own settings a roadmap for initiating and documenting positive changes to their patient care practices.

Figure 1.

Overview of project.

Funding information: This project was funded by the Canadian Institutes of Health Research Knowledge to Action Grant (KAL-147564).

Potential Conflicts of Interest: AT reports Section 9 Trademark No. 924835 for CARD. The author has submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.