Being a nurse can be difficult as it is, but the job is made even harder when you have to deal with patients who are afraid of needles and injections. This is a very common situation that you will find yourself in. In addition it is not only children who suffer from this phobia. Adults can also be completely immobilized by their fear of needles. As a nurse you need to know how to handle this situation when it arises.
What Is A Phobia For Needles And Injections?
A phobia is different to a fear. A fear is based on logical thought and a knowledge that something real can happen. A phobia is an illogical fear of something that cannot hurt you, or an exaggerated fear of something that is not very important. Consequently someone with a phobia for needles and injections is disproportionately afraid of needles and reacts to them with a strong fear response that does not match the severity of the situation. As a nurse it is not your job to cure this phobia of needles and injections, but you do have a professional responsibility to create an environment where your fearful patient feels as relaxed and calm as possible. They need to have the injection or they need to have their blood taken, and it is your responsibility to find the best and most appropriate way to achieve that end. In a fast-paced environment such as nursing, this is easier said than done.
Don’t Rush The Procedure
What often happens in these cases is that the nurse is in a hurry, gets tired of waiting for the patient to stop ‘acting out’ and simply gets a few helpers to restrain the patient while she performs the procedure. There are two outcomes to this strategy:
- Yes, you get the patient’s blood, or you successfully administer the injection. For some nurses who are just there to do their job, this is enough and they consider the procedure to have been successful.
- You lose your patient’s trust. In cases where the patient has an extreme fear or phobia you are simply adding to that fear by having him or her restrained. In addition they are unlikely to trust you, or any other health care professional for that matter, who comes near them with a needle from that point onwards. This is something that nurses who care deeply for the well being of their patients will try to avoid at all costs.
Speak With The Patient
It is very important that you speak with the patient before the procedure begins as well as during the procedure. There are a number of things that you and the patient should decide together before beginning the procedure. This can relieve the stress of a particularly fearful patient considerably:
- Give the patient a certain degree choice regarding the environment or room in which you will give the injection or draw blood
- Give the patient a chance to choose what position they would like to be in. i.e. lying down, sitting up, etc., when the procedure is performed
- In cases where the needle can be inserted in one of several areas, allow your patient to choose the area they would prefer
- Give your patient the choice of having an anesthetic in extremely severe cases and allow them to choose between topical and general
- Agree with the patient that you will not puncture until they have given their consent
This can take a long time, but it will serve you and your patient well in the long run.
Desensitizing
This is also a strategy that can take a long time and it is only suggested that you attempt to desensitize your patient if you have enough time. This involves allowing your patient to gradually become more and more comfortable with the situation and can take hours. The best method involves mixing humor and relaxation techniques, such as breathing, with actions related to the injection. For example you may allow the patient to swab their own skin as you tell each other stories. You could then let them examine the needle or cannula closely and in their own time while you do breathing exercises or tell jokes. If the patient shows increased levels of anxiety, take a few moments to do some breathing exercises and calm them down. And then repeat the exercise that provoked the anxiety in the first place again and until they are able to handle it without fear.
Visualizations And Distractions
While you are working with the patient you can suggest that they think of a ‘happy place’ while the actual procedure occurs. For example you could ask them to focus on a specific smell, sight, or sound that they love and to almost meditate on that while they are having their blood taken or they being injected. This may seem like a waste of time or a pointless and substance-less exercise, but it serves as a distraction tool even if the patient doesn’t take it seriously. This method can be combined with breathing to help your patient attain a level of calm that will allow them to get through the ordeal with as little anxiety as possible. The actual procedure is normally quite quick, so you will not need to guide your patient to visualize for very long. This method often helps a patient to realize just how quick a procedure can be and they may be far less fearful next time.
Calming Medications
In some cases relaxation techniques and chatting simply will not be enough. There are a number of patients who are afraid of needles and injections who should be seeing a metal health professional about their condition. These patients will not be able to get through the procedure using simple techniques. In this case you may need to administer:
- Anxiolytics
- Sedatives
Medication needs to be administered in such a way that it is not a fearful experience for the patient. Speak with the patient about it first. This will require giving them time to calm down. Say that you have a way for them to get the necessary injection painlessly. Allow them to choose the method (anxiety medication or a sedative that could render them unconscious for the procedure). Do not push a technique on them, and do not administer medication without their consent as this will culminate in an increased fear.
Tips To Give Patients Who Are Afraid Of Needles And Injections
There are a number of tips that you can give any patients who are afraid of needles and injections that you come across in your job as a nurse that they will be able to use to ‘survive’ their next needle ordeal:
- Tell your patients that they must inform you, the nurse giving them the shot, of their fear. It is far better for a nurse to be informed of the situation before beginning the procedure. This will also give you an opportunity to look at the situation a little more closely and determine if the patient requires restraining or if you will need assistance giving the shot.
- Your patients should be encouraged to talk during the process. Tell your patient to talk to the nurse giving them the shot throughout the process about something that they enjoy. This will help them to relieve their stress and anxiety.
- Tell your patients that that it is better to look away from the injection when it is given. This is something that they can use to relieve their stress in future situations involving needles and injections as well.
- Encourage your patients to find a mental process that will help them to get through the shot. For example they could repeat “Everything is OK” over and over again, or they could count. They will need to find a process that will help them personally.
- Point out to your patients that they should not put off getting an injection, but rather have it done as soon as possible.
- If your patient is inclined to faint as a result of needles and injections, tell them to ask to have the shot given while they are lying down (if possible) so that they can slowly recover and get up in their own time.
- If your patient’s phobia is particularly bad you may need to suggest that they get a prescription for ant-anxiety medication form a health care professional.
Because patients who are afraid of needles and injections may have deep seated psychological problems, you may want to suggest that they see a mental health professional, especially in cases where their phobia is severe. However you should only do this if you feel that your patient will not be offended by the suggestion. If you feel that making a suggestion is outside your scope of practice or contrary to your facility’s procedural policies, abstain.
