Reflections of an RN post World Immunisation Week

RN Holly Robinson reflects on her daily dealings with immunisation in the practice and the struggles parents can face.

  Last week was world Immunisation week, an opportunity for practitioners to reflect on and promote the use of vaccines, in order to achieve the protection of people of all ages against disease. There are so many different aspects of immunisation that as practitioners we deal with daily. On reflection, I have seen the positive impact that immunisation plays and also the negative impact. We try not to look at the negative impact so much, but of late I seem to be seeing its impact much more, with the rise of preventable diseases rearing their ugly heads in communities closer to home.

  Ultimately we do the best that we can do, and often we feel that that is good enough, but sometimes we face challenges that cause us to reflect a lot more on our knowledge, our practice and our tolerance.

  I’ve always had a soft spot for parents that have to bring their school aged children into our practice for their immunisations when they refuse to have them done at school because of their fear of needles. The majority of parents come across as composed, firm and authoritative, and while the others try to stay composed, you register some fear or the “I CAN DO THIS” mantra flashing in their eyes. Kudos to them, they never give in. They want their children to be fully immunised and they are not letting the screaming and kicking antics of their child’s behaviour throw them off their mission.

  It’s a personal dread of mine when I hear the ever increasing volume and panic of the “NO” being expressed from their “walk” from the front door of the practice and into the treatment room. The parent usually has to drag them into the room, shutting the door to seal off the only escape route the child has. “You are not leaving this room until you get the needle” is a starting point for most parents, and then the coaxing ranges from “Please darling, it will only sting for a second” to the desperate “You won’t even feel it”. With patient hysterical and parent exhausted there is that moment where both parent and nurse silently agree that it is time…

  We tell the parent to hold them as tight as they possibly can and find an area of exposed flesh to jab and hope that that flying fist doesn’t get any closer to your face or those feet don’t make contact with your shin. The needle goes in and within 5 seconds the injection is done, they fly up out of the parents grasp and with a quick band aid on they often tear out of the room screaming that they hate their parents and you as well. You get thanked for your patience, and by this time the parent is both physically and emotionally drained, but they succeeded in doing what they thought was best for their child. Thank goodness it is 6 months till the next one…

  Needle phobias can be quite traumatic for children, their parents and to us as practitioners. No one would ever catch me saying that I love needles, but as an RN I have become accustomed to receiving and giving them. For a lot of patients however, the phobia runs deeper than “I just don’t like them”. They experience a genuine flight reaction including panic, sweating, shaking, adrenaline surges and fear; a genuine fear that takes grasp of them and no matter how reasonable we try to make it, to them it is a serious conscious need to escape.

 I was confronted with my own 9 year olds son’s phobia of needles when he wanted to go to Malaysia with his dad for the MOTOGP. The proviso of attending - he and his father needed to get their travel vaccinations. That became the deal, so of course then he didn’t want to go. He was adamant; he wasn’t getting any needles - he just wouldn’t go. It was a big time phobia; one that ended up with him been awake sobbing for nearly 5 hours, purely because the thought of having a needle scared him so much that he was willing to miss out on the experience of a lifetime because of it.

 When I found out about the NSW Immunisation specialist service that is offered at Westmead and Randwick children’s hospitals I felt that a weight had been immediately lifted, not only from my “Mum” shoulders, but also the “Registered Nurse” shoulders. What a fantastic service to have! They offer consultations with specialists by referral, they run an opportunistic drop in service, telehealth and the gem that I know will help so many young people out there (including my son) is that they offer vaccines under sedation via multiple methods, they even offer counselling.

 Having a service that offers the option of sedation and other modalities of working with parents and their children who experience the negative impact of immunisations will not only help the children and adolescents, but it will have a huge positive impact on the parents and the practitioners who are often dealing with these patients.

 I can speak from experience that in those moments where you are holding them tight, listening to their angst and their internal fear escaping in screams, feeling like the most terrible person in the world, you hold a lasting guilt that maybe the fight isn’t worth it, but it is, it always is. And it is because of such a service that it relieves that burden from a parent, it enables us to continue to make the decisions we feel are best for our children and it is with that same hope, that these services become readily available to everyone everywhere, so that immunising our children is never a struggle.

Click here for more education on immunisation .

Stephen CarboneHolly Robinson
BN GDipMid AAPM. Winner of 3 professional awards, Holly has been nursing for over 10 years, 8 years in primary health care and now practice manager of a busy private practice in Campbelltown. Holly is qualified midwife and her passion lies in child and family health and women’s health with a keen interest in sexual health and continence care and promotion.