Nurse Tips for Administering Pain-Free Immunizations

No one likes getting injections. Some patients tolerate it and others avoid injections at all costs because they fear the needle or possible pain from the shot. Pain is a subjective response that is heightened by fear.

Using proven strategies to administer pain-free injections, nurses can improve a patient’s experience and compliance with medical recommendations. Our two nurse contributors share their tips for administering pain-free injections, which have helped them and their colleagues improve patient outcomes.

As most people can attest, the pain of an injection is short-lived and relatively minor compared to other medical procedures, chronic diseases, or injuries. Yet, the fear of injections can negatively impact patient compliance and outcomes.

A 2019 systematic review in the Journal of Advanced Nursing revealed needle fear was as high as 50% in adolescents and 30% in young adults. According to the data, needle fear was the reason for avoiding the flu vaccine in 27% of hospital employees, 16% of all adults, and 8% of healthcare workers.

Nurses meaningfully impact a patient’s future experiences and willingness to comply with immunization recommendations when they can reduce or eliminate the perception of pain during an injection.

Vickie Ensor Bands, MSA, MSN, RN, has been a nurse for over 40 years and is the director of community outreach and health improvement for the University of Maryland Upper Chesapeake Health.

“Patients are scared and anxious and are depending on the person giving them the injection to have the skill needed not to hurt them,” she said.

Although pain is a subjective experience, nurses must recognize the common triggers. One common factor is muscle tightness at the site of the injection since it can cause more inflammation and discomfort.

Lori Garman BSN, RN, has been a clinical nurse since 2004. She also notes that restraining a patient during an injection can raise muscle tightness and result in a far more painful injection.

Another factor is the medication being administered. Bands notes that the solution’s pH, viscosity, and chemical makeup can cause pain during the injection. Other factors that nurses must consider are the size and length of the needle, the temperature of the medication, and the accurate placement of the injection. Bands notes that placement is particularly important in the elderly.

“Many older adults can have muscle wasting and the person giving the injection needs to use great skill when injecting in making sure they do not hit the bone. This can cause pain at the time of the injection as well as days of lasting discomfort,” she said.

Pain-free injection administration is possible and will likely impact the patient’s willingness to follow their physician’s immunization recommendations in the future. Consider these five tips the next time you’re giving an injection.

Each time an injection is given, the area must be landmarked. The needle must enter the right location to avoid nerve damage or accidentally inject directly into the bloodstream. You can’t identify the deltoid muscle in the arm or accurately inject the quadricep in the leg without first measuring landmarks.

Choose a needle length that reaches into the muscle without hitting the bone. The length of the needle will differ for a bodybuilder vs. an 85-year-old housebound woman with little muscle development. The size of the needle also has an impact on the patient’s pain response.

Select the smallest needle bore that is large enough to comfortably deliver the medication. When in doubt, the institution’s pharmacist is a good resource.

Bands recommends that medications known to irritate the tissue should be given at room temperature and injected slowly. This helps decrease the patient’s pain response. Most biologic medications are stored near 40 degrees Fahrenheit. Injecting cold medication increases nerve stimulation and pain. Injecting medication slowly helps the tissue to absorb it and not create a fluid pocket.

When the medication is not irritating it is the needle that causes the most discomfort. Sharp, small bore needles cause the least pain. The objective is to insert the needle quickly, inject the medication slowly, and remove it quickly to reduce the impact on the sensory nerves. Bands described the technique like using a dart.

Patients who are focused on the needle and watching the shot go in tend to experience more pain. Nurses can use mechanical and auditory distraction techniques when administering injections. Sometimes applying them simultaneously is the best technique.

“Distraction helps to lessen the pain as the patient is not focused on the vaccine being administered. My advice is to talk to patients about the weather, something popular on TV, or the news,” Garman said.

Experts have also shown that mechanical distraction, such as skin tapping or deep muscle pressure, can help distract the body from the pain response.

Giving injections to children has its own unique challenges. Children may not only have needle fear, but likely don’t decide to get an injection. This puts them in a position of being out of control. Parents can help by preparing their children before an office visit where they may get a shot.

Nurses can coach parents to explain the procedure with neutral terms, such as “poke”, “pinch”, or “pressure” instead of “pain” and “shot.” Children should be allowed to express their fear and feel heard. At the time of the injection, nurses can show parents how to hold their child so there is minimal movement during the injection.

“The child should never be restrained, but we want to ensure they are safely receiving the vaccine, and the healthcare professional is safe while administering the vaccine,” Garman notes.

“Giving an injection to a child can be as anxiety producing to the person giving it as it is to the child receiving the injection,” says Band. Children are also a moving target and nurses often have a small window of opportunity to give the injection appropriately.

She recommends preparing the medication before entering the room and keeping it out of sight while a parent distracts the child. “Right needle, right location, and being quick, in and out, are key things to consider when giving a child a vaccine or injection,” she said.