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When nurses provide pain-free shots, they can have a meaningful impact on a patient’s future health decisions. These five tips can help you achieve that goal.

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.

Importance of Pain-Free Immunization Experiences

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.

Common Causes of Pain During Immunization

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.

Tips for Pain-Free Vaccine Administration

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.

1 | Location, Location, Location

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.

2 | Size and Length of the Needle

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.

3 | Room Temperature and Given Slowly

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.

4 | In and Out Quickly

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.

5 | Distraction Is Key

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 Shots to Children

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.

By Jenny Englerth

It is not an exaggeration to say that as a society, we are failing to keep our children healthy. Parents and caregivers do their best but the systems that support children’s health are poorly designed and under-resourced. School health education programs are being slashed, mental health needs are growing, the obesity epidemic is not improving, and pediatric vaccination levels are at a 30-year low.

What is happening in policy decisions on the national level is glaringly evident in our own communities.

As the president and CEO of Family First Health, I’m acutely aware of these needs. In York, where Family First Health is based, about 18 percent of children in grades K-12 are considered obese. The CDC says that number jumps to 26.2 percent for Hispanic and 24.8 percent for Black children, so it is a social justice and equity issue as well as a public health issue.

Obesity in children increases the risk for physical health issues like high blood pressure, high cholesterol, Type 2 diabetes, and asthma, while mentally it is associated with anxiety and depression. We can address these health risks and support our children if we, as a community, work in new and different ways with children and their families.

By providing early, hands-on education for students to make decisions that will positively impact their health, today and in the future, we can change the course at an individual and community level. Now is the time to act.

The last week in April marked Every Kid Health Week, which spotlighted the actions schools and families are taking to improve the health and wellness of their kids. Family First Health works with many school districts and specifically with the students and families of the School District of the City of York to improve the health of our children through our school-based health center at Hannah Penn K-8.

Our school-based health center team provides healthcare and health resources via our health center on the school campus, allowing students to receive medical attention from medical staff during the school day. We also have a health coach located in the school who educates students about smart eating habits, exercise, hygiene, and other health-related topics such as mental health, puberty, and sexual health and is responsive to the unique needs of the students in the school we serve.

Recently, the School District of the City of York identified an increase in vaping. Family First Health was there to step in and coordinate presentations on the risks of vaping along with alternatives for managing stress. When the school identifies a need, we are there to support them and offer our services and resources.

“The partnerships with FFH and other health agencies have provided key resources that allow trained professionals to speak to our students about health-related issues. It is an opportunity that many times parents and families miss due to a variety of barriers. The partnerships help to stop the cycle of misinformation as they are hearing information from trusted adults who are professionals in the building,” said Dr. George Fitch, Assistant Superintendent of Student Services for the School District of the City of York.

Our Hannah Penn Center is York County’s only school-based health center. The medical services include medical, dental, behavioral health, and community health programs. These are also open to the public – so a mom, making an appointment for her child, can be cared for at the same location.

While it’s great to discuss the benefits of these in-school health centers on student well-being, the numbers speak for themselves. In one study, just low to moderate use of school-based health centers by students related to approximately a 33 percent lower likelihood of them dropping out of school.

At a time when parents and policymakers are looking to make schools safer spaces for students, providing them with accessible resources for healthy living is one of the easiest ways to help them.

Jenny Englerth is the president and CEO of Family First Health.

ADAMS COUNTY, Pa. (WHP) – One community health program is looking to address higher mortality concerns among low-income women who feel unseen and unheard by the healthcare system. Organizers say a lot of falls back on accessibility.

“As a first time parent, you have no idea what you’re doing and you’re scared,” Hailey McKee told CBS 21 News’ Samantha York.

McKee gave birth to her daughter, Penelope, 15 months ago. She was immediately hit with the harsh reality so many other parents are facing: inflated expenses.

“$27 for a big pack of diapers that might last you a month,” McKee explained. “And that’s generic brand.”

Rising costs are straining young families. Baby formula spiked 30% in the last three years, according to the U.S. Bureau of Labor Statistics. Wipes are up over 10% in price.

“How am I going to be able to do this?” McKee questioned when she learned she was pregnant.

McKee turned to Family First Health’s Nurse-Family Partnership program, which promotes health equity.

“We’re meeting these women in the places where they need it the most,” Nurse-Family Partnership Program Manager and Nurse Supervisor Lisa Lathrop explained. “When they can sometimes feel the most vulnerable.”

In Pennsylvania, over 24% of counties don’t have full access to maternity care, according to the Pennsylvania Department of Health. It leaves nearly 200,000 residents in need of support.

“Even though I was working, I mean, we still didn’t have much,” McKee recalled.

“Young women, in particular, I think often times women who are living with lower income, they feel very unheard and unseen in their health appointments,” Lathrop continued.

“I think a lot of times with the healthcare system that you’re just left to figure it out on your own,” McKee said.

Nurse-Family Partnership recognizes a lack of health coverage keeps low-income parents from the care they need. Instead, they’re meeting them where they are: at home.

“They’re always there,” McKee said.

“Being that we only serve first-time pregnant mothers who meet income guidelines, we’re serving people who we can make the biggest difference in their lives,” Lathrop added.

The program connects expectant mothers to a registered nurse, free of charge, who becomes their personal healthcare provider and guides them through pregnancy and the first two years of the child’s life.

“I feel like it gave me confidence, even when I was in one of my darkest times,” McKee explained. “Because you’re in survival mode.”

“They’re more motivated to provide a better life for their own child than what they might have had when they were a child,” Lathrop said.

The community health program also refers parents to other support groups to help the family become economically self-sufficient.

“Having them get a car seat for me and, you know, stuff my car full of clothes was like a huge weight off my shoulders,” McKee recalled. “Because I felt like a bad mom.”

Those behind the program say it enables those stuck in a healthcare gap to feel seen and heard.

“They have felt empowers to ask more questions of their healthcare providers,” Lathrop explained.

“You have to be your own advocate,” McKee said. “And just keep going at them until somebody hears you.”

Those interested can contact the program’s team at 717-843-6330 or 717-916-4099. They can also email dcaraballo@familyfirsthealth.org or clathrop@familyfirsthealth.org.

More information about the program can be found here.

Watch the video here

YORK COUNTY, Pa. (WHP) – According to the World Health Organization, the U.S. has the highest mortality rate for mothers among high income countries. Black mothers are nearly three times more likely to die from pregnancy-related complications.

Family First Health is meeting expectant mothers in the places they need it most. Its Nurse-Family Partnership program connects mothers to a registered nurse for support through their pregnancy at no charge.

Those behind the program say a lack of health coverage is often a barrier for low-income parents to get the care they need and they often feel unseen and unheard by the healthcare system.

“Being that we only serve first-time pregnant mothers who meet income guidelines, we’re serving people who we can make the biggest difference in their lives,” said Nurse-Family Partnership Program Manager and Nurse Supervisor for Adam and York City Lisa Lathrop.

Nurse-Family Partnership services include:

• The support to have a healthy pregnancy and healthy baby
• Board Certified Lactation Consultants and Certified Lactation Counselors on Staff to help with breastfeeding
• Certified Car Seat technician to assist with safe car seat installation
• Spanish speaking in-home interpreter
• The ability to learn and practice things that make you more confident as a mom, like breastfeeding, nutrition, child development, safe-sleep techniques, and much more
• Referrals for healthcare, childcare, job training, and other support services available in your community
• Support to continue your education, develop job skills, or follow your dreams for the future

Women who are pregnant with their first child, pregnant 28 weeks or less and meet income requirements are eligible.

In the Nurse-Family Partnership program, nurses are available until the child is two years old.

Those interested can contact the program’s team at 717-843-6330 or 717-916-4099. They can also email dcaraballo@familyfirsthealth.org or clathrop@familyfirsthealth.org.

More information about the program can be found here.

Watch the video here

YORK, Pa – Family First Health is raising awareness on the importance of healthcare for students for National School-Based Health Care Awareness Month

Throughout the country, there are 3,000 health centers on school grounds. One of them is the Hannah Penn Center at Hannah Penn K through Eight.

It’s York County’s only school-based health center.

More than 50% of the students at Hannah Penn are also patients of Family First Health.

Nikole Tome, the School-Based Health Center Manager at Family First Health’s Hannah Penn Center said, “The best thing is that for students, they are able to succeed in school. Obviously we need to meet those health needs so that they’re able to be the best they can be in a school setting. So we are helping to eliminate the barriers that they may have to receiving care.”

The health center is open to the community and offers a 24-hour on-call physician, language interpreters, a Health and Wellness Coach, and Community Health Workers.

It’s funded through the United Health Foundation.

Watch the video here

DAUPHIN COUNTY, Pa (WHP) – Healthcare providers say inflation is fueling the access to care crisis among low-income patients.

“You have a health challenge and transportation issues or housing that is substandard, those things come together and make your health issues more challenging,” Community Progress Council President and CEO Robin Rohrbaugh said.

“If those challenges aren’t readily met, that’s going to impair how people do regarding their healthcare,” added Highmark Wholecare Chief Medical Officer Joseph Stankaitis.

“For people who are working, they’re trying to survive,” Family First Health Community Health Program Lead Celia Serrano said. “There is a huge amount of people that do not have insurance here in this community.”

Medical professionals are seeing low-income patients skip appointments they can’t afford.

“Once upon a time, I was in their shoes,” said Serrano.

She has spent the last two years at Family First Health, going into the community to connect those worried about making ends meet to care.

“For a point there, I was unemployed and I needed to be on public assistance,” Serrano explained. “So I know what a lot of this community goes through, I can relate to it.”

In York County, Serrano works with Haitian Creole patients, Hispanics, undocumented immigrants and those in the five-year waiting period of being lawfully in the U.S. She says many are unaware of the services available to them.

“One of the major barriers is language,” Serrano continued.

It’s a barrier seen at Community Progress Council, too, which also tries to streamline the process of finding insurance coverage for low-income patients.

“If you’re not feeling well and you’re trying to navigate through housing services and transportation and healthcare and food programs, you just don’t have the capacity to do it,” Rohrbaugh said.

And more health insurers are recognizing this need. Highmark Wholecare offers a Medicare Dual Special Needs non-medical package for patients who have both chronic health problems and live in poverty.

“Because the population that we serve is incredibly challenged,” Stankaitis continued.

AmeriHealth Caritas, UPMC Health Plan and Pennie insurance are among others offering more care at less cost.

“It levels the playing field,” Stankaitis added.

Serrano says, with so many patients coming in without insurance, Family First Health also offers a slide fee which allows them to pay for clinical care based on their income to address one of the biggest concerns they hear.

“They’re afraid that they cannot get quality healthcare,” she said, advocating more education on resources is needed.

Watch the video here