A presentation by Allan Cyna at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine. All available content from SSAI2017: https://scanfoam.org/ssai2017/ Delivered in collaboration between scanFOAM, SSAI & SFAI.

1. Needle phobia
Communicating with children (and parents)
Dr Allan M Cyna
allan.cyna@sa.gov.au
September 8th 2017

2. Needle phobia
• Disclosures/ Conflicts
• Definitions and aetiology
• Mythology
• Goals of Management
• Techniques
• Distraction techniques
• LAURS
• Lived in imagination
• Switch wire imagery

3. Needle phobia Aetiology
• Negative Suggestion
• (Parents, friends)
• Prior experience
• Initial Sensitising Event (ISE)
• Symptom Producing Event (SPE)
• Reinforcing Events
• Avoidance behaviours

4. Needle phobia
Conscious
Subconscious

5. Needle phobia mythology
• Needle phobics must have a gas induction
• EMLA (anaesthetic cream) is essential
• Premedication is always necessary
• Best to warn the patient that its going to hurt or sting!

6. A large part of needle phobia is
the anticipatory stress

7. Needle phobia - Goals of Management
• Restore patient’s sense of
• Trust with medical staff
• Competence
• Control
• Independence
• Include the patient
• as an integral and active participant in his/her care
rather than a passive recipient

8. Optimising communication
• Facilitates cooperation
• Minimises distress / helps patients and parents relax
• Easy to administer
• Can provide analgesia
• Minimal side effects
• Empowers the patient

9. Needle phobia
Why children are likely to respond subconsciously
• Prone to fantasy
• Little reality testing
• Highly responsive to suggestion
• Ready acceptance of authority (usually)

10. Needle phobia - Greeting / Goals / Rapport
• What do you like being called?
• What do your friends call you?
• Is it Ok if I call you …….

11. Needle Phobia: The L.A.U.R.S. of communication
• Listening
• Acceptance
• Utilisation
• Reframing
•Suggestion

12. The 75 essential steps for Effective
Communication when managing Needle Phobia
Listen Listen Listen- Listen- Listen - Listen- Listen- Listen Listen
Listen- Listen- Listen- Listen- Listen- Listen- Listen- Listen-
Listen Listen Listen Listen- Listen- Listen - Listen- Listen- Listen
Listen Listen- Listen- Listen- Listen- Listen- Listen- Listen-
Listen- Listen Listen Listen Listen- Listen- Listen - Listen-
Listen- Listen Listen Listen- Listen- Listen- Listen- Listen-
Listen- Listen- Listen- Listen Listen Listen Listen- Listen- Listen
- Listen- Listen- Listen Listen Listen- Listen- Listen- Listen-
Listen- Listen- Listen- Listen- Listen Listen, Listen,
Listen

13. Needle Phobia
Reflective listening and checking in!
Did you hear what was said?
Did you understand what was meant?
Does the child know they have been heard?
Does the child (and parent) know they have been understood?

14. Needle phobia
LAURS Acceptance
Appreciating different realities
1. The first reality
2. The second reality
3. The third reality

15. Needle phobia
LAURS Utilisation
• Favourite colour
• Favourite activity
(?As a focus during potentially painful procedures)
• Favourite food Drink

16. Needle phobia
LAURS Reframing
“Just starting to put the needle in” vs “Just finishing up now”
“This may sting” versus “This will allow us to give medication
more safely and comfortably”

17. LAURSSuggestion
• Direct / Indirect
• ‘Yes’ sets
• Truisms
• Reversed effect
• Double binds (Toes vs cough)
• Use of Metaphor (switch)

18. TRY
Sting
Pain
Needles
Worry
Not
Needle phobia
Sabotage words

19. Needle Phobia Unintended negative suggestions!
• Its only a Sharp scratch
• Try not to move
• It might sting a little!
• Its only a small needle

20. Needle Phobia Supporting Evidence
• Lang EV et al. Can words hurt? Patient-provider interactions during invasive procedures. Pain
2005;114:303-9
• Dutt- Gupta et al. The effects of communication on pain. BJA Dec 2007

21. Needle Phobia and Suggestion
The pain in the main is plainly in the brain!

22. Needle phobia
LAURS in an emergency
Patient: “If you come near me with that needle, I’ll die!”
Anaesthetist: “That’s OK, - why don’t you just let that arm die for a
moment then!”

23. Managing needle phobia
A goal without steps is merely a wish! (Yapko 2008)
• Can I show you some (magic) tricks that can help?
• Is it OK to give this one go?
• Is it OK to
• stand next to you?
• look at the arm?
• put this tourniquet on, so the arm can feel sleepy?
• tap the hand so it feels sleepier than it is already?
• wipe the sensation away with the antiseptic?
• Wriggle toes whilst we Finish?

24. Little words
Largest ripple
Lived in imagination

25. ‘Lived in’ ImaginationNeedle phobia

29. In Short:
“Whether you think you can or whether you
think you can’t – You are probably right!”
Adapted from Henry Ford

30. Communicating with children
• Appreciate the impact of language
• Believe that patients can do more than
• they think they can
• we think they can
• Choice and Control are important

32. allan.cyna@sa.gov.au