The art of easing needle-fear

It has been 30 years since Karin Enskär, Professor of Paediatric Nursing at the Department of Women’s and Children’s Health, last worked at the paediatric cancer unit at Uppsala University Hospital. Now, after many years at institutions such as Jönköping University College, she is back in Uppsala.

“I have actually felt since I left Uppsala after my specialised training and internship that I wanted to come back. But the opportunity arose in Jönköping, and then I started a family, so it just didn’t fit.”

Since 2021, Karin Enskär has been working at Uppsala University again as a professor of Paediatric Nursing, but also spends one-third of her time at the children’s hospital and one-third on teaching.

The child should be in focus

Paediatric nursing is about putting the child first but also the family around the ill child. Karin’s most important task, both as a nurse and a researcher, is to see how to best support children and families to achieve the best possible life along the challenging path that treatment entails, despite what has happened.

“I have never really worked with adults. Nursing for children in cancer care was what I got into from the start as a nurse, and then later as a researcher. The encounters with the children are the most rewarding. What I have studied and focused on the most is how care can be enhanced and improved regarding children’s experience of, for example, cancer treatment, and not in the form of effective drugs but things around it, like distraction and diversion. The focus has been more on care than treatment,” summarises Karin Enskär.

The worst part is the needles

The headline of this text may seem diminishing, but it highlights a small but important part of Karin’s research work. It also leads us to the subjects of needle-fear and soap bubbles. And video games.

According to Karin’s experiences, children often perceive certain moments in healthcare as worse than others during their hospital stay.

“Clearly, through my years, the children highlight that the worst part is the needles and I have tried to study how to improve their experience. Among other things, we have looked at what I call complementary or non-pharmacological methods – like soap bubbles or video games ­– that can make the experience better.”

“Questioned” by her niece

For example, it has been shown that video games alleviate discomfort among children who find that particular video game enjoyable. If the game is perceived as boring, it has less or no effect.

“It may seem entirely logical, and it is, but it still shows important things. My niece hurt herself once, and to distract her, I handed her an iPad and said, ‘This is what my research consists of.’ Her response was straightforward: ‘Why? Doesn’t everyone understand that this makes it better?’

But it’s not just about handing a video game to a child and expecting it to make things better. Some want video games; others think soap bubbles work better. It’s so very individual what works, and that’s what we’re trying to implement in healthcare. Should the nurses at the children’s hospital perhaps have a pack of soap bubbles in their pocket?” Karin rhetorically asks.

How do you perceive the relationship between medical treatment and the type of care you have researched in healthcare today?
“Everyone knows about these things that I try to highlight, but then it’s a question of finding time for it and affording it. There is more focus on treatment and cure, which is, of course, the most important – even if you ask the children and, not least, the parents. But for a nurse, treatment is not always the most important task; it’s managing the consequences of it and making a difficult and unpleasant experience for the child more bearable. Care, to put it simply,” says Karin and continues:

“When I started in healthcare, it was sadly the case that a majority of children did not survive. They do today, and that means that they thankfully get older and can remember their experience and talk about it. Astrid Norberg, Sweden’s first Professor of Paediatric Nursing, once said: ‘Good care is only visible in its absence,’ and I think that is spot on.”

Individualised approach is important

However, procedures do not necessarily have to involve distractions through soap bubbles or anything else. The interaction and demeanour of the staff towards the child, above all, are the most important, according to Karin Enskär.

“The absolute most important thing the staff can do is to see the child. You should, off course, listen to the parents, but the child should be in focus. Children cannot decide on their treatment, but they can decide on other things, and participation is important. The nurse should not just enter the room and ask, ‘Is it okay if I inject you?’ but instead ask how the child wants it. ‘Do you want to sit on mom’s or dad’s lap? Do you want this or that plaster?’ I believe that individualising care based on the child’s wishes is very good. What does the child think is fun? Then write down the answer in the journal for the next nurse or physician to read.”

More nurses do research

Even though Karin Enskär’s research has shown important results that she is currently trying to raise awareness of and implement in healthcare, there is another aspect that she highlights as her most important contribution.

“My most concrete example that I usually bring up regarding my research is actually that I may have encouraged other nurses to dare to pursue various issues and enter the field of research themselves. When I started, there were not many nurses who chose to do research, but there have been more since then. So, I feel in some way that I may have contributed to important progress since I started. Also, through my teaching, the opportunity opens up to talk about these things early on, things that research has found so that the next generation of nurses has it top-of-mind from the start,” she says.

Robin Widing