See the project video here: https://vimeo.com/456312354
Sensory Tools for Reducing Needle Fear, is the first ever toolkit to help parents calm and reassure their children through the blood test experience. The toolkit presents a range of visionary methods to address needle fear in a very new way in the children’s ward.Needle fear is a big problem affecting 63% of children under the age of 8 years in routine injections and blood tests (Orenius et al., in 2018; Kortesluoma & Nikkonen, 2004); causing distress that can stay with them for long after the procedure and has been found to be an integral part in the formation of needle phobias that can become a life-long barrier to using healthcare services (Orenius et al., in 2018).
Fig. 1 Fieldwork with Danske Hospitalsklovne in Kolding Sygehus.
Needles are one of the most feared aspects of going to hospital for children (Orenius et al., in 2018). In fieldwork Roseanne discovered that children who became very scared would need to be restrained or sedated; their appointments would take much longer to complete and could need to be rescheduled. This meant that children who were particularly distressed might need to have the test repeated to get enough blood for the test. Parents and nurses tried their best to help scared children, using extra time but this can cause that waiting times to become extended at greater cost to the healthcare system, until there comes a point where parents and nurses need to restrain the child, preceding without their consent. Anxious parents were also found to influence their child’s fear, by signaling their unease through their body language. While children with known needle phobias were less likely to be prepared adequately at home before their blood test or injection, in a social phenomenon to manage the child’s fear in advance (Duff 2013). This could lead to telling ‘little white lies’ about the needle procedure ahead or even bribing the child with toys or money to get them to comply, also signaling an increased severity of the situation to the child.
Fig. 2 Fieldwork to understand the child’s perspective in pediatric blood sampling.
Co-designed with families, Pediatric Nurses and Play therapists, Sensory Tools for Reducing Needle Fear presents four effective techniques for parents to calm and reassure their children before, during and after the blood test situation, making the blood test safer, quicker and less likely to cause a needle phobia. It is the first ever toolkit to help parents calm and reassure their children through the blood test experience.
Fig. 3 Sensory Tools for Reducing Needle Fear.
The first tool, the Magic Brush, was inspired by a simple hypnosis technique developed by child psychiatrist Dr. Leora Kuttner, which protects the child from pain by using their imagination and senses. The Magic Brush is used to apply imaginary paint to the child’s arm, which through focused attention and imagination creates a type of hypnoanalgesia (hypnotic pain relief) protecting the child from feeling any pain from the needle in their test (Kuttner, 2012).
Fig. 4 The Magic Brush
The second tool, the Sound Shell is designed to calm children in loud hospital environments, through sound resonance creating a calming ASMR (autonomous sensory meridian response) experience when listening to it. The third tool helps parents to distract anxious children by blowing bubbles while at the same time calming themselves by slowing their breath. This helps them to replace anxious protective behaviour cues with positive ones. While the final tool, the Acupressure Ball, is used to apply pressure to specific acupressure points in the wrist, helping to ease anxiety or any residual pain after the test is complete.
The tools can be used on their own or together, and come with an interactive flyer where the parent can see how to use them through illustrations and QR codes to videos on youtube. The videos were filmed in the style of ASMR videos, so these can also help to calm the viewer by simply watching them. The tools build on the trusting relationship of the parent and child by soothing the senses through asmr sounds, meditative breathing, hypnoanalgesia and acupressure, removing the need for total sensory deprivation, bribery, chemical sedation or coercive restraint to complete the test against the patient’s consent.
Fig. 5 The Acupressure Ball
The sensory tools create positive social value by building upon the existing trusting child-parent bond. Activating parents on how to effectively reassure their child, so their child can face the anticipation of pain with their parent by their side, during the 30 minute wait, in the hospital waiting room before their test. This supports the development of healthy coping skills, resilience, parent-child bonding and a good relationship with healthcare. Decreasing the risk of developing a phobia of needles.
Sensory Tools for Needle Fear, is the first ever toolkit to help parents calm and reassure their children through the blood test experience. It proposes a new way to support the children’s psychological wellbeing through fearful procedures like blood tests in hospital. Roseanne’s entrepreneurial spirit and courage for collaborating with multidisciplinary stakeholders such as play therapists, bioanalysts and pediatric nurses also creates opportunities for a high innovative potential through cross pollination between fields of knowledge, further strengthening the contextual fit of her ideas but also giving her work a legacy that lasts longer than the lifespan of the project. Roseanne’s project also highlights a new need for a designer’s skillset to create child centered healthcare experiences that are sympathetic to the needs of children, which is currently missing.Roseanne’s work demonstrates the value that design research can offer healthcare. We see here a very real example of where design research methods aid the development of meaningful knowledge that is useful not only in the design process but also in the practice of healthcare professionals. Roseanne discovered the need for a clearer mechanism of how needle experiences can lead to needle phobias after reading many medical papers and interviewing Karin Bundgaard Nielsen, a clinical nurse based at Kolding Sygehus.
Fig. 6 Roseanne’s diagram of needle fear and the formation of phobias from healthcare experiences.
Roseanne’s work builds on the findings of medical researchers, adding insights from her research at Kolding Sygehus, by proposing a new diagram/model that can be used in the training of healthcare professionals, to demonstrate the importance of the healthcare experience on children, and how it can lead to the formation of needle phobias (see Fig.3).
Fig. 8 Roseanne brings pediatric nurses, play therapists, hospital clowns and bioanalysts together, this leads to important discussions on their different approaches to helping patients beat fear in healthcare, which adds relevant clinical knowledge to the project leading to the development of the sensory tools and the new model of needle fear for training.
Roseanne’s work demonstrates a high design quality, showcasing strong craftsmanship and aesthetics skills, not only in the pieces themselves but the photographs of the work too. She uses co-created colours in the tools from asking nurses and play therapists “What is the colour of a healthy happy child when they leave the ward?”. These colours have then been carefully curated in different combinations to create a child-friendly aesthetic. Which she then tested with her target group in a play test, finding the best combinations to create excitement and appeal. The shapes and colours evoke a feeling of jewellery or toys, which creates a sense of trust and tacility. The soft materials and shapes intuitively invite the user to touch and experience the tools with their senses, invoking a playful sense of joy and calm, that the user naturally tries to share with another such as a parent or nurse. All of Roseanne’s designs have been developed to fit into the current healthcare system, making the designs easy to implement, easy to clean and be used by parents and nurses. Codesigning the tools with healthcare professionals Roseanne has been able to identify the optimal place for the tools in the current blood test system, using materials which complement their current hygiene and cleaning regulations. Deciding that the use of the tools should be primarily facilitated by the parents, guided by simple instructions or videos also helps in the instances where bioanalysts work alone, where they are physically unable to distract and comfort the child while performing the test, due to the skill and attention required to perform the test without hurting the child. Roseanne’s Sensory Tools for Reducing Needle Fear helps to decrease the negative economic impact on the health services from prolonged or repeated blood sampling due to needle fear and phobia. Although there isn’t anything like it yet, we can see the economic value of design to decrease fear in the MRI department at Kolding sygehus where a multifaceted project to reduce children’s fear during MRI scans was explored in 2018. Which after a cost-benefit analysis found that the approach to reduce fear was hugely beneficial, paying for itself in only 2 years (with 250 patients) even though it included the implementation of a very expensive system. (There are much more blood tests then scans, and when the covid vaccine is ready many of us will be vaccinated). The Sensory Tools would be affordable to manufacture making this project scalable to different healthcare environments around the world and are relevant to everyone looking after children experiencing fear in healthcare.
Fig. 8 The Sound Resonance Shell, “Listen carefully, can you hear the sea?”
Through embracing make believe, social play and fantasy, Roseanne’s four sensory tools are developmentally appropriate for children between 3 – 8 years (Jones, 2018), which is also the group most vulnerable to needle fear (under 8 years), and the age where most needle phobias begin (5 years) (Orenius et al., in 2018).
In Sensory Tools for Reducing Needle Fear, Roseanne presents a new understanding of the importance of the child’s perspective in healthcare experiences. As we seek to implement child centered care experiences across Scandinavia (Von Troil, 2013) it raises some important questions: How sedated or distracted should children be in healthcare? Is it ok to use restraint forcing children through painful procedures against their consent? Through the uneven power balance in healthcare are we making our children fearful of healthcare? and what lessons are teaching our children about consent for their and others bodies when we go ahead against their wishes?
Through her work Roseanne exemplifies the Nordic design tradition through her codesign approach to solving the wicked problems of needle fear in children’s healthcare. Working with curiosity and empathy to create better solutions for a kinder world Roseanne invites participants and stakeholders from different professional backgrounds into her work, creating bespoke research probes, dialogue tools and empowering participants to share their perspective in the development of new design possibilities that affect them. This means that Roseanne is able to develop designs with a great contextual fit that understands the user’s needs, pains, gains and life values.
As we wait for a vaccine for the current pandemic there is also a debat rising about the ethical challenge of enforced vaccination, but this challenge is something that most children experience already when they experience needles without their consent. Roseanne presents a new way to think about child centered healthcare and the ethical treatment of children during needle procedures, proposing solutions to make this process less daunting and more efficient for some of our most vulnerable members of society.Through generative research in the children’s ward of Kolding Sygehus, Roseanne has also been able to develop a new model of how needle fear and phobias relate to the blood test experience which has been published in Børne- og Ungesygeplejersken (November issue), with her photo also appearing on the front page. Roseanne’s research and designs have received considerable interest from healthcare professionals and since her graduation, giving presentations about her findings to different departments of the hospital. Roseanne has also been nominated for a Danish Design Award and hopes to help share the knowledge she has gained over this project to improve the blood test experience for children across Denmark.
Master’s Project by Roseanne Marie Kimber
Roseanne.Marie.Kimber@gmail.com
http://www.RoseanneKimber.com
Bibliography
Drewes, A.A. and Schaefer, C.E. (2018). Play-Based Interventions or Childhood Anxieties, Fears and Phobias. New York: Guilford Press.
Jones, M. (2018). The Necessity of Play for Children in Healthcare. Pediatric Nursing. November-December, 2018 (44) 6.
Kortesluoma, R. L., & Nikkonen, M. (2004). ‘I had this horrible pain’: The sources and causes of pain experiences in 4- to 11-year-old hospitalized children. Journal of Child Health Care, 8(3), 210–231.
Orenius, T., Säilä, H., Mikola, K., & Ristolainen, L. (2018). Fear of Injections and Needle Phobia Among Children and Adolescents: An Overview of Psychological, Behavioral, and Contextual Factors. SAGE Open Nursing, (4) 1–8.
Von Troil, H. (2013). Children’s Participation and Decision Making in Medical Matters. Denmark: Rosendahls-Schultz Grafisk.
