Maj Sivapriya S1 , Col Leena Kumari2 1Clinical Tutor, College of Nursing, CH
(CC), Lucknow, India 2 Principal, College of Nursing, CH (CC), Lucknow,
India Abstract:
Pain is a common and a ubiquitous sensation for children and adult. Every child
has his or her own perception of pain. Routine immunizations are the most
frequent painful medical procedure during childhood. A fundamental principle
of responsible medical care is ‘do not hurt’ but ‘do not harm’ since pain is
harmful to children, the care givers are committed in preventing harm to their
patients. Pain is a major source of distress for children and their families as well
as health care providers. Skin tapping (Helfer skin technique) is one of the
methods which keeps the muscles relaxed and thus reduce pain while
administering IM injection. Objective is to assess the pain level of neonate
during intramuscular injection with usual standard technique. To assess the pain
level of neonate during intra muscular injection with Helfer skin tap technique
and to compare the pain level of neonates during intramuscular injection with
and without the use of Helfer skin tap technique. Materials and Methods: Study
design used is True experimental post test control design. Study setting includes
Labour room in a selected tertiary care hospital. Study population is 100 new
born babies. Sampling technique used is Purposive sampling to select the
eligible population and simple random sampling is used to allocate the subjects
into experiment and control group. Tools used include Neonatal Infant Pain
Scale (NIPS). Results: The data collected was analyzed using descriptive and
inferential statistics. The study findings high lights that 86 % of the neonates in
the experimental group had mild pain, only 14% perceived severe pain during
IM injection by using helfer skin tap technique. 86 % of the neonates in the
control group had severe pain, only 14% perceived moderate pain during IM
injection by using conventional routine technique There is a significant decrease
in the pain score between the administration of IM injection with helfer skin tap
technique .
According to Keen study, the Z track intramuscular injection technique was
compared with the standard injection technique for occurrence and severity of
pain and lesions at the injection site. The Z-track technique significantly
reduced incidence of pain and lesions at selected time intervals, severity of
discomfort at selected time intervals, and severity of lesions at all time intervals
post injection (Keen, 2010). Randomized controlled study conducted on the
effectiveness of manual pressure on pain severity in Iran 2012. The study
concluded that manual pressure in IM injection site leads to pain relief and we
can apply this technique for reducing pain severity and promote comfort (Nasiry
et al., 2012). Consistent with Schechter pain reduction throughout child
immunizations: evidence-based review and suggestions reveals that pain related
to immunizations may be a source of anxiety and distress for the kids receiving
the immunizations, their families, and also the health care providers who should
administer them. Immunizations are stressful for all kids; till innovative
approaches are developed, systematic use of accessible techniques will
considerably decreased the burden of distress induced by these procedures
(Schechter, Zempsky, Cohen, McGrath, McMurtry, Bright,2007). In line with
Esmailzadeh, I.M injection, Nurses are suggested to use local cold therapy to
reduced pain intensity of benzathine penicillin I.M injection in clients.
However, additional studies are required to identify the underlying mechanisms
( Esmailzadeh, 2012)
Amira Ahmed Hassnein1 , Hanan Mohamed Mohamed Soliman2 *1 Assist
prof. of Faculty of Nursing, Mansoura University, Medical- Surgical Nursing
Department *2 Lecturer of Faculty of Nursing, Mansoura University, Medical-
Surgical Nursing Department ,60 El-Mansoura,EL Gomhoria street, El
mansoura city, Egypt. E Mail: hanansoliman697@ymail.com,
hanansolaiman@mans.edu.eg.com DOI:
http://dx.doi.org/10.15520/ijnd.2016.vol6.iss2.135.12-22
Abstract: Intramuscular injection is common procedure that nurses frequently
carry out which causes pain and distress to the patient, Pain is a feeling
triggered in the nervous system. Pain may be sharp or dull. Aim of the study: To
evaluate the Efficacy of Helfer Skin Tap Technique on reducing Pain intensity
Associated with Intramuscular Injection at the study setting. Methods: A quasi
experimental research design was conducted at medical and surgical units at
Main Mansoura University Hospital. The data were collected from purposive
sample 100 patients of both sexes who correspond to inclusion criteria. Each
patient was administered repeated intramuscular injections at the gluteal site.
Then pain level with administration of intramuscular injection by traditional
technique was compared with pain level with Helfer Skin Tapping Technique.
The tools developed and used for data collection were socio-demographic
characteristics and assessment of pain level with Universal Pain Assessment
Tool. Results: The pain perception of patients in terms of pain level of
traditional technique was found to be significantly higher than pain level of
Helfer skin tapping Technique. Conclusion: Skin tapping technique was
effective in reducing pain level of patients. Thus, skin tapping technique can be
used as an intervention to reduce pain associated with administration of
intramuscular injection. Keywords: Intramuscular Injection, Helfer Tapping,
Pain.
A STUDY TO ASSESS THE EFFECTIVENESS OF HELFER SKIN TAP
TECHNIQUE DURING IMMUNIZATION IN INFANTS IN SELECTED
HOSPITAL AND ANGANWADI OF AMBALA, HARYANA
P Meera, K. Yogesh, K. Gurneet
ABSTRACT
A. The objectives of the study was to assess and compare level of pain in
infants with and without Helfer skin tap technique during immunization
and find out relationship between level of pain and duration of cry. One
hundred infants were selected through purposive sampling technique,
who were attending immunization clinic. The interobserver reliability of
FLACC pain scale was established and it was found to be (0.9) and
duration of cry 0.8. The range of acceptability by Cronbach α agreement
is from 0.60 to 1.00. The computed ‘t’ value of 0.0047 indicates that
mean level of pain (6.7) of infants in control group was higher than mean
level of pain (5.3) of infants and in duration of cry ‘t’ value of 3.882
indicates that mean duration of cry (28.9) of infants in control group was
higher than mean duration of cry (37.4) of infants in experimental group.
There is a correlation between pain and duration of cry. Cry increases
with pain.
Keywords: Infants, pain, Helfer skin tap technique, FLACC pain scale,
immunization, pentavaccine
Procedure:
The researcher obtained the needed official permissions from the Research Ethics Committee
of the faculty of Nursing Mansoura University and the hospital authorities approved the
study. After a pilot study on 10 patients, Patients who had the inclusion criteria were selected
by daily referring to the wards. In the beginning, the researcher presented the necessary
explanations about the research objectives to the patients. Each respondents were taken four
injection two by traditional technique followed by two by Heifer technique and pain level
were compared, also structured interview were done for each patient to collect necessary data
to determine relation of other variable and pain level . The researcher introduced herself to
the Head nurse of the word. The researcher remained in the medical and surgical wards from
8am to 4pm. The researcher involved in all the routine functioning of the wards so as to
create a familiar environment for the patients attending the wards. The investigator (1)
Welcomed and interviewed the respondents to fill the first tool I- Demographic data sheet to
obtain the baseline information and elicit their personal and medical data. .The interview was
conducted at the nurses' station in the injection room. The respondents were made
comfortable and assessed for any needs that needed to be fulfilled prior to conducting the
interview. Immediately before giving I.M injection. The investigator (2) places the patient in
side lying position and flexes the knee to relax muscles. The investigator (2) makes a wide V
with thumb & rest of the fingers taps the muscle which is intended to use with the palmar
aspect of fingers 16 times before the insertion and counts 1.2. & 3 while removing the needle
during IM injection. After the injection was administered to the respondents, the investigator
(1) assess the pain intensity within 1 minute of administration of the injection using tool II-.
Universal Pain Assessment Tool to assess the pain perception of the respondents after
receiving IM injection Each respondents were taken four injection two by traditional
technique followed by two by Helfer technique . OPERATIONAL DEFINITION Efficacy:
during this research study efficacy refers to the extent to which the Helfer Skin Tap technique
and traditional technique helps to reduce the pain caused by IM injection as measured by
universal pain scale. Helfer Skin Tap technique: It's a method in which the researcher taps the
muscle which is intended to use with the palmar side of fingers sixteen times before the
insertion and three counts whereas removing the needle throughout IM injection. Pain: Pain is
an unpleasant subjective sensational experienced by people whereas receiving IM injection
and is measured by universal pain scale soon once the withdrawal of needle. Patients
receiving IM injection: It refers to both sexes who receive injection intra muscularly at 90
degree angle into dorso gluteal muscles at the medical and surgical department
