Month: July 2021

This article is about how to have less fear and pain when getting an injection, so I decided to be kind and use a photo of a different kind of needle… not to further upset anyone! A friend told me that just seeing news reports about COVID upset her because they so often showed needles being given… she was terrified of needles and couldn’t watch, even on TV.

And she’s not alone. Twenty five percent of people report being afraid of getting an injection and 5 to 10% are reported to actually refuse injections because of needle phobias. But with a deadly disease like COVID-19, we need to have as many people vaccinated as possible to stop the spread of the virus. An ideal scenario would be to have enough people immunized to make the virus extinct, as was done with polio. Perhaps we were so successful with it because they developed an oral form of the vaccine. Remember the drops on the sugar cube? Nothing to fear there!

But, until they find a way to present the COVID vaccine as a sweet treat, we need to remove all barriers we possibly can to getting immunized.

When I started giving injections, I worried about causing pain… I didn’t want to hurt anyone! I knew there had to be something in the administration technique that reduced pain, as some flu shots I’d had in the past were completely painless while others had quite a sting, so I read everything I could about reducing needle pain. I learned there are lots of things both you and the injector can do that help.

This year, after seeing some dubious injection technique in TV news reports, I wrote an article about how injectors can drastically reduce the pain of an injection, making the needle itself almost (or in some cases, completely) painless. Our national pharmacy journal ran my article 3 times, and it was published on an American nurse practitioner website too! I hope the information is helping to lessen the pain of immunization for some people. Injections really can be pain-free—I can honestly say I didn’t feel the needle at all at my second COVID shot. It’s all about technique and that nurse was very good! 😊

So, if you’re afraid of needles, read on…

Pain-free injections

Some key actions for injectors to take to reduce injection pain are to let the alcohol dry, make sure the needle goes into the belly of the muscle (not too shallow, and not too high or low on the arm), put a little pressure on the skin near the injection site (so your brain will register pressure not pain), insert and remove the needle quickly (avoids pain, just like a quick paper cut is often painless), and put pressure on the injection site (with a cotton ball) immediately afterward. It also helps to do something to distract the person, even if it’s just by telling them to take a deep breath.

As a patient, it’s absolutely your right to ask the person giving you an injection to let the alcohol dry before injecting, or to give the needle at a certain spot if you know where a deltoid (arm) injection is supposed to be given. You could also ask them to make it as quick as possible and offer to hold the cotton ball afterward to continue the pressure on the injection site while the injector completes records and prepares a bandage. If you’re an injector and interested in reading the article I wrote, here’s a link to the post on the Nurse Practitioners for Women’s Health website.

What you, as a patient, can do: Play the “CARD” system…

CARD is an acronym for 4 activities that reduce pain, fear, fainting and other symptoms some people experience when getting an injection or before and after. It stands for Comfort, Ask, Relax and Distract. The system was scientifically tested in schools in Niagra, Ontario, and was found to reduce fear of needles by almost half. The system is easily adapted to work in most settings where injections are given.

Here’s what they suggest:

Comfort—Wear short sleeves so it’s easy to expose the injection site. Bring a snack: eating something can keep you busy and distracted.

Ask—If you’re worried about anything, for example side effects, don’t hesitate to ask. The person giving the injection usually knows the answers to most questions about injections or can easily find the answer for you. Did you know there is a numbing cream/patch you can use? Ask about this before you go if you think it will help (It is available at most pharmacies and has to be applied to the injection site an hour before the injection. Make sure you know exactly where to apply it.). Should you look at the needle or look away? Do you want to be told just before it’s given, or would you rather not know? Tell the injector for your preference.

Relax—If the muscle that is being injected is contracted or tense, the needle is more likely to hurt. Make sure your arm is completely limp and relaxed. Although it’s more difficult right now with COVID restrictions, having a friend accompany you can help you feel more confident and relaxed. Make your appointment at the same time as a friend or family member so you can boost each other’s confidence while waiting. Take a deep belly breath just as the needle is being given to help you to relax. This works as a distraction too (discussed next).

Distract—Distraction can actually reduce the pain you feel. I used to let younger children play a drawing game on my iPad to distract them (especially effective when iPads were new!). After the injection (when they didn’t like me anymore), I would ask if they’d like me to send their drawing to Mommy or Daddy’s computer… that almost always made me a cool person again and distracted them from what just happened! But even chatting with the injector can also help you relax. Tell them your worries—there’s often something extra they can do to help resolve your fears, or just talk about the weather to distract yourself. One elderly gentleman that I gave a flu shot to insisted that I hadn’t given him his injection—he had been busy chatting with an attractive assistant and didn’t even notice when I gave him his needle! It only took me about 2 seconds to give the actual injection, so it was easy to miss, I guess…

In addition to addressing the pain of injections, the CARD system also considers the stress that many people experience when getting an immunization. And it’s not just children and adolescents… adults fear injections too. It’s time for us all to improve injection experiences by working together to make them easier, more comfortable and more pleasant.

Click here to learn more things you can do to squelch your fear of needles… CARD for adults: https://immunize.ca/card-adults

…A softer kind of needle

References:

Tips for Giving a Pain-Free, Effective Injection—Jeannie Collins Beaudin (NPWH website)

Improving the vaccination experience with CARD—Government of Canada, Public Health Services

CARD for Adults—Immunize Canada

#FearOfNeedles #PainFreeInjections

Privacy is important these days, and nothing is more private than our medical information. But when it comes to being safe in a pandemic, it’s also important to know how safe stores, restaurants and businesses are, especially as they start to fully re-open and masks are no longer mandated. Whether a person has been fully vaccinated makes a huge difference in how likely they are to catch the coronavirus and transmit it to others, as well as how sick they might become if they contract the virus.

Do we have a right to ask a person’s vaccination status before they provide a service, especially if unmasked? Can an employer require their employees to disclose their immunization status and make this information public? Can you be required to show proof of COVID vaccination before travelling to another country?

CTV News interviewed several personal injury, employment and privacy specialists to get their expert opinion on these questions. Their comments were interesting, I thought, so I wanted to share some of what they said. Quite a can of worms…

What if you can’t get vaccinated?

Of course, there are some people who cannot be vaccinated for medical reasons, such as allergy to a component of the vaccine, or who do not respond well to vaccines, due to low immune function or medications that block the immune system. These people need to be protected from discrimination.

Employers cannot force employees to disclose their vaccination status to clients and they certainly cannot disclose this information on the employees’ behalf, the lawyers emphasized. One suggested businesses could post a sign on their door saying that no personal health information would be divulged about their employees. But that sounds like something that might have the potential to reduce business…

Safety first

However, employers have a right and requirement to provide a safe work environment for other employees and their clients. This means that employers may need to know who is unvaccinated… whether they cannot, or choose not, to take the vaccine. In the name of safety, these employees may find themselves required to work from home or in a modified position that reduces contact with others, if there is a potential safety risk to others. If that’s not possible, due to the nature of the work, they may be considered unsuitable for the position and not be hired.

Can you ask if employees are vaccinated?

Yes, as a customer you have a right to ask an employee or service provider if they are vaccinated, but they are not legally required to answer. Employers are not allowed to reveal health information, like immunization status, without the employee’s permission. However, customers may start to “shop around” for safer places to do business, if this information is not revealed.

An alternative, is for businesses to continue to provide safety measures, like physical distancing, altered store layout, sanitization and perhaps continued masking to make customers feel safer when shopping there or using their services.

With COVID-19, vaccination status has become less of a privacy issue. Many people (like me!) are excited and happy to be fully vaccinated, and want to tell the world, even though it’s really private medical information. It’s quickly becoming a minor privacy issue for most people—in fact, it’s becoming the norm.

Of course, it can work the other way too—businesses may want to ask customers whether they are vaccinated. In fact, some already are, like airlines who will only allow those who are fully vaccinated to book a flight. Countries and even some Canadian provinces are only allowing those who are 2 weeks past their second shot to enter without restrictions, citing safety of their citizens. Many are also requiring proof of a negative COVID test as well… all medical information that, in other situations, would be private.

Can vaccination be required before travelling to another country?

Yes, certain vaccines, like yellow fever, are already required for travel to certain countries. This sets a precedent for requiring any vaccine that is deemed necessary to improve safety while travelling. Although we’re still waiting for the dust to settle on travel vaccine requirements, no-one will be surprised if full COVID immunization is required by many countries to protect their citizens as well as travellers. International discussions about the form that “COVID-19 vaccination passports” will take emphasizes that these will be a likely requirement for travel when international borders open.

Safety trumps privacy… always

Employment lawyer, Sunira Chaudhri, discussed whether a business could be held liable if a customer were to become sick after contact with unimmunized employees. While she said it isn’t completely clear yet, she also said it’s certainly possible an employer who allows unvaccinated employees to contact clients unmasked (after mask restrictions are lifted) could be sued if a client or other employee became very ill. To make the workplace as safe as possible, she indicated, employers are going to have to ask about vaccination status and employees are going to have to disclose it. “Safety trumps privacy, always” she said.

So, just like airlines and other countries are requiring proof you are 2 weeks past your second COVID-19 vaccination, employers may develop policies and protocols that require proof of vaccination before an employee returns to the workplace or works in close contact with clients. It’s not the law that you have to get vaccinated, but there may be consequences for those who are not, like an assignment to a position with little or no contact with other employees or the public, or losing a job altogether.

What about insurance?

They didn’t interview an insurance specialist, but their comments would have been informative as well. If the insurance industry becomes involved and senses increased liability (and future costs), choosing not to be immunized against COVID-19 could become very expensive for employers and employees. I guess it all depends on how low case counts and risk of contracting coronavirus infection become. Epidemiology experts predict that COVID is here to stay and will continue to circulate in the human population, hopefully as a less severe infection as our immunity builds. Perhaps even most of the unvaccinated population will eventually develop immunity from having recovered from an actual infection.

The bottom line is that we may not have a true choice (other than to just stay home) as to whether to disclose our vaccination status. Safety first… But hopefully, eventually enough of us worldwide will be vaccinated to stop or at least drastically slow the circulation of this deadly virus and these requirements will become a temporary measure. It’s already happened with polio and some other diseases that are included in childhood immunizations. Until then, be ready to produce proof of vaccination if you want to travel and possibly if you want to apply for that new job.

Next week…

And if the reason you (or someone you know) hesitates to get your COVID shots is that you’re afraid of needles (common in 25% of the population!), next week’s blog might help you!

References:

Customers can ask about an employee’s vaccination status, but employers can’t share it: experts–CTV News

6 Frequently Asked Questions: Vaccinations + the Workplace–Miller Titerle + Company