title: Relaxation and guided imagery do not reduce stress, pain and unpleasantness for 11- to 12-year-old girls during vaccinations.
abstract: OBJECTIVE
  Relaxation and guided imagery is a distraction technique known to reduce discomfort during paediatric medical procedures. We examined whether its use decreased the stress experienced by 11- to 12-year-old girls receiving the human papilloma virus vaccination, as well as the intensity and unpleasantness of any pain.
  
  
  METHODS
  A randomised crossover trial was conducted with 37 girls. During the first vaccination, each girl was randomised to receive either relaxation and guided imagery or standard care. They then received the other form of care during the second vaccination. Salivary cortisol was measured before each vaccination, and 30 minutes after it was administered. The girls reported pain intensity and pain unpleasantness before and directly after each vaccination and stress after each vaccination.
  
  
  RESULTS
  On a group level, relaxation and guided imagery did not decrease cortisol levels, self-reported stress, pain intensity and pain unpleasantness. Salivary cortisol levels decreased significantly in both groups during the second vaccination.
  
  
  CONCLUSIONS
  Relaxation and guided imagery did not prove beneficial during the vaccination of 11- to 12-year-old girls and is not recommended as a regular nursing intervention. However, further research is needed into effective techniques to help children who experience pain unpleasantness in connection with needle procedures.
authors.affiliation: Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.|Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Stefan
authors.initials: S
authors.lastname: Nilsson
authors.affiliation: School of Education, Health and Social Studies, Nursing and Health Care, Dalarna University, Falun, Sweden.
authors.forename: Maria
authors.initials: M
authors.lastname: Forsner
authors.affiliation: Department of Nursing, Health and Culture, University West, Trollhättan, Sweden.
authors.forename: Berit
authors.initials: B
authors.lastname: Finnström
authors.affiliation: Department of Social and Welfare studies, Division of Health, Activity and Care, Linköping University, Norrköping, Sweden.
authors.forename: Evalotte
authors.initials: E
authors.lastname: Mörelius
mesh_terms: D000367:Age Factors; D002648:Child; D018592:Cross-Over Studies; D005239:Fear; D005260:Female; D006801:Humans; D019018:Imagery, Psychotherapy; D010146:Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D012064:Relaxation Therapy; D013315:Stress, Psychological / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D013548:Sweden; D016896:Treatment Outcome; D014611:Vaccination / Q000009:adverse effects* / Q000523:psychology
chemical_list: D053918:Papillomavirus Vaccines
keywords: Child; Cortisol; Immunisation; Nonpharmacological; Pain