Improving the vaccination experience at school:
An educational video for public health and school staff
Hi, I'm Leslie. I'm a public health nurse, and I'm going to talk to you
about how to make vaccinations at school a positive experience
for everyone: students, public health nurses, school staff and parents.
This information is evidence-based. All the techniques are scientifically
proven and recommended in clinical practice guidelines.
School-based vaccination clinics are a convenient and
efficient way of reaching youth to protect their health.
By doing our best to help kids have a positive experience,
we not only show students that we care about them,
but we also promote vaccinations.
Kids are more likely to get vaccinated in the future
if they have a positive experience early on in the school setting.
Anything that can help kids and promote health
is something schools want to be a part of.
Research shows us there are very specific things that
can help make vaccinations a more positive experience.
Many of these strategies are intuitive for nurses
and already part of their practice.
We've combined these strategies in a program called the CARD system.
This is an approach to vaccination that promotes student-centred care and coping.
CARD was designed with input from students,
public health nurses, school staff and parents.
Each letter of the word CARD stands for a different category of evidence-based
interventions that reduce pain, fear or fainting during vaccination.
C stands for comfort; A stands for ask questions;
R stands for relax; and D stands for distract.
We modified policies related to our school vaccination
program to make sure we were incorporating the principles of CARD
at two specific time points: first, in our vaccine planning activities
and second, during the day of vaccination.
Let's review these steps together.
Plan for the vaccination clinics ahead of time and work with school
staff to secure appropriate spaces for vaccination clinics.
The library is a popular choice.
It has several advantages over other spaces.
First, it can be blocked off to traffic, which minimizes interruptions.
Second, it has large tables that can be rearranged for the clinic.
Third, it usually has a private office or is near to one.
This is important for students who want privacy.
Fourth, a separate waiting area for students can be
created right outside the library. This way, students are not watching
others being vaccinated before it is their turn.
It's ideal if you can confirm these spaces are dedicated for vaccination
with the administrative staff of the school ahead of time.
Also, try to pick a time in the morning. This minimizes a buildup
of student anxiety in anticipation of the clinic and nurses' anxiety
from having to rush if it is scheduled for later in the day.
Next, educate students and school staff about CARD
using CARD educational videos and pamphlets.
Make an appointment for public health nurses
to show the videos in the classroom.
For some public health units, this can be done at the same time
nurses visit schools to distribute the consent forms.
If nurses are not present in the school,
then share the videos and pamphlets with schools,
and ask the staff to share them with the students.
The videos are online, so they can be accessed
by anyone who wants to view them.
Then, have students fill out the preferred coping strategy
on the student CARD pamphlet.
Review these requests to plan upcoming clinics.
For example, private room, presence of a support person
or use of an electronic device as a distraction agent.
Be sure the options are clear. For example, a student can have
one friend to be their support person rather than a few.
Store all this information in a safe place for future reference.
On the day of vaccination, work with school staff to ensure the clinic setup
minimizes visual cues that promote fear and the spreading of fear to others,
known as fear contagion. For example, use a separate waiting area for students,
set up tables and chairs to prevent students watching one another,
use a table divider to prevent students watching needles being prepared
and to also provide a reminder of CARD and have a distraction kit
available with items like bubbles. Bubbles are always a big hit.
Visit students in the classroom before the start of the clinic to introduce
the nurses, review the clinic procedures and remind students about CARD.
This helps to prepare for the procedure and build a rapport with the students.
Identify students who are highly fearful and vaccinate them first.
Also identify students with special requests, such as a private room
or the presence of a support person and triage them appropriately.
CARD will not make all students comfortable
with vaccinations at school. There are some students with
very high levels of needle fear that are not suitable
candidates for vaccinations at school.
These students will probably self-identify as such.
Refer them to experts that can treat their needle fear.
Then, they can be vaccinated after that.
Use a student-centered approach to vaccination delivery.
Remember that pain and fear are individual experiences.
No one feels pain and fear the same way.
Help students to play their own CARDs. This means inquire about their level of
fear, ask them what cards they want to play and support them in their choices.
Provide choices if they do not select specific strategies.
Coach them through the procedures. Afterwards, ask students how they felt.
Make sure to chart this information for future reference
so it can inform the next immunizer.
So, a few things that they can do is, you know,
giving them the opportunity to choose looking away or looking at the needle,
having a friend with them, having a parent with them,
having some other sort of distraction like their phone or a book or a game.
Those are the kinds of things that will help them get through that moment.
Let's see how it works.
And so, some kids are nervous about—are nervous about getting
vaccines and others are not. On a scale of zero to three,
zero being not scared at all or three being really nervous, how are you feeling?
Great. What card are you gonna be playing today?
Okay, and what did you bring for that?
Oh, excellent. Are you gonna play a game or listen to some music?
Okay, fantastic. So, I'm gonna get some things ready here.
Relax your arm, and I can help you with that.
Yeah, we want to make it, like, loose like spaghetti.
All done. How was that?
Fantastic. Get a band-aid...
Let's see another example.
Some kids get really nervous with vaccines and some kids
aren't nervous at all. Let's say we had a scale of zero to three.
Zero is gonna be the lowest. Where would you say you are on that scale?
So, that's pretty high. So, you remember the CARD system
that Kelly just went over with you as well. What kind of card are you
gonna play today that's gonna help you with that?
Nice. What kind of things you're gonna do to relax?
Right, can you show me how you do that?
Perfect. And what about distraction?
Squishy? And I see you've brought a buddy with you, too.
If the student brings a friend, ask the friend how they're going to help.
So, you know what else can really help if your buddy blows bubbles.
Do you like bubbles? Bubbles can be fun, so I'm gonna...
have your buddy—what's your buddy's name?
Brooke. Hi Brooke.
Do you think you can blow some bubbles while I get things ready here?
Deep breath. Oh, you're doing extremely well.
One more, honey, and then you're done.
Good job. You're completely done. What do you think?
You did really really well. And thanks, Brooke, for helping out.
Using the card system can make a really big difference.
Everyone is prepared, and the clinics are far less chaotic.
Students experience less pain, fear and dizziness.
I think it really worked.
It really helped having this with me, and I had a little distraction.
I used the distract card by bringing in my Squishy. I also brought in my phone
so I could play some games, and I used comfort by asking
if I could just get two needles in my—in just the same arm.
Um, well, being a buddy, like, it just really made me feel good
because just knowing that, like, I'm helping someone
that felt similar to how I felt, and just helping her, like, for the future
and just, you know, giving her some confidence.
My name is Tonni, and my daughter just had her grade 7 vaccines.
Well, she has been very nervous about immunizations.
She has been for many years, and, you know, I told her about—
that there might be the CARD system, so we were just, you know,
easing our way, working into trying something that we were
hoping would be helpful to get her through the immunizations.
So, when my daughter came home from school that day, I wasn't sure
how the reaction would be, but when she came home,
I could tell by the smile on her face, she was calm she was relaxed.
I knew that it went well even before she even said anything.
And when she did tell me how wonderful it did go, I was just so relieved
and I was so proud of her and I could tell that she was proud of herself, as well.
Asking students about fear is like addressing the elephant
in the room, really, because we all have some level of fear or anxiety
about something. It's just addressing the issue head-on instead of pretending
like we're all coming from the same point because we clearly aren't.
It's a great starting point to open the conversation.
Kids know that we're empathetic and we know how afraid they are,
and then that sets the stage for asking about the CARDs
they want to play and coaching them.
Using the CARD system just provides a framework to work within.
So, as nurses, you already know what you're going to
be doing with vaccinations, but it just puts it into a way—
uh, organized way and runs the clinic very smoothly, that way.
I really enjoyed my experience with the CARD system.
I felt all the interactions with the students were fantastic.
I love what I do, and this made it even better.
The CARD system is not just about needles and needle pain.
It's also about teaching kids ways to cope.
They could use these same tools to cope with other stresses
in their lives, whether it's a test, an assessment, something else
going on at home. It can be used far beyond needle pain,
but it certainly will help in the— in the vaccination process.
Before the CARD system, we did have instances
where students would experience significant anxiety.
They weren't aware of their rights, their ability
to self-advocate on behalf of themselves.
The CARD system gives them that capability, and the hope is that with
the implementation of the CARD system, that the kids will advocate for themselves
and have a better experience through the vaccination process.
With the schools, the teachers and the principals, the relationships we
have with them are embellished because, through this process of
working with CARD and providing informed consent, teaching with
the students ahead of time, we are meeting their curriculum needs as well.
The CARD protocol is simple, effective and research-based.
The nurse in your school area is looking forward to helping your students
make healthy decisions around their immunization and physical health.
As educators, we too want students to make informed,
wise decisions about their health.
Here's a wonderful opportunity to work together with a common goal.
Try CARD in your public health unit.
You'll be amazed at what a difference it makes.
Our nurses here say that once they learned about CARD, they can't go back.