Abstract
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Objective: To clarify the information nurses use when making clinical judgments regarding physical restraint during childhood vaccinations.
Introduction: Physical restraint may be required during childhood vaccinations to ensure safe vaccine administration; however, excessive restraint can increase children’s fear and distress. Therefore, nurses should assess each child and situation and determine whether restraint is necessary and how it should be provided. Understanding the information informing these judgments may contribute to safer and more individualized support during vaccination.
Methods: This qualitative descriptive study included 10 registered nurses with at least five years of nursing experience who worked in healthcare facilities providing pediatric care. Semi-structured interviews were conducted between October 2024 and June 2025 to explore what nurses observed and considered when determining the need for and method of physical restraint during childhood vaccinations. Interview data were transcribed verbatim and deductively classified into four sources of information medical records and pre-existing information, vaccination-related factors and practice environment, information obtained from accompanying caregivers, and information obtained from children. Data within each source were then analyzed inductively.
Results: The information used by nurses was classified into four sources: medical records and pre-existing information, vaccination-related factors and practice environment, information obtained from accompanying caregivers, and information obtained from children. Medical records and pre-existing information included, for example, children’s developmental characteristics, underlying conditions, previous vaccination experiences, and usual cooperation during medical examinations and procedures. Vaccination-related factors and the practice environment included the type and number of vaccines, physicians’ instructions and vaccination procedures, and staffing availability. Information obtained from caregivers included the child’s preparation for vaccination and caregivers’ ability and willingness to assist with physical restraint. Information obtained from children included, for example, their ability to sit independently, body size, cooperation during the medical examination on the day of vaccination, fear and anxiety regarding injections, understanding and anticipation of the vaccination, crying, physical movements, and escape behaviors. Overall, nurses used information available before vaccination together with information obtained from children and caregivers as the procedure progressed.
Conclusions: Nurses clinical judgments regarding physical restraint during childhood vaccinations were based on information from multiple sources. Nurses assessed not only pre-existing information but also information obtained as the vaccination process unfolded. These findings suggest that decisions regarding the need for and method of physical restraint involve ongoing assessment and integration of information as the situation develops.
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