‘On the edge of a whirlpool’: Living with a fear of needle procedures

Abstract

This study explores the lived experience of needle phobia through individual interviews with five participants. The understanding and experience of three medical imaging nurses carrying out procedures on patients with needle phobia is also explored to provide clinical context and comparison. The study is guided by the values of phenomenology and in particular the body philosopher Merleau-Ponty. It will also draw on the research of nurse scholars Patricia Benner and Irena Madjar who have focused on the body and embodiment in nursing practice. Interpretation of the data is informed by the work of Anthony Giddens. The study unravelled a fear notable for its personal idiosyncrasies, and variable origins. It is an obscure fear that is experienced as intensely physical and embodied but is not primarily about pain. A needle piercing the skin violates the integrity of the skin surface, even the sense of self and at worst threatens to overwhelm, likened by one participant to being on the edge of a whirlpool. Living with the fear involves managing a wayward body, with particular capacities for action, but plagued by uncertainty at how it will respond when faced with a needle procedure. It is an irrational fear that impacts upon life choices and ‘pierces the protective cocoon’; the main emotional support that allows us to cope with life, arousing a sense of shame that something so simple cannot be mastered and threatening the usual competent face the person presents to the world. In contrast, the nurses saw needle phobia as an emotional reaction related to pain; they felt empathy and concern for their patient but also personal anxiety when faced with a distressed or fearful patient. Narratives revealed the challenge and dichotomy of their caring, learning and instrumental role. This was particularly acute for the novice practitioner. Caring and coping with their own reactions was closely intertwined with getting the job done. Ethical dilemmas arose. Mutual vulnerability was demonstrated with the nurse’s sense of competence also threatened when the procedure failed. The study revealed significant implications for clinical practice both in regard to caring for people with needle phobia and in teaching and mentoring nurses. A partnership approach to care emerged as the most appropriate way to meet the varying subjective needs of people with needle phobia, while allowing nurses to combine both their pathic and instrumental touch.