Research Article| Volume 66, e137-e144, September 2022

Home administration of needle injections for children with rheumatic diseases: A qualitative study on nurses’ perception of their educational role

  • Kari Sørensen
    Corresponding author at: Department of Nursing Science, University of Oslo, Norway.
    Department of Nursing Science, Medical Faculty, University of Oslo, Norway

    Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Norway

    Department of Postgraduate Studies, Lovisenberg Diaconal University College, Oslo, Norway
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  • Helge Skirbekk
    Department of Health Management and Health Economics, Medical Faculty, University of Oslo, Norway

    Department of Undergraduate Studies, Lovisenberg Diaconal University College, Norway
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  • Gunnvald Kvarstein
    Department of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway

    Division of Emergencies and Critical Care, Oslo University Hospital, Norway
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  • Hilde Wøien
    Department of Nursing Science, Medical Faculty, University of Oslo, Norway

    Division of Emergencies and Critical Care, Oslo University Hospital, Norway
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Published:April 28, 2022DOI:


      • Children with RD and parents manage long-term injection-based treatment at home.
      • Nurses provide injection training at short-term admissions or outpatient clinics.
      • Nurses perceive their educational role as important, but lack pedagogical competence.
      • Reflection in clinical practice may promote nurses' professional development.
      • Pediatric specialist nurses appear to be well positioned to provide patient education.



      To explore nurses' perceptions of their educational role, pedagogical competence, and practice in teaching children with rheumatic diseases and their parents to manage subcutaneous injections at home.

      Design and methods

      In this qualitative study, we used thematic analysis to analyze data from three focus groups with 14 nurses responsible for patient education at one pediatric ward and two outpatient clinics.


      We identified three main themes capturing nurses' perceptions of their educational role: myriad expectations, awareness of own competence, and facilitation and prioritization of patient education. Nurses perceived patient education as an expected but challenging duty of their work. They described a lack of pedagogical competence, insecurity in managing parents' and children's fears and worries, and limited organizational structures guiding their educational role. Nurses who worked in outpatient clinics felt freer to individualize education compared to ward nurses.


      Nurses perceive their educational role as significant in enabling children and parents to manage subcutaneous injections at home; however, they require pedagogical competence integrated with daily practice to provide high-quality care. Short-term admissions require a different organization of patient education than before.

      Practical implications

      Nurses need increased training in communication and management of children's pain and fear during needle injections. Competence development should include opportunities for reflection and guidance in clinical practice. Pediatric specialist nurses at outpatient clinics seem to have better competence to provide individual patient education for these families. The potential advantage of web-based solutions for nurses' patient education is a promising avenue for future research.


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