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Painless injections: Helfer skin tap technique

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 DOI Number: 10.5958/0973-9130.2019.00108.7

Impact of Helfer Skin Tap Technique in Reduction of Pain

During Vaccination among Infants- A Literature Review

Hemangi Chaudhari1, Vipin Vageriya2

1
M.Sc. Nursing Student, 2Assistant Professor, Manikaka Topawala Institute of Nursing-
CHARUSAT-Changa-Gujarat

Abstract
Pain is an unpleasant sensation that can range from mild, localized discomfort to agony. It is too difficult to
face pain of vaccinations in children.Helfer skin tapping technique is resulting to minimize the level of pain
during intramuscular injections among children.

Objective- Primary objective behind this literature review is to find out effectiveness of helfer skin tap
technique in reduction of level of pain among children.

Method- A systematic literature review was conducted. The literature includes last 8years’ data. The literature
reviewed was obtained through different database includes CINHAL (Cumulative index TO Nursing &
Allied Health Literature), MEDLINE (Medical Literature Analysis & Retrieval System Online), PubMed,
Science Direct, SpringerLink, ProQuest & Google scholar.

Result—Pain level of experimental group is less than control group. Helfer skin tap technique is effective to
reducing the level of pain among infants who are undergone with pentavalent vaccination.

Conclusion—Helfer skin tap technique is helpful in minimizing the level of pain during vaccination among
infants. All the nurses can perform Helfer skin tap technique in routine practices for reducing pain intensity.

Keywords- Helfer skin tap technique, vaccination, pain, mechanical stimulation, intramuscular injection.

Introduction is the most widely practiced percutaneous procedure.

Pain is an unpleasant sensation which caused
by strong stimuli which create severe pain.1 It is
an unpleasant sensory and emotional experience
associated with actual or potential tissue damage. It
is a feeling triggered in the nervous system. Pain may
be sharp or dull. It may come and go, or it may be
constant.2Vaccinations can be painful. Kids don’t like
them, and parents don’t like seeing their children suffer.3
Fear of needles is a common phobia for children.4
Children have fear to the injections and because of that
fear they are crying. All parents are continually striving
to find the best way to respond those cries.5 Vaccination
Each child is compulsorily exposed to this in his early
childhood. The most common side effect of vaccination
is pain.6In 1998, Ms Joanne Helfer made an attempt
to alleviate pain due to intramuscular injection by
developing„ “Helfer Skin Tapping technique” in which
tapping of the skin over the injection site. The technique
uses basic concepts of theory of pain; including the gate
control theory.7Mechanical stimulation which is given
by tapping, can diminishes the influence of small, pain-
carrying fibers. It consists two basic points:
Muscle relaxation, which physically decreases the
resistance to needle entry into the skin.

Diversion, by simultaneous tapping over the skin

before the needle is inserted and removed. 8
Corresponding author:
Mr. Vipin Vageriya It was concluded that there is need to minimize
Email ID- Vipinvageriya.nur@charusat.ac.in the pain level of children while giving intramuscular
 174 Indian Journal of Forensic Medicine & Toxicology, April-June 2019, Vol. 13, No. 2
injection or vaccine.
Material Methods and Findings
The study is headed mainly on minimize the
pain during vaccination by providing Helfer skin tap
technique among infants.The following electronic
databases are searched: ProQuest, Embase, Pubmed,
EBSCO, Scopus, the British Nursing Index and the
Cumulative Index to Nursing & Allied Health Literature
(CINHAL), e-journals and journal available in library.
Literature Review
A quasi experimental study was conducted on
efficacy of Helfer skin tap technique on pain intensity
as perceived by the patients receiving intramuscular
injection at medical and surgical units of Main Mansoura
University Hospital, by Amira AH. et al. at Egypt in
year 2016. The data were collected by using purposive
sampling technique. 100 patients of both sexes who
correspond to inclusion criteria were taken. Each patient
was administered repeated intramuscular injection at
the gluteal muscle site. The level of pain is compared
with two techniques, at the time of intramuscular
injection administration through traditional technique
and Helfer skin tapping technique. The tools used for
data collection were socio-demographic characteristics
and assess the level of pain by using Universal Pain
Assessment Tool.The result shows that pain level of
traditional technique was higher than pain level of Helfer
skin tapping technique. Study concluded that Helfer skin
tap technique was effective in minimize the pain level
of patients.9
A quantitative study was conducted on effects of
Helfer skin tapping and Z-Track techniques on pain
intensity among hospitalized adult patients who are
receiving intramuscular injection at Menoufia University
Hospital in September, 2016. Quasi–experimental
research design was used to conduct the study. 100
participants were randomly alternatively divided into
two equal group of 50. Group I which will receive Helfer
skin tap techniqueand group II which will receive Z-track
technique and the samples fix with the inclusion criteria.
Structured interview questionnaire and universal pain
assessment tool were used to collect the data. Results
reveals that Helfer skin tapping technique(HST) and Z
track technique were help to reducing the level of pain
while administration of intramuscular injection. The
study was concluded that the responsibility of nurse is
to minimize the pain while intramuscular injections by
using Helfer skin tapping and Z-track techniques. So in
future these kinds of studies definitely will be useful to
the entire health care delivery system.7
A quantitative study was conducted at Kanchipuram
on effectiveness of Helfer skin tap technique vs usual
standard technique in reducing pain during intramuscular
injection among adult patients in selected hospital of
Kelambakkamin 2016.Quasi experimental research
design was used to conduct the study. 60 samples (30
in experimental and control group) were selected by
using simple random sampling technique. Structured
questionnaire was used to collect the data. The result
shows that, in experimental group 87% having mild
pain, 10% having moderate pain and only 3% having
severe pain. In control group 83% having moderate
pain, 17% having severe pain. There was a significant
association between the selected demographic variables
and Heifer skin tap technique is effective in reducing
pain than standard usual technique during intramuscular
injection.10
A quantitative study conducted on effectiveness
of rhythmic skin tap technique to minimize procedural
pain during intramuscular injection among the patients
admitted in the selected tertiary care hospital, Belgaum
at Karnataka by medial surgical department of KLE
university in July, 2014. True experimental post-test
design was selected to conduct the study. 60 samples
were taken by using non probability simple random
sampling technique. The pain level was assessed by using
visual analogue scale to determine the effectiveness of
rhythmic skin tap technique. Descriptive and inferential
statistics were used for data analysis. The result shows
that pain was reduced among patients who all are
receiving intramuscular injections in experimental
group and skin tapping technique is effective during
intramuscular injection. The study concluded that pain
was reduced among patients after administration of
rhythmic skin tapping technique. So, it proved as an
effective treatment for reducing the pain.11
A quantitative study was conducted on assessing
the effectiveness of Helfer skin tap technique on pain
during intramuscular injection among neonates born in
labour room of selected tertiary level hospital at UP in
2013. True experimental post test control design was
selected to conduct the study. 100 new born babies
were selected by using purposive and simple random
 Indian Journal of Forensic Medicine & Toxicology, April-June 2019, Vol. 13, No. 2
sampling techniques. Data were collected by Neonatal
Infant Pain Scale. Collected data were analyzed by
using descriptive and inferential statistics. The study
result shows that 86 % of the neonates having mild pain,
14% were having severe pain during intramuscular
injection in experimental group. 86 % of the neonates
were having severe pain and 14% were having moderate
pain during intramuscular injection by using routine
technique. Thus, Helfer skin tapping technique is more
effective on pain during intramuscular injections.
The study concluded that Helfer skin technique is an
effective way to minimize the pain during intramuscular
injection. It should be compulsory step in intramuscular
injection and thus agony of patients can be reduced. The
standards for nursing care clearly supports a holistic
care of our clients.12
A quantitative study was conducted on effectiveness
of Helfer skin tap technique and routine technique
on pain reduction among patients who are receiving
intramuscular injection at government general hospital,
Pondicherry in 2012.50 subjects were taken by using
simple random sampling technique. 25 subjects
were taken in experimental group who are receiving
intramuscular injections by using Helfer skin tapping
technique and 25 subjects in control group who all are
receiving intramuscular injections by routine technique.
Study result shows that the Helfer skin tap technique
is effective in reducing pain level during intramuscular
injection among patients at correlation of p<0.05 level.
The study concluded that the intensity of pain is less
when intra muscular injection is administered using
Helfer skin tap technique. It works on the theoretical
basis such as gate control theory. The technique can
be adapted to the nursing education and to the nursing
practice so that the quality can be ensured.13
A quantitative study was conducted to assess the
effectiveness of skin tap technique in reducing pain
response in January, 2012. 60 samples were selected
by purposive sampling technique that is 30 each in
experimental and control group. The resultreveals that
the pain level was less in experimental group. 80%
of infants in experimental group having mild pain
and 16.66% of infants in control group having mild
pain. There was association between the pain scores
and selected variables. Study concluded that skin tap
technique was proved effective to minimize the pain
level during intramuscular injections.14
175
A quasi experimental study was conducted to assess
the effect of Helfer Rhythmic skin tap technique on
procedural pain among patients receiving intramuscular
injection by Saleena S. et al. at orthopaedic wards of
Govt. Medical College Kozhikode, Kerala in May,
2011. 82 patients admitted in orthopaedic wards, in
the first post-operative day after orthopaedic surgery,
who were receiving Inj. Voveran were selected by
purposive sampling technique to Group I and II. Brief
Pain Inventory were used to measure pre-procedure
pain intensity and interference, Anxiety Scale were
used to assess the pre-procedural anxiety, Numerical
pain intensity scale and Visual Analogue scale were
used to assess pain during intervention. SPSS- version
15 and descriptive, inferential statistics were used for
data analysis.There is significant reduction in pain level
of patients who are receiving intramuscular injection
with Helfer rhythmic skin tapping technique, compared
to that with conventional technique. There is no
association between pain perception scores of patients
receiving intramuscular injection with Helfer rhythmic
skin tap technique and selected socio demographic
variables. Study shows that Helfer rhythmic skin tap
technique is effective in reducing pain perception during
intramuscular injection. By this technique, routinely
nurses can contribute to improve patient’s comfort level
by minimizing the interventional pain.15
Result
Over all literature reflect that helfer tap skin
technique is very effective in reduction of pain sensation
after intramuscular injection. It is easy, cheap and non
invasive procedure, which help in reduction of pain
level.
Conclusion
The study concluded that small children are very
sensitive to pain. Cry is the first sign which we can
observe when pain start. Helfer skin tape technique can
be applied by any health personnel. It does not require
any training. Apply this technique, before giving
intramuscular injection. It is very effective method.
It helps to reduce the severity and level of pain. It
can be applied during vaccination like pentavalent,
pneumococal and other injections.
Ethical Clearance- It is obtain from IEC-HR
Source of Funding- No funding        
 176 Indian Journal of Forensic Medicine & Toxicology, April-June 2019, Vol. 13, No. 2
Conflict of Interest -Nil
References
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