Healthcare Professionals’ Use of Guided Imagery in Combination with Relaxation in Child Health Care: A Pilot Web-Based Survey

Research Article

Austin J Nurs Health Care. 2016; 3(1): 1025.

Healthcare Professionals’ Use of Guided Imagery in Combination with Relaxation in Child Health Care: A Pilot Web-Based Survey

Forsner M1*, Kronvall A-K1,2, Larsson S1,3 and Nilsson S4,5

1Dalarna University, School of Education, Health and Social Sciences, Falun, Sweden

2RegionVästra Götaland, Skaraborgs Hospital, Sweden

3Köping Municipality, School Health Care at Ullvi Upper Secondary School, Köping, Sweden

4University of Borås, School of Health Sciences, Borås, Sweden

5University of Gothenburg, Institute of Health and Care Sciences, Gothenburg, Sweden

*Corresponding author: Maria Forsner, Department of Education, Health and Social Sciences, Caring Sciences, Dalarna University, Sweden

Received: September 23, 2015; Accepted: January 10, 2016; Published: January 12, 2016


Background: The implementation of effective non-pharmacological painreducing treatment in child healthcare is considered desirable and an important part of nursing care. The distraction technique Guided Imagery (GI) is easy to use and suitable for children. Training in the technique is required but little is known about factors influencing the further use of the technique in child healthcare.

Objective: The aim of the study was to test an instrument designed to investigate factors influencing the use of GI after receiving training in the technique.

Design: The study was a pilot cross-sectional design.

Setting: The study sample consisted of Swedish healthcare professionals trained in GI.

Participants: Seventy-four healthcare professionals answered the questionnaire.

Methods: A web-based questionnaire analysed factors influencing the frequency of the use of GI.

Results: The results showed three subscales: other’s positive attitudes, own perceived competence and others’ negative attitudes. The analysis showed positive correlation between one of these subscales and how often the participants used GI, suggesting that own perceived competence influences healthcare professionals’ use of GI.

Conclusions and Implications: Although the survey had limited coverage and ought to be repeated, the findings as well as earlier research suggest that both managers and educators need to be aware that own perceived competence in GI can influence the extent of implementation in practice.

Keywords: Child Health Care; Non-Pharmacological Pain Management; Nursing Practice; Training


Pain and anxiety are problematic for children when in contact with healthcare, and intervening to decrease these emotions for children is an issue for nurses in child healthcare [1]. Nonpharmacological pain management strategies are recommended but seem to be insufficiently implemented. Organizational factors, high workload and lack of time as well as feeling insecure were found to obstruct the implementation of non-pharmacological methods in paediatric care [2,3].

Nursing interventions encouraging children to be actively involved are preferable [4]. Children themselves appreciate focusing on positive things instead of illness [5] and welcome distraction to decrease procedural anxiety [6]. Imagery is one of children’s own pain relief strategies [7].

Guided Imagery (GI) is a distraction technique to help children to concentrate on positive fantasies instead of uncomfortable sensations [8]. GI has been found to help children with chronic pain [9] postoperative pain [10-12], during vein puncture [13], and repeated painful procedures in cancer treatment [14,15]. Combination of distraction and cognitive behavioural techniques are recommended [16]. Whitaker (2002) Recommend that GI is preceded by relaxation.

With the intention to strengthen pain management in child healthcare in Sweden, healthcare professionals have been offered courses in GI. The training in GI lasted one to two days, combining theory and exercises following [13] as described by Forsner et al. [17]. To investigate the degree of implementation and factors influencing healthcare professionals’ use of GI an instrument was designed and tested.


A cross-sectional, web-based survey was performed.


Seventy-four healthcare professionals answered the questionnaire; 72 were women, and the mean age was 47.3 years.


The questionnaire was inspired by Polkki et al. [3] and consisted of 59 items. Thirty-nine statements addressed factors suggested to influence the practice of GI, such as perceived own competence in GIspecific as well as general pain management, factors related to parent and children, workload and support from managers and colleagues and. Furthermore demographic factors such as age, gender, number of own children education, training in the method and work experience was were addressed. The answers were designed as a Likert scale, and the questionnaire was pre-tested by three nurses experienced in GI.


All healthcare professionals who undertook training in GI in Sweden from 2000 to 2009 was were approached. An invitation including a web link to the questionnaire was sent out by email to 264 participants, and additionally, 18 participants were invited by ordinary mail. In 70 cases, the message was returned as undeliverable. Three persons declined participation, but most dropouts did not respond at all. After two reminders 74 persons had answered the questionnaire. The survey responses were anonymous and voluntariness was ensured by the required active choice to enter the web link.


Fifty-eight (78.3%) of the respondents were specialists in child healthcare, and 35 (47.3%) of them had worked in healthcare for over 30 years. Fifty-seven participants (77.1%) were parents themselves (Table 1).

Citation: Forsner M, Kronvall A-K, Larsson S and Nilsson S. Healthcare Professionals’ Use of Guided Imagery in Combination with Relaxation in Child Health Care: A Pilot Web-Based Survey. Austin J Nurs Health Care. 2016; 3(1): 1025. ISSN : 2375-2483