Phenomenology Online

A Resource for Phenomenological Inquiry

Giving an Injection

 

Field, Peggy-Anne

 

What is it like to give an injection? What is it like to hurt another human being? What is it like to violate someone else’s body in this way? Here is a personal account of one registered nurse’s experience of giving an injection:

When I have to give an injection, I begin to feel quite anxious and I feel I want to delay the procedure for as long as possible … I think if I wait for a while my anxiety will lessen.

 

I have been the recipient of several injections and many of them have been quite painful, so as I set about giving an injection I wonder if when I insert the needle through the skin is it going to cause pain? As a nurse, I have been taught that one of my functions is to alleviate pain-not to cause it. It is my duty to give the injection, so I must do so.

 

I approach the bedside hoping I will get the procedure over with as little fuss as possible. On the way I rationalize that this injection will be of benefit to the patient and by the time I reach the bedside I feel and look (I hope) calm and confident … I tell myself this is just like throwing a dart.

 

If I have to get help because the patient is uncooperative I feel pretty rotten. I think that the patient will not consider me to be the best nurse on the unit.

 

The Injection

What is an injection? On first sight, it is the act of giving medication by use of a syringe and needle. Whether the injection is into the skin surface, into the muscle, or into the vein, the body surface must be broken. The word “into” is the key to the act. To give an injection, I must intrude to break into the inner space of an “other.” The term “other” is used to describe those persons with whom one interacts, but who can be recognized as having an existence separate from that of oneself. The “other” can be a peer, a friend, a patient, a relative, depending on the situation in which the interaction occurs. The other normally has an observable boundary, the skin; everything beyond this is sanctum to the individual. In normal everyday life, we seldom think of the body of the person we meet beyond the exterior of the skin. In our culture we further extend our boundary by covering much of our skin surface with clothing. The skin serves to separate our public from our private self. Through the use of clothing, I can dress or undress myself for public life or for intimacy. In public, exposure of the skin to show a naked thigh or buttock may cause eelings of embarrassment; it violates the modesty of self or the modesty of another. How do we think of the body beyond the skin? How do we deal with the other, not as a naked or exposed person, but as a person whose body I have to break into? What makes it difficult for nurses to give an injection with the same ease as they exhibit when placing a thermometer in a patient’s mouth? In order to address the question of the deep meaning of giving an injection, we want to inquire into the language of injections, the nature of the giver, the gift, the receiver and the act of giving itself.

 

The Language of Injections

“His next shot will be in eight weeks, then that will be the last until a booster shot at 18 months. ”

 

Four-year-old Karen, watching her brother’s immunization: “Did I cry when I was little when the nurse stabbed me?”

 

To three-year-old David, about to be injected: “It’s just a little mosquito bite.” “I remember getting the needle for rubella when I was in school.”

 

In our daily use of language, the terms “shot” and “stab” are associated in our minds with violence, with assault upon another person. If I shoot or stab I hurt the other and so cause him pain. The response to being hurt may be anger and retaliation against the source of insult to our person. When the mosquito bites, we retaliate by hitting out at the insect. We are affronted by the violation of the bite. But in what way is the needle a violent instrument? In the popular vernacular, the phrase “to needle” and to “get under your skin” are used to illustrate one person’s aggravation of another. To needle means that I harm you by verbal aggression. I attack your inner self. I get under your skin. Yet the needle can be a constructive tool it stitches works of embroidered beauty. It can be used to repair a torn jacket, or, indeed, to close a torn piece of skin when the doctor sutures a wound. Why then, when it is used to give an injection, is it seen as a weapon, a destructive tool? When the doctor sutures, he anaesthetizes the area to prevent pain. In giving an injection pain is created. In violating the skin do we also violate the trust of the patient? The nurse who gives the injection does not serve evil but good, yet she must cause pain in order to do what is best for the patient. We can say, “I need to get an injection,” but at the same time we must believe that pain in the present will result in future rewards. If we do not believe this, then our faith in the giver may be underminded and we doubt the goodness of the gift, perceiving it as a violent attack upon our person. Thus we come to doubt the good intentions of the giver and come to view the act as one of aggression.

 

The Giver

 

“I have been taught that one of my functions is to alleviate pain-not to cause it.”

 

“My main concern is that the drug will relieve the pain and suffering to help to alleviate the symptoms.”

 

“If I give him the needle, it will prevent him getting sick. It would be worse if he was sick than it is for him to have the needle now” (immunization).

 

The word “nurse” and the word “nurture” are both derived from the Latin word nutrire, to nourish. The one who nourishes acts like a mother, to succor and to protect the child from harm. The nurse is a mother “surrogate,” a substitute for the real mother in a situation where the adult is as a dependent child in need of care and/or protection. The nurse is the protector and yet she must undertake an act that will hurt the one that she seeks to protect. A duty is the conduct that I owe to another. I owe it to the patient to protect him. I know I must hurt the other in order to protect him from real harm; that I must give pain in order to protect from disease. My gift serves the good of the other, so I will act with calculated violence, knowing that I may cause the other pain, because I believe that the violation of the body of the other is ultimately an act of caring or love.

 

I will try to explain to the other why my act is necessary for his good, for if he does not see my act as justified, new doubts will be raised as to the rightness of my act. My act will be less impersonal if I consider the feelings of the other, and his acceptance of my act will confirm the goodness of that which I would do to him. I need to know that I am trusted by the other and that I am not violating my caring role.

 

Hurting the Other

“I have been a recipient of several injections and many of them have been quite painful. ”

 

“I dislike giving medications that sting or cause discomfort-probably because I don’t like to cause pain.”

 

My feelings seem to be grounded in the act of giving an injection, but to be anxious I must have a consciousness of something toward which my fear is intentionally directed and which therefore has a meaning. Zborowski (1958) states that fear of pain is second only to fear of death. Pain forces us to ask “What is to be done?” Buytendijk (1961) states: “If I have experienced pain, I have experienced suffering.”

 

We all fear death and illness, but we do not talk about it either to others or to ourselves. We act as if illness and pain did not exist. To a person who is unprepared, experiences of pain and illness become catastrophes. I have experienced the pain of an injection and, because I am afraid of pain, I seek to avoid it. Our word “pain” is derived from the Latin word poena, which means “punishment.” The fear of punishment is rooted in the fear of pain. Because I fear pain, I am anxious at the thought of pain. I reflect this anxiety to the other: “I fear that my act will hurt you and you will suffer pain.” Also I fear that if I am the cause of that pain, you will turn against me as I turn against the mosquito that attacks me.

 

Preparing for the Injection

“When I have to give an injection, I begin to feel quite anxious and I feel I want to delay the procedure as long as possible.”

 

“There is a build-up of tension beforehand, especially for beginners. ”

 

“I have a right to choose what I want and so does the patient, so if I have to give him a medication he doesn’t want, I feel guilty.”

 

When we do something we don’t want to do then there is an attempt to push time away. If I delay, perhaps I won’t have to face up to it, perhaps things will change. It is like dragging one’s feet as a child. If one went slowly, one foot after the other, scuffing over the floor, the bedroom seemed much farther away at bedtime than it did in the morning when one ran eagerly to breakfast. If I move slowly in preparing the injection, maybe it won’t be needed anymore. While seconds pass at the normal rate, it seems as if each one lasts a minute. I deny the reality of passing time, extending it to gain composure.

 

But I must act if I care for the other. What does it mean to care? (The word “care” is derived from the Anglo-Saxon caru meaning sorrow or anguish.) It means to love, but it also means that those who love must be prepared to suffer with others their sorrow and anguish. If I act and the other sees my act as non-caring and reacts with anger, then this anger will diminish me as someone who wants to communicate my care. Here is the anguish of choice, the loneliness of making a decision. I am torn between the benefits of the injection and my own fear of pain. As I stand there I experience the pain of past injections I have received and I add this pain to the reality of the now. I am afraid of my hurt and I reflect this on the other.

 

Usually the patient agrees that he needs the injection; then I am absolved from my guilt that I will hurt the other. But what of those who do not understand, the confused person, the child, the unconscious person? The young child and confused person may struggle and resist. I have to act without their awareness that I do it out of care for them. I must protect them, yet I must violate their desire for self-protection. If I act against their wishes, I destroy their trust, and my action will be seen as an assault upon their personhood. Not to act is a betrayal of their trust as the action i necessary for their good. I cannot solve the dilemma, I can only balance the results of acting and not acting one against the other and select the act which I believe will be of benefit to the other.

 

Thus the act of giving an injection is a significant act having a foundation both in my human existence and the existence of the other. The act has feelings that go beyond its immediacy to the life-experience of the I who gives the injection and the other who receives it. We are alone, the two of us, the giver and the receiver. I give the injection to the other and this constitutes the act.

 

The Act

The injection is spoken of as a “procedure.” It is described as “just like throwing a dart.” One nurse describes the act thus:

 

I go to the patient’s room, check the name on the door, call out the person’s name. I explain to the patient that I have his/her injection and specify what it is (insulin, antibiotic, anti-emetic, etc.). I quadrant the buttock, imaging the network of nerves and blood vessels lying beneath. I swab the area and quickly put the needle in the centre of the tissue, draw back on the syringe and inject.

 

The act itself is a depersonalized act, but the recipient of an injection is a human with feelings and emotions like my own. I speak with him and tell him what must be done. To give the injection, I must go beyond the surface existence and mutilate the existence of the other. I no longer see man in his worldly image as a whole; he becomes a study of anatomy imagined in my mind, a network of blood vessels, muscles and nerves. The skin is stripped away and the anatomical self is exposed to my imagined reality. I envisage an area as the target for my dart and aim for the bulls-eye at its centre. If the patient stays motionless, it enhances my sense of the human body as object. The stillness creates the feeling that the patient has become an object-has become one with his body. The surounding world in which his existence was a reality disappears. If he moves, in that very moment, the “objectness” of the body is destroyed. My mind calculates the odds; if the patient is still, if I am on target, the hurt will be minimal. I must be careful, full-of-care. The needle and syringe are an extension of my fingers, my hand, of me. If my hand shakes the needle may hit a blood vessel or nerve. Yet, it is not the needle that will cause the damage but my hand, of which the needle is but an extension. I am solely responsible for the results of my act.

 

In giving an injection to oneself, one is both the giver and the receiver. Shirley is able to describe her subjective feelings, her own personal experience of what it is like to give and receive an injection. Objective feelings are those which can be measured, or where the feeling reaction can be observed and shared by several people. This is the reaction the nurse normally observes as she watches for a client response. Shirley, who has given her own insulin for many years, says:

 

Giving an injection is much like combing my own hair. In much the same way as I can pull the right way when I’m combing my hair to avoid hurt, I am able to adjust my reaction to the needle when I am administering it myself, and avoid the anxious feeling of not knowing whether the nurse will hurt me.

 

When one gives oneself an injection, the fear of pain, of hurting oneself, is still there. But the hand that holds the syringe and needle is one’s own. The reality of the experiencing giver and the experiencing receiver are one existence, and the choice of acting is one’s own. There is no other to violate my trust, and I do not view the invasion of my body as an aggressive act. I control the hurt and know that I need not suffer pain.

 

The Response to the Act

“I never really enjoyed giving injections but after compliment from patients about a ‘good needle,’ my confidence increased.”

 

“If I have to give an injection the patient doesn’t want, I feel pretty rotten and I think the patient will not consider me to be the best nurse on the unit. ”
There is a dichotomy between the objectified other to whom I give the injection and the experiencing other who expresses his fee]ings and emotions. It is the anatomical other who receives the injection, but it is the experiencing other who will, or will not, feel pain. If the other does not feel pain from my act, my view of myself as a caring, nurturing being is reflected in his words and actions. In his words, I see myself as a caring being and feel rewarded for my act. If the other responds by saying he is hurt or by struggling or crying out, I am rejected as a caring person. In the reflection of the image created by the other, I am established in my own view as a new type of being who must support new qualifications. I am made aware that I hurt him, that I acted in a way that was not congruent with my role as nurturer. I have become the enemy, the one who invades the territory of another, using aggression to mount an attack. My act of caring is rejected, I am shamed in my own sight as I see reflected the meaning to the other of my act.

 

The Child

“I don’t really want to do this but I am doing it because I know it will help. ”

 

“It always hurts, according to children.”

 

“I will not be a friend.”

 

“They are so tiny, so fragile.”

 

When I give an injection to a child, I am like the parent who must punish the child to protect him from harm. When the child plays with a lighted match, the parent must say “No” and may punish the child because he loves him, but the child may not understand that the punishment is to protect him from harm. If he is angry when he has been deprived of the match, he may say to the parent, “I hate you.” When I give an injection to a child, I risk the loss of his love. The child, as other, will show me how he feels. In his reflection of myself I will see an image that is uncaring.

 

The child is like a fragile, delicate vase entrusted to my care, one slip of my hand and he will be damaged beyond repair. The child is small and I feel that I may harm him. I cannot tell him what I have to do, so he will struggle and resist my act. I am forced to acknowledge his existence; his humanness is forced upon me, so I am conscious of his existence in a way I can deny with the adult other. In the eyes of the child, I am reflected as uncaring and unloving if he is hurt by my act. He trusts me to be caring, to protect him and I betray that trust. I am forced by the child’s experience to see my action as one that gives him pain. In the withdrawal of the child’s trust, my act of nurturance becomes perceived by me as a violation of the inner-self of the child other. I am no longer a friend in the eyes of the child. I am reflected as one who takes advantage of the vulnerability of the other to attack. I am shamed by the altered concept of myself-as-being. I must face the child’s response and, in so doing, feel the sorrow of my loss of the child’s trust in me.

 

The Unconscious Patient: The Silent Body

“I feel concerned, I have no way of judging if I have caused pain. ”

 

“I am less apprehensive, the skin is more taut, more insensitive. There’s no personality to cope with, you can concentrate on the task.”

 

“I have a nagging feeling, maybe they can feel it but can’t say anything. A response, positive or negative is an important part of giving an injection. ”

 

When I give an injection to an unconscious patient, I am torn between two possible realities. The lack of consciousness of the other separates him from his environment, creating a barrier to his interaction with external things (Van den Berg, 1966). He still exists, his feelings and emotions secret to himself. He lies before me as an uncommunicating being, yet I believe him to be an experiencing being. However, he does not move or stir in his bed, and he is disassociated from the reality of my existence. His skin feels taut, more like tanned leather than that of a living being. It is easy to deny him the right of existence, to objectify his presence and deny that he experiences sensory feeling or that he experiences emotions. If I deny his existence, I am no longer anxious because I cannot harm an object, I cannot cause it pain.

 

I reflect on what may be happening within the private self of the other and feel empty when he does not respond to my act with either praise or anger. This very joining of the self wilh the other in communication is a part of the process of giving an injection. When it does not happen, I am like an empty vessel deprived of water, whether it be brackish or pure. I give to another but I do not know in what manner my gift is received. I am cheated by the non-response of the other, and thus the act itself is incomplete.

 

Not every nurse will find her experiences described in these observations on giving an injection. No-one can put themselves in totally the same situation as another, for everyone experiences things in a different way. Every nurse begins the act of giving an injection with her own past and her own expectations of the future. Each injection is the nurse’s own personal situation, unique to her. This description is a general one that attempts to find patterns or schemes in the experience of individuals. It attempts to reproduce experienced reality recognizing it can never cover the individual case. Perhaps it will help educators to better understand the meaning of the anxiety that is observed as a student undertakes the act of giving her first injection, so she may help the student reflect and come to understand the meaning of that experience.

 

 

References

Buytendijk, F.J.J. (1950). The phenomenological approach to the problem of feelings and emotions. In M. L. Reymert (Ed.), Feelings and emotions: The Mooseheart symposium. New York: McGraw-Hill.

Buytendijk, F. J. J. (1961). Pain. London: Hutchison.

Denzin, N. (1978). Sociological methods: A sourcebook (2nd ed.). New York: McGraw-Hill.

Sartre, J.P. (1964). The encounter with the other. Being and nothingness: An essay in phenomenological ontology. New York: Citadel Press.

Van den Berg, J.H. (1958). The handshake. Philosophy Today. 2, 28-34.

Van den Berg, J.H. (1966). The psychology of the sick bed. Pittsburg: Duquesne University Press.

Van Manen, M. (1979). An introduction to phenomenology. University of Alberta: Faculty of Education.

Zborowski, M. (1958). Cultural components in response to pain. In E. G. Jaco (Ed.), Patients, physicians and illness. New York: The Free Press.