자연주의적 탐구조사(Naturalistic Inquiry)

Background
This review is an updated version of the original Cochrane review published in Issue 4, 2006. Needle-related procedures are a common source of pain and distress for children. Our previous review on this topic indicated that a number of psychological interventions were efficacious in managing pediatric needle pain, including distraction, hypnosis, and combined cognitive behavioural interventions. Considerable additional research in the area has been published since that time.

Objectives
To provide an update to our 2006 review assessing the efficacy of psychological interventions for needle-related procedural pain and distress in children and adolescents.

Search methods
Searches of the following databases were conducted for relevant randomized controlled trials (RCTs): Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; PsycINFO; the Cumulative Index to Nursing and Allied Health Literature (CINAHL); and Web of Science. Requests for relevant studies were also posted on various electronic list servers. We ran an updated search in March 2012, and again in March 2013.

Selection criteria
Participants included children and adolescents aged two to 19 years undergoing needle-related procedures. Only RCTs with at least five participants in each study arm comparing a psychological intervention group with a control or comparison group were eligible for inclusion.

Data collection and analysis
Two review authors extracted data and assessed trial quality and a third author helped with data extraction and coding for one non-English study. Included studies were coded for quality using the Cochrane Risk of bias tool. Standardized mean differences with 95% confidence intervals were computed for all analyses using Review Manager 5.2 software.

Main results
Thirty-nine trials with 3394 participants were included. The most commonly studied needle procedures were venipuncture, intravenous (IV) line insertion, and immunization. Studies included children aged two to 19 years, with the most evidence available for children under 12 years of age. Consistent with the original review, the most commonly studied psychological interventions for needle procedures were distraction, hypnosis, and cognitive behavioural therapy (CBT). The majority of included studies (19 of 39) examined distraction only. The additional studies from this review update continued to provide strong evidence for the efficacy of distraction and hypnosis. No evidence was available to support the efficacy of preparation and information, combined CBT (at least two or more cognitive or behavioural strategies combined), parent coaching plus distraction, suggestion, or virtual reality for reducing children's pain and distress. No conclusions could be drawn about interventions of memory alteration, parent positioning plus distraction, blowing out air, or distraction plus suggestion, as evidence was available from single studies only. In addition, the Risk of bias scores indicated several domains with high or unclear bias scores (for example, selection, detection, and performance bias) suggesting that the methodological rigour and reporting of RCTs of psychological interventions continue to have considerable room for improvement.

Authors' conclusions
Overall, there is strong evidence supporting the efficacy of distraction and hypnosis for needle-related pain and distress in children and adolescents, with no evidence currently available for preparation and information or both, combined CBT, parent coaching plus distraction, suggestion, or virtual reality. Additional research is needed to further assess interventions that have only been investigated in one RCT to date (that is, memory alteration, parent positioning plus distraction, blowing out air, and distraction plus suggestion). There are continuing issues with the quality of trials examining psychological interventions for needle-related pain and distress.

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Psychological interventions for needle‐related procedural pain and distress in children and adolescents

Psychological Science in the Public Interest

Procedural pain management: a position statement with clinical practice recommendations.

Fundamentals of Nursing: Human Health and Function

We explored the role of religiosity and spirituality on (i) feelings and attitudes about breast cancer, (ii) strategies for coping with breast cancer, and (iii) health care seeking behaviors among breast cancer survivors in Iran We conducted in-depth semistructured interviews with 39 breast cancer survivors We found that spirituality is the primary source of psychological support among participants Almost all participants attributed their cancer to the will of God Despite this, they actively have been engaged with their medical treatment This is in surprising contrast to Western cultures in which a belief in an external health locus of control diminishes participation in cancer screening, detection, and treatment These findings can help researchers to provide a framework for the development of appropriate and effective culturally sensitive health interventions

Muslim breast cancer survivor spirituality: coping strategy or health seeking behavior hindrance?

Aims and objectives. To determine the frequency of needlestick injuries and barriers of reporting such injuries amongst Iranian nurses. Background. Exposure to blood-borne pathogens because of needlestick injuries in particular is a potential risk for healthcare workers, including clinical nurses. The burden of sharp injuries sustained by healthcare workers is still unclear, primarily because of underreporting. Design. A cross-sectional study was undertaken amongst 111 clinical nurses working in five major teaching hospitals in Tehran/Iran during 2007-2008 who were randomly selected. Methods. A validated self-reported questionnaire containing demographic characteristics and history of experiences with contaminated needlesticks as well as probably reason/s for underreporting such injuries was used. Results. More than half of the enrolled nurses (54 center dot 1, n = 60) had no experience of contaminated injuries, while the rest of 45 center dot 9 (n = 51) had experienced at least one contaminated needlestick injuries during their clinical performance. More than one-third (34 center dot 0, n = 38) had experienced a mean of 58 contaminated needlestick injuries during the past 12 months (crude incidence: 0 center dot 52 NSI/nurse/year). Only 14 nurses (36 center dot 8) with needlestick injuries experiences had officially reported their experiences. The major reasons for not reporting needlestick injuries were dissatisfaction with follow-up investigations by officials after reporting the events (33 center dot 3) and safe/low risk considering of source patients (29 center dot 2). Conclusions. Increased frequency and underreporting of needlestick injuries amongst Iranian nurses is going to be a major concern. As a preventive strategy, further interventions such as constant staff training, life-long learning and standardising postexposure procedures are recommended. Relevance to clinical practice. Determining the prevalence, burden and reasons for underreporting needlestick injuries by clinical nurses are required for establishing a preventive strategy to decrease hospital infections.

Frequency and barriers of underreported needlestick injuries amongst Iranian nurses, a questionnaire survey.

The Effect of Programmed Distraction on the Pain Caused by Venipuncture among Adolescents on Hemodialysis

Elderly people are especially vulnerable to loneliness. Loneliness as an important phenomenon is correlated with a variety of emotional, physical and health-related complications. However, a few studies have investigated the experience of loneliness from the perspectives of elderly people living in communities. The aim of this study was to explore the lived experiences of Iranian elders of loneliness. A qualitative study using phenomenological approach was employed with four men and nine women living in their own houses. In-depth interviews were transcribed verbatim and analysed using hermeneutic methods. The emerged themes were 'an aversive emotional state', 'isolated from intimate relationships', 'being deprived from social and external support systems' and 'being abused and neglected'. Our study findings support the view that the experience of loneliness creates an aversive emotional state which is associated with negative and painful feelings. In addition, it was revealed that lack of access to intimate relationships and supportive systems as well as the experience of being abused and neglected were major factors contributing to the feelings of loneliness among Iranian elders. In terms of recommendation for practice, worldwide nurses are expected to be knowledgeable about the factors which increase feelings of loneliness. Alternatively, they should develop coping mechanisms among elders with the cooperation of their family members; also, attract community attention in order to improve social services in both quality and quantity.

Understanding loneliness in the lived experiences of Iranian elders.

The purpose of this study was to explore the experiences of Syrian women with breast cancer regarding their chemotherapy. A qualitative design, based on the content analysis approach, was used for the data collection and analysis of the perspectives of women with breast cancer in Syria. Semistructured interviews were carried out with 17 women who underwent chemotherapy after mastectomy in a chemotherapy center in Latakia between June and October 2010. Four main themes emerged from the study: psychological discomfort (negative emotion, body image, and depressive symtoms), physical problems (acute consequences of chemotherapy and general aspects of chemotherapy), social dysfunction (social isolation and lack of marriage opportunites), and failure in the family role (mother role and sexual relationship). Understanding the experiences of women with breast cancer regarding chemotherapy enables nurses to devise appropriate strategies to provide better support and care to patients in order to improve their quality of life.

Monireh Anoosheh

Papers

Muslim breast cancer survivor spirituality: coping strategy or health seeking behavior hindrance?

Frequency and barriers of underreported needlestick injuries amongst Iranian nurses, a questionnaire survey.

The Effect of Programmed Distraction on the Pain Caused by Venipuncture among Adolescents on Hemodialysis

Understanding loneliness in the lived experiences of Iranian elders.

Experiences of Syrian women with breast cancer regarding chemotherapy: A qualitative study