5-EPIFAT trial protocol: a multi-center, randomized, placebo-controlled trial of the efficacy of pharmacotherapy for fatigue using methylphenidate, bupropion, ginseng, and amantadine in advanced cancer patients on active treatment.

BACKGROUND: Cancer-related fatigue (CRF) is still undertreated in most patients, as evidence for pharmacological treatments is limited and conflicting. Also, the efficacy of the pharmacological agents relative to each other is still unclear. Therefore, medications that may potentially contribute to improving CRF will be investigated in this head-to-head trial. Our main objective is to compare the efficacy of methylphenidate vs. bupropion vs. ginseng vs. amantadine vs. placebo in patients with advanced cancer. METHODS: The 5-EPIFAT study is a 5-arm, randomized, multi-blind, placebo-controlled, multicenter trial that will use a parallel-group design with an equal allocation ratio comparing the efficacy and safety of four medications (Methylphenidate vs. Bupropion vs. Ginseng vs. Amantadine) versus placebo for management of CRF. We will recruit 255 adult patients with advanced cancer who experience fatigue intensity ≥ 4 based on a 0-10 scale. The study period includes a 4-week intervention and a 4-week follow-up with repeated measurements over time. The primary outcome is the cancer-related fatigue level over time, which will be measured by the functional assessment of chronic illness therapy-fatigue (FACIT-F) scale. To evaluate safety, the secondary outcome is the symptomatic adverse events, which will be assessed using the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events in cancer clinical trials (PRO-CTCAE). Also, a subgroup analysis based on a decision tree-based machine learning algorithm will be employed for the clinical prediction of different agents in homogeneous subgroups. DISCUSSION: The findings of the 5-EPIFAT trial could be helpful to guide clinical decision-making, personalization treatment approach, design of future trials, as well as the development of CRF management guidelines. TRIAL REGISTRATION: IRCT.ir IRCT20150302021307N6. Registered on 13 May 2023.

Acupressure Intervention Program for Older Adults in Australian Residential Aged Care Facilities: A Qualitative Evaluation.

The current study explored participants' experiences and perceptions of receiving acupressure within an Australian aged care context. Participants were older adults living in three residential aged care facilities who had received an acupressure intervention. Data were collected using semi-structured interviews and analyzed using a thematic approach. Twelve participants (10 females and two males) were interviewed. Four major themes emerged: Having Better Sleep, Feeling Calm and Relaxed, Promoting Well-Being and Functional Status, and Acceptability of Acupressure. Participants' perception of the acupressure was positive, as participants found acupressure to be beneficial for the improvement of sleep, mood, and general well-being. Participants' overall perception supports the acceptability of acupressure and suggests acupressure may be beneficial for improving sleep, relaxation, and well-being in older adults. [Journal of Gerontological Nursing, 50(1), 30-36.].

"I use salt. However, I also use soy sauce, oyster sauce, sometimes chili sauce and .": interviews with Australians of Chinese ancestry regarding reducing salt consumption for hypertension prevention.

BACKGROUND: High dietary salt consumption is a significant health issue in Chinese populations. This study identified the facilitators for and barriers to salt reduction for prevention of hypertension among Chinese Australians. METHODS: An inductive qualitative study with semi-structured interviews (n = 8) was conducted with convenience samples recruited from social media. Adults who a) were over 18 years old, b) were of Chinese ancestry and c) had lived in Australia for at least 6 months were eligible for participation. Interview transcripts were transcribed and analysed using content analysis. RESULTS: Four facilitators for and eight barriers to reducing salt consumption were synthesised from the narrative materials. The facilitators were: 1) individual perceptions of health benefits, 2) salt alternatives, 3) digital information and 4) increased awareness of negative health impacts from a high-salt diet. The barriers identified were: 1) negative physical changes not apparent, 2) inadequate salt-related health education, 3) hidden salt in food products, 4) inadequate food literacy, 5) pricing, 6) busy lifestyle, 7) low perceived susceptibility and 8) individual food taste preference and cooking habits. Peer and family influence had positive and negative effects on participants' likelihood of reducing salt consumption. CONCLUSIONS: The facilitators for and barriers to maintaining a low-salt diet in Chinese Australians were multifaceted and interrelated. Future salt-reduction strategies should focus on the health benefits of reduced salt consumption and practical interventions such as salt alternatives and education on low-salt food choices and cooking methods and changing perceptions about salt reduction to become a social norm in the Chinese community.

An integrative review of supportive relationships between child-bearing women and midwives.

AIMS: To review and evaluate the literature on the factors related to developing supportive relationships between women and midwives, including facilitators and barriers. DESIGN: An integrative review. METHOD: The search used CINAHL, MEDLINE, Embase, EMcare, Maternity and Infant Care, PsycINFO, and Google Scholar from January 2009-June 2020. Two reviewers screened the eligible studies, and 2,399 records were identified. Quality was assessed with the mixed methods appraisal tool, and 14 articles were included. RESULTS: The findings highlight that successful relationships require therapeutic communication, trust, respect, partnership, and shared decision-making. Supportive relationships improve women's satisfaction and birth outcomes, and continuity of care model is an enabling factor. Further research is required to understand supportive relationships in non-continuity of care models and when different cultural backgrounds exist.

The Effect of Acupressure on Sleep Quality of Older People in Australian Residential Aged Care Facilities: A Pilot Randomized Controlled Trial.

This study investigated the effects of acupressure on sleep quality, anxiety, depression, and quality of life among older people in Australia. Acupressure improved overall subjective sleep quality and anxiety but no differences in depression and quality of life. Future studies with larger sample sizes are required to generate good evidence.

Effect of Benson and progressive muscle relaxation techniques on sleep quality after coronary artery bypass graft: A randomized controlled trial.

OBJECTIVE: This study aimed to investigate the effect of Benson relaxation (BR) and progressive muscle relaxation (PMR) techniques on the sleep quality of patients undergoing coronary artery bypass graft (CABG) surgery. METHOD: This study was a three-arm, parallel, randomized controlled trial. 120 patients who underwent CABG surgery at two academic hospitals in an urban area of Iran were randomly allocated into three groups (40 per group): the BR, PMR, and control groups. Patients in the BR and the PMR groups performed relevant exercises twice a day for four weeks. Sleep quality was measured before and immediately after the intervention using Pittsburgh Sleep Quality Index. RESULTS: Within-group comparison in the BR (t = 3.51, p = 0.001) and the PMR (t = 4.58, p < 0.001) group showed that the overall sleep quality showed a significant improvement after the intervention when compared to baseline. The between-group comparison showed that both the BR and PMR groups showed significant improvements in subjective sleep quality (F = 3.75, p = 0.02), habitual sleep efficiency (F = 4.81, p = 0.01), and overall sleep quality (F = 5.53, p = 005) when compared to the control group after the intervention. However, no statistically significant differences were identified among the three study groups in terms of sleep latency, sleep duration, sleep disturbances, sleeping medication, and daytime dysfunction after the intervention (p > 0.05). CONCLUSION: The study showed that a four-week program of both PMR and BR can be effective in the overall improvement of sleep quality in patients following CABG. Further research is required to replicate the findings of the present study.

Erratum: Lee, R.L.T., et al. Effects of an Unstructured Free Play and Mindfulness Intervention on Wellbeing in Kindergarten Students. Int. J. Environ. Res. Public Health 2020, 17, 5382.

The authors wish to make the following corrections to their paper [...].

Effects of an Unstructured Free Play and Mindfulness Intervention on Wellbeing in Kindergarten Students.

Play is known as the core occupation of young children as it lays a foundation for their early development and physical, emotional and social wellbeing. Literature suggests that unstructured free play and mindfulness interventions may independently promote wellbeing among preschoolers. However, there is no clear evidence of their combination in supporting wellness in early learning environments. We conducted a quasi-experimental study with 42 children aged four to six years, attending two kindergartens in Hong Kong. The intervention included unstructured play with non-directional loose parts (play materials), conducted outdoors for one hour daily followed by a mindfulness intervention for 10 min per day indoors. The intervention lasted for five consecutive days. We examined happiness and aspects of playfulness before and after the intervention, finding a significant increase in all areas. Given greater freedom in play choice, children showed more disruptive behaviors during unstructured play than the control group engaging in recess as usual. We conclude that unstructured play in addition to mindfulness intervention is effective in promoting students' happiness and playfulness, both of which may help maintain mental health and wellbeing amid stressors such as transition and separation. The increased disruptive behavior requires additional investigation.

Systematic review of the impact of unstructured play interventions to improve young children's physical, social, and emotional wellbeing.

This review aimed to examine the effectiveness of unstructured play interventions on young children's physical, emotional and social wellbeing in various community settings. Eligibility criteria of articles included (1) studies which included young children aged three to seven years; (2) intervention studies which involved unstructured, free or loose parts play; (3) experimental or randomized controlled trial designs, with or without random allocation to groups; and (4) target variables of the study should include measurable physical, social or psychological constructs as modifiable outcomes. Electronic searches were conducted from June 2018 to March 2019 in ERIC, MEDLINE, PubMed, ProQuest, Sage Publications, Web of Science, Scopus, and Sociological Abstracts. Data were extracted from the included studies independently by using a pilot form. The study outcome measures of unstructured play in the eight selected articles were categorized into three aspects of children's physical health, social skills and emotional wellbeing. All studies reported positive impacts on children's physical activity level, social engagement and emotional wellbeing. We conclude that our review with identified impacts would assist future research directions and policy implementation in this promising field..

Older people's perspectives on use of complementary and alternative medicine and acupressure: A qualitative study.

OBJECTIVE: This study explored older people's knowledge, experience and perception of complementary and alternative medicine (CAM) and acupressure, and their willingness to accept acupressure. METHOD: This qualitative descriptive study, using semi-structured interviews, was conducted at two residential aged care facilities. Thematic analysis was used to analyse the data. RESULTS: Fifteen older people participated. Participants had limited knowledge about CAM and acupressure. Many of them had positive views on CAM, and were willing to accept acupressure. There were five major themes: knowledge and understanding about CAM, experience of using CAM, general views on use of CAM, reasons for not using CAM, and willingness to accept acupressure. CONCLUSION: The findings show the diverse views on CAM and acupressure from the perspectives of the older people in this study. There is a need for further research investigating the usefulness of CAM and acupressure in aged care settings.

Acupressure to improve sleep quality of older people in residential aged care: a randomised controlled trial protocol.

BACKGROUND: Sleep disturbance in older people is an important health issue that is associated with many other health problems. Effective interventions are required to address sleep problems in this group. Acupressure has been suggested as a potential therapeutic technique to improve sleep. The aim of this study is to evaluate the effects of an acupressure intervention on sleep quality, anxiety, depression, and quality of life among older persons in residential aged care facilities within an Australian context. METHODS/DESIGN: This is a randomised controlled trial with two parallel groups in a pre- and post-test study. Study participants will be older people living in residential aged care facilities. They will be assigned to intervention and control groups using computer-generated random numbers. The intervention group will receive 12-min acupressure three times per week for four consecutive weeks, applied on three acupoints: HT7, PC6, and SP6. The control group will receive only routine care. The primary outcome measure is sleep quality, and secondary outcomes include anxiety, depression, and quality of life. Data will be collected before the intervention, immediately after the end of the intervention, and 2 weeks after the intervention. DISCUSSION: This study targets a poorly met healthcare need of older people who are experiencing sleep disturbance and its negative consequences. To the researchers' knowledge, this is the first study evaluating acupressure in an Australian aged care context, using specific acupoints and a standardised acupressure protocol. If the results show positive outcomes, acupressure could be used to manage sleep disturbances for older people in the Australian context as well as in the global ageing population. This will contribute to reducing negative consequences of sleep disturbance and use of sleep medications. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12619000262101. Registered on 20 February 2019.

Patients' experiences of coping with multiple chronic conditions: A qualitative descriptive study.

OBJECTIVE: To explore the experiences of how Chinese adults cope with multiple chronic conditions in everyday life. BACKGROUND: Having multiple chronic conditions is stressful, requiring people to make physical and mental adaptations. There is little evidence exploring how people cope with multiple chronic conditions, especially in an Asian context. DESIGN: A qualitative descriptive design was employed. The Consolidated criteria for reporting qualitative research (COREQ) was used to report this study. METHODS: This study was conducted in a tertiary referral and teaching hospital in Bengbu, Anhui, China, between August and October 2018. A purposive sample of 14 people with multiple chronic conditions, aged between 32 and 75 years, completed a demographic questionnaire and semi-structured face-to-face interviews. The interviews were digitally recorded and transcribed verbatim. Qualitative content analysis guided data analysis. RESULTS: Four distinctive themes comprising subthemes were developed from participants' narratives pertaining to coping with multiple chronic conditions: (a) appraising multiple chronic conditions, (b) addressing multiple chronic conditions management, (c) maintaining psychological well-being and (d) fulfilling a social role. Illustrative quotations were cited to support each theme. CONCLUSIONS: This study underscores that people cope with multiple chronic conditions in everyday life by using a compendium of coping strategies. As one of the influencing factors, culture dominates the ways of coping at different levels among people with multiple chronic conditions. These findings expand the current literature on coping based on an Asian perspective and inform further cross-culture research on this topic. RELEVANCE TO CLINICAL PRACTICE: Healthcare professionals should understand peoples' experiences of coping with multiple chronic conditions to provide more holistic and dynamic health care to address their actual needs. Healthcare professionals should be acquainted with how culture impacts individuals' coping and develops culture-tailored supportive programmes such as family-based interventions, to promote the health of people with multiple chronic conditions.

An integrative review of acupressure interventions for older people: A focus on sleep quality, depression, anxiety, and agitation.

OBJECTIVES: This integrative review aimed to synthesize studies that investigated the effects of acupressure on sleep quality, depression, anxiety, and agitation in older people, and to describe the acupressure procedures and techniques applied in the included studies. METHODS: A literature search was conducted using electronic databases including CINAHL, Cochrane Library, EMBASE, and MEDLINE. The inclusion criteria for the review were studies examining the effect of acupressure in older people aged 60 years and above, measured the outcomes for sleep quality, depression, anxiety or agitation, applied body acupressure, and published in English language. The exclusion criteria were studies using auricular acupoints only, and articles published in any language other than English. Methodological quality of studies was assessed using the critical appraised tools developed by the Joanna Briggs Institute. The information about study design, findings, and description of acupressure intervention were extracted, summarized, and synthesized. RESULTS: A total of 255 articles were identified from the search and as well one article from cross-references. From there, a total of 19 studies were included in this review. Nine studies consistently showed positive effects of acupressure on sleep quality, and four studies consistently showed that acupressure reduced depression. The outcomes of acupressure on anxiety and agitation showed inconsistent findings, in which three studies measured anxiety and five studies measured agitation. There was also variation of acupressure techniques applied in the reviewed studies. CONCLUSION: This review found some emerging evidences that acupressure can be beneficial for older people who suffer from sleep problems and depression. Use of specific acupressure points, with standardized acupressure treatment protocols, may improve sleep quality and possibly psychological wellbeing of older people. Future research with well-designed mixed method studies are required to produce stronger evidence, as well as in-depth understanding of acupressure intervention in aged care context.

Nurses' Perceptions of Psychosocial Care and Barriers to Its Provision: A Qualitative Study.

BACKGROUND: Psychosocial care is the culturally sensitive provision of psychological, social, and spiritual care through therapeutic communication. Current evidence suggests that effective psychosocial care improves patients' health outcomes and quality of life. PURPOSE: The aim of this study was to explore nurses' perceptions and experiences in providing psychosocial care to patients and to identify the related barriers and challenges. METHODS: An exploratory qualitative design using semistructured, individual, face-to-face interviews was adopted. A purposive sample of 18 registered nurses was recruited from the geriatric, medical, and surgical wards in an acute general hospital in Singapore. Interviews were audio-recorded, transcribed, and analyzed thematically. RESULTS: Four major themes emerged: patient-centered care, communication, interprofessional care, and barriers to psychosocial care. Nurses perceived that psychosocial care consists of providing holistic care, spiritual care, support to the patient and family members, and showing empathy. Furthermore, psychosocial care is composed of communication between nurses and the patient and family members as well as communication among nurses. In addition, psychosocial care involves collaboration between healthcare professionals as well as multidisciplinary care. Barriers that are perceived by nurses include lack of time, language barriers, being task-oriented, excessive documentation, lack of family involvement, and fear of complaints. CONCLUSIONS: This study highlighted the perceptions of nurses regarding psychosocial care and the challenges in providing this care. Future studies are needed to explore ways to overcome these barriers and to enhance nurses' competencies in providing psychosocial care. The findings indicate a need to plan future interventions to provide nurses with both skill development and support to improve their ability to integrate psychosocial care, which will improve patient outcomes.

Job Satisfaction and Subjective Well-Being Among Midwives: Analysis of a Multinational Cross-Sectional Survey.

INTRODUCTION: There is a considerable amount of empirical evidence to indicate a positive association between an employee's subjective well-being and workplace performance and job satisfaction. Compared with nursing research, there is a relative lack of consistent scientific evidence concerning midwives' subjective well-being and its determinants related to domains of job satisfaction. The purpose of the study was to examine the association between the domains of job satisfaction and components of subjective well-being in hospital midwives. METHODS: This cross-sectional descriptive study involved 1190 hospital midwives from 7 countries. Job satisfaction was measured by the McCloskey/Mueller Satisfaction Scale. Subjective well-being was conceptualized in the study by the 2 components (the affective and the cognitive component). The affective component of subjective well-being (ie, emotional well-being) was assessed by the Positive and the Negative Affect Scale. The cognitive component of subjective well-being (ie, life satisfaction) was measured by the Personal Well-Being Index. Pearson correlations and multiple regression analyses were used to determine associations between variables. RESULTS: Findings from correlation and regression analyses indicated an overall weak association between the domains of job satisfaction and components of subjective well-being. Satisfaction with extrinsic rewards, coworkers, and interaction opportunities accounted for only 13% of variance in the cognitive component (life satisfaction). The affective component (emotional well-being) was weakly associated with satisfaction with control and responsibility. DISCUSSION: The low amount of variance suggests that neither component of subjective well-being is influenced by the domains of job satisfaction. Further studies should focus on identifying other predictors of subjective well-being among midwives. A better understanding of how specific job facets are related to the subjective well-being of midwives might assist employers in the design of counseling and intervention programs for subjective well-being of midwives in the workplace and workplace performance.

Job satisfaction and leaving intentions of midwives: analysis of a multinational cross-sectional survey.

AIM: To investigate the relationship between turnover intentions and job satisfaction among hospital midwives from seven countries and to determine how the related variables differ between countries. BACKGROUND: Studies investigating professional turnover and job satisfaction among midwives are limited in scope. METHOD: A cross-sectional descriptive survey was used to investigate the intended turnover and job satisfaction relationship among 1190 hospital midwives in European and Asian countries. Data were collected using a set of questionnaires that included questions regarding the leaving intentions of midwives and the McCloskey/Mueller satisfaction scale. RESULTS: Midwives were least satisfied with their extrinsic rewards and professional opportunities and with the balance between family and work. Significant differences were found in all domains of job satisfaction according to midwives' intentions to leave their current workplace in hospital or profession of midwife, and to work abroad. CONCLUSION: There are some general satisfying and dissatisfying elements for the profession of midwife across different countries. IMPLICATIONS FOR NURSING MANAGEMENT: The results highlight the importance of understanding midwives' leaving intentions and related factors across different countries. To prevent midwife turnover, health-care managers should gain greater insight into the early stage of midwives' turnover intention.

The effectiveness of therapeutic play intervention in reducing perioperative anxiety, negative behaviors, and postoperative pain in children undergoing elective surgery: a systematic review.

Children undergoing surgical procedures commonly experience stress and anxiety, exhibit negative behaviors, and complain of postoperative pain. Parents also experience anxiety when their children undergo surgery. Therapeutic play intervention has been used to prepare hospitalized children for invasive medical procedures for decades. However, there has been no systematic review to examine the effectiveness of therapeutic play intervention for improving children's health-related outcomes such as perioperative anxiety and postoperative pain. The aim of this review was to synthesize current empirical evidence on the effectiveness of therapeutic play intervention in reducing perioperative anxiety, negative behaviors, and postoperative pain in children undergoing elective surgery and in reducing their parents' perioperative anxiety. Systematic searches of electronic databases of the Cumulative Index to Nursing and Allied Health Literature, PubMed, ProQuest Dissertations and Theses, Scopus, and Web of Science and screening of the reference lists of included articles from these databases identified studies on the topic. Relevant studies were methodologically assessed and appraised by two independent reviewers using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. Six studies were identified. The outcome measurements were heterogeneous across all six studies. These studies had conflicting outcomes regarding the effectiveness of therapeutic play intervention in children's perioperative anxiety, negative behaviors, and postoperative pain. Two studies showed that the intervention significantly reduced parents' preoperative anxiety. The current empirical evidence on the effectiveness of therapeutic play intervention in children's perioperative anxiety, negative behaviors, and postoperative pain is inconclusive. More studies on the effectiveness of therapeutic play intervention using rigorous designs and involving parents are needed.

Validation of Chinese and English versions of the Holistic Well-being Scale in patients with cancer.

OBJECTIVE: The study aims to examine the psychometric properties of the Holistic Well-Being Scale (HWS), a new instrument developed on the Eastern concepts of affliction, and equanimity in a new sample involving patients with cancer. METHODS: A cross-sectional survey was conducted with 300 patients with cancer in Singapore. The patients completed the HWS, WHO-5 Well-Being Index (WHO-5), and Hospital Anxiety and Depressions Scale (HADS). Thirty-two patients participated in the 2-week retest. RESULTS: Mixed findings were obtained from the original seven-factor model in our sample: six factors had acceptable internal reliabilities (Cronbach's α; range, 0.657-0.809), and construct validities were partially supported. Factor analysis suggested three factors: Blissful-self (α = 0.874), Disturbed-self (α = 0.885) and Embittered-others (α = 0.709). The novel factors demonstrated good test-retest reliability (ICC; range, 0.894-0.930) and construct validities, which were shown by significant correlations with HADS and WHO-5 in the predicted directions. CONCLUSIONS: The present study is the first step taken to validate a scale that is essential in the development of culturally appropriate psychosocial interventions to support and promote personal well-being of cancer patients. The findings suggest that the three-factor model may be more applicable to the Singapore context, but it does not necessarily invalidate the original HWS. The results were discussed in terms of the meaning of the original HWS factors and cultural differences in coping behaviors between Singapore and Hong Kong, though both are Asian countries. The HWS could be further tested in other Asian populations as achieving holistic well-being is a common goal for patients in many cultures.

Using simulation learning through academic-practice partnership to promote transition to clinical practice: a qualitative evaluation.

AIM: To explore the effect of an innovative simulation education programme on nursing students' transition-to-practice experiences. BACKGROUND: Academic-practice partnership is emerging as an important vehicle for improving nursing students' transition-to-practice. Using existing university resources, academic educators and alumni developed an innovative simulation educational programme known as the Simulated Professional Learning Environment (SIMPLE) to align the educational process with the realities of nursing practice. Educators and alumni collaborated to create and facilitate 15 hours of simulation sessions that comprised the learning platform for the SIMPLE programme. DESIGN: This was a descriptive qualitative study. METHOD: Focus groups were conducted in 2012 with 22 final-year nursing students completing their transition-to-practice clinical practicum. The interview transcripts were analysed using content analysis. RESULTS: Three themes were identified from the analysis: 'experiencing the role of staff nurse'; 'knowing how to'; and 'learning from the 'seniors'. Experiencing the role of staff nurse in the programme showed the nursing students what to expect and how to prepare for their roles. Knowing how to focus on holistic patient care, manage 'difficult' clients and communicate with other healthcare professionals were the learning outcomes gained from the programme. Learning from the 'seniors' about hospital work processes positively influenced the nurses' transition-to-practice experiences. CONCLUSION: This study provides support for introducing the simulation education programme as an enhancement during nursing students' final year to improve their transition-to-practice experiences. A stronger collaborative relationship between academic educators and practising nurses could be further fostered by expanding this learning platform.

Pain relief effect of breast feeding and music therapy during heel lance for healthy-term neonates in China: a randomized controlled trial.

OBJECTIVES: to test the effectiveness of breast feeding (BF), music therapy (MT), and combined breast feeding and music therapy (BF+MT) on pain relief in healthy-term neonates during heel lance. DESIGN: randomised controlled trial. SETTING: in the postpartum unit of one university-affiliated hospital in China from August 2013 to February 2014. PARTICIPANTS: among 288 healthy-term neonates recruited, 250 completed the trial. All neonates were undergoing heel lancing for metabolic screening, were breast fed, and had not been fed for the previous 30 minutes. INTERVENTIONS: all participants were randomly assigned into four groups - BF, MT, BF+MT, and no intervention - with 72 neonates in each group. Neonates in the control group received routine care. Neonates in the other three intervention groups received corresponding interventions five minutes before the heel lancing and throughout the whole procedure. MEASUREMENTS: Neonatal Infant Pain Scale (NIPS), latency to first cry, and duration of first crying. FINDINGS: mean changes in NIPS scores from baseline over time was dependent on the interventions given. Neonates in the BF and combined BF+MT groups had significantly longer latency to first cry, shorter duration of first crying, and lower pain mean score during and one minute after heel lance, compared to the other two groups. No significant difference in pain response was found between BF groups with or without music therapy. The MT group did not achieve a significantly reduced pain response in all outcome measures. CONCLUSIONS: BF could significantly reduce pain response in healthy-term neonates during heel lance. MT did not enhance the effect of pain relief of BF. IMPLICATIONS FOR PRACTICE: healthy-term neonates should be breast fed to alleviate pain during heel lance. There is no need for the additional input of classical music on breast feeding in clinic to relieve procedural pain. Nurses should encourage breast feeding to relieve pain during heel lance.