Non-pharmacological pain interventions for sickle cell crisis in pediatrics: A scoping review.

PROBLEM: Sickle cell crises (SCC) are recurrent, severe pain episodes experienced by people living with sickle cell disease (SCD). Non-pharmacological interventions have been recommended for SCC pain management however, little is known about the impact of these interventions on SCC pain. This scoping review aims to systematically identify evidence on the use and effectiveness of non-pharmacological interventions for pain management during SCC in the pediatric population. ELIGIBILITY CRITERIA: Studies were eligible if they are published in English and focusing on the use of any non-pharmacological interventions on pain during SCC in pediatric patients. Nine databases were searched including Medline, CINAHL and PsychInfo. Also, the reference lists of relevant studies were searched. SAMPLE: The database searching yielded 1517 studies. After the title and abstract screening, 1348 studies were excluded, and 169 full texts were retrieved and screened. One study was identified through handsearching. Finally, 27 articles were included in this scoping review. RESULTS: Across all studies, 27 different non-pharmacological interventions were identified. There were inconsistent results regarding the effectiveness of virtual reality, guided imagery, and cognitive-behavioral interventions in experimental studies. The most common interventions used at home were prayer, massage, and distraction. The main interventions used in hospitals were prayer and fluid intake, but this was explored by a few studies. CONCLUSION: Pediatric SCD patients use numerous non-pharmacological interventions to manage pain during SCC. However, the impact of many interventions on SCC pain has not been empirically investigated. IMPLICATIONS: Further research is necessary to establish the effectiveness of non-pharmacological interventions on SCC pain.

A taxonomy of risk-associated alternative health practices: A Delphi study.

Defining alternative health care and the recording of associated adverse events and harm remains problematic. This Canadian study aimed to establish and classify risk-associated alternative health practices in a Delphi study undertaken with an interdisciplinary panel of 17 health experts in 2020. It provides a new functional definition of alternative health care and an initial taxonomy of risk-associated alternative health care practices. A number of risk-associated practices were identified and categorized into general practices that conflict with biomedical care or largely untested therapies, alternative beliefs systems, physical manipulative alternative therapies, and herbal and nutritional supplements. Some risk significant harms including major physical injuries or even death. The lack of systematic methods for recording adverse events in alternative health care makes establishing the frequency of such events challenging. However, it is important that people engaging with alternative health care understand they are not necessarily risk-free endeavours, and what those risks are.

Divinity in nursing: The complexities of adopting a spiritual basis for care.

In this paper, the historical alignment of nursing with divinity-based perspectives and modern New Age nursing theories are explored. The nature of divinity in nursing is examined, together with the complexities and issues that arise in adopting a spiritual basis for care. The work of the key theorists in this area (Rogers, Newman, Parse, Watson, Dossey) is reconsidered and fundamental epistemological problems inherent in this approach reviewed. Specific concerns with the interpretation of holistic care, adoption of doxastic logic, faith-based rationales, influence of Caucasian Judeo-Christian and New Age values, misappropriation of science, use of pseudoscience and development of divinity as social consumer product are discussed. Practical problems with using a spiritual basis in contemporary nursing practice are also explored and the alignment of divinity-based nursing theories with the modern antiscience movement is examined. Overall, the re-emergence of divinity-based nursing and spiritual basis for care may be problematic, and would seem to counter the development of an inclusive profession. Additionally, the alignment of nursing with antiscience movements rejecting biomedicine has significant public health implications. This is argued as a regressive step for the advancement of the profession.

A rapid evidence assessment of recent therapeutic touch research.

AIM: To synthesize the most recent evidence investigating the effectiveness and safety of therapeutic touch as a complementary therapy in clinical health applications. DESIGN: A rapid evidence assessment (REA) approach was used to review recent TT research adopting PRISMA 2009 guidelines. METHODS: CINAHL, PubMed, MEDLINE, Cochrane databases, Web of Science, PsychINFO and Google Scholar were screened between January 2009-March 2020 for studies exploring TT therapies as an intervention. The main outcome measures were for pain, anxiety, sleep, nausea and functional improvement. RESULTS: Twenty-one studies covering a range of clinical issues were identified, including 15 randomized-controlled trials, four quasi-experimental studies, one chart review study and one mixed methods study including 1,302 patients. Eighteen of the studies reported positive outcomes. Only four exhibited a low risk of bias. All others had serious methodological flaws, bias issues, were statistically underpowered and scored as low-quality studies. No high-quality evidence was found for any of the benefits claimed.

Internet health scams-Developing a taxonomy and risk-of-deception assessment tool.

The prevalence of health scams in Canada is increasing, facilitated by the rise of the Internet. However, little is known about the nature of this phenomena. This study sought to methodically identify and categorise Internet-based Health Scams (IHS) currently active in Canada, creating an initial taxonomy based on systematic Internet searches. A five-step Delphi approach, comprised of a multidisciplinary panel of health professionals from the University of British Columbia, in Vancouver, Canada, was used to establish consensus. The resulting taxonomy is the first to characterise the nature of IHS in North America. Five core areas of activity were identified: body image products, medical products, alternative health services, healthy lifestyle products, and diagnostic testing services. IHS purveyors relied on social expectations and psychological persuasion techniques to target consumers. Persuasion techniques included social engagement, claims of miraculous effects, scarcity, and the use of pseudoscientific language. These techniques exploited personality traits of sensation seeking, needing self-control, openness to taking risks, and the preference for uniqueness. The data gathered from the taxonomy allowed the Delphi panel to develop and pilot a simple risk-of-deception tool. This tool is intended to help healthcare professionals educate the public about IHS. It is suggested that, where relevant, healthcare professionals include a general discussion of IHS risks and marketing techniques with clients as a part of health promotion activities.

The slippery slope of nursing regulation: challenging issues for contemporary nursing practice in Canada.

This paper provides readers with an overview of some contemporary issues associated with nursing regulation and scope of practice in Canada. Issues with the current organizational structure of nursing regulation and its impact on nursing advocacy in Canada are explored. An argument is presented that nursing regulation needs more consistency and collaboration in Canada. Several examples are used to illustrate this. Fragmentation of regulation is explored and regulatory disciplinary processes are examined in relation to some countries with similar professional structures. The impact of changes in the regulatory status of complementary and alternative health practitioners on nursing is also critiqued. We provide recommendations for future policy and practice to better pave the way for nursing scope and regulatory clarity.