A systematic review of cross-cultural comparison studies of child, parent, and health professional outcomes associated with pediatric medical procedures.

UNLABELLED: The purpose of this review was to evaluate systematically all published and unpublished research concerning culture and medical procedural pain in children. Databases, reference lists, and electronic list servers were searched as data sources. Fifteen studies met the inclusion criteria. Most studies (80%) were conducted solely in the United States comparing Caucasian American groups to other local subculture(s) (ie, African American, Hispanic, or Japanese). The studies compared, cross culturally, pediatric pain-related outcomes in children, parents and/or health professionals. The medical procedural experiences included surgery, immunization, spinal tap, bone marrow aspiration, needle procedures, orthopedic, and wound-related injuries. The evidence published to date suggests that cultural factors may be associated with children's pain experiences when elicited by medical procedural pain, specifically children's pain behavior. Nevertheless, research using more sophisticated research methods is needed to develop culturally sensitive behavioral pain measures. Measures that include physiological pain parameters in addition to other behavioral outcomes may be helpful. Culturally comparative research would benefit from the use of theoretical frameworks to advance our understanding of the cultural underpinnings of child pain development and guide future research. PERSPECTIVE: The current evidence supports that children and parents belonging to cultural minority groups, and in need of health care, are a vulnerable population. Together, researchers and clinicians are encouraged to explore this understudied area, and take advantage of sophisticated methods developed by disciplines like cross-cultural psychology.

Spirituality, religion, and pain.

Understanding the relationships between spirituality and health has become increasingly important in health research, including nursing research. Very little of the research thus far has focused on spirituality, religion, and pain even though spiritual views have been intertwined with beliefs about pain and suffering throughout history. Spiritual views can have a substantial impact on patients' understanding of pain and decisions about pain management. The author reviews the research literature on spirituality and pain from a historical perspective. The analysis is concerned with how spirituality and religion have been used to construct a meaning of pain that shapes appraisal, coping, and pain management. The clinical implications include respectful communication with patients about spirituality and pain, inclusion of spirituality in education and support programs, integration of spiritual preferences in pain management where feasible and appropriate, consultation with pastoral care teams, and reflection by nurses about spirituality in their own lives. A discussion of research implications is included.

Reflections on ... writing for successful publication.

BACKGROUND: Most writers feel stuck at some point in the writing process. These reflections are based on what occupational therapists and others have learned from their own experiences about writing papers and publishing their work in peer-reviewed journals. METHOD: In 2004, I invited students and colleagues to send me their top three writing strategies to prepare for an interactive workshop on writing for publication. These writing strategies were later posted on a website and sent to everyone whom I had initially contacted. RESULTS: The writing strategies began with choosing the topic and moving the writing along through the submission process. They concluded with responding to feedback from reviewers and building one's writing skills. PRACTICE IMPLICATIONS: These reflections may provide other writers with ways to pursue their writing projects.

Dalhousie dyspnea scales: construct and content validity of pictorial scales for measuring dyspnea.

BACKGROUND: Because there are no child-friendly, validated, self-report measures of dyspnea or breathlessness, we developed, and provided initial validation, of three, 7-item, pictorial scales depicting three sub-constructs of dyspnea: throat closing, chest tightness, and effort. METHODS: We developed the three scales (Throat closing, Chest tightness, and Effort) using focus groups with 25 children. Subsequently, seventy-nine children (29 children with asthma, 30 children with cystic fibrosis. and 20 children who were healthy) aged 6 to 18 years rated each picture in each series, using a 0-10 scale. In addition, each child placed each picture in each series on a 100-cm long Visual Analogue Scale, with the anchors "not at all" and "a lot". RESULTS: Children aged eight years or older rated the scales in the correct order 75% to 98% correctly, but children less than 8 years of age performed unreliably. The mean distance between each consecutive item in each pictorial scale was equal. CONCLUSION: Preliminary results revealed that children aged 8 to 18 years understood and used these three scales measuring throat closing, chest tightness, and effort appropriately. The scales appear to accurately measure the construct of breathlessness, at least at an interval level. Additional research applying these scales to clinical situations is warranted.

In the eye of the dragon: women's experience of breast cancer and the occupation of dragon boat racing.

BACKGROUND: Women with breast cancer are at risk of developing lymphedema following surgical and/or medical treatment of the disease. Recently, women have challenged traditional advice about limiting upper extremity activity to prevent lymphedema by participation in dragon boat racing. PURPOSE: In this qualitative pilot study, three women were interviewed about the meaningfulness of dragon boat racing in their lives. METHODS: The women were interviewed twice and their interviews analyzed using thematic analysis. RESULTS: Seven themes are discussed: attraction of dragon boat racing; physical and emotional well-being; competition; social support; transcendence/connectedness/oneness; re-occurrence of cancer; and, public awareness. Competition enabled the participants to rebuild self-confidence and to regain control over their physical health and emotional well-being. Balancing support and competition was key to finding satisfaction in this occupation. The women did not believe that dragon boat racing affected their risk for developing lymphedema. PRACTICE IMPLICATIONS: People who engage in the occupation of dragon boat racing find it meaningful and develop new coping strategies. Participating in dragon boat racing can decrease stress and shift the meaning of having breast cancer to a more positive view of the experience.

Reflections on: "So... what do you do?" Occupation and the construction of identity.

BACKGROUND: What we do has always played a leading part in social conversations about who we are. In part, these social questions are about occupational identity. PURPOSE AND METHOD: Occupational identity is an emerging concept in the occupational therapy literature. In this paper, the concept of occupational identity is examined through the observations of a former research participant in a previous study on the meaning of gardens and gardening in daily life, and the recent work of researchers in occupational therapy and occupational science. RESULTS: Three themes are examined in these reflections. They are occupation and continuity of occupational identity, the contributions of productivity, leisure and self-care to occupational identity and, the public and private aspects of occupational identity. PRACTICE IMPLICATIONS: Exploration with a client about what occupations are most meaningful in her or his life may be a means to understanding the person's construction of an occupational identity. Understanding the nature of the client's occupational identity may be a necessary beginning to developing a collaborative approach to what is needed in occupational therapy intervention.

The social context of neonatal pain.

Neonatal pain and neonatal pain management occurs in a social context and is influenced by this context. Changes in the practice of pain management have clearly occurred over the last 20 years. Changes have occurred because of the confluence of scientific research and lobbying, primarily by parents. Although the standard of care for neonatal pain has risen dramatically in the past 20 years, much remains to be done. Procedure pain appears to be a continuing issue, and pain in the cognitively handicapped neonate has not been addressed. Research on the social context of pain is almost entirely lacking.

Spirituality unplugged: a review of commonalities and contentions, and a resolution.

Spirituality is an important and essential component of occupational therapy, but recent publications in occupational therapy literature also raise questions about the adequacy of the Canadian Association of Occupational Therapists' definition of spirituality and the relationship of spirituality to occupational performance. Re-examination of spirituality and occupation is needed to better understand the role of occupational therapists with respect to spirituality. In this paper, the authors examine the common themes that are inherent in definitions of spirituality from diverse professional perspectives. The commonalities and contentions inherent in these definitions are then contrasted with the perspectives of occupational therapists. This discussion is followed by a challenge for re-examination of spirituality in the Canadian Model of Occupational Performance, and an argument that occupational identity rather than spirituality should have a central position. The implications of spirituality and occupational identity for evidence-based occupational therapy are considered.