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Use of virtual reality in managing paediatric procedural pain and anxiety: An integrative literature review

Abstract

Aims

This integrative review aimed to identify, analyse and synthesise studies investigating the clinical efficacy of virtual reality (VR) distraction for children undergoing varying painful and anxiety-inducing medical procedures across different hospital settings and to identify implications for research and clinical practice.

Background

Virtual reality has been leveraged as a distraction tool in the healthcare setting to help patients manage procedural pain and anxiety. Initial studies in the burn wound care setting using VR as a non-pharmacological analgesia led to the use of VR during other medical procedures.

Design

An integrative review of the literature was conducted following the PRISMA guidelines across four electronic databases. Published studies between 2000 and 2020 investigating the clinical efficacy of VR in managing paediatric procedural pain or anxiety were included for review.

Results

Reviewed studies collectively included 2,174 patients aged 6 months-18 years used VR during burn wound care, post-burn physiotherapy, dental, needle-related and other procedures. Additionally, ten studies included samples with adults, for which paediatric data could not be isolated (n = 507). Overall, studies supported the efficacy of VR in managing procedural pain and anxiety in the paediatric setting.

Conclusion

Virtual reality is redefining pain management by immersing children in a virtual world, reducing pain and anxiety at the hospital. A notable gap was the neglected use of VR in children with chronic conditions receiving orthopaedic procedures as part of their standard care.

Relevance to Clinical Practice

Ultimately, VR distraction will reduce the fear associated with medical interventions, preventing increased pain sensitivity, exacerbated anxiety and healthcare avoidance in adulthood. Nurses will play an important role in ensuring the smooth integration of VR in clinical practice by championing the technology and transferring evidence-based methods for VR use.

Defining CD4 T helper and T regulatory cell endotypes of progressive and remitting pulmonary sarcoidosis (BRITE): protocol for a US-based, multicentre, longitudinal observational bronchoscopy study

Por: Koth · L. L. · Harmacek · L. D. · White · E. K. · Arger · N. K. · Powers · L. · Werner · B. R. · Magallon · R. E. · Grewal · P. · Barkes · B. Q. · Li · L. · Gillespie · M. · Collins · S. E. · Cardenas · J. · Chen · E. S. · Maier · L. A. · Leach · S. M. · OConnor · B. P. · Hamzeh · N. Y.
Introduction

Sarcoidosis is a multiorgan granulomatous disorder thought to be triggered and influenced by gene–environment interactions. Sarcoidosis affects 45–300/100 000 individuals in the USA and has an increasing mortality rate. The greatest gap in knowledge about sarcoidosis pathobiology is a lack of understanding about the underlying immunological mechanisms driving progressive pulmonary disease. The objective of this study is to define the lung-specific and blood-specific longitudinal changes in the adaptive immune response and their relationship to progressive and non-progressive pulmonary outcomes in patients with recently diagnosed sarcoidosis.

Methods and analysis

The BRonchoscopy at Initial sarcoidosis diagnosis Targeting longitudinal Endpoints study is a US-based, NIH-sponsored longitudinal blood and bronchoscopy study. Enrolment will occur over four centres with a target sample size of 80 eligible participants within 18 months of tissue diagnosis. Participants will undergo six study visits over 18 months. In addition to serial measurement of lung function, symptom surveys and chest X-rays, participants will undergo collection of blood and two bronchoscopies with bronchoalveolar lavage separated by 6 months. Freshly processed samples will be stained and flow-sorted for isolation of CD4 +T helper (Th1, Th17.0 and Th17.1) and T regulatory cell immune populations, followed by next-generation RNA sequencing. We will construct bioinformatic tools using this gene expression to define sarcoidosis endotypes that associate with progressive and non-progressive pulmonary disease outcomes and validate the tools using an independent cohort.

Ethics and dissemination

The study protocol has been approved by the Institutional Review Boards at National Jewish Hospital (IRB# HS-3118), University of Iowa (IRB# 201801750), Johns Hopkins University (IRB# 00149513) and University of California, San Francisco (IRB# 17-23432). All participants will be required to provide written informed consent. Findings will be disseminated via journal publications, scientific conferences, patient advocacy group online content and social media platforms.

Interprofessional collaboration in connection with a medical ship: nurses’ experiences

Abstract

Aims and objectives

To describe nurses´ experiences of interprofessional collaboration (IPC) in connection with a medical ship offering primary health care in Papua New Guinea.

Background

More than a third of the population in Papua New Guinea are living in severe poverty, resulting in serious and fatal diseases. Due to rough terrain and lack of infrastructure, most of them cannot benefit from health care in the cities. Thus, a medical ship is used since the sea route is one of the few possible ways to reach the people.

Design

A qualitative study with an inductive and descriptive approach was performed, and content analysis of the data was used.

Methods

In January 2018, eleven nurses from seven countries were interviewed onboard the medical ship assessing their experiences when performing IPC. The COREQ checklist for qualitative studies was applied in the conduct and reporting of this study.

Results

Three generic categories emerged: Nurses’ motivation to achieve the common goal of doing good using IPC; Nurses’ view of performing IPC within special conditions; and Nurses’ perception of their role in IPC. Overall, the IPC was perceived by the nurses as well functioning. Having a common goal, positive mindset and effective communication improved the team's collaboration. When these aspects were accomplished, the chances of overcoming the challenge of working in new circumstances and limited space with a newly formed team were increased.

Conclusion

Good collaboration within an interprofessional team required repeated sharing of information. This demonstrates the importance of communication and engagement to overcome existing challenges when working interprofessionally.

Relevance to clinical practice

This study recommends the establishment of IPC for similar contexts such as onboard Youth With a Mission and ashore, as well as in disaster situations or home care where the healthcare professional must collaborate and adapt to new circumstances and prevailing situations.

Cover Images

Cover Images

The cover image © Shriners Hospitals for Children‐Canada is based on the Original Article The day‐to‐day experiences of caring for children with Osteogenesis Imperfecta : A qualitative descriptive study by Aimee Castro, Argerie Tsimicalis et al.,https://doi.org/10.1111/jocn.15310..


The day‐to‐day experiences of caring for children with Osteogenesis Imperfecta: A qualitative descriptive study

Abstract

Aims and objectives

To explore the day‐to‐day experiences of family caregivers who are caring for children with Osteogenesis Imperfecta (OI).

Background

Osteogenesis Imperfecta is a rare genetic condition known to cause bone fragility. Family caregivers of children with OI play an important role in helping these children live well at home.

Design

A qualitative descriptive design was used.

Methods

A qualitative descriptive study was conducted in accordance with the COREQ guidelines. Adult family caregivers (n  = 18) of children with OI were recruited from a university‐affiliated, paediatric orthopaedic hospital in Montreal, Canada. Individual interviews were conducted, transcribed verbatim and inductively thematically analysed.

Results

Osteogenesis Imperfecta family caregiving entailed: (a) managing regular day‐to‐day caregiving activities, including morning routines, evening routines and the facilitation of their child's mobilisation; (b) coping with periods that made the caregiving routine more challenging, such as fractures, surgeries and pain; and (c) devising long‐term strategies to support day‐to‐day care, such as managing the environment, accessing medical and school resources, and coordinating care and respite.

Conclusions

The day‐to‐day routine of caring for a child with OI may be disrupted by challenging periods and improved by long‐term strategies developed to ease day‐to‐day care. These strategies suggest future directions for clinicians and policymakers to improve health services and caregiver well‐being.

Relevance to clinical practice

Clinical, policy and research endeavours need to incorporate new interventions to support the needs of family caregivers. These recommendations may be relevant to other clinicians and policymakers working with families living with rare and chronic physical conditions.

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