Throughout the trajectory of the cancer experience, children and adolescents will likely face pain and anxiety in a variety of circumstances. Integrative therapies may be used either alone or as an adjunct to standard analgesics. Children are often very receptive to integrative therapies such as music, art, guided imagery, massage, therapeutic play, distraction, and other modalities (Doellman, 2003). The effect of integrative modalities on pain and anxiety in children with cancer has not been systematically examined across the entire cancer experience. An in-depth search of PubMed, CINAHL, MedLine, PsychInfo, and Web of Science, integrative medicine journals, and the reference lists of review articles using the search terms pain, anxiety, pediatric, child*, oncology, cancer, neoplasm, complementary, integrative, non-conventional, and unconventional yielded 164 articles. Of these, 25 warranted full-text review. Cohen’s d calculations show medium (d=.70) to extremely large (8.57) effect sizes indicating that integrative interventions may be very effective for pain and anxiety in children undergoing cancer treatment. Integrative modalities warrant further study with larger sample sizes to better determine their effectiveness in this population.

Decreased mean scores for outcome measures indicate that Reiki therapy did decrease pain, anxiety, heart, and respiratory rates, but small sample size deterred statistical significance. This preliminary work suggests that complementary methods of treatment such as Reiki may be beneficial to support traditional methods to manage pain and anxiety in children receiving palliative care.

Introduction The 2011 IOM report stated that pain management in children is often lacking especially during routine medical procedures. The purpose of this review is to bring a developmental lens to the challenges in assessment and non-pharmacologic treatment of pain in young children. Method A synthesis of the findings from an electronic search of PubMed and the university library using the keywords pain, assessment, treatment, alternative, complementary, integrative, infant, toddler, preschool, young, pediatric, and child was completed. A targeted search identified additional sources for best evidence. Results Assessment of developmental cues is essential. For example, crying, facial expression, and body posture are behaviors in infancy that indicate pain: However in toddlers these same behaviors are not necessarily indicative of pain. Preschoolers need observation scales in combination with self-report while for older children self-report is the gold standard. Pain management in infants includes swaddling and sucking. However for toddlers, preschoolers and older children, increasingly sophisticated distraction techniques such as easily implemented non-pharmacologic pain management strategies include reading stories, watching cartoons, or listening to music. Discussion A developmental approach to assessing and treating pain is critical. Swaddling, picture books, or blowing bubbles are easy and effective when used at the appropriate developmental stage and relieve both physical and emotional pain. Untreated pain in infants and young children may lead to increased pain perception and chronic pain in adolescents and adults. Continued research in the non-pharmacological treatment of pain is an important part of the national agenda.

Objective To calculate the effect of Reiki therapy for pain and anxiety in randomized clinical trials. Data Sources A systematic search of PubMed, ProQuest, Cochrane, PsychInfo, CINAHL, Web of Science, Global Health, and Medline databases was conducted using the search terms pain, anxiety, and Reiki. The Center for Reiki Research was also examined for articles. Study Selection Studies that used randomization and a control or usual care group, used Reiki therapy in one arm of the study, published in 2000 or later in peer-reviewed journals in English, and measured pain or anxiety were included. Results After removing duplicates, 49 articles were examined and 12 articles received full review. Seven studies met the inclusion criteria: four articles studied cancer patients; one examined post-surgical patients; and two analyzed community dwelling older adults. Effect sizes were calculated for all studies using Cohen’s d statistic. Effect sizes for within group differences ranged from d=0.24 for decrease in anxiety in women undergoing breast biopsy to d=2.08 for decreased pain in community dwelling adults. The between group differences ranged from d=0.32 for decrease of pain in a Reiki versus rest intervention for cancer patients to d=4.5 for decrease in pain in community dwelling adults. Conclusions While the number of studies is limited, based on the size Cohen’s d statistics calculated in this review, there is evidence to suggest that Reiki therapy may be effective for pain and anxiety. Continued research using Reiki therapy with larger sample sizes, consistently randomized groups, and standardized treatment protocols is recommended.

Introduction Chronic illness effects one in ten adolescents worldwide. Adolescence involves a desire for autonomy from parental control and the necessity to transition care from parent to child. This review investigates the transition to adolescent self‐management of chronic illness treatment behaviors in the context of parent‐adolescent relationships. Methods A systematic search of PubMed, CINAHL, and Web of Science was conducted from earliest database records to early June 2017. Articles were included if they focused on adolescents, addressed illness self‐management, discussed the parent‐adolescent relationship, and were published in English. Articles were excluded if the chronic illness was a mental health condition, included children younger than 10 years of age, or lacked peer review. Results Nine studies met inclusion criteria. Outcomes included challenges to adolescent self‐management, nature of the parent‐adolescent relationship, illness representation, perceptions of adolescent self‐efficacy in compliance, medical decision making, laboratory measures, and adolescent self‐management competence. Across diagnoses, parents who were available to monitor, be a resource, collaborate with their adolescent, and engage in ongoing dialogue were key in the successful transition to autonomous illness management. Conclusions There is a paucity of research addressing the experiences of adolescents in becoming experts in their own care.

Results provide important information on the complexity of disease processes for children referred to palliative care, types of illnesses referred, survival, and pain levels. Results reflect earlier referral to palliative care for most children and highlight the medical complexity especially for children with congenital and genetic diagnoses.

Self-care is something nurses know they should do, but do they? While attending national End-of-Life Nursing Education Consortium train-the-trainer courses, attendees have an opportunity to participate in a 1-hour self-care session, sharing personal stories of how they and their organizations participate in this care, admitting barriers in taking good care of themselves, and talking about the importance and challenges of finding balance in life. During a period of 13 months, 605 nurses who attended one of nine national End-of-Life Nursing Education Consortium courses responded to a survey about self-care that was developed by End-of-Life Nursing Education Consortium investigators and faculty. The nurses, who filled out the survey voluntarily, ranged in age from 22 to 78 years and had between 0 and 58 years of nursing experience. The respondents practiced in all types of healthcare settings from hospices to hospitals, skilled nursing facilities, schools of nursing, and in critical care, pediatrics, geriatrics, oncology, hospice, palliative care, and medical/surgical settings. The purpose of this article was to share the descriptions of self-care among End-of-Life Nursing Education ConsortiumYtrained nurses. It is important that palliative care nurses practice self-care so they can, in turn, provide excellent care for others.

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