Psychometric evaluation of the Chinese version of the state anxiety scale for children

A noninferiority trial on information-based video versus self-selected video distraction technique for preoperative anxiety reduction in school children: Prepare trial

BACKGROUND

Distraction techniques using smartphones to watch cartoon videos and play videogames have been successfully used to reduce preoperative anxiety in school children. However, the literature about the use of video-based preoperative information technique for anxiety reduction in that age group still remains understudied with conflicting results. We hypothesized that there would be no meaningful difference in anxiety score at induction period between the information-based video versus self-selected video distraction technique.

METHODS

Eighty-two children between 6 and 12 years undergoing surgery were randomized to self-selected video (n = 41) and information-based video (n = 41) distraction group in this prospective, randomized, noninferiority trial. Children in self-selected video group were shown video of their choice using smart phones, while children in the information-based video group were shown video of operation theater (OT) set up and induction procedure. The children were taken inside operating room along with parents watching the respective videos. Modified Yale Preoperative Anxiety Scale (m-YPAS), just before induction of anesthesia was recorded as the primary outcome. Induction compliance checklist score, anxiety of the parents, and short-term postoperative outcomes in 15 days (telephonically) were recorded as secondary outcomes.

RESULTS

The mean difference in the baseline mYPAS score (95% CI) between the two groups was -2.7 (-8.2 to 2.8, p = .33) and -6.39 (-12.74 to -0.44, p = .05) just before the induction period. The upper bound of the 95% CI did not cross the value of 8, which was the noninferiority margin decided prior to study commencement. 70.73% cases had perfect induction in the self-selected video distraction group, compared to 68.29% in the information-based video group. After 15 days of postoperative follow-up, participants in the self-selected video group had a larger proportion of negative outcomes (53.7%) compared to information-based video group (31.7%), p = .044.

CONCLUSION

Information-based technique using smart phone is non inferior to self-selected video-based distraction-based technique in decreasing PA with an additional advantage of decreasing postoperative short-term negative outcomes.

TRIAL REGISTRATION

CTRI identifier: CTRI/2020/03/023884.

Emotional intelligence mediates the protective role of the orbitofrontal cortex spontaneous activity measured by fALFF against depressive and anxious symptoms in late adolescence

As a stable personality construct, trait emotional intelligence (TEI) refers to a battery of perceived emotion-related skills that make individuals behave effectively to adapt to the environment and maintain well-being. Abundant evidence has consistently shown that TEI is important for the outcomes of many mental health issues, particularly depression and anxiety. However, the neural substrates involved in TEI and the underlying neurobehavioral mechanism of how TEI reduces depression and anxiety symptoms remain largely unknown. Herein, resting-state functional magnetic resonance imaging and a group of behavioral measures were applied to examine these questions among a large sample comprising 231 general adolescent students aged 16-20 years (52% female). Whole-brain correlation analysis and prediction analysis demonstrated that TEI was negatively linked with spontaneous activity (measured with the fractional amplitude of low-frequency fluctuations) in the bilateral medial orbitofrontal cortex (OFC), a critical site implicated in emotion-related processes. Furthermore, structural equation modeling analysis found that TEI mediated the link of OFC spontaneous activity to depressive and anxious symptoms. Collectively, the current findings present new evidence for the neurofunctional bases of TEI and suggest a potential "brain-personality-symptom" pathway for alleviating depressive and anxious symptoms among students in late adolescence.

Comparison of psychosocial adaptations among childhood cancer survivors, their siblings and peers in Taiwan

PURPOSE

This study aimed to understand the difference in psychosocial adaptation among childhood cancer survivors, their healthy siblings and peers, and the factors affecting the psychosocial adaptation of these cancer survivors.

DESIGN AND METHODS

A total of 222 children (ages 8-17) including childhood cancer survivors, their siblings, and healthy peers participated in this cross-sectional study. All the children completed the anxiety and quality of life scales for their age groups.

RESULTS

Anxiety levels and quality of life were similar among the childhood cancer survivors, their siblings, and their peers. The anxiety of elementary school-age survivors of acute leukemia was higher than that of those with solid tumors. Elementary school-age survivors who completed three or more years of treatment had lower anxiety than those who completed treatment within the three years. For adolescent survivors, the higher their body mass index, the higher their anxiety, which was associated with low quality of life. Those diagnosed with anxiety and at an older age had lower quality of life.

CONCLUSIONS

Although there were no differences in survivors' psychosocial adaptation compared to their siblings and healthy peers, more than half of these adolescents had moderate to severe anxiety. Future study may need to explore the causes of their anxiety.

PRACTICE IMPLICATIONS

During the follow-ups of the childhood cancer survivors, age-specific adaptive strategies can be discussed to reduce their anxiety and improve their quality of life.

Stress and the brain: Perceived stress mediates the impact of the superior frontal gyrus spontaneous activity on depressive symptoms in late adolescence

Identifying factors for the prediction of depression is a long-standing research topic in psychiatry and psychology. Perceived stress, which reflects the tendency to appraise one's life situations as stressful and overwhelming, has emerged as a stable predictor for depressive symptoms. However, the neurobiological bases of perceived stress and how perceived stress influences depressive symptoms in the healthy brain remain largely unknown. Here, we investigated these issues in 217 healthy adolescents by estimating the fractional amplitude of low-frequency fluctuations (fALFFs) via resting-state functional magnetic resonance imaging. A whole-brain correlation analysis showed that higher levels of perceived stress were associated with greater fALFF in the left superior frontal gyrus (SFG), which is a core brain region for cognitive control and emotion regulation-related processes. Mediation analysis further indicated that perceived stress mediated the link between the fALFF in the left SFG and depressive symptoms. Importantly, our results remained significant even when excluding the influences of head motion, anxiety, SFG gray matter structure, and school environment. Altogether, our findings suggested that the fALFF in the left SFG is a neurofunctional marker of perceived stress in adolescents and revealed a potential indirect effect of perceived stress on the association between the SFG spontaneous activity and depressive symptoms.

Feasibility of psychoeducational interventions in managing chemotherapy-associated nausea and vomiting (CANV) in pediatric oncology patients

PURPOSE

Childhood cancer patients often suffer from Chemotheraphy-Associated Nausea and Vomiting (CANV). To alleviate CANV, relaxation techniques and patient education were combined to develop a multidimensional psychoeducational intervention package. The aim of this pilot study was to assess the feasibility of the two major components, namely, (1) relaxation, and (2) patient education, of a psychoeducational intervention, prior to the commencement of the main study.

METHODS

A pre-test-post-test control group design was adopted. Twenty patients were allocated equally to the relaxation group (10 participants) and to the educational group (10 participants). Twenty historical matched control cases were identified to form the control groups. Besides, a process evaluation was adopted to assess the feasibility of the study.

RESULTS

In relation to episodes of vomiting on day 3, a significant difference was detected from the results (X(2) = 8.54, p = 0.036), in that fewer patients in the relaxation group experienced vomiting. A significant difference was not found in both the use of antiemetics and body weight between the groups. All subjects in the intervention groups adhered to the intervention and completed the questionnaire without difficulty. Patients and parents perceived the intervention as being moderately useful.

CONCLUSIONS

Although the beneficial effect of relaxation and education in alleviating CANV was not well-supported statistically, the findings from descriptive data suggest that these interventions promoted the intake of antiemetics as a preventive method. Both interventions and instruments were well-received by the patients and also by their parents.

Perioperative anxiety and postoperative pain in children and adolescents undergoing elective surgical procedures: a quantitative systematic review

AIMS

To examine the relationship between perioperative anxiety and postoperative pain in children and adolescents undergoing elective surgical procedures and the differences in children's perioperative anxiety and postoperative pain among subgroups of demographics.

BACKGROUND

While anxiety and pain are regarded as two common problems experienced by children and adolescents perioperatively and the relationship between them has been reported in previous studies, there has been no review paper examining this phenomenon.

DESIGN

A quantitative systematic review.

DATA SOURCES

Nine electronic databases were searched for studies published in English from the inception date of the databases to December 2010, using various combinations of search terms of 'adolescents', 'anxiety', 'child', 'pain', 'surgery' and 'correlation/relationship'.

REVIEW METHODS

Using the Joanna Briggs Institute's comprehensive systematic review strategies, relevant studies were independently appraised and extracted by two reviewers using the standardized critical appraisal instruments and data extraction tool from Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument.

RESULTS

Ten studies were included in this review from 943 studies initially retrieved. Children and adolescents who had higher level of perioperative anxiety experienced a higher level of postoperative pain. Inconclusive evidence was found regarding differences of perioperative anxiety and postoperative pain between demographic subgroups of gender, age and past surgical experience.

CONCLUSION

Results of this review inform healthcare providers of the role perioperative anxiety plays on children's and adolescents' postoperative pain and indicate the need to use interventions to reduce perioperative anxiety and, therefore, optimize their postoperative pain management during the perioperative period.

Exploring influencing factors of postoperative pain in school-age children undergoing elective surgery

PURPOSE

The purpose of this study was to examine the influencing factors of postoperative pain among children undergoing elective surgery.

DESIGN AND METHODS

A survey was conducted in 2011 with a convenience sample of 66 children, 6 to 14 years old, in a tertiary hospital in Singapore.

RESULTS

Children experienced moderate preoperative anxiety and postoperative pain. Gender, preoperative anxiety, and negative emotional behaviors were significant influencing factors for postoperative pain. Boys reported less postoperative pain than girls.

PRACTICE IMPLICATIONS

Effective strategies for assessing and managing children's preoperative anxiety are needed to achieve an optimal postoperative pain management outcome.

Anxiety and pain in children undergoing elective surgical procedures: a systematic review

BACKGROUND

Anxiety and pain are two significant problems experienced by children undergoing elective surgical procedures, which may lead to suboptimal postoperative outcomes. Previous studies have shown a correlation between perioperative anxiety and pain in children.

OBJECTIVES

This review aimed to present the best available evidence on the correlation between perioperative anxiety and pain in children undergoing elective surgical procedures, and to determine the relationship between children's demographics, their anxiety and pain level in the perioperative period.

INCLUSION CRITERIA

Participants were children aged between five to 18 years old who were scheduled for an elective surgical procedure in the hospital setting.No specific intervention was of interest. So long as the primary studies examined correlation of children's anxiety and pain in the perioperative period, they were considered for inclusion.This review focused on children's preoperative level of anxiety; children's postoperative level of anxiety; children's postoperative pain intensity; and/or children's postoperative behavioural changes.This review included quantitative research studies, such as randomised-controlled trials, cohort studies, and descriptive studies which addressed the correlation between perioperative anxiety and perioperative pain in children undergoing elective surgical procedures.

SEARCH STRATEGY

A three-step search strategy was utilised in this review. The following databases were searched for articles published in English from the inception date of databases to December 2010: CINAHL, PubMed, Scopus, PsycINFO, Mednar, Trip Database, ProQuest Dissertations and Theses, Scirus ETD and Web of Science.

METHODOLOGICAL QUALITY

Papers selected for retrieval were assessed independently by two reviewers for methodological quality prior to inclusion in the review using standardised critical appraisal tools from Joanna Briggs Institute. There were no disagreements between the two reviewers, so the third reviewer was not required.

DATA EXTRACTION

Data were extracted using the standardised data extraction tools: the Joanna Briggs Institute Meta-Analysis Statistics Assessment and Review Instrument (JBI-MAStARI) for randomised-controlled trials, cohort studies, and descriptive/case series.

DATA SYNTHESIS

Since the ten included studies used various study designs and outcome measures for the levels of anxiety and pain, this made meta-analysis impossible and therefore the findings were summarised and presented in narrative form.

RESULTS

This review included two randomised-controlled trials, two cohort studies, five observational descriptive studies and one descriptive survey study. Eight studies revealed that children who had higher levels of pre- and post-operative anxiety experienced a higher level of post-operative pain. Pearson correlation coefficients of these eight studies were reported in the findings, with coefficients ranging between r = 0.29 (p < 0.05) to r = 0.57 (p < 0.001). There is no conclusive evidence supporting the relationships of children's demographics characteristics (i.e. gender, age and past surgical experience) and their perioperative anxiety and pain.

CONCLUSION

Children who had higher levels of pre- and post-operative anxiety experienced a higher level of post-operative pain. The review results inform healthcare providers of the role perioperative anxiety plays on paediatric postoperative pain.This evidence serves to generate implications for clinical practice and future studies in order to better manage children's perioperative anxiety and eventually improve their postoperative pain management. However, this review revealed insufficient evidence supporting the correlation between children's demographic data, namely gender, age and past surgical experience and their perioperative anxiety and pain.

IMPLICATIONS FOR PRACTICE

Children's perioperative anxiety should be routinely assessed prior to procedures in the clinical setting. This review also recommends that interventions be developed and implemented so as to reduce pain and anxiety for children during the perioperative period.

IMPLICATIONS FOR RESEARCH

Future studies are needed to examine the effectiveness of different interventions in reducing children's perioperative anxiety and pain, and to examine the relationship between anxiety and pain in other settings and countries. Future research should also be directed towards developing a reliable, shorter and practical anxiety assessment tool.

Relationships among mental health, self-esteem and physical health in Chinese adolescents: an exploratory study

This study explored the relationships among mental health, self-esteem and physical health in Hong Kong Chinese adolescents. Chinese students (N = 1945) between the ages of 12 and 19 from four secondary schools of different regions were invited to participate in the study. This study revealed that a significant number of adolescents in Hong Kong are experiencing depressive symptoms. The overall results indicated that self-esteem of adolescents was correlated to and a predictor of their physical and mental health. Health care professionals should take a more assertive role in promoting relevant health education to the community with emphasis on helping adolescents develop positive self-esteem.

Effectiveness and appropriateness of therapeutic play intervention in preparing children for surgery: a randomized controlled trial study

PURPOSE

This paper aims to examine the effectiveness and appropriateness of using therapeutic play in preparing children for surgery.

DESIGN/METHOD

A randomized controlled trial was employed. Children (7-12 years of age; n = 203) admitted for surgery during a 13-month period were recruited.

RESULTS

The results support the effectiveness and appropriateness of using therapeutic play in preparing children for surgery.

PRACTICE IMPLICATIONS

The study results promote awareness in nurses and parents that play is a very important part of children's lives, and heighten the importance of integrating therapeutic play as an essential component of holistic and quality nursing care to prepare children for surgery.

Evaluating the effectiveness of preoperative interventions: the appropriateness of using the children's emotional manifestation scale

AIMS

This study aimed to compare the effectiveness of two preoperative nursing interventions and examining the appropriateness of using the Children's Emotional Manifestation Scale in evaluating the effectiveness of preoperative interventions.

BACKGROUND

There is some evidence that the Children's Emotional Manifestation Scale can be used as an objective assessment tool in documenting children's emotional responses. However, it is uncertain from previous study that whether the scale can be used in evaluating the effectiveness of preoperative interventions.

DESIGN

A randomized controlled trial, between subjects design was carried out in a well-established day surgery unit.

METHOD

Children (7-12 years of age; n = 203) admitted for elective day surgery during a 13-month period, were recruited. By using a simple randomization method, 97 of children were assigned to the experimental group receiving therapeutic play intervention and 106 children were assigned to the control group receiving routine information preparation.

RESULTS

Children receiving therapeutic play preparation reported statistically significant lower anxiety levels, fewer negative emotions and lower heart rates and mean arterial blood pressures than children receiving information preparation. Children with high preoperative anxiety levels manifested more negative emotional behaviour during anaesthesia induction and were associated with faster heart rates and higher mean blood pressures.

CONCLUSION

The study demonstrates the appropriateness of using the Children's Emotional Manifestation Scale in evaluating the effectiveness of preoperative nursing interventions and presents clear evidence to support the effectiveness of therapeutic play intervention in preparing children for surgery when compared with the information preparation approach.

RELEVANCE TO CLINICAL PRACTICE

This study contributes towards enriching the experience of using child-sensitive research tools in evaluating the effectiveness of preoperative nursing interventions. The findings heighten the awareness of the importance of integrating therapeutic play as an essential component of holistic and quality nursing care to prepare children for surgery.

Effects of preoperative therapeutic play on outcomes of school-age children undergoing day surgery

The purpose of this study was to examine the effects of therapeutic play on outcomes of children undergoing day surgery. Two hundred and three children admitted for day surgery were invited to participate in a randomized controlled trial. The experimental group received therapeutic play; the control group received routine information preparation. Children in the experimental group reported significantly lower state anxiety scores in pre- and postoperative periods and exhibited fewer negative emotions at induction of anesthesia than children in the control group. No significant differences were found between the two groups in postoperative pain. The study provides some evidence that therapeutic play is effective in pre- as opposed to postsurgical management of children.

Maternal Attachment Inventory: psychometric evaluation of the Korean version

AIM

This paper is a report of an assessment of the validity and reliability of the Korean language version of the Maternal Attachment Inventory.

BACKGROUND

Although the Maternal Attachment Inventory has been widely used to measure mother-infant attachment, no psychometric evaluation of the measure with a Korean population has been reported.

METHOD

Data from 196 mothers within 6 weeks postpartum were collected during July to November 2003 and used to evaluate the validity and reliability of the Korean version of the Maternal Attachment Inventory. Validity was examined using exploratory factor analysis, item-to-subscale correlations, and correlations with other theoretically relevant variables (maternal foetal attachment and maternal sensitivity). For reliability testing, Cronbach's alpha coefficients, item analyses, and subscale-to-total correlations were examined.

FINDINGS

Factor analysis showed that the Korean version had three factors explaining 62.9% of the variance. Item-to-subscale correlation coefficients ranged from 0.49 to 0.91. Correlation coefficients between the Maternal Attachment Inventory and both maternal foetal attachment and maternal sensitivity ranged from 0.10 to 0.64. However, correlations between the third factor scores and both maternal foetal attachment scores and maternal sensitivity scores were not statistically significant. Cronbach's alpha coefficients ranged from 0.65 to 0.94. Correlation coefficients of the inter-item analysis ranged from -0.01 to 0.87. Corrected item-total correlation coefficients were 0.31-0.82. Subscale-to-total correlation coefficients of the Maternal Attachment Inventory ranged from 0.52 to 0.92.

CONCLUSION

Most items of the Korean version of the Maternal Attachment Inventory were adequate for measuring mothers' affectionate attachment. The instrument, however, exhibited weaknesses in the psychometric properties related to validity and reliability, particularly regarding the three items included in the third factor. More studies using factor analysis of the Maternal Attachment Inventory are needed.

Development and validation of a short form of the Chinese version of the State Anxiety Scale for Children

BACKGROUND

There is a lack of a simplified instrument for use in busy clinical settings to measure and differentiate anxiety levels of children.

OBJECTIVES

To develop a short form of the Chinese version of the State Anxiety Scale for Children (CSAS-C) and test psychometric properties of the new form.

DESIGN

The study was divided into two phases with phase one aimed at developing a short form of the CSAS-C, while phase two aimed at testing psychometric properties of the new form. A test-retest, within-subjects design was employed. Children (7-12 years of age) admitted for surgery in a day surgery unit during two consecutive years' summer holiday were invited to participate in the study. In phase one, selected participants (N=112) were asked to respond to the CSAS-C. In phase two, selected participants (N=82) were asked to respond to the short form of the CSAS-C.

RESULTS

Using exploratory factor analysis, a subset of 10 items, which was highly correlated with scores obtained from the full form (r=0.92) and, which had acceptable internal consistency (r=0.83) was developed. The psychometric properties of this short form have been empirically tested, showing adequate internal consistency reliability, good concurrent validity, and excellent construct validity.

CONCLUSION

This study addresses a gap in the literature by developing a 10-item short form of the CSAS-C. Results indicate that this short form is an appropriate and objective assessment tool for measuring anxiety levels of Chinese children in a busy clinical setting where time constraints make unfeasible the use of the full form.

Psychoeducational preparation of children for surgery: the importance of parental involvement

OBJECTIVE

To examine the effects of therapeutic play intervention on outcomes of children undergoing day surgery, and to highlight the importance of parental involvement in the psychoeducational preparation of children for surgery.

METHODS

A randomized controlled trial, two group pre-test and repeated post-test, between subjects design was employed. Hong Kong Chinese children (7-12 years of age; n=203) admitted for elective surgery in a day surgery unit, along with their parents during a 13-month period, were invited to participate in the study. By using a simple complete randomization method, 97 of children with their parents were assigned to the experimental group receiving therapeutic play intervention, and 106 children with their parents were assigned to the control group receiving routine information preparation.

RESULTS

The results showed that both children and their parents in the experimental group reported lower state anxiety scores in pre- and post-operative periods. Children in the experimental group exhibited fewer instances of negative emotional behaviors and parents in the experimental group reported greater satisfaction. The results, however, find no differences in children's post-operative pain between the two groups.

CONCLUSION

The study provides empirical evidence to support the effectiveness of using therapeutic play intervention and the importance of parental involvement in the psychoeducational preparation of children for surgery.

PRACTICE IMPLICATIONS

The findings heighten the awareness of the importance of integrating therapeutic play and parental involvement as essential components of holistic and quality nursing care to prepare children for surgery.

The content validity index: are you sure you know what's being reported? Critique and recommendations

Scale developers often provide evidence of content validity by computing a content validity index (CVI), using ratings of item relevance by content experts. We analyzed how nurse researchers have defined and calculated the CVI, and found considerable consistency for item-level CVIs (I-CVIs). However, there are two alternative, but unacknowledged, methods of computing the scale-level index (S-CVI). One method requires universal agreement among experts, but a less conservative method averages the item-level CVIs. Using backward inference with a purposive sample of scale development studies, we found that both methods are being used by nurse researchers, although it was not always possible to infer the calculation method. The two approaches can lead to different values, making it risky to draw conclusions about content validity. Scale developers should indicate which method was used to provide readers with interpretable content validity information.

Assessing children's emotional responses to surgery: a multidimensional approach

AIM

This paper reports a study to assess the interrelationships between physiological measures of children's heart rates and blood pressure, subjective measures of children's level of anxiety, and direct behavioural observations in children's emotional responses to surgery.

BACKGROUND

Psychological upset has been described as a multidimensional phenomenon which includes behavioural, subjective, and physiological components. However, a majority of previous studies have employed only one or two measures of psychological upset. Most importantly, the interrelationships among these three components of psychological upset have seldom been explored.

METHODS

A cross-sectional design was employed, and 106 Chinese children admitted for day surgery during the summer of 2004 were invited to participate in the study. They were asked to respond to the Chinese version of the State Anxiety Scale for Children. Their mean arterial blood pressure and heart rates were recorded in the operating theatre after being transferred to the operating table but before anaesthesia induction. A research nurse used the Children's Emotional Manifestation Scale to document the children's emotional behaviours during anaesthesia induction. The data were collected in 2004.

RESULTS

Children with high preoperative anxiety levels manifested more negative emotional behaviour during anaesthesia induction. Those with more negative emotional behaviour or high levels of state anxiety also had faster heart rates and higher mean arterial blood pressure.

CONCLUSION

A child's response to stressful medical procedures can be varied. The emotional responses of children to surgery need to be understood as a multidimensional phenomenon. To gain a more comprehensive understanding of the effects of surgery on children, it is recommended that assessment strategies used should reflect the multidimensional phenomenon of the emotional upset.

Do trait anxiety and age predict state anxiety of school-age children?

AIM

The aim of this study was to determine whether the trait anxiety scores and age of children could predict their state anxiety scores under stressful and relaxing situations.

BACKGROUND

Surgery can cause considerable stress and anxiety that can have a profound effect on children. It is crucial for nurses to differentiate preoperative anxiety levels in children and to identify those children who are most likely to exhibit high levels of anxiety when undergoing surgery before any intervention can be appropriately planned, provided and evaluated.

METHODS

A test-retest within subjects design was used. Five hundred and nineteen primary school-age children were invited to participate in the study. Participants were asked to respond to the Chinese version of the State-Trait Anxiety Inventory for Children under stressful (pre-academic examination) and relaxing (post-academic examination) situations.

RESULT

Multiple regression analysis showed that the trait anxiety of children was a strong predictor of their state anxiety in a stressful situation but not in a relaxed one. Compared to trait anxiety, age was found to be a weak predictor of the state anxiety of children in either situation.

CONCLUSION

This study confirmed that trait anxiety of children could be predicted from their state anxiety under a stressful situation.

RELEVANCE TO CLINICAL PRACTICE

The trait anxiety scale could be a useful screening tool for nurses to identify those children who are most likely to exhibit high levels of anxiety when undergoing surgery. Understanding the trait anxiety of children in advance could help nurses implement appropriate preoperative psychological intervention that can meet the individual needs of the child and thus promote better recovery.

Children's Emotional Manifestation Scale: development and testing

AIMS AND OBJECTIVES

The objectives of this study were to develop an objective and operationalized behavioural observation scale that can be used to document children's emotional responses during stressful medical procedures, and to test the psychometric properties of this newly developed scale.

BACKGROUND

The availability of a valid and reliable instrument that accurately documents the manifestation of children's emotions prior to undergoing surgery or during stressful medical procedures is crucial before any intervention can be appropriately planned and evaluated. There is a lack of such an instrument with effective psychometric properties in the literature.

DESIGN

A cross-sectional study was employed. A convenience sample of 82 children admitted for day surgery was recruited in this study.

METHOD

Based on systematic literature search, a number of observable emotional behaviours with different levels or intensities were identified. A panel of nurse experts was set up to review this finding and develop the scale. Intra-class correlation was used to estimate the inter-rater reliability coefficient. Internal consistency reliability was assessed by determining the Cronbach's alpha. Content validity was established by six nurse experts' ratings. The validity of the scale was also confirmed by convergent validity.

RESULTS

The results showed that there was adequate inter-rater reliability, high internal consistency reliability, good content validity and excellent convergent validity.

CONCLUSIONS

This study has addressed a gap in the literature by developing an objective tool to document children's emotional responses during stressful medical procedure, which are under-researched in the literature.

RELEVANCE TO CLINICAL PRACTICE

The Children's Emotional Manifestation Scale was developed to provide a simple, objective and consistent method for nurses to document children's emotional behaviour during stressful medical procedures. Clinical nurses can also use this scale to evaluate preoperative interventions directed towards minimizing anxiety and bolstering coping mechanisms in children undergoing surgery.

The reliability and validity of the Chinese version of the trait anxiety scale for children

The availability of a valid and reliable tool that accurately measures and differentiates pre-operative anxiety level of children is crucial before any intervention can be appropriately planned, provided, and evaluated. The purposes of this study were to translate the original Trait Anxiety Scale for Children into Chinese and evaluate the psychometric properties of the newly translated scale for its utility in clinical practice and research. Five hundred and nineteen children from a primary school were recruited for this study. The instrument demonstrated adequate internal consistency reliability, and strong evidence of content and construct validity. Factor analysis confirmed the construct validity of the scale with a good fit between the factor structure of the scale and the observed data. Results suggest that the Chinese version of the Trait Anxiety Scale for Children can be used as a self-report assessment tool in measuring trait anxiety level of Chinese children ages 7-12 years.