Effects of a Clown-Nurse Educational Intervention on the Reduction of Postoperative Anxiety and Pain Among Preschool Children and Their Accompanying Parents in South Korea

Assess the Effect of Detract Technique among Post-operative Toddlers with Cleft Lip and Cleft Palate

Background

Children who undergo surgery frequently experience postoperative pain or POP. Pain experienced by children can be addressed as a basic human right. Because hospitals can be extremely stressful places for families and their children, pain, and discomfort associated with intrusive techniques can lengthen hospital stays for children and lead them to heal more slowly than they would have otherwise. Engaging the kids in intellectual pursuits is one way to use distraction techniques to take their minds off unpleasant stimuli and lessen their suffering.

Purpose

The current study's goal was to evaluate the impact of the distract technique on postoperative infants with cleft lip and palate who were between the ages of 1 and 3 years old.

Materials and Methods

The Saveetha Medical College and Hospital served as the host institution for the quantitative method with a preexperimental investigation.

Sampling Method

Convenience sampling was used to select 60 postoperative children with cleft lip and palate who were between the ages of one and three.

Interventions

One intervention group and a control group were randomly assigned to each of the 60 postoperative youngsters. Distract technique (tactile ball) was started for the intervention group 20 min prior to operation day and continued for 30 days. The first group (the control group) received standard care, which included analgesic medication. The second group (the intervention group) received no analgesic medication and was played with a tactile ball by a nurse who happened to be one of the researchers working in the pediatric unit where the study was conducted. Acetaminophen (10-15 mg/kg) was given to the children in the control group as an analgesic.

Results

The descriptive analysis (P > 0.05) did not reveal any statistically significant differences between the groups.

Medical clowning in hospitalized children: a meta-analysis

BACKGROUND

Medical clowning has been proven effective in reducing pain, anxiety, and stress in many sporadic, usually small-scale studies. Our meta-analysis aims to evaluate the efficiency of medical clowns in reducing pain and anxiety in hospitalized pediatric patients and their parents in different medical fields.

METHODS

A thorough literature search was conducted from different databases, and only randomized controlled trials (RCTs) were included with children aged 0 to 18 years old. A total of 18 studies were included, and statistical analysis was performed on the combined data.

RESULTS

A total of 912 children (14 studies) showed significantly reduced anxiety when procedures were performed with a medical clown compared with the controls (- 0.76 on anxiety score, P < 0.001). Preoperative anxiety was lower in 512 children (nine studies) with clown interventions than in the controls (- 0.78, P < 0.001). The pain scale was completed by 338 participants (six studies), indicating a trend toward reduced pain during procedures performed while the clown was acting compared to controls (- 0.49, P = 0.06). In addition, medical clown significantly (- 0.52, P = 0.001) reduced parental anxiety in 489 participants in ten studies; in six of the ten studies, with a total of 380 participants, medical clown significantly reduced parental preoperative anxiety (P = 0.02).

CONCLUSION

Medical clowns have substantial positive and beneficial effects on reducing stress and anxiety in children and their families in various circumstances in pediatrics.

The effect of finger puppet on pain and emotional manifestation for venous blood collection in the pediatric emergency department: A randomized controlled trial

AIM

To determine the effect of distraction with a finger puppet for venous blood collection in the pediatric emergency department on children's pain and emotional manifestation.

METHODS

Randomized controlled trial with 80 children (aged 3-6 years) who applied to the pediatric emergency department between October 2021 and March 2022. The attention of child was distracted from the procedure by playing with finger puppets before and during the venous blood collection in the finger puppet group. The children in the control group underwent routine blood collection. The procedural pain was measured with the Face, Legs, Activity, Cry, Consolability Scale (FLACC) and the emotional response was measured with the Children's Emotional Manifestation Scale (CEMS).

RESULTS

The mean FLACC pain scores of the children in the finger puppet group were statistically significantly lower than the children in the control group (p < 0.001). It was also found that the finger puppet group's mean scores of CEMS before and during the procedure were statistically lower than those of the control group (p < 0.001).

CONCLUSIONS

Finger puppets can be used to reduce pain and positively change children's emotional responses during painful procedures such as blood collection.

The effect of an interactive robot on children's post-operative anxiety, mobilization, and parents' satisfaction; randomized controlled study

PURPOSE

To evaluate the effect of an interactive robot on Turkish children's post-operative anxiety, mobilization, and parents' satisfaction related to post-operative care.

METHOD

A randomized controlled study was conducted with 84 children who will undergo day surgery aged 5-10 years and their parents at a university hospital between June 2020-April 2022. The interactive robot was provided to accompany the children during the postoperative mobilization. Children in the control group received standard care during mobilization. Data were collected using the Personal Information Form, Children's State Anxiety (CSA), Parental Satisfaction Scale-Visual Analog Scale, and Mobilization Chart.

RESULTS

It was determined that the CSA score of the children in the control group were higher than the intervention group before their first mobilization after surgery (p = 0.005). During the first (p = 0.042) and second (p = 0.012) mobilization, it was determined that the mobilization duration of children in the intervention group was longer than the children in the control group. It was found that the parents of the children in the intervention group had a high level of satisfaction.

CONCLUSION

It has been determined that interactive robots positively affect postoperative mobilization in children undergoing day surgery, reduce the anxiety level of children before mobilization, and increase the duration of mobilization. In addition, the use of interactive robots increased parents' satisfaction with post-operative mobilization care.

PRACTICE IMPLICATIONS

Using interactive robots to reduce the stress and anxiety of children during the perioperative process can be a promising approach to improve their recovery by providing early mobilization.

Effect of Distraction Interventions on Anxiety in Children Undergoing Surgery: A Meta-Analysis

Due to the unfamiliarity of the surroundings, children having surgery endure worry and tension. Untreated anxiety in children impairs postoperative healing and causes changes in postoperative behavior. The purpose of this review was to determine the efficacy of distraction therapies on anxiety in children undergoing surgery. The systematic review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards. PubMed via MEDLINE, CINAHL, ProQuest, Web of Science, and the Cochrane Central Register of Controlled Trials were used to find relevant trials. Full-text papers published in English from January 1, 2000 to December 31, 2021 were included. Children undergoing surgery aged 1 to 18 years were included. A data extraction form was created to extract data from the selected studies. According to the Cochrane risk of bias assessment tool, studies were classified as “low risk,” “high risk,” or “unclear risk.” Review Manager software was used to do a quantitative meta-analysis. Thirteen studies looked at the effect of distraction intervention on children. Nine of them were selected for meta-analysis. The distraction interventions included in this review were: handheld video game, play dough and play with blocks and puzzles, tablet-based interactive distraction, animated video, painting and storytelling, age-appropriate video, distraction with video glasses, watching a movie, and bringing favorite toy during hospital stay. Meta-analysis showed that distraction interventions are effective on preoperative anxiety in children (standardized mean difference = –17.07, 95% confidence interval: 27.11–7.02, p = 0.0009).

Intervention to Reduce Anxiety Pre- and Post-Eye Surgery in Pediatric Patients in South Korea: A Preliminary Quasi-Experimental Study

In this study, we aimed to identify the effect of preoperative information on postoperative anxiety among children undergoing one-day eye surgery. We utilized a nonequivalent control group and a pretest–posttest quasi-experimental design. The participants were 15 children in the experimental group and 15 children in the control group. Preoperative information was provided to the experimental group in the waiting room. Anxiety level was measured using the Children’s Emotional Manifestation Scale and pulse rate. For pulse rate, there were no statistically significant differences between the groups. In the behavioral anxiety response, there were statistically significant differences between the experimental and control groups (Z = −4.15, p < 0.001). The results suggest that the provision of preoperative information can be an effective intervention for reducing postoperative anxiety and improving the health of children undergoing surgery.

Effects of therapeutic clowning on pain and anxiety during venous blood sampling in Turkey: Randomised controlled trial

PURPOSE

The research aim was to investigate the effects of therapeutic clowning on pain and fear during the process of venous blood sampling in children.

DESIGN AND METHODS

This study was conducted in a randomised controlled trial from January to March 2020. The study population consisted of children from 7 to 12 years of age who came to the research centre for blood sampling. The research sample consisted of 166 children (83 in the intervention group and 83 in the control group) who met the research criteria and came to the research centre on a specific date through probable sampling. For the data collection, a questionnaire form, the Visual Analogue Scale and the Children's Fear Scale were used. Therapeutic clowning was used in this process for the intervention group. There was no intervention for children who were in the control group. The calculation of percentage distribution and means, χ² test, analysis of variance analysis in repeated measures and least significant difference and independent t-test were used to analyse the data.

RESULTS

The results of the research indicated that children in the intervention group had significantly lower pain and fear than children in the control group (p < .001). Therapeutic clowning seems to effectively reduce pain and fear during venous blood sampling for children from 7 to 12 years of age. Our results support using therapeutic clowns which is an inexpensive, safe, and effective method for lowering children's pain and fear during venous blood sampling.

PRACTICE IMPLICATIONS

The use of therapeutic clowns could become the standard of care in blood sampling for children from 7 to 12 years of age in hospitals. Therapeutic clowning, which is an easy-to-use, low-cost and practical method to provide better communication and cooperation with the family and the child, can be used as a complementary therapy in all nursing areas, especially in the field of paediatrics. Nurses could be encouraged to be trained on the use of therapeutic humour based upon a standardised approach and offered guidance on how to apply entertaining methods such as clowns. Therapeutic clowning can be examined in other applications in nursing care in light of these results.

Effectiveness of hospital clowns for symptom management in paediatrics: systematic review of randomised and non-randomised controlled trials

OBJECTIVE

To evaluate evidence from randomised controlled trials and non-randomised controlled trials on the effectiveness of hospital clowns for a range of symptom clusters in children and adolescents admitted to hospital with acute and chronic conditions.

DESIGN

Systematic review of randomised and non-randomised controlled trials.

DATA SOURCES

Medline, ISI of Knowledge, Cochrane Central Register of Controlled Trials, Science Direct, Scopus, American Psychological Association PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Latin American and Caribbean Health Sciences Literature.

STUDY SELECTION

Randomised and non-randomised controlled trials were peer reviewed using the following eligibility criteria: children and adolescents who were admitted to hospital for acute conditions or chronic disorders, studies comparing use of hospital clowns with standard care, and studies evaluating the effect of hospital clowns on symptom management of inpatient children and adolescents as a primary outcome.

DATA EXTRACTION AND SYNTHESIS

Two investigators independently screened studies, extracted data, and appraised the risk of bias. Methodological appraisal was assessed by two investigators independently using the Jadad scale, the revised Cochrane risk-of-bias tool for randomised controlled trials (RoB 2), and the risk of bias in non-randomised studies (ROBINS-I) tool for non-randomised controlled trials.

RESULTS

24 studies (n=1612) met the inclusion criteria for data extraction and analysis. Most studies were randomised controlled trials (n=13). Anxiety was the most frequently analysed symptom (n=13), followed by pain (n=9), psychological and emotional responses and perceived wellbeing (n=4), stress (n=4), cancer related fatigue (n=3), and crying (n=2). Five studies used biomarkers, mainly cortisol, to assess stress or fatigue outcome following hospital clowns. Most of the randomised controlled trials (n=11; 85%) were rated as showing some concerns, and two trials were rated with a high risk of bias. Most non-randomised controlled trials (n=6; 55%) were rated with a moderate risk of bias according to ROBINS-I tool. Studies showed that children and adolescents who were in the presence of hospital clowns, either with or without a parent present, reported significantly less anxiety during a range of medical procedures, as well as improved psychological adjustment (P<0.05). Three studies that evaluated chronic conditions showed favourable results for the intervention of hospital clowns with significant reduction in stress, fatigue, pain, and distress (P<0.05).

CONCLUSIONS

These findings suggest that the presence of hospital clowns during medical procedures, induction of anaesthesia in the preoperative room, and as part of routine care for chronic conditions might be a beneficial strategy to manage some symptom clusters. Furthermore, hospital clowns might help improve psychological wellbeing in admitted children and adolescents with acute and chronic disorders, compared with those who received only standard care.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018107099.

Effects of Therapeutic Clowning on Pain and Anxiety During Intrathecal Chemotherapy in Turkey

PURPOSE

The aim of the present study was to explore the effect of therapeutic clowning on pain and anxiety during intrathecal chemotherapy.

DESIGN & METHODS

The study was conducted using a quasi-experimental method with a pretest-posttest control group design. The study sample was composed of children between 7 and 12 years old (N = 78) who had been diagnosed with acute myeloid leukaemia and acute lymphoblastic leukaemia and were undergoing intrathecal chemotherapy in a hospital in Turkey. The study was conducted with children who received services at this hospital. The results were obtained from 74 children (i.e. 36 in the control group, 38 in the clown group). The data were collected with a questionnaire developed by the researchers, the Visual Analogue Scale (VAS) and the Faces Pain Rating Scale (FACES). VAS and FACES were used to measure pain and anxiety levels. Therapeutic clowning was applied to children in the intervention group. Analyses included percentage distributions, mean, chi-square, t-test, variance, and correlation analysis.

RESULTS

Results showed that children in the clown group had significantly lower pain and anxiety than children in the control group (p < .001).

CONCLUSIONS

According to the results, therapeutic clowning was effective in relieving the pain and anxiety of children between the ages of 7 and 12 years who undergone intrathecal chemotherapy.

PRACTICE IMPLICATIONS

Due to its positive effects, therapeutic clowning could be explore for use in other areas of paediatric nursing for the children between the ages of 7 and 12 years as a complementary treatment.

Effects of a posttonsillectomy management program using a mobile instant messenger on parents' knowledge and anxiety, and their children's compliance, bleeding, and pain

PURPOSE

Pediatric tonsillectomy is a highly common surgery for children. The inclusion of tonsillectomy in the diagnosis-related group payment system in Korea has resulted in a shorter hospital stay for patients who undergo tonsillectomy. This, in turn, provides parents with additional caregiver roles in the home.

OBJECTIVES

This study aimed to investigate the effects of a postdischarge management program (PDMP) using Mobile Instant Messenger (MIM) on parents' knowledge and state anxiety about postoperative care, and their children's compliance with care instructions at home, frequency of bleeding, and pain intensity after tonsillectomy.

DESIGN AND METHODS

A nonequivalent control group nonsynchronized design.

SETTINGS AND PARTICIPANTS

Participants were 52 tonsillectomy children aged 3-7 years and their 52 parents (27 for the experimental group and 25 for the control group) from a hospital, in Korea. The control group received a routine written and oral predischarge education, while the experimental group received a predischarge education and a daily MIM for 7 days. For the experimental group, bidirectional communication between the nurse and parent when necessary using MIM are available during the intervention period.

RESULTS

Parents in the experimental group reported a significantly higher knowledge about postdischarge management and lower state anxiety than the control group. Children in the experimental group showed a significantly greater improvement in compliance with the care instructions at home than the control group. However, bleeding frequency and pain intensity were not significantly lower in the experimental group than that in the control group.

PRACTICAL IMPLICATIONS

Nurses play a critical role in preventing and managing the complications of tonsillectomy. Providing proper parental education about pediatric posttonsillectomy care at home is critical for a successful recovery. With the explosion of smartphone technology, the MIM-based PDMP is a useful and effective strategy in helping parents and children in posttonsillectomy care at home.

The information needs of children having clinical procedures in hospital: Will it hurt? Will I feel scared? What can I do to stay calm?

BACKGROUND

Children often have unmet information needs when attending hospital, and this can cause them anxiety and uncertainty. If children are prepared and informed about what will happen during a procedure, they tend to have a better experience. Finding out what children want to know before they attend hospital for procedures could provide significant benefits for children, their families, and healthcare professionals. This study set out to investigate children's perspectives of what information is important and valuable to know before attending hospital for a planned procedure.

METHODS

A "write and tell" activity sheet underpinned a semistructured qualitative interview with children attending hospital for a planned procedure. The interview focussed on the information children thought was important to know before a procedure. Data were analysed using content analysis techniques.

RESULTS

One hundred six children aged between 8 and 12 years old participated in the interviews. The children identified 616 pieces of information they thought would be of value to children attending hospital for procedures. These were inductively coded into three types of information: procedural, sensory, and self-regulation. Children want to know detailed procedural and sensory information to actively construct a script of a procedure and then build on this with information about specific strategies to help them cope with and self-regulate the situation.

CONCLUSION

This study has identified three types of information children recognize as important in preprocedural preparation. Children construct an understanding of a planned procedure through actively scaffolding procedural, sensory, and self-regulation information.

Unstructured play for anxiety in pediatric inpatient care

PURPOSE

The purpose of this study was to examine the effects of unstructured play activities on the anxiety levels of hospitalized children.

METHODS

A nonequivalent control group pretest posttest design was employed for this study. The sample included children (N = 165) ages 4-7 years admitted to a large pediatric referral center in the United Arab Emirates. The control group (n = 84) received usual care, while the experimental group (n = 81) engaged in age-appropriate unstructured play activities using disposable games and toys. Parents and siblings, if present, were encouraged to participate. Research assistants conducted the play activities twice a day, with 30-min morning and evening sessions. Anxiety was measured at baseline and at the end of days 2 and 3 with a translated form of the Short-State-Trait Anxiety Inventory for Children.

RESULTS

Anxiety scores in both groups were similar at baseline and decreased significantly over the 3 days. Compared with the control group, anxiety scores in the intervention group were significantly lower on day 2 (12.7 ± 2.3 vs. 10.7 ± 2.5, p = .003) and day 3 (10.6 ± 2.2 vs. 9.47 ± 2.4, p < .001). The greatest decrease occurred in the percentage of children in the experimental group with medium-level anxiety scores: baseline (n = 61, 75%), day 2 (n = 24, 30%), and day 3 (n = 0, 0%).

CONCLUSIONS

This simple, low-cost play intervention implemented by nurses resulted in statistically and clinically significant decreases in the anxiety levels of children in an acute inpatient setting.

Children's postoperative symptoms at home through nurse-led telephone counseling and its effects on parents' anxiety: A randomized controlled trial

PURPOSE

The objective of this study was to evaluate children's postoperative symptoms at home after outpatient surgery through nurse-led telephone counseling and the effects of the nurse-led telephone counseling on parents' state-trait anxiety scores.

DESIGN AND METHODS

In this prospective randomized controlled study, nurse-led telephone counseling was provided every day to parents in the intervention group until they came for the follow-up visit. Parents of children (n = 54) ages 3-17 years who had undergone outpatient surgery for appendicitis, cholecystectomy, or ovarian cysts were eligible to participate in the study. On the first postoperative day and at the follow-up visit, the Spielberger State-Trait-Anxiety Inventory (STAI) was administered to parents who were randomly allocated to the intervention (n = 24) and control groups (n = 30).

RESULTS

The parents reported on postoperative symptoms such as pain, activity levels, excretion, sleep, nutrition, and wound infection. While there was no difference in STAI scores for parents between the groups at the first postoperative day, there was a significant decrease in STAI scores in the intervention group versus the control group, with parents in the intervention group reporting lower anxiety scores.

PRACTICE IMPLICATIONS

Our results suggest that nurse-led telephone counseling is effective at reducing anxiety in parents of children after outpatient surgery.

Parental state anxiety correlates with preoperative anxiety in Chinese preschool children

AIM

Preoperative anxiety in children is largely dependent on age and is influenced by anxiety level in parents. The current study compared the level of preoperative anxiety in preschool children versus school-aged children and its relationship with the state and trait anxiety of the parents.

METHODS

This study included 54 preschool children (2-5 years of age) and 48 school-age children (6-12 years) scheduled to receive ear, nose and throat, plastic or ophthalmologic surgeries. Preoperative anxiety of children was assessed in the holding area immediately prior to the surgery using a modified Yale Preoperative Anxiety Scale (m-YPAS). Compliance with anaesthesia induction was assessed using an Induction Compliance Checklist (ICC). The state and trait anxiety of the parent who accompanied the child was assessed using a State-Trait Anxiety Inventory (STAI) questionnaire.

RESULTS

Both m-YPAS and ICC scores were higher in preschool children than in school-age children with significant correlation between the two measures. The STAI-S score of parents was higher in the preschool group than in the school-age group. No significant difference was found in STAI-T score between the two age groups. Children's m-YPAS score correlated with parental STAI-T score in both groups (rho = 0.297, P = 0.029 and rho = 0.338, P = 0.019, respectively) but only with STAI-S score in the preschool group (rho = 0.400, P = 0.003).

CONCLUSIONS

Both preschool children and their parents are more anxious than school-age dyads prior to surgery. The anxiety level of the children correlates with state anxiety of the parents in preschool children but not in school-age children.